Emma C. Barnes1,,2, Igor Fernandes1,,3, Peyton C. Thompson1,,4, Angel S. Pagan-Jimenez1,,5, Sherry Pinkstaff1,,2, Hollie Saunders1, Arvind Balavenkataraman1, Scott A. Helgeson1, Bryan J. Taylor, FACSM1. 1Mayo Clinic Florida, Jacksonville, FL. 2University of North Florida, Jacksonville, FL. 3Purdue University, West Lafayette, IN. 4Duke University, Durham, NC. 5University of Puerto Rico, San Jaun, PR.

BACKGROUND: Increased pulmonary ventilation during cardiopulmonary exercise testing (CPET) causes the generation of potentially infectious micrometer-size respiratory particles. As such, many clinical centers still require staff to don additional personal protective equipment during CPET and/or patients to test negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before CPET. PURPOSE: To determine the effect of adding a bacterial/viral filter to the standard mouthpiece assembly during CPET on 1) the amount of detectable micrometer-size particles generated and 2) the cardiopulmonary responses to exercise. METHODS: Five healthy adults (one female; 37 ± 3 y) performed a maximal ramp incremental CPET on two separate occasions: 1) with and 2) without a bacterial/viral filter incorporated into the standard CPET mouthpiece assembly (i.e., flanged mouthpiece and flow sensor plus or minus bacterial/viral filter). The order of the two CPETs was randomized between participants. Cardiopulmonary indices and ratings of perceived exertion (leg discomfort, dyspnea) were measured during CPET. Small (≤4.9 μm) and large (5-10 μm) size particle generation during CPET was quantified using a light-scattering particle counter. RESULTS: Peak oxygen consumption (50.1 ± 14.5 vs. 46.3 ± 11.9 ml/kg/min) and oxygen pulse (21.2 ± 6.6 vs. 19.4 ± 5.7 mL/beat) were greater with vs. without filter (both P ≤ 0.04). Conversely, peak power (302 ± 95 vs. 308 ± 97 W), minute ventilation (131 ± 42 vs. 129 ± 41 L/min), ventilatory equivalent for CO2 (nadir; 24 ± 2 vs. 25 ± 2), heart rate (175 ± 10 vs. 176 ± 9 beats/min), and O2 saturation (98 ± 2 vs. 98 ± 2%) were not different with vs. without filter (all P ≥ 0.56). Neither leg discomfort (9.8 ± 1.1 vs. 9.6 ± 0.9, P = 0.37) nor dyspnea (8.4 ± 1.5 vs. 9.0 ± 1.4, P = 0.38) were rated differently between the two trials. Relative to baseline ambient values, the increase in small micrometer-sized particle counts during the 5th and final minute of CPET was markedly attenuated with vs. without filter (5th minute: with filter 20 ± 106 vs. without filter 157 ± 48 particles/L; final minute: with filter 70 ± 101 vs. without filter 331 ± 252 particles/L); however, these differences were not statistically significant. Large micrometer-sized particle counts did not increase appreciably during CPET and were unaffected by filter use. CONCLUSIONS: Adding a bacterial/viral filter to the standard mouthpiece assembly does not appear to negatively impact the cardiopulmonary or perceptual responses to CPET but may help mitigate the risk of micrometer-size particle generation during such exercise.

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