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Hyperbaric Oxygen as an Adjuvant for Athletes

Authors:
  • Hiroshima Prefectural Rehabilitation Center

Abstract and Figures

There has recently been a resurgence in interest in hyperbaric oxygen (HBO) treatment in sports therapy, especially in Japan. Oxygen naturally plays a crucial role in recovery from injury and physiological fatigue. By performing HBO treatment, more oxygen is dissolved in the plasma of the pulmonary vein via the alveolar, increasing the oxygen reaching the peripheral tissues. HBO treatment is therefore expected to improve recovery from injury and fatigue. HBO treatment has been reported to reduce post-injury swelling in animals, and in humans; swelling was also mitigated, but to a lesser extent. Positive results have also been reported regarding tissue remodelling after injury, with injuries involving bones, muscles and ligaments showing improved recovery. Furthermore, HBO treatment has effectively increased recovery from fatigue. This was clearly seen at the Nagano Winter Olympics, where sports players experiencing fatigue were successfully treated, enabling the players to continue performing in the games. Despite its potential, HBO treatment does have its risks. Increasing oxygen levels in tissues poses a risk to DNA through oxidative damage, which can lead to pathological changes in the CNS and the lungs. Regarding the operating of HBO systems, safer administration should be advised. Further research into HBO treatment is required if this therapy is to become more widespread. It should become possible to tailor treatment to an individual’s condition in order to use HBO treatment efficiently.
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Sports Med 2005; 35 (9): 739-746
C
URRENT
O
PINION
0112-1642/05/0009-0739/$34.95/0
2005 Adis Data Information BV. All rights reserved.
Hyperbaric Oxygen as an Adjuvant
for Athletes
Yoshimasa Ishii,
1
Masataka Deie,
1
Nobuo Adachi,
1
Yuji Yasunaga,
1
Patrick Sharman,
1
Yutaka Miyanaga
2
and Mitsuo Ochi
1
1 Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
2 Sports Medicine, Institute of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
There has recently been a resurgence in interest in hyperbaric oxygen (HBO)
Abstract
treatment in sports therapy, especially in Japan. Oxygen naturally plays a crucial
role in recovery from injury and physiological fatigue. By performing HBO
treatment, more oxygen is dissolved in the plasma of the pulmonary vein via the
alveolar, increasing the oxygen reaching the peripheral tissues. HBO treatment is
therefore expected to improve recovery from injury and fatigue.
HBO treatment has been reported to reduce post-injury swelling in animals,
and in humans; swelling was also mitigated, but to a lesser extent. Positive results
have also been reported regarding tissue remodelling after injury, with injuries
involving bones, muscles and ligaments showing improved recovery. Further-
more, HBO treatment has effectively increased recovery from fatigue. This was
clearly seen at the Nagano Winter Olympics, where sports players experiencing
fatigue were successfully treated, enabling the players to continue performing in
the games.
Despite its potential, HBO treatment does have its risks. Increasing oxygen
levels in tissues poses a risk to DNA through oxidative damage, which can lead to
pathological changes in the CNS and the lungs. Regarding the operating of HBO
systems, safer administration should be advised.
Further research into HBO treatment is required if this therapy is to become
more widespread. It should become possible to tailor treatment to an individual’s
condition in order to use HBO treatment efficiently.
In recent years, the development of new rehabili- treatment. Conventionally HBO has been used in
tation techniques and regimes for sports players with medical treatments such as cerebral infarction, car-
injuries has advanced rapidly. The knowledge of bon monoxide poisoning and the bends (decompres-
medical doctors and trainers has grown beyond con- sion disease). The British physiologist Henshaw car-
ventional Western medical treatment to also include ried out the first HBO treatment using an air press
Eastern medicine. This increased consciousness of organ in 1662.
[1]
This advancement spread to the rest
alternative forms of treatment has positively affect- of Europe in the 19th century, and to the US in the
ed the players, with an improvement in choice of first half of the 20th century. Initially, the effective-
rehabilitation. One such treatment that has recently ness of the treatment was overestimated, and it was
captured attention is hyperbaric oxygen (HBO) slowly dropped by institutions and declined in popu-
740 Ishii et al.
larity. It remained mostly unused until, in 1960, tial for the synthesis of these extracellular compo-
Boerema of the Netherlands brought it back into the nents. Certain processes, such as the hydroxylation
spotlight. He reported that pigs, which inhaled oxy- from proline to hydroxyproline, cannot be per-
gen with three times atmospheric pressure for 15 formed in the rough endoplasmic reticulum without
minutes, were able to survive and make a full recov- oxygen, so collagen synthesis becomes impossible.
ery, despite having almost all erythrocytes re-
In the remodelling phase, tissue is slowly re-
moved.
[2]
However, widespread use of HBO in
placed over many hours using the oxygen supply
sports medicine only came about with advances in
provided by the blood supply vessel already built
technology. The equipment that pressurises pure
into the organisation (except cartilage) of the mus-
oxygen must have a high standard of safety, not only
culoskeletal system. Thermotherapy or massage to
regarding pressurisation, but also for preventing the
the damaged area can also improve oxygen circula-
oxygen from igniting. HBO was first tried on a
tion and improve recovery. If the damage is small,
sports injury in Scotland, where it was used to treat
the tissue is recoverable with nearly perfect organi-
the injuries of professional soccer and golf players
sation. If the extent of the damage is large, a scar
in the late 1980s. James et al.
[3]
reported that the
(consisting mainly of collagen) may replace tissue.
disease period of the damage was shortened by 70%.
Consequently, depending on the injury, this colla-
The interest in HBO treatment for sports injuries has
gen will become deficiently hard in the case of
since spread, especially in Japan. This article dis-
muscle repair, or deficiently loose in the case of
cusses the theoretical background and the clinical
ligament repair.
application of HBO to sports players.
