The physiological and disturbing effects of surgical face masks in the COVID-19 era

Bratisl Lek Listy. 2021;122(11):821-825. doi: 10.4149/BLL_2021_131.


Background: In the COVID-19 pandemic, the concern about mask-harmful effects disturbed mask-adherence. However, it is not certain whether the masks cause cardiopulmonary overload.

Objective: To investigate the physiological and disturbing effects of surgical face masks during exercise.

Method: The study was conducted in a tertiary hospital with 100 healthy volunteers between September 2020 and January 2021. Individuals with impaired walking, cardiopulmonary disease, and smoking were not included in the study. Initially, respiratory rate (RR), heart rate (HR), oxygen saturation (SpO2), end-tidal carbon dioxide (EtCO2) were measured. Participants underwent 6-minute walking test (6MWT) with and without surgical masks. Mask-discomfort questionnaire was applied before and after 6 MWT with the mask.

Results: Surgical masks during 6 MWTs significantly increased HR, RR, and EtCO2 levels (p<0.001). Walking distance (p<0.001) and SpO2 level (p=0.002) were significantly decreased with mask. In Mask-Discomfort Questionnaire, humidity, temperature, resistance, salinity, odor, fatigue (p<0.001), and itching (p=0.001) scores significantly increased after 6MWT with mask.

Conclusion: In healthy volunteers, HR, RR, EtCO2 were increased, and SpO2 and walking distance were decreased in the short-term, light exercise performed with the surgical mask. Findings support the concern that masks may cause cardiopulmonary overload (Tab. 3, Fig. 1, Ref. 17). Text in PDF Keywords: COVID-19, masks, physiology, psychological side effects, questionnaire.

MeSH terms

  • COVID-19*
  • Humans
  • Masks
  • Pandemics
  • SARS-CoV-2
  • Walking