Uni-Tübingen

Enough Air to Breathe

Three studies by the Institute for Occupational Medicine at the University of Tübingen changed the recommendations for wearing masks in the workplace during the coronavirus pandemic.

Would wearing a mask over our mouth and nose leave us breathless, particularly during strenuous activity like carrying boxes or climbing stairs at work?

At the beginning of the Covid 19 pandemic in 2020, no one knew the exact answer and people were concerned that wearing masks could cause permanent damage. For companies, their employees, and insurance companies, understanding the implications of wearing masks was extremely important. At the time, the only guidance was provided by the German Social Accident Insurance regulation for the use of respiratory protection devices for work in dusty environments. It stipulated how long masks could be worn, such as heavy-duty masks that must be worn over the entire head when removing asbestos. There were no studies on the consequences of wearing medical masks, which were compulsory for a long time during the pandemic.

Occupational physicians and safety officers asked the Institute for Occupational and Social Medicine, and Health Services Research at the University of Tübingen to
research the effects of masks in the workplace. “Test subjects sorted bottles, carried boxes, or cycled on a fitness bike, mostly for more than two hours. Sometimes they wore a mask, sometimes not. We measured their vital functions: heartbeat, blood pressure, oxygen saturation, carbon dioxide in the blood, and physical performance. And we also asked about their subjective well-being,” says Prof. Benjamin Steinhilber from the Institute for Occupational Medicine, who is also the leading author of the studies. The results of the studies were clear: “Well-being suffered while wearing masks, but vital functions were within the normal range, whether someone wore a mask or not,” says Benjamin Steinhilber. The gender of the study participants or their individual fitness also had no measurable effect.

Steinhilber presented his results to working groups on occupational safety in companies. As a result of these and similar studies, German Social Accident Insurance updated its guideline in November 2021, which still applies to all accident insurances and which all employers mustact on. This regulation states that there is no need for a time limit on wearing masks during working hours for health reasons during a pandemic. Exceptions still need to be considered, such as chronic respiratory disease, dampening of the mask, or individual resilience.

The scientific review processtook longer. Steinhilber and colleagues finally published their studies in 2022 and 2023 in professional journals 123 that are now considered reference articles on the subject today. A large number of other institutions have now also investigated the effects of wearing medical masks in the workplace on human vital functions and confirmed the results of the study from Tübingen.


1 Robert Seibt, Mona Bär, Monika Rieger, Benjamin Steinhilber: „Limitations in evaluating COVID-19 protective face masks using open circuit spirometry systems: respiratory measurement mask introduces bias in breathing pressure and perceived respiratory effort”, Physiological Measurement, 13 January 2023

2 Steinhilber et al., Influence of Face Masks on Physiological and Subjective Response during 130min of Simulated Light and Medium Physical Manual Work. An Explorative Study, healthcare, 2023, 11, https://doi.org/10.3390/healthcare11091308 

3 Steinhilber et al., Effects of Face Masks on Physical Performance and Physiological Response during a Submaximal Bicycle Ergometer Test, International Journal of Environmental and Public Health, 2022, 19, https://doi.org/10.3390/ijerph19031063 

Text: Tilman Wörtz


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