Oxygen is generally advantageous to tissue for-
mation and organisation, except in the case of hy-
1. The Necessity of Oxygen for
aline cartilage, which needs a low oxygen environ-
Sports Players
ment to maintain a low frictional coefficient. It has
also recently been pointed out that stem cells are
involved in the recovery process. Stem cells are
1.1 The Effectiveness of Oxygen Against
always being released into the blood from marrow,
an Injury
where they patrol the inside of the body. Mesenchy-
Natural recovery works in an organised manner
mal stem cells, once gathered at the location of
following a sports injury such as a fracture, ligament
damage, differentiate into osteoblasts, fibroblasts, or
injury or other damage. Generally, this recovery
chondrocytes according to the environment of the
process is classified by three phases: inflammatory,
injury. Therefore, the role of oxygen in recovery
proliferative and remodelling. Oxygen plays a cru-
promotion involves many factors, such as cell
cial role in each of these phases.
proliferation, differentiation and extracellular ma-
In the inflammatory phase, the hypoxia-induced
trix production.
factor-1α, which promotes, for example, the glyco-
lytic system, vascularisation and angiogenesis has
1.2 The Effectiveness of Oxygen Against
been shown to play an especially important role.
Recovery from Fatigue
However, if the oxygen supply could be controlled
Fatigue produced by physical exertion is consid-
without promoting blood flow, the blood vessel
ered to be physiological fatigue, and is defined as
permeability could be controlled to reduce swelling
‘being in the recoverable state of a transient func-
and the associated sharp pain.
tional fall physiologically and mentally’, which is
In the proliferative phase, in musculoskeletal tis-
distinct from pathological fatigue. There are three
sues (except cartilage), the oxygen supply to the
main causes and mechanisms that result in physio-
damaged area is gradually raised and extracellular
logical fatigue:
matrix components such as fibronectin and proteog-
lycan are synthesised. The oxygen supply is essen-
diminishment of an energy source;
2005 Adis Data Information BV. All rights reserved. Sports Med 2005; 35 (9)
Hyperbaric Oxygen as an Adjuvant for Athletes 741
accumulation of a fatigue substance; the atmospheric pressure, it becomes possible to
raise the partial pressure of oxygen to near the
malfunction of metabolism regulation.
1000mm Hg. This is essentially the conditions of
The human body is continuously maintaining
application of HBO for medical treatment.
homeostasis despite external stresses. However, this
In HBO treatment, the capacity of the gas stored
balance breaks down with certain stress factors such
inside the body is reduced by high pressure, and then
as infection, anaemia, cold, heat, impatience and
the partial oxygen pressure (pO
2
) of arterial blood is
anger. Thus, the secretion of hormones from the
raised in the treatment of diseases such as hypoxia
brain or the adrenal gland is greatly related to fa-
disease, cell damage from infection, or a malignant
tigue.
tumour. Although these effects are the same for each
Three factors (recovery in the supply of energy,
disease, this treatment is currently used only in the
rapid removal of fatigue substances, and stabilisa-
field of emergency medicine. HBO treatment of an
tion of hormone levels) are important in recovery
injury should:
from fatigue. Increasing the oxygen supply to a
reduce swelling of soft tissue;
musculoskeletal system in the state of fatigue acti-
vates cellular activity, increases adenosine triphos-
promote the medical treatment of ligament dam-
phate (ATP) synthesis, and promotes the metabo- age or fracture;
lism of fatigue substances. HBO can therefore be
reduce the pain accompanying ischaemia;
considered as a method of promoting recovery from
prevent infection (based on oxygen toxicity).
fatigue.
The relationship between wound recovery and
Oxygen therapy should not be performed unnec-
oxygen supply deserves attention; basic research on
essarily and superfluously because of its benefits in
this has prospered in recent years.
recovery promotion from fatigue. Increased levels
of oxygen in the blood can cause tissue damage by
2.1 The Effect of HBO on Recovery
oxidation. Therefore, it is necessary to maintain
Promotion of an Injury
optimal oxygen balance by considering factors such
The injured body part has a shortage of oxygen as
as application times, concentration and pressure,
a result of inhibited blood flow, swelling and a drop
which are developed from the understanding of the
in capillary blood vessel permeability. The main
theoretical background of HBO.
focus of HBO treatment is to cancel the shortage of
oxygen in a damaged body part. Kivisaari and Ni-
2. Principles of Hyperbaric Oxygen
inikoski
[4]
have reported measurement of pO
2
in
(HBO) Treatment
subcutaneous tissue in rats. The pO
2
of injured
tissue is generally about 5–15mm Hg, which is low
Oxygen is usually taken into the blood from
compared with normal tissue (40–45mm Hg). Al-
alveoli by breathing, where it combines with the
though the elevation of pO
2
is expected to cause
haemoglobin in blood and is carried to peripheral
several effects on the damaged tissue, each were
tissues. However, since the oxygen absorption of
examined separately during recovery periods.
haemoglobin is low at 100mm Hg, the oxygen satu-
ration is limited by the haemoglobin concentration During the inflammatory phase of healing, HBO
in the blood. By performing HBO treatments, ac- reduces the oedema, the swelling around the dam-
cording to Henry’s law (in the conditions of temper- aged part, and sharp pain. When Skyhar et al.
[5]
ature regularity, the quantity of the gas dissolved in created the compartment syndrome (e.g. rise of mus-
contact with a liquid is proportional to partial pres- cle pressure of the anterior lower thigh part by
sure of the gas), more oxygen is dissolved in the oedema, swelling and crushing) of the dog leg, HBO
plasma of the pulmonary vein via the alveolar, of 2 atmospheres absolute (ATA) pure oxygen sub-
which increases oxygen that reaches the peripheral sequently reduced muscular wet weight, and it is
tissues. Consequently, using pure oxygen with twice reported that mitigation of swelling was seen. How-
2005 Adis Data Information BV. All rights reserved. Sports Med 2005; 35 (9)
742 Ishii et al.
ever, in clinical research using human subjects, it HBO group and the ultimate load and stiffness was
seems that there is not such a large improvement.
significantly greater at 14 days (2.5 ATA/2 hours).
When Staple and Clement
[6]
performed HBO treat-
When Best et al.
[13]
examined the influence of the
ment on 66 people with muscular pain of the quadri-
contraction ability of flounder-line damaged repro-
ceps femoris, the group that received the HBO treat-
ductive organs on rats, the HBO treatment (3 ATA)
ment reported no large difference in recovery, espe-
showed that the recovery effect may vary with dif-
cially regarding subjective sharp pain. Furthermore,
ferent types of muscle fibres. When we looked at the
when Borromeo et al.
