Does hyperbaric oxygen therapy (HBO) improve athletic performance?

Hyperbaric Oxygen Therapy Does Not Improve Athletic Performance

Hyperbaric oxygen therapy (HBO) is not recommended for improving athletic performance as there is insufficient evidence supporting its efficacy for this purpose. 1, 2

Evidence Assessment of HBO for Athletic Performance

Current Guidelines and Recommendations

• HBO therapy is recognized for specific medical conditions but not for athletic performance enhancement. Guidelines do not support its use for performance improvement 3
• The 2024 IWGDF/IDSA guidelines specifically suggest against using HBO therapy as an adjunctive treatment due to low certainty of evidence, high costs, and limited availability 3
• HBO is primarily indicated for medical conditions such as necrotizing soft tissue infections, compromised skin grafts, and non-healing wounds, not for performance enhancement 3

Research Evidence on Athletic Performance

• A 2021 systematic review and meta-analysis found that HBO therapy before or after exercise had no significant effect on performance or recovery 1
• Studies on HBO for sports performance show contradictory results with either no effect or minimal ergogenic benefits, with significant risk of bias and placebo effects 2
• The research on HBO for athletic performance is limited by small sample sizes, lack of blinding, and randomization problems 4

Physiological Effects and Mechanisms

• HBO delivers 100% oxygen at pressures greater than atmospheric pressure (typically 2.0-2.8 ATA) 5
• Theoretical benefits include increased oxygen delivery to tissues, improved leukocyte function, and enhanced mitochondrial function 3
• However, these theoretical benefits have not translated to measurable performance improvements in well-designed studies 1, 2

Specific Considerations for Athletes

Timing of HBO Therapy

• Pre-exercise HBO therapy shows no statistically significant effect on subsequent exercise performance 1
• Post-exercise HBO therapy demonstrates no significant improvement in recovery metrics 1
• Intra-exercise HBO therapy has shown some positive effects on muscle endurance in individual studies, but evidence is insufficient for recommendation 1

Sex-Based Differences

• Limited research exists on sex-specific responses to HBO therapy for athletic performance 3
• Women may have different physiological responses to hypoxia compared to men, with potentially different adaptations to oxygen therapies 3
• Research suggests women may have lower sensitivity to hypoxia than men, which could affect responses to HBO therapy 3

Practical Considerations

• HBO therapy is expensive, has limited availability, and requires specialized equipment 3
• The cost-benefit ratio for athletic performance enhancement does not justify its use 3
• Time commitment for effective treatment protocols (typically 3-10 sessions of 1-2 hours each) may disrupt training schedules 5

Potential Risks and Limitations

Safety Concerns

• Side effects may include transient myopia, barotrauma of the middle ear or sinuses, and claustrophobia 3
• HBO therapy can occasionally induce seizures 3
• The therapy should not delay or interfere with standard training or rehabilitation protocols 3

Research Limitations

• Most studies have methodological limitations including small sample sizes and inadequate controls 4, 6
• There is significant heterogeneity in HBO protocols and exercise regimens across studies 2
• Further research with well-designed trials is needed before HBO can be recommended for athletic performance enhancement 2

Alternative Approaches for Performance Enhancement

• Traditional altitude/hypoxic training strategies like "Live High-Train Low" have more established evidence for improving endurance performance 3
• Proper periodization and individualization of training are critical aspects with stronger evidence for performance enhancement 3
• Focus on evidence-based recovery methods, nutrition, and conventional training adaptations rather than HBO therapy 3