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| Project Details |
| Funding Scheme : | General Research Fund | ||||||||||||||||||||
| Project Number : | 14608521 | ||||||||||||||||||||
| Project Title(English) : | Wearing face masks during exercise in the heat: Does intensity and physical activity level matter? | ||||||||||||||||||||
| Project Title(Chinese) : | 炎熱環境下佩戴口罩運動: 強度和體力活動水平需關注嗎? | ||||||||||||||||||||
| Principal Investigator(English) : | Prof Wong, Stephen Heung-sang | ||||||||||||||||||||
| Principal Investigator(Chinese) : | |||||||||||||||||||||
| Department : | Dept of Sports Science & Physical Education | ||||||||||||||||||||
| Institution : | The Chinese University of Hong Kong | ||||||||||||||||||||
| E-mail Address : | hsswong@cuhk.edu.hk | ||||||||||||||||||||
| Tel : | 3943 6095 | ||||||||||||||||||||
| Co - Investigator(s) : |
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| Panel : | Humanities, Social Sciences | ||||||||||||||||||||
| Subject Area : | Education | ||||||||||||||||||||
| Exercise Year : | 2021 / 22 | ||||||||||||||||||||
| Fund Approved : | 858,000 | ||||||||||||||||||||
| Project Status : | Completed | ||||||||||||||||||||
| Completion Date : | 30-6-2024 | ||||||||||||||||||||
| Project Objectives : |
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| Abstract as per original application (English/Chinese): |
現時香港特區政府建議市民在乘坐公共交通工具或在擁擠的地方逗留時應戴上外科口罩，以降低傳播2019冠狀病毒病 (COVID-19) 的風險。為了進一步遏止本地 COVID-19 病例數量的急劇增加，政府於2020 年 7 月 29 日將戴口罩的要求擴大到所有戶外公共場所，強制要求在運動時佩戴口罩。雖然此要求/限制已於2020年 8 月下旬取消，但香港大部分普通民眾仍繼續在運動鍛練時戴上口罩。這引起了許多關於戴口罩安全性的重要問題，因為目前國際間並沒有針對一般人群佩戴口罩運動的循證為本建議。此外，包括世界衛生組織 (WHO) 在內的大型組織建議不要在運動時戴口罩，因為這可能會導致呼吸困難。另一針對香港的關注為在炎熱環境下戴口罩運動是否安全，皆因過去並沒有文獻研究過在炎熱天氣不戴口罩運動對生理的影響。 為解決上述問題，是次的研究計劃旨在檢測在不同強度的高溫環境下佩戴外科口罩運動，對於健康的體力活躍和久坐不動的成年人的生理、心理感知和認知反應的影響。簡要而言，共 100 名 18-30 歲的健康大學生（50 名動態活躍和 50 名靜態不活躍）將按照隨機順序進行六項獨立的實驗試驗，其中包括他們要在高溫環境中在跑步機作 15 分鐘輕度、中度和劇烈強度運動，期間佩帶或不佩帶口罩。主要測量結果將包括心血管健康指標、心肺和體溫調節反應，以及心理感知反應和認知功能評估。這項研究產生的科研成果將為政府和相關的衛生專業人員提供有價值的信息，並有助於制訂循證、實用且安全、針對特定人群在炎熱環境下佩戴口罩進行體力活動的指南。 |
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| Realisation of objectives: | The study was conducted from January 2022 to June 2024. Data collection began in early 2022 and was completed by the end of 2023, which was heavily affected by the COVID-19 pandemic. Specifically, this study utilized a crossover design, requiring participants to visit the lab seven times: screening and familiarization trial, followed by six main trials. We used advertisements at universities and partner institutions to successfully recruit 184 potential participants, and 106 were involved in the main trial, achieving the targeted sample size. During the trial, only 8 participants dropped out, resulting in a dropout rate of less than 10%, as proposed. The study successfully addressed its three primary objectives through a carefully designed randomized crossover trial with 98 healthy adults completing the study. Specifically, there were 69 males and 29 females, with an average age of 20.1 and 21, respectively. Participants completed exercise sessions at light, moderate, and vigorous intensities, both with and without facemasks, in controlled hot and humid conditions (30°C, 70% relative humidity) in a randomized order. Below is a detailed assessment of how each objective was achieved. Objective 1: Examine Cardiovascular, Cardiopulmonary, and Thermoregulatory Effects This objective was fully accomplished. Pre- and post-trial, venous blood samples were collected by registered nurses, and corresponding physiological outcomes were measured by trained research assistants, including blood pressure, flow-mediated dilation (for endothelial function), and sweat analysis. Some physiological indicators were monitored during the main trial, such as heart rate, oxygen uptake (VO2), and cardiopulmonary function, including minute ventilation (VE), tidal volume (VT), carbon dioxide output (VCO2), the respiratory exchange ratio (RER), and breathing frequency (BF). After all blood samples were collected, cardiovascular-specific markers were analyzed, including N-terminal pro-brain natriuretic peptide (NT-proBNP), TNNT1, creatine kinase-MB (CK-MB), and lactate levels. Thermoregulation was measured by forehead temperature and core temperature. For detailed results, please see Zheng et al. (under review). Objective 2: Investigate Psycho-Perceptual Responses and Cognitive Function This objective was fully achieved. The Rate of Perceived Exertion (RPE) was used to indicate participants' physical exertion using the Borg Scale (ranging from 0–20) at 3-minute intervals during all trials. We assessed participants’ comfort or discomfort after each trial across ten domains: breathing resistance, tightness, feeling unfit, humidity, heat, odor, fatigue, itchiness, saltiness, and overall discomfort, using a visual analog scale (VAS) ranging from 0–10. Additionally, the perceived enjoyment of each experimental trial and feelings of competence and confidence during each trial were assessed using the Physical Activity Enjoyment Scale (PACES) and the Chinese Self-Efficacy for Exercise Scale (SEE-C) after each trial. We used generalized estimating equations (GEE) with Bonferroni post hoc comparisons to analyze the data; detailed findings can be found in Zheng et al. (under review). For cognitive function, the Stroop Color and Word Test (SCWT) was used pre- and post-trial. Objective 3: Determine Influence of Habitual Physical Activity Level This objective was also fully achieved. We provided each participant with an ActiGraph GT3X+ (ActiGraph LLC, Pensacola, FL, USA) to wear on their wrist for 7 continuous days, 24 hours per day. After they returned the ActiGraph, we analyzed the data and divided participants into physically active and physically inactive groups. Various outcomes were compared between these two groups. In addition, since this study started in early 2022 and continued until 2023, exercise and Long COVID were important topics during that time. Therefore, the findings of this study led to further investigations, resulting in three peer-reviewed academic papers being published. 1.Zheng, C., Yu, F.Y., Chan, P.S., Sun, F.H., Chen, X.K., Huang, W.Y., Wong, S.H., Fang, Y., Wang, Z.X.* (2024) Receiving three doses of inactivated or mRNA COVID-19 vaccines was associated with lower odds of long COVID symptoms among people with a history of SARS-CoV-2 infection in Hong Kong, China: A cross-sectional survey study. Epidemiology and Infection. 11(152): e166. doi: 10.1017/S0950268824001687 2.Zheng, C., Chen, X.K., Sit, C.H., Liang, X., Li, M.H., Ma, A.C., Wong, S.H.* (2024) Effect of physical exercise-based rehabilitation on long COVID: A systematic review and meta-analysis. Medicine and Science in Sports and Exercise. 56(1): 143-154. doi: 10.1249/MSS.0000000000003280. 3.Zheng, C., Huang, W.Y., Sun, F. H., Wong, M. C., Siu, M.F., Chen, X.K.*, Wong, S.H.* (2023) Association of Sedentary Lifestyle with Risk of Acute and Post-Acute COVID-19 Sequelae: A Retrospective Cohort Study. The American Journal of Medicine. 138 (2): 167-374. doi: 10.1016/j.amjmed.2023.12.002. | ||||||||||||||||||||
| Summary of objectives addressed: |
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| Research Outcome | |||||||||||||||||||||
| Major findings and research outcome: | This study examined how wearing facemasks during exercise in hot, humid conditions affects physiological responses across different intensity levels. A randomized crossover trial with 98 healthy young adults revealed several key findings: Effects of Wearing Facemasks on Cardiovascular, Cardiopulmonary, and Thermoregulatory Responses Exercise intensity, rather than facemask use, was the primary driver of changes in cardiac biomarkers. Creatine kinase-MB (CK-MB) levels increased significantly after vigorous exercise compared to light intensity (p < 0.001), suggesting greater muscle stress at higher intensities. Blood pressure and endothelial function (measured via flow-mediated dilation) also rose with exercise intensity but showed no differences related to mask use. This indicates that short-duration masked exercise does not impose additional cardiovascular strain beyond what occurs at each intensity level. Regarding respiratory function, facemasks significantly impacted breathing efficiency. Oxygen uptake (VO2), minute ventilation, and tidal volume were consistently lower during masked exercise across all intensities, with the most pronounced effects during vigorous activity (p < 0.001). Oxygen saturation (SpO2) also declined more during high-intensity exercise with masks. These findings demonstrate that masks increase breathing resistance, impairing the body's ability to meet oxygen demands during exertion—especially in hot, humid environments where respiratory stress is already elevated. Additionally, while core temperature remained stable, forehead temperature rose more during vigorous exercise with masks. Effects