[7]
performed the HBO treat-
influence of HBO on the repair of partial transection
ment on 32 patients with acute leg joint sprains, they
of the patella ligament in rats, more messenger RNA
also reported that the mitigation of sharp pain and
(mRNA) levels for type I procollagen were pro-
swelling did not occur appreciably. However, fur-
duced after HBO treatment. In 7–14 days after inju-
ther research is needed to evaluate HBO due to the
ry, mRNA levels for type I procollagen were found
poor system for evaluating the effect on patients.
to be 1.4- to 1.5-fold greater in the HBO-treated
group (2 ATA/60 minutes).
[1,4]
Furthermore, condi-
HBO treatment is expected to affect remodelling
tions of 2 ATA/60 minutes was compared with 2
of damaged tissue, angiogenesis and synthetic pro-
ATM/30 minutes and 1.5 ATA/30 minutes using the
duction of extracellular matrix components (espe-
same experiment model for 2 weeks. When collagen
cially collagen etc.). Generally, it is supposed that
tissue was compared among the three groups that
vascular endothelial growth factors are stimulated,
underwent the HBO treatment, the speed of liga-
and the low oxygen stimulus in the convalescence of
ment recovery occurred in the order of 2 ATA/60
an injury works in the favour of blood vessel regen-
minutes first, followed by 2 ATA/30 minutes, and
eration. However, according to the report of
finally 1.5 ATA/30 minutes.
[14]
Although these re-
Mechine et al.,
[8]
treatment with HBO results in a
ports suggest that HBO is advantageous for medical
rise of blood vessel density under granulation, and
treatment, the optimal conditions for treatment (at-
promotes a blood vessel bud. Whether HBO is ad-
mospheric pressure, duration of sessions, frequency
vantageous over low oxygen therefore involves the
of session, and duration of treatment) still need to be
consideration of many factors. Many effects in the
determined. Furthermore, while injuries involving
regeneration of damaged tissue and angiogenesis
bones, muscles and ligaments have shown promis-
have been reported. Kivisaari and Niinikoski
[9]
re-
ing results, HBO treatment of cartilage tissue, which
ported that intermittent HBO for 2 hours twice daily
is generally in a low oxygen environment, might
had no significant influence on the closure rate of
actually be detrimental.
open skin wounds with normal blood supply; how-
ever, in ischaemic wounds, HBO enhanced the
Our previous research in sport injury involved 22
wound closure rate in the final healing stage. Moreo-
general athletes with various injuries including
ver, according to Uhl et al.,
[10]
it is believed that the
seven leg joint sprains, four knee ligament damages,
effects of the 100% oxygen twice daily HBO treat-
four partial muscle ruptures, three peripheral nerve
ment (2 ATA/45 minutes) improves re-epithelisa-
injuries, two fractures and two other injuries.
[15]
tion in normal and ischaemic skin tissue.
Depending on the clinical condition of the patient,
atmospheric pressure was set between 1.3–2 ATA,
The recovery process of a damaged medial col-
and the exposure time was from 30 to 90 minutes.
lateral knee ligament has been investigated. Webster
The evaluation of the patients afterwards included
et al.
[11]
reported that the elasticity and fracture
both subjective and objective symptoms. As a result,
intensity of a ligament recovered to almost its nor-
70% of the patients experienced improvement (ta-
mal value within 4 weeks with HBO treatment (2.8
ble I). Furthermore, there was a correlation between
ATA/1.5 hours) and Mashitori et al.
[12]
also reported
that type I procollagen gene expression at 7 or 14 improvement and time from the injury in which the
days after injury was significantly higher in the
treatment was administered. Although there were
2005 Adis Data Information BV. All rights reserved. Sports Med 2005; 35 (9)
Hyperbaric Oxygen as an Adjuvant for Athletes 743
45 minutes at 2.0 ATA, removal was 70.0% (figure
1). The setting atmospheric pressure performed with
1.3 ATA was significantly higher than that of
others.
[1,8]
Therefore, HBO is not only expected to
be beneficial for an externally caused injury, but
also for improving training and conditioning for
athletes. It is believed, however, that further re-
search is necessary to develop optimised HBO
guidelines tailored to each type of injury and condi-
tioning.
The best experience of HBO use as a recovery
Table I. The result of hyperbaric oxygen (HBO) treatment for 22
injured athletes (reproduced from Ishii et al.,
[15]
with permission)
Result Description No. of
athletes
Remarkably Both objective and subjective 6
improved symptoms were subsided within 3d
Moderately Either objective or subjective 11
improved symptoms were subsided within
1–2wk
Unchanged Both objective and subjective 5
symptoms were unchanged after HBO
Worsening Either objective or subjective 0
symptoms were worsened within
1–2wk
Total 22
method from muscular fatigue occurred during the
Nagano Winter Olympics with seven participating
five ‘no change’ cases, there were no ‘worsening’
athletes. After physical activity, the athletes re-
cases and adverse effects, other than slight ear pain,
ceived HBO treatment for 30–40 minutes at 1.3
were not reported by any of the patients.
ATA, with a maximum of six times per athlete and
an average of two times per athlete. An athlete who
2.2 The Effect of HBO on
experienced tension and sharp pain of the abdominal
Physical Conditioning
muscles was able to play a game after HBO treat-
ment with almost no pain. Another player who was
Factors that improve the conditioning of muscles
experiencing anterior knee pain was treated within 2
and internal organs where transient oxygen is insuf-
days of injury and was able to perform afterwards
ficient have recently been investigated. Fischer et
with no difficulty. These test cases show that HBO
al.
[16]
have reported that HBO treatment between
treatments demonstrate high performance without
games of tennis removes ammonia from the blood,
leads to quicker recovery from fatigue, and prepares
adverse effects such as muscular pain and nerve
the player for the next game. In this study, condi-
paralysis. Players were also able to benefit from the
tions for the HBO treatment were milder than the
conditioning effects of HBO treatment.
conditions for medical emergencies. Also, atmos-
pheric pressure does not need to exceed 1.5 ATA
and the exposure time to oxygen is for no longer
than 30 minutes. Haapaniemi et al.
