Sports despite masks: No negative effects of FFP2 face masks on cardiopulmonary exercise capacity in children

Abstract

Abstract Introduction: Face masks were recognized as one of the most effective ways for preventing the spread of the COVID-19-virus in adults, the benefits of wearing those were extended to children and adolescents and led to limited physical education (PE) lessons or cancellation of them. This further decreased the amount of physical activity available to children and adolescents during the pandemic. However, there is little published data on the potential adverse effects on wearing the most effective and partially mandatory FFP2/N95 face-masks during PE or physical activity (PA) in this age. Even though the pandemic has been declared as passed by the WHO, the rise of a new pandemic and thus the use of face-masks for limiting its spread is inevitable, so we need to be prepared in a better way for alternative options to lockdown and limitation of PA in such a scenario. Material and Methods 20 healthy children aged 8–10 years performed two identical cardiopulmonary exercise tests as an incremental step test on a treadmill within an interval of two weeks, one time without wearing a protective mask and one time wearing a FFP2 mask. The cardiopulmonary exercise parameter and especially the endexpiratory gas exchange for oxygen and carbon dioxide (petO2 and petCO2) were documented for each step, at rest and 1 minute after reaching physical exhaustion. Results 12 boys (mean age 8.5 ± 1.4 years) and 8 girls (mean age 8.8 ± 1.4 years) showed no adverse events until maximal exertion. The mean parameters measured at peak exercise did not differ significantly between both examinations (mean Peak VO2 = 42.7 ± 9.5 vs 47.8 ± 12.9 ml/min/kg, mean O2pulse 7.84 ± 1.9 ml/min vs. 6.89 ± 1.8, mean VE/VCO2slope 33.4 ± 5.9 vs. 34.0 ± 5.3). The most significant difference was the respiratory exchange rate (RER, 1.01 ± 0.08 vs 0.95 ± 0.08). The measured respiratory gases (end tidal O2 and CO2) decreased respectively increased significantly into nearly each step wearing an additional FFP2-mask without reaching levels of hypercapnia or hypoxia. Conclusion In this study, no significant differences of the cardiorespiratory function at peak exercise could be discerned when wearing a FFP2/N95 face mask. While the end-tidal values for CO2 increased significantly and the end-tidal values for O2 decreased significantly, these values did never reach pathological levels. Furthermore, the children terminated the exercise at a lower RER and heart rate (HR) suggesting a subconscious awareness of the higher strain. Since the detrimental effects of limiting sports during the pandemic are well documented, stopping PE lessons altogether because of the minor physiological effects wearing these masks instead of simply stopping pushing children to perform at their best seems premature and should be reconsidered in the future.