Effects of Surgical Masks on Cardiopulmonary Function in Healthy Subjects
February 12th, 2021
We study the effect of surgical masks on cardiopulmonary function based on a cardiopulmonary exercise test (CPET). This study shows that surgical masks reduce cardiopulmonary exercise capacity and ventilation in healthy young subjects and wearing masks might affect aerobic exercise capacity more in female subjects than in male subjects.
Wearing a mask in public areas might impede the spread of the infection disease by preventing both the inhalation of infectious droplets and their subsequent exhalation and dissemination. However, there are few studies on the effect of wearing a mask on cardiopulmonary function. Different types of masks have different effects on increasing expiratory resistance and inspiratory resistance.
During a respiratory disease pandemic, people may need to wear masks for extended period of time to perform daily activities. Cardiopulmonary exercise testing is a important means of the cardiovascular rehabilitation mask assessment by reflecting variable parameters of the body's cardiopulmonary functioning during exercise with increasing load. We use CPET to evaluate the interference of masks on cardiorespiratory reserve and exercise endurance, which can guide the application of masks during a respiratory infectious disease pandemic.
Xiaoyue Zhao will demonstrate biometry evaluation. Yongchun Jiang and Siqing Wang will demonstrate the CPET test. Weijie Lin will be our subject model for the presentation.
Begin by setting the room temperature to 25 degrees Celsius and preparing the first aid equipment. Ask the subject to sit upright without leaning on the back of the chair with their feet on the ground. Ask them to keep their head at a natural level or slightly tilted upwards, but to avoid bending their head down or bending over.
To perform the forced vital capacity test, ask the subject to breathe calmly for five seconds. Then inhale strongly, and then exhale strongly for six seconds. Finally, ask them to inhale back and keep breathing calmly.
Perform the whole procedure under the guidance of a doctor or a formally trained exercise physiologist. To perform the maximum voluntary ventilation test, ask the subject to breathe calmly four or five times. Then repeat the breath continuously for 12 or 15 seconds at the maximum breathing amplitude and the fastest breathing speed.
Briefly tell the subject about the procedure. Then scrape the body hair at the position of the electrocardiograph electrodes. And use 75%alcohol to remove extra dander and grease.
Place the ECG electrodes and attach them to the 12-lead ECG wires. Fix the ECG machine to the chest using a strap. Choose a mask that fits the size of the subject's face and attach it firmly to the face, making sure that there is no gap between the mask and the face.
Fix the flowmeter on the vent and the K4 device onto the vest. Ask the subject to sit on the seat, step on the pedals and adjust the height of the handlebars to a comfortable position for the subject. Have them grab the handlebar with both hands.
Place a blood pressure cuff on the subject's upper right arm for dynamic blood pressure recording. Then place a finger pulse oxygen on the left index finger for the dynamic recording of blood oxygen. Calculate the subject's exercise resistance parameters and set the progressive resistance plan for the exercise phase.
Click on the start button to activate the cycle ergometer. Ask the subject to keep a static sitting posture for two minutes, then start cycling for two minutes. Ask the subject to continue cycling until they can't maintain the pace.
Then ask them to cool down for three minutes. When finished, have the subject keep the static sitting posture for three minutes for observation of vital signs. Then remove data acquisition equipment, face mask, vest and ECG electrodes.
Use the rating of perceived exertion scale to measure physical activity intensity levels that are apparently related to the heart rate during exercise. Then use BORG'S scale to evaluate the exertion of resistance training. A score of six represents resting activity with no effort, and a score of 20 represents exhaustive exercise.
After a 48-hour washout period, select a mask that fits the size of the subject's face and attach it firmly to the face, ensuring that there is no gap between the mask and the face. The 10 participants recruited in this pilot study had similar baseline characteristics such as age and physical fitness. There were no significant differences in age, height or BMI between the male and female groups.
For the spirometry, the female group showed lower FVC, lowered forced expiratory volume in one second, lower MVV and lowered peak expiratory flow compared with the male group. The results of CPET under different conditions are shown here. For exercise tolerance and cardiac function, both male and female groups showed a significant decrease in anaerobic threshold per kilogram and oxygen pulse during the mask-on condition, but no significant differences in the oxygen uptake related to work rate.
The male group also showed a significant decrease in resting heart rate, and the female group showed a significant decrease in peak oxygen uptake per kilogram during the mask-on condition. For ventilatory function, both male and female groups showed a significant decrease in tidal volume while wearing a mask, but no differences were found in the breathing reserve percentage. Both groups showed a significant decrease in ventilation during the mask-on condition, and no difference was found in total CPET performance.
When performing this protocol, subjects should be encouraged to exercise to their maximum endurance, or until the practitioner ends the exercise due to symptoms, such as asthmatic ECG trends, complete apathy, or second or third degree heart block.