[17]
twisted a
tourniquet around the thigh of a rat and created a
sparse blood model of the leg for the testing of
HBO. Compared with controls, 2.2 ATA for 45
minutes led to increases in ATP and phosphocrea-
tine levels in muscle 4 hours later. Additionally,
lower lactic acid levels were observed in these pa-
tients. The removal of lactic acid was eliminated
more quickly with HBO treatment in six men 48
minutes after exercise. In subjects inhaling air for 45
minutes at 1 atmospheric pressure, lactic acid re-
moval was 61.0%. In patients inhaling pure oxygen
for 45 minutes at 1.0 ATA, removal was 64.7%; for
45 minutes at 1.3 ATA, removal was 76.0%; and for
0
20
40
60
80
100
*
Lactate removal rate (%)
O
2
(45 min)
±1.3 ATA
O
2
(45 min)
±2.0 ATA
Control
O
2
(45 min)
Fig. 1. Lactate removal rate under different conditions. The lactate
removal rate = (the value of blood lactate at 3 min after exercise
the value of blood lactate at 48 min after exercise) × 100/the value
of blood lactate at 3 min after exercise. Data are means ± SD, * p <
0.05 (vs control) [reproduced from Ishii et al.,
[18]
with permission].
ATA = atmospheres absolute.
2005 Adis Data Information BV. All rights reserved. Sports Med 2005; 35 (9)
744 Ishii et al.
3. Administration groups. After 2 weeks of HBO treatment, the aver-
age weight increase of the HBO rats was significant-
So far, we have talked about the theoretical back-
ly less than that of the control group (p < 0.05)
ground of HBO and basic research already done on
[figure 2]. However, there were no significant dif-
HBO. The following sections now discuss the
ferences in weight increase between the two groups
clinical application of HBO treatment.
at 1, 3 and 4 weeks. Values of plasma growth
hormone (GH) and plasma thyroid stimulating hor-
3.1 Adverse Effects
mone (TSH) are shown in figure 3. There were no
As with all treatments, the adverse effects of
significant differences in plasma GH or plasma TSH
HBO must be examined and determined to be less
between the HBO group and the control group at 1
serious than the benefits of the treatment. HBO, by
and 2 weeks. These results suggest that HBO has
increasing oxygen levels, poses a risk to DNA
influenced the whole bodyweight in the adolescent
through oxidative damage. The increased levels of
rats during HBO application, However, this was a
oxygen increase oxygen radicals in cells, which are
temporary response and did not influence plasma
able to attack and degrade DNA. The detrimental
hormone level in the blood. Further studies are
action by such oxygen is called oxygen poisoning,
needed, but it appears we have to take care with the
the main target of which is the CNS and the lungs.
use of HBO for young athletes.
As a clinical condition, the symptoms of oxygen
poisoning include uneasiness in the front chest, nau-
3.2 Safety Control
sea, vomiting, giddiness and tinnitus. Since these
Before HBO treatment can find widespread use
CNS symptoms tend to occur in the brain, they are
in the sports field, it would require the standardisa-
generally called symptoms of brain oxygen poison-
tion of equipment and safety regulations. Physicians
ing. For example, the congestion of an oedema in the
would need to be trained by engineers about the
alveolar, glass film formation and non-air alveolar
safety standards of hyperbaric environmental
are pathological changes that occur in the lungs.
medicine. The medical community would become
Although such symptoms have not occurred during
responsible for such systems, but explosions have
HBO treatment, longer durations of treatment re-
occurred five times previously in Japan, which has
quire these possibilities to be taken into considera-
tion.
We have studied the hormonal influence of HBO
after ligament injury in adolescent rats. Forty male
Wistar rats (aged 8 weeks) were used in this study.
Prior to the experiment, the rats were housed in
cages for 1 week. After 9 weeks of age, rats were
anaesthetised and a wound creation was made in the
middle of the patellar ligament by the same method
as our previous reports.
[19]
Rats were divided after
wound creation into two groups (n = 20). In the
HBO group, rats were treated with HBO at 2 ATA
for 60 minutes/day (311.2 ± 17.2g), and in the
control group, rats were merely exposed to air. In the
HBO group, HBO was applied 14 times over the
first 2 weeks. After 2 weeks, rats were without
HBO. Rats were fed a standard diet and housed in
individual cages. As a result, whole bodyweight
increased with time in both the HBO and the control
43210
0
20
40
60
80
100
120
140
160
Weight increase (g)
*
Control
HBO
HBO treatment
Time (wk)
Fig. 2. Average bodyweight increase of rats treated with hyperbaric
oxygen (HBO) and controls. Data are means ± SD, * p < 0.05 (vs
control
)
. The arrows indicate application of HBO on the HBO
g
roup.
2005 Adis Data Information BV. All rights reserved. Sports Med 2005; 35 (9)
Hyperbaric Oxygen as an Adjuvant for Athletes 745
the team medical staff beforehand, and also to make
it clear that it is only to be used complementary to
other treatments.
4. Conclusions
HBO treatment has been shown to be promising
for tissue remodelling after injury and for the recov-
ery of fatigue. However, further research is required,
focusing on tailoring treatment to an individual’s
condition, which will allow efficient use of HBO.
Acknowledgements
All authors agree with the contents of the manuscript and
affirm that this work has not been submitted or published
elsewhere. The authors would like to acknowledge Prof.
Tetsuya Tateishi of the National Institute for Materials Sci-
ences and Prof. Takashi Ushida of the University of Tokyo.
The authors would also like to thank Dr Tsukasa Kanda and
Dr Takeo Imada for their valuable assistance in these research
projects. No benefits in any form have been received or will
be received from a commercial party related directly or
indirectly to the subject of this article.
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10
20
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50
60
Plasma GH (ng/mL)
Plasma TSH (ng/mL)
0
1
2
3
4
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12
b
a
Control
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Fig. 3. Values of (a) plasma growth hormone (GH) and (b) plasma
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E-mail: yoishii@hiroshima-u.ac.jp
2005 Adis Data Information BV. All rights reserved. Sports Med 2005; 35 (9)
... The first recorded hyperbaric oxygen treatment was performed by British physiologist Nathaniel Henshaw in 1662, who created an airtight room called a 'domicilium'. Henshaw was able to manipulate the pressure in the room using large bellows [16,17]. ...
... Oxygen inherently plays an essential role in recovery from injury and fatigue. HBOT acts to increase the amount of oxygen dissolved in plasma, allowing more oxygen to reach the peripheral tissues [16]. It follows Henry's law, which can be summarised as "gas solubility in a solution depends on the partial pressure applied to it but does not change the affinity of haemoglobin for oxygen" [18]. ...
