FFP2 induced breathing resistance does not affect gas exchange, metabolism and well-being during brisk walking and stair climbing - A randomized controlled trial

Abstract Objectives N95 or Type II filtering face pieces (FFP2) are often worn during work hours or on public transportation to prevent airborne infection. The aim of this randomized controlled crossover study is to assess the impact of FFP2 induced breathing resistance on pulmonary function, blood gas values and discomfort during walking and stair climbing. Methods N=16 healthy adults (24.8 ± 2.2 years; 10 females,) participated. Interventions included 1) six minutes of walking in a 16-meter-long hallway (612 meters) and 2) eight minutes of stair climbing in a two-story staircase (420 stairs), both with and without a FFP2 (>48 hour wash-out). Spiroergometric data (Ventilation, breathing frequency, tidal volume, oxygen uptake and carbon dioxide exhalation (primary outcome), end tidal carbon dioxide- and oxygen pressure) and self-reported response (Perceived exertion, dyspnoea and pain) were assessed during activities. Blood gas analysis (capillary carbon dioxide- (pCO2) (primary outcome) and oxygen partial pressure (pO2), pH, lactate and base excess) was measured after cessation of activities. Manipulation effects (FFP2 versus no mask) were tested using repeated measures analyses of variance. Results Analysis showed no effect of FFP2 on pCO2 or other blood-gas parameters but on carbon dioxide exhalation during walking: (mean 1067, SD 209 ml/min) and stair climbing (mean 1908, SD 426 ml/min) (F(15)=19.5; p<0.001; ηp2=0.566 and F(15)=14.3; p=0.002; ηp2=0.489) compared to no mask wearing (mean 1237, SD 173 ml/min; mean 1908, SD 426 ml/min). Ventilation was decreased and dyspnoea was increased by FFP2 during activities. FFP2 led to lower oxygen uptake and end tidal oxygen but higher end tidal carbon dioxide during stair climbing. Conclusions FFP2 decreased ventilation based on slower breathing patterns and led to limitations in pulmonary gas exchange and increased subjective dyspnoea. However, invasive diagnostics revealed no signs of clinically relevant metabolic effects during common everyday physical activities.