on Psycho-Perceptual Responses and Cognitive Function The study revealed significant psycho-perceptual impacts when exercising with facemasks in hot, humid conditions. Participants reported markedly higher perceived exertion (RPE) during masked trials, particularly at vigorous intensities (p < 0.001), along with elevated discomfort in breathing resistance, tightness, and overall strain (p < 0.001). While exercise intensity universally increased discomfort (e.g., heat and humidity scores peaked), mask use independently exacerbated these effects without altering activity enjoyment (PACES) or self-efficacy (SEE-C). Cognitive function, assessed via the Stroop test pre- and post-exercise, showed no mask-related differences. Influence of Habitual Physical Activity Level We compared results between physically active and inactive groups. Overall, both groups showed similar results, indicating that habitual physical activity level has limited effects on these acute trial outcomes. The study highlights the need to balance infection control measures with exercise practicality in hot environments, particularly for those engaging in higher-intensity activities. Future research should examine longer durations and special populations to refine these recommendations. | ||||||||||||||||||||
| Potential for further development of the research and the proposed course of action: |
This study provides crucial experimental data on the physiological and perceptual effects of exercising with facemasks in hot, humid environments. It is the first large-scale investigation to examine the effects of wearing facemasks at different exercise intensities in this specific context. Although COVID-19 has stabilized over the past two years, wearing facemasks in such environments remains an important topic. Future studies should consider longer exercise durations, as 15 minutes may not be sufficient to observe differences in certain physiological markers. Additionally, other outcomes could be measured, and participants could be separated by gender to investigate potential differences in responses. Future directions will also include collaborations with occupational health researchers to develop specialized recommendations for essential workers who are required to wear masks during physical labor in hot conditions. It is vital to explore different types of facemasks, such as N95 masks, to assess their specific impacts on exercise performance and comfort. By addressing these factors, we can enhance safety and performance for individuals exercising or working in challenging environments. | ||||||||||||||||||||
| Layman's Summary of Completion Report: | This study explored how wearing a facemask during exercise in hot and humid conditions affects the body. Researchers tested 98 healthy young adults while they exercised at light, moderate, and vigorous intensities—both with and without a surgical mask—in a controlled chamber set to 30°C and 70% humidity. Key findings showed that while masks had little impact on heart-related markers (like blood pressure), they did reduce breathing efficiency, making it harder to take in oxygen, especially during higher-intensity workouts. Participants also reported greater discomfort, such as heat, humidity, and breathing resistance, when wearing masks during exercise. The study highlights that while masks are safe for short, low-to-moderate exercise in hot climates, they may worsen discomfort and breathing challenges during intense activities. This is particularly relevant for regions like Hong Kong, where heat and humidity are common. The results help inform guidelines for mask use during exercise, balancing COVID-19 safety with physical comfort. Although COVID-19 has stabilized, wearing facemasks during exercise or physical labor is still common in Hong Kong. This study provides valuable information on this topic. | ||||||||||||||||||||
| Research Output | |||||||||||||||||||||
| Peer-reviewed journal publication(s) arising directly from this research project : (* denotes the corresponding author) |
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| Recognized international conference(s) in which paper(s) related to this research project was/were delivered : |
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| Other impact (e.g. award of patents or prizes, collaboration with other research institutions, technology transfer, etc.): |
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| SCREEN ID: SCRRM00542 |