... In addition to physical injury, HBOT has been effective in recovery from fatigue and improvement of endurance. One example is the use of HBOT for competitors at the Nagano Winter Olympics to combat fatigue and allow players to return to the games with a better performance than without HBOT [16]. Also, Fischer et al reported use of HBOT between tennis games improved recovery from fatigue by removing ammonia from the blood. ...
Article
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Hyperbaric Oxygen Therapy (HBOT) has been a recognised treatment for a multitude of injuries for decades and presents significant opportunities for the improvement of wound healing, blood vessel restoration, reduction in recovery time after surgery, treatment of neurological and neurodegenerative disorders, improvement of memory and cognition, sports injury rehabilitation, cartilage regeneration, and overall quality of life. This paper aims to investigate HBOT and its indications for use, both as an adjuvant with other established treatments and independently, in order to provide an overview of treatment avenues with immense possibilities and versatility.
... HBO exposure has been suggested as an adjuvant treatment for enhancing muscle repair and recovery from exerciseinduced muscle damage (Ishii et al., 2005). While oxygen plays a crucial role in recovery from physiological fatigue, few studies have been conducted to determine the effects of HBO on post-exercise recovery (Branco et al., 2016;Ishii et al., 2005;Park et al., 2018). ...
... HBO exposure has been suggested as an adjuvant treatment for enhancing muscle repair and recovery from exerciseinduced muscle damage (Ishii et al., 2005). While oxygen plays a crucial role in recovery from physiological fatigue, few studies have been conducted to determine the effects of HBO on post-exercise recovery (Branco et al., 2016;Ishii et al., 2005;Park et al., 2018). There is thus a lack of knowledge concerning the potential benefits of HBO on subsequent performance. ...
... Therefore, it's possible that HBO also plays a positive role in the subsequent performances. Moreover, HBO has shown beneficial effects on blood lactate removal with exposures at 1.3 ATA compared to passive recovery (PR) (Ishii et al., 2005;Park et al., 2018). This result can explain in part the perception of recovery improvement observed after intense training (Branco et al., 2016). ...
Article
Background: The improvement of athletes’ recovery seems crucial to maintaining a high-performance level. Since hyperbaric oxygenation (HBO) could be a valuable recovery method, this study aimed at determining the effects of post-exercise HBO at modest pressure (97% O2; 1.3 ATA) on physiological response and subsequent cycling performance compared to passive recovery (PR; 21% O2; 1 ATA). Methods: Twelve trained cyclists completed two testing sessions in a random crossover design. Both sessions consisted of one fatiguing exercise immediately followed by either HBO or PR recovery inter�vention (75 minutes), then a 5-minute maximal cycling effort. Cycling power output, heart rate variability (HRV) during recovery, blood lactate, and the rating of perceived exertion (RPE) were analyzed and compared between conditions. Results: Compared with PR, the cycling power output was significantly higher after HBO (307.5 ± 19.0 W vs 314.5 ± 19.3 W; p = .005; ES = 0.11 [−0.70–0.90]). Moreover, several HRV indices revealed an improvement in HRV recovery in HBO condition. Blood lactate was not significantly different between conditions, neither following the fatiguing exercise nor the maximal effort. HBO decreased RPE after maximal cycling effort and improved the perceived recovery the day after testing sessions (p < .001). Conclusion: This study suggests that HBO is an efficient strategy to improve cardiac parasympathetic reactivation and is beneficial for subsequent performance.
... Oxygen is commonly administered to patients suffering from conditions that induce systemic hypoxemia (such as adult respiratory distress syndrome and carbon monoxide poisoning; Bourke et al., 2018;Jaber et al., 2016;Weaver et al., 2002) and regional tissue hypoxia (such as stroke and ischemic heart disease; Golledge & Singh, 2019;Moradkhan & Sinoway, 2010;Rockswold et al., 2013) as well as to patients under critical care, anesthesia, and perioperative management (Levy et al., 2016;Martin & Grocott, 2013;Renda et al., 2018). Oxygen is also occasionally administered to healthy individuals, such as athletes, for enhancing performance during sports events, such as races (Ishii et al., 2005;Kujawski et al., 2020). ...
... Data are expressed as the average levels in six plasma samples from each group. (Bourke et al., 2018;Golledge & Singh, 2019;Jaber et al., 2016;Levy et al., 2016;Martin & Grocott, 2013;Moradkhan & Sinoway, 2010;Renda et al., 2018;Rockswold et al., 2013;Weaver et al., 2002) as well as to healthy individuals, such as athletes (Ishii et al., 2005;Kujawski et al., 2020). ...
Article
Oxygen is often administered to patients and occasionally to healthy individuals as well; however, the cellular toxicity of oxygen, especially following prolonged exposure, is widely known. To evaluate the potential effect of oxygen exposure on circulating stem/progenitor cells and cardiac ischemia/reperfusion (I/R) injury, we exposed healthy adult mice to 100% oxygen for 20 or 60 min. We then examined the c‐kit‐positive stem/progenitor cells and colony‐forming cells and measured the cytokine/chemokine levels in peripheral blood. We also induced cardiac I/R injury in mice at 3 h after 60 min of oxygen exposure and examined the recruitment of inflammatory cells and the fibrotic area in the heart. The proportion of c‐kit‐positive stem/progenitor cells significantly increased in peripheral blood at 3 and 24 h after oxygen exposure for either 20 or 60 min (p < .01 vs. control). However, the abundance of colony‐forming cells in peripheral blood conversely decreased at 3 and 24 h after oxygen exposure for only 60 min (p < .05 vs. control). Oxygen exposure for either 20 or 60 min resulted in significantly decreased plasma vascular endothelial growth factor levels at 3 h, whereas oxygen exposure for only 60 min reduced plasma insulin‐like growth factor 1 levels at 24 h (p < .05 vs. control). Protein array indicated the increase in the levels of some cytokines/chemokines, such as CXCL6 (GCP‐2) at 24 h after 60 min of oxygen exposure. Moreover, oxygen exposure for 60 min enhanced the recruitment of Ly6g‐ and CD11c‐positive inflammatory cells at 3 days (p < .05 vs. control) and increased the fibrotic area at 14 days in the heart after I/R injury (p < .05 vs. control). Prolonged oxygen exposure induced the mobilization and functional impairment of stem/progenitor cells and likely enhanced inflammatory responses to exacerbate cardiac I/R injury in healthy mice.
