High-intensity Exercise With Or Without Face Mask Increases Biomarkers For Heart Failure In The Heat

PURPOSE: Although the COVID-19 pandemic has recently become more stable, wearing face masks in public settings is still an effective strategy for preventing the spread of viruses. This study aims to examine the effect of different intensities of exercise, with or without a face mask, on biomarkers for heart failure in hot conditions. METHODS: This study is a randomized crossover trial that recruited 98 young adults (age: 21.4 ± 2.3 years, body mass index: 21.4 ± 2.0 kg/m2, maximal oxygen consumption [VO2max]: 43.0 ± 8.8 ml/kg/min), with 70.4% of them being male. Each participant randomly completed six trials, which included 15 minutes of brisk walking or running at low-intensity (35% VO2max), moderate-intensity (55% VO2max), or high-intensity (75% VO2max), with or without a face mask, in hot conditions (temperature: 30 ± 1 °C, humidity: 70 ± 3%). N-terminal pro-brain natriuretic peptide (NT-proBNP) and Troponin T type 1 (TNNT1) were analyzed using Elisa kits, and creatine kinase-MB (CK-MB) was measured using a cobas® c 111 analyzer. The data were analyzed using a generalized estimated equation (GEE) with Bonferroni post-hoc comparisons. RESULTS: There were significant group × time interaction effects observed in NT-proBNP (p < 0.001). A higher level of NT-proBNP was found after high-intensity compared to moderate-intensity when participants doing exercise with face masks (0.4 ± 0.3 vs. 0.3 ± 0.3 ng/mL, p = 0.02). GEE analysis revealed a significant group × time interaction effect for CK-MB (p < 0.001). Specifically, a higher level of CK-MB was found after high-intensity exercise compared to low-intensity or moderate-intensity exercise, with (15.5 ± 6.5 vs. 14.1 ± 7.5 vs. 12.2 ± 5.8 ng/mL) or without a face mask (16.01 ± 8.0 vs. 13.1 ± 6.4 vs. 12.7 ± 8.5 ng/mL). Compared to pre-exercise, the TNNT1 level was significantly increased for all six trials (p < 0.001), with no difference between trials. CONCLUSION: This study found that several heart failure-related biomarkers increase after high-intensity exercise, while no difference was observed between wearing a face mask or not. These findings provide valuable implications for public health efforts, particularly highlighting the increased risk of heart events when engaging in high-intensity exercise in hot and humid conditions. Research Grants Council (RGC) General Research Fund (GRF), Hong Kong [14608521]