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Overview
This study investigates the impact of wearing surgical masks on cardiopulmonary function and exercise capacity in healthy young adults using cardiopulmonary exercise testing (CPET). The findings indicate that surgical masks reduce exercise capacity and ventilation, with potential differences in the degree of impact between male and female subjects.
Key Study Components
Area of Science
- Exercise physiology
- Cardiopulmonary function
- Respiratory health
Background
- Masks are widely used to prevent the spread of infectious respiratory diseases.
- There is limited research on how mask-wearing affects cardiopulmonary function during exercise.
- Different mask types can alter expiratory and inspiratory resistance.
- Understanding these effects is important for public health recommendations during pandemics.
Purpose of Study
- To evaluate the effects of surgical masks on cardiopulmonary exercise capacity and ventilation.
- To compare the impact of mask-wearing between male and female subjects.
- To inform guidelines for mask use during physical activity in public health contexts.
Methods Used
- Cardiopulmonary exercise testing (CPET) with and without surgical masks.
- Biometric evaluation and spirometry (forced vital capacity, maximum voluntary ventilation).
- Continuous monitoring of ECG, blood pressure, and blood oxygen during exercise.
- Use of perceived exertion scales (BORG scale) to assess exercise intensity.
- Comparison of results between male and female groups with similar baseline characteristics.
Main Results
- Both male and female groups showed significant decreases in anaerobic threshold per kilogram and oxygen pulse when wearing masks.
- Female subjects had lower forced vital capacity, forced expiratory volume in one second, maximum voluntary ventilation, and peak expiratory flow compared to males.
- Significant decreases in tidal volume and ventilation were observed in both groups during mask use.
- Female subjects experienced a significant decrease in peak oxygen uptake per kilogram with masks.
- No significant differences were found in oxygen uptake related to work rate or total CPET performance.
Conclusions
- Wearing surgical masks reduces cardiopulmonary exercise capacity and ventilation in healthy young adults.
- The reduction in aerobic exercise capacity may be more pronounced in female subjects.
- These findings can guide recommendations for mask use during exercise, especially in public health emergencies.
Frequently Asked Questions
Executive Industry Relevance
Cardiopulmonary exercise testing (CPET) provides a quantitative framework for evaluating how external interventions, such as surgical masks, impact physiological function under load. Understanding these effects is critical for biopharma teams developing respiratory therapeutics, optimizing trial protocols, and ensuring translational continuity in disease-relevant systems. The ability to isolate and measure mask-induced changes in cardiopulmonary parameters supports predictive confidence in both early discovery and preclinical model selection.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables mechanistic de-risking by quantifying the physiological impact of respiratory interventions.
- Supports functional target validation through objective measurement of cardiopulmonary reserve and exercise tolerance.
- Facilitates portfolio triage by identifying interventions that significantly alter key physiological endpoints.
Screening & Assay Development
- Establishes validated protocols for measuring forced vital capacity, maximum voluntary ventilation, and exercise-induced changes.
- Standardizes quantitative outputs for cross-study and cross-cohort comparison.
- Enables reproducible assessment of intervention effects on ventilation and aerobic capacity.
Translational & Preclinical Research
- Aligns human physiological readouts with disease-relevant endpoints for translational biomarker development.
- Supports continuity from discovery through preclinical validation by providing robust, quantitative measures of cardiopulmonary function.
- Informs risk-adjusted advancement decisions for respiratory and exercise-related therapeutic programs.
Pipeline & Workflow Integration
CPET-based protocols integrate into the discovery-to-preclinical continuum by providing standardized, quantitative endpoints for respiratory intervention assessment.
- Discovery Biology: Quantifies intervention effects on cardiopulmonary function, supporting hypothesis testing and pathway clarification.
- Screening: Delivers reproducible, quantitative outputs for forced vital capacity and ventilation under controlled conditions.
- Analytics: Provides statistical comparison of dependent variables such as tidal volume, oxygen uptake, and anaerobic threshold.
- Translational Research: Bridges human physiological data to preclinical models for biomarker alignment.
- Enterprise Reuse: Offers a reusable protocol for evaluating respiratory interventions across multiple programs.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces mechanistic ambiguity in respiratory intervention studies.
- Operational Value: Standardizes measurement and analysis of cardiopulmonary endpoints for reproducibility.
- Strategic Value: Enables informed go/no-go decisions and capital-efficient portfolio management.
- Portfolio Impact: Supports risk-adjusted prioritization of respiratory and exercise-related assets.
Implementation Considerations
- Requires expertise in exercise physiology and cardiopulmonary testing protocols.
- Needs access to CPET instrumentation, ECG, spirometry, and data acquisition systems.
- Demands cross-team standardization for protocol execution and data analysis.
- Adaptation may be necessary for different subject populations or disease models.
- Practical limitations include subject compliance and the need for controlled environmental conditions.