... However, with the subjectivity of improvement after exhaustion of high training intensities, although natural regeneration (depending on injury or extent of destruction of muscle fibres) caused by overtraining or inhibiting excessive water-muscle ratio is a process, the use of hyperbaric therapy (HBOT) would produce promising results in all the breaks of damage regeneration and muscle tissue remodelling as well as the benefits of neoangiogenesis due to the lack of cardio exercises associated with the data limitation problem, and the potential protection against myodestruction of anabolic steroids [6][7][8][9]. From this point of view, the question that remains redundant is, would recreationalists applying anabolic steroids really profit from hyperbaric therapy (HBOT) treatments alone or in addition to the stacking application of various anabolic steroids. On the other hand, amateur and Olympic sports without the use of illicit pharmacological agents are an absolutely justified indication for hyperbaric treatment (HBOT) for a number of crucial reasons. ...
... It is also suggested that hyperoxic gas inhalation during the post-exercise recovery period enhanced arterial oxygen saturation, which attenuated muscle fatigue via activating muscle cell activity and removing metabolic waste accumulation. [30][31][32] However, theoretically, HG inhalation through a nasal cannula has been considered to have minor effects on the increased oxygen concentration in inspired gas as described in the "Participants and Methods" section. Therefore, the hypothesis that inhaled hyperoxic gas strongly contributes to the improvement of exercise performance in this study must be denied. ...
Article
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Molecular hydrogen has been suggested to have a cytoprotective effect on the whole body and to enhance exercise performances. However, the effect of hydrogen-rich gas mixture (HG) inhalation on physiological responses has been poorly investigated. We examined the impact of acute HG inhalation on subsequent oxidative stress, muscle damage, and exercise performances during the recovery period after a strenuous exercise. This is a two-trial, double-blind, crossover, repeated measures study. Eight physically active male volunteers inhaled HG (estimated fraction of inspired oxygen and hydrogen were 21.57 and 4.08% at most, respectively) or normal gas (placebo, ambient air 400 m above sea level) during a 60-minute recovery phase after oxidative stress-inducing exercise) completion comprising 30-minute treadmill running at an intensity corresponding to 75% of maximal oxygen uptake and squat jumps (5 sets × 10 repetitions). Before oxidative stress inducing exercise and 10 minutes after the post-exercise gas inhalation, blood and urine samples were obtained and exercise performances (jumping ability; pedaling power output; muscle strength) were evaluated. Post-exercise HG inhalation attenuated the increase in urinary 8-hydroxydeoxyguanosine excretion rate (P < 0.05), a DNA oxidation marker, and the reduction in the countermovement jump height (P < 0.05), compared with Placebo inhalation. Other exercise performances and blood oxidative stress and muscle damage markers did not differ between HG and Placebo inhalation. Moreover, the increase in urinary 8-hydroxydeoxyguanosine excretion rate was significantly associated with countermovement jump performance reduction (r = –0.78, P < 0.01). These findings suggested that HG inhalation during post-exercise recovery period might improve exercise performance via reducing systemic oxidative damage. The study was approved by the Human Research Ethics Committee of the University of Yamanashi (approval No. H29-006) on June 28, 2017.
... increases adenosine triphosphate synthesis) and promotes the metabolism of fatigue-related substances. 46 Specifically, fatigue-associated metabolic factors produced during the process of 47 ), which may be better removed after applying an oxygen therapy. Indeed, it has been reported that HBOT reduces fatigue in chronic fatigue syndrome, 20 which has been attributed to its ability to lower reactive oxygen species and acid lactic levels, and in muscle fatigue after exercise. ...
Article
Full-text available
Background Fibromyalgia (FM) is characterized by chronic pain and fatigue, among other manifestations, thus advising interventions that do not aggravate these symptoms. The main purpose of this study is to analyse the effect of low-pressure hyperbaric oxygen therapy (HBOT) on induced fatigue, pain, endurance and functional capacity, physical performance and cortical excitability when compared with a physical exercise program in women with FM. Methods A total of 49 women with FM took part in this randomized controlled trial. They were randomly allocated to three groups: physical exercise group (PEG, n = 16), low-pressure hyperbaric oxygen therapy group (HBG, n = 17) and control group (CG, n = 16). Induced fatigue, perceived pain, pressure pain threshold, endurance and functional capacity, physical performance and cortical excitability were assessed. To analyse the effect of the interventions, two assessments, that is, pre and post intervention, were carried out. Analyses of the data were performed using two-way mixed multivariate analysis of variance. Results The perceived pain and induced fatigue significantly improved only in the HBG ( p < 0.05) as opposed to PEG and CG. Pressure pain threshold, endurance and functional capacity, and physical performance significantly improved for both interventions ( p < 0.05). The cortical excitability (measured with the resting motor threshold) did not improve in any of the treatments ( p > 0.05). Conclusions Low-pressure HBOT and physical exercise improve pressure pain threshold, endurance and functional capacity, as well as physical performance. Induced fatigue and perceived pain at rest significantly improved only with low-pressure HBOT. Trial registration ClinicalTrials.gov identifier NCT03801109.
... Each of these stages entails a complex sequence of physiological and cellular events, which are considered to depend on an adequate blood supply for transport of cells and metabolites 7 . After severe muscle damage, the vasculature is largely destroyed 2,29 . ...
Article
Full-text available
Hyperbaric oxygen (HBO) treatment promotes early recovery from muscle injury. Reactive oxygen species (ROS) upregulation is a key mechanism of HBO, which produces high O2 content in tissues through increased dissolution of oxygen at high pressure. Nitric oxide (NO), a type of ROS, generally stabilizes hypoxia-inducible factor (HIF) 1α and stimulates secretion of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) from endothelial cells and macrophages, which then induces angiogenesis. The purpose of the present study was to investigate whether HBO could promote angiogenesis via induction of NO and induce muscle regeneration in contused rat skeletal muscles. The HBO protocol consisted of 2.5 atmospheres absolute (ATA) 100% oxygen for 120 minutes, once a day for 5 consecutive days. We also evaluated the effects of a ROS inhibitor (NAC) or NOS-specific inhibitor (L-NAME) on HBO. HBO significantly increased NO3−, VEGF, and bFGF levels and stabilized HIF1α within 1 day. HBO promoted blood vessel formation at 3–7 days and muscle healing at 5–7 days after contusion. Administration of both NAC and L-NAME before HBO suppressed angiogenesis and muscle regeneration even after HBO. HBO thus promoted angiogenesis and muscle regeneration mainly through generation of NO in the early phase after muscle contusion injury.
... Accordingly, HBOT has been reported to be beneficial in accelerating cell recovery and tissue repair, which are considered to help eliminate fatigue and recover stamina. HBOT has gained considerable attention among sports medicine specialists as an adjuvant therapy to accelerate athletes' muscular injury recovery, but the exact efficacy remains unclear [8,[17][18][19][20]. ...
Article
Full-text available
Early recovery from muscular injury is crucial for elite athletes. Hyperbaric oxygen therapy (HBOT) has been reported to be beneficial in terms of accelerating cell recovery and tissue repair, which are considered to be helpful for eliminating fatigue and recovering stamina. This study was performed to evaluate the efficacy of HBOT for exercise-related muscular injury. Forty-one athletes with exercise-related muscular injuries were recruited and randomized into an HBOT group and a control group. All participants received 10 sessions of either HBOT or placebo treatment. The brief pain inventory (BPI) was completed, and serum samples were analyzed. Data were collected before treatment (T1), at the end of the fifth treatment session (T2), at the end of the tenth treatment session (T3), and two weeks after T3 (T4). At T3, the HBOT group showed prominent reductions in the levels of creatine phosphokinase (CK), glutamic oxaloacetate transaminase (GOT), and myoglobin (MB), which lasted until T4. However, the control group did not present any statistical differences in levels from T1 to T4. In terms of pain intensity and interference, the HBOT group showed significant improvements at T3, while no improvements were observed in the control group. In conclusion, HBOT facilitates the early recovery of exercise-related muscular injury. This trial is registered with ISRCTN17817041 .
... High-pressure oxygen has been shown to increase arterial pressure and reduce heart rate (Lund et al., 1999), and hyperbaric conditions have been shown to reduce serum lactate accumulation during aerobic exercise (Neubauer et al., 1999;Stellingwerff et al., 2005). Ishii et al. (2005) reported that HBO treatment showed fast recovery of lactate in the athletes. In this study, the lactate removal effect of low-pressure HBO after maximal exercise was consistent with the results of Sueblinvong et al. (2004). ...
Article
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The purpose of this study was to investigate the effects of low-pressure hyperbaric oxygen (HBO) treatment before and after maximal exercise on lactate concentration and heart rate and antioxidant capacity. Ten healthy male college students were recruited from amateur soccer players. Subjects were performed a maximal exercise 3 times at inter-vals of at least 7 days according to the treatment method (control, pre-treatment, posttreatment). Lactate concentration, heart rate, and anti-oxidant capacity were measured before, post, and after recovery 30 min of maximal exercise. The lactate concentration and heart rate of recovery 30 min was significantly lower in the low-pressure HBO treat-ed group after the maximal exercise compared with the control group and the low-pressure HBO treated group before maximal exercise, and it could affect the removal of the fatigue substance caused by the maxi-mal exercise. These results suggest that the low-pressure HBO treat-ment which is a new possibility for recovery of peripheral fatigue.
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Apart from improving the consolidation of its references and databases, sports medicine has also increased forms of treatment that reduce the time of recovery from injuries. One of these is the use of hyperbaric oxygen therapy (OHB) for a) the healing of ligament and muscular-skeletal injuries, and b) improvement in sports training and performance. When a subject is injured, the affected area has a decrease in oxygen intake due to injured vessels, effects of inflammation, and alteration of vascular permeability. The objective of this is study to share the advantages that OHB offers for sports injury recovery by eliminating the lack of oxygen to the lesion. Under normal conditions, at 1 ATA (atmosphere absolute), 98.4% of oxygen binds to hemoglobin and the remaining portion is dissolved in the plasma. Under OHB treatment, at 2 and 3 ATA, 3.8% to 6.8% of oxygen is dissolved in plasma respectively, and the PaO2 oscillates between 1.400 and 2.200 mm of Hg. The methodology included treatment sessions for injured athletes on two to 20 occasions, with a duration of 60 to 90 minutes each, varying the pressure according to the case. The results have been significant in recovery from sports injuries such as torn anterior cruciate ligament, muscle fatigue etc.
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Article
In a study on rats, long-tern intermittent hyperbaric oxygenation at 2 ATA had no effect on the healing rate of open wounds in which the circulation was left intact. When the wound edges were devascularized, however, hyperbaric oxygen enhanced the wound closure rate in the final stages of healing, thus counteracting the delay caused by disturbed blood supply. During the hyperbaric exposure, tissue pO-2 increased considerably in both normal and devascularized skin, whereas tissue pCO-2 increased only slightly. Combined systemic and local hypoxia--12% oxygen at 1 atm--retarded the closure rate of full-thickness skin wounds. This was noted both in acclimatized and in unacclimatized rats. Thirteen-day adaptation to hypoxia increased the healing rate and subcutaneous tissue pO-2 to normal levels, but when hypoxia was continued, tissue pO-2 and the wound closure rate decreased markedly. This was probably due to a decreased blood flow induced by secondary erythrocytosis and an elevated blood viscosity.
Article
This study examined the effect of exposures to hyperbaric oxygen on the development of the edema and necrosis of muscle that are associated with compartment syndromes that are complicated by hemorrhagic hypotension. A compartment syndrome (twenty millimeters of mercury for six hours) was induced by infusion of autologous plasma in the anterolateral compartment of the left hind limb of seven anesthetized dogs while the mean arterial blood pressure was maintained at sixty-five millimeters of mercury after 30 per cent loss of blood volume. These dogs were treated with hyperbaric oxygen (two atmospheres of pure oxygen) and were compared with six dogs that had an identical compartment syndrome and hypotensive condition but were not exposed to hyperbaric oxygen. Forty-eight hours later, edema was quantified by measuring the weights of the muscles (the pressurized muscle compared with the contralateral muscle), and necrosis of muscle was evaluated by measuring the uptake of technetium-99m stannous pyrophosphate. The ratio for edema was significantly (p = 0.01) greater in dogs that had not been exposed to hyperbaric oxygen (1.15 +/- 0.01) than in the dogs that had been treated with hyperbaric oxygen (1.01 +/- 0.03), and the ratio for necrosis of muscle was also significantly (p = 0.04) greater in dogs that had not had hyperbaric oxygen (1.96 +/- 0.41) than in those that had been treated with hyperbaric oxygen (1.05 +/- 0.11). Comparisons were also made with the muscles of four normal control dogs and separately with the muscles of six normotensive dogs that had an identical compartment syndrome and normal blood pressure and were not treated with hyperbaric oxygen.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
A new method of measuring tissue gases using an implanted Silastic tube has been developed. The Silastic tonometer is filled with anoxic saline which equilibrates to the average PO2 and PCO2 of the surrounding tissue within a few minutes. The equilibrated fluid is collected in an Astrup glass capillary tube that is then emptied into a microcuvette containing either an oxygen or carbon dioxide electrode. Because of the chemical inertness of Silastic, inflammatory reaction around the tonometer is minimal.
Article
Glutathione serves as an important intracellular defence against reactive oxygen metabolites and has been shown to be depleted from a number of tissues upon oxidative stress. In the present study we have investigated the levels of total glutathione (reduced + oxidized) in skeletal muscle of the rat after prolonged ischemia and reperfusion with and without treatment with hyperbaric oxygen (HBO) for the initial 45 minutes immediately following reperfusion. A tourniquet model for temporary, total ischemia was used, in which one hind leg was made ischemic for 3 or 4 hours. Muscle biopsies were taken after 5 hours of reperfusion. In postischemic muscle there was a significant decrease of total glutathione compared to control muscle, but in the 3-hour-ischemia-groups the loss of total glutathione was less in HBO treated animals than in untreated. HBO treatment also preserved ATP and PCr and decreased edema formation in the postischemic muscle following 3 hours of ischemia and reperfusion when compared to untreated animals. However, after 4 hours of ischemia, HBO treatment failed to improve any of these parameters in the postischemic muscle. Thus, our results demonstrate that HBO treatment lessens the metabolic, ischemic derangements and improves recovery in postischemic muscle after 3 hours of ischemia followed by reperfusion.
Article
The influence of hyperbaric oxygen on reepithelialization and on microvascular perfusion of wounds in normal and ischemic skin tissue was investigated by using a standardized model, in ears of hairless mice. Animals were treated within 2 hours of wound creation and then twice daily with 100% oxygen at 2 atmospheres of absolute pressure. Ischemia was induced by ligating two of the three major vessels of the ear 2.5 days before wound creation. Wound surface area was measured every third day after wound creation. In addition, microvascular blood flow before and during the wound healing process was measured by scanning the ear with a new laser Doppler perfusion imager. In normal tissue (n = 13), hyperbaric oxygen therapy significantly accelerated wound healing by 2 days (p < 0.01) as compared with controls (n = 16). In ischemic tissue (n = 16), treatment with hyperbaric oxygen reduced time for reepithelialization in control animals (n = 16) from 14.3 to 9.9 days (p < 0.001). Laser Doppler data showed no difference in tissue blood flow between treated and untreated animals. In comparison with normal tissue, wound healing in ischemic tissue was characterized by a reduced and less intense hyperemic response. These data suggest that hyperbaric oxygen therapy improves reepithelialization in normal and ischemic skin tissue. The beneficial effect is not associated with changes in microvascular perfusion and therefore is probably due to high arteriolar oxygen content and oxygen diffusion.
Article
Hyperbaric oxygen therapy, an established therapeutic intervention in diving medicine, is being investigated in wound management, where oxygen is an integral part of the healing process. Currently, the evidence is controversial as to whether there is a basis for using hyperbaric oxygen in normal wounds. This review explains the rationale for the use of hyperbaric oxygen therapy and reports on the initial research in the area of hyperbaric oxygen in sports-induced injury. In addition to the increased dissolved content of oxygen in the plasma, the combination of pressure and oxygen seems to promote systemic vasoconstriction and yet inhibition of vasoconstriction in the injured area, which will limit oedema. The safety of hyperbaric oxygen in otherwise healthy athletes is examined. Potential contraindications to hyperbaric oxygen therapy include individuals who are febrile, suffer from upper respiratory infections, or have suffered a trauma to the chest where a pneumothorax is suspected or have a predisposition to tension pneumothorax. The initial human and animal model studies have shown promising, and in some instances significant, acceleration of healing. The potential benefits for sports injuries appear to be a blunting of initial injury, possibly by controlling the neutrophil adhesion and release of oxygen free radicals as well as an enhancement of healing processes requiring oxygen-like collagen formation phagocytosis.
Article
We conducted a randomized double-blind study of 32 subject with acute ankle sprains to compare treatment with hyperbaric oxygen at 2 atmospheres absolute pressure (N = 16) (treatment group) with treatment with air at 1.1 atmosphere absolute pressure (N = 16) (control group) in a hyperbaric chamber. Each group received three treatments at their respective pressures: one for 90 minutes and two for 60 minutes each. Mean age, severity grade, and time to treatment (treatment group, 34.3 +/- 6.3 hours; control group, 32.6 +/- 4.6 hours) were similar in both groups. Joint function measured by a functional index improved from 0.40 +/- 0.2 to 6.3 +/- 0.4 with hyperbaric oxygen and from 0.8 +/- 0.3 to 5.3 +/- 0.6 with air. The change from initial to final evaluation was significantly greater in the treatment group. Foot and ankle volume by water displacement decreased from 1451 +/- 57 ml to 1425 +/- 63 ml with hyperbaric oxygen and from 1403 +/- 50 ml of 1371 +/- 45 ml with air (no difference was noted between hyperbaric oxygen treatment and air treatment using a two-day analysis of variance). Subjective pain index fell from 3.3 +/- 0.5 to 0.8 +/- 0.3 with hyperbaric oxygen and from 2.6 +/- 0.3 to 0.3 +/- 0.2 with air. No differences were noted in passive or active range of motion when comparing hyperbaric oxygen treatment with air treatment. Time to recovery was the same in both groups (treatment, 16.0 +/- 6.3 days; control, 15.4 +/- 2.8 days). Regression analysis to determine the influence of time to treatment, initial severity of injury, hyperbaric oxygen, and age showed no effect of hyperbaric oxygen treatment on time to recovery.