Personal trainers should be well-versed in all cutting-edge treatments related to recovery and general health, especially when such treatments can be utilized by athletes or fitness clients. Hyperbaric Oxygen Therapy, or HBOT, is one such treatment that is becoming more widely utilized and available to the general public.

What is Hyperbaric Oxygen Therapy?

HBOT is a treatment where the medical use of oxygen at an ambient pressure greater than atmospheric pressure is used to treat a variety of conditions. In other words, HBOT can treat the body by using higher than local atmospheric pressure inside a special chamber. In hyperbaric therapies, hyperbaric oxygen therapy (BGO) means that 100% pure oxygen is administered at pressures higher than atmospheric pressure (for example, more than 1 atmosphere absolute or ATA) for therapeutic reasons.

It works on the premise of Boyle’s Law which states the more pressure you put on a gas, the smaller the gas bubble becomes. This in turn makes it easier to diffuse into the tissues of the human body and allows it to get to where it needs to go.

There are two root words in Hyperbaric:

Hyper + Baric

The literal translation of hyper in Greek and Latin is over-excess or above normal.  The literal translation of baric in Greek and Latin relates to weight in the atmosphere.

Put together, the term hyperbaric literally means an above-average or excess amount of atmospheric weight (which is essentially high pressure). Therefore, HBOT is a therapeutic treatment involving the intake of medical-grade oxygen at higher than normal pressures.

The equipment required for HBOT consists of a pressure chamber. It can be rigid or flexible and serves as a means to deliver 100% oxygen. It’s operated on a predetermined schedule by trained professionals who monitor the individual receiving the treatment and adjust the pressure as needed.

Most chambers have a way for the people receiving the treatment inside of it to communicate with the professional while they get the treatment. Some chambers hold only one person, and you would lay in it while others hold 5-7 people or more. In this case, you would sit up and experience the treatment with the others in the chamber.

Because the hyperbaric chamber is pressurized, when a person goes into one, it’s often referred to as a ‘dive’. 

HBOT has been approved by the American Medical Association (AMA) and the Federal Drug Administration (FDA) as a trusted integrative treatment.

 

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The History of HBOT

In 1662, a British physician named Nathaniel Henshaw built the first pressurized room to treat digestive and pulmonary conditions. This was the start to oxygen therapy. Unfortunately, the use of oxygen therapy stalled until 1788 when compressed hyperbaric air was used in a diving bell for underwater repair. This inspired August Siebe to create the first deep-sea diving suit in 1819.  But it wasn’t until 1834 that the first hyperbaric tank was created and arrived on the scene courtesy of Dr. Junod. The Bulletin of the Academy of Medicine attributed Dr. Junod’s use of HBOT successfully to treat a variety of medical conditions.

Over the years, the use of HBOT expanded and really received a lot of public attention in the 1960’s because President Kennedy’s sick infant was treated at the Children’s Hospital in Boston to treat Respiratory Distress Syndrome (RDS). While the infant didn’t survive, it sparked the medical community’s interest to do further research to use the treatment. Today, 95% of infants born with RDS survive with medical treatment.

Early on, it was used to treat decompression sickness, or the bends. This is also called generalized barotrauma, referring to injuries caused by a rapid decrease in the pressure that surrounds the human body (either air or water). Deep-sea and scuba divers are the most common people to experience it but it can also happen during high-altitude or unpressurized air travel.

It has also been used to treat gas gangrene and carbon monoxide poisoning. Some recent research is showing promising results to treat cerebral palsy and multiple sclerosis, but it is not definitive. More research needs to be done.

It is used to treat arterial gas embolism caused by pulmonary barotrauma of ascent. In other words, in emergencies, it can be used to treat divers to recompress. Since then, more and more athletes are using HBOT.

Hyperbaric Oxygen Therapy and Athletes

HBOT is becoming a favorite recovery tool for athletes because of its tremendous benefits to the human body.

Athletes use HBOT treatment for the following reasons:

  • Injury Prevention
  • Performance Optimization
  • Rehabilitation & Recovery

As advances in technology occur, sports and athletics become increasingly competitive and demanding on the human body. So, there’s a strong need for athletes to focus on recovery from injuries or even just recover from training or day-to-day activity and movement.

  • HBOT accelerates the breakdown of lactic acid and can help athletes recover from training fatigue.**
  • Its powerful anti-inflammatory and wound-healing acceleration properties can be applied to athletic injuries.**
  • Taking in medical-grade 100% oxygen in HBOT can potentially increase mental focus and clarity on and off the field **

**These statements have not been FDA approved and are under preliminary research phases. If you have any medical conditions, it is best to receive a consult by a credentialed medical provider.**

In a double-blind, randomized, placebo-controlled study on 37 healthy middle-aged (40–50-year-old) master athletes during 2018 and 2020, Hadanny et al. (2022), found that HBOT enhances physical performance in healthy middle-aged master athletes. This included VO2max, power, and VO2 Anaerobic Threshold (VO2AT). The findings stated that this could be due to significant improvements of mitochondrial respiration and increased mitochondrial mass.

In the experiment, the participants were exposed to 40 repeated sessions of either HBOT (at two absolute atmospheres or ATA, breathing 100% oxygen for 1 hour) or a placebo treatment, (breathing 1.02 ATA for one hour).

The group receiving HBOT had 16 participants and the one receiving sham treatment had 15 participants. The HBOT group showed a significant increase in the maximal oxygen consumption (VO2max) and in the oxygen consumption measured at the anaerobic threshold (VO2AT) compared to the sham group. The HBOT group also showed significant increases in both maximal oxygen phosphorylation capacity, maximum uncouple capacity, and mitochondrial mass marker compared to those receiving the placebo treatment.

While this study focused on a small population of elite endurance athletes, the results are significant and show the efficacy of HBOT on VO2max, power and VO2AT along with its positive effects on mitochondria.

I’ll look forward to seeing more research and applications of HBOT for athletes and helping them maintain optimal condition, prevent injuries, and maximize their performance.

What else is HBOT approved to treat?

Per the National Hyperbaric Treatment Center, as of October 8, 2011, there are 14 FDA-approved conditions as follows:

  • Severe Anemia
  • Air or Gas Embolism
  • Carbon Monoxide Poisoning
  • Decompression Sickness
  • Intracranial Abscess
  • Compromised Grafts and Flaps
  • Necrotizing Soft Tissue Infections
  • Osteomyelitis (Refractory)
  • Acute Thermal Burn Injury
  • Delayed Radiation Injury (Soft Tissue and Bony Necrosis)
  • Clostridial Myositis and Myonecrosis (Gas Gangrene)
  • Idiopathic Sudden Sensorineural Hearing Loss
  • Arterial Insufficiencies, such as Central Retinal Artery Occlusion
  • Crush Injuries, Compartment Syndrome and Other Acute Traumatic Ischemia

HBOT Risks

While HBOT is a non-invasive treatment approach, and serious complications are rare, it’s still important to be prudent and cautious.

Some potential risks include:

  • Lung collapse (rare)
  • Temporary vision changes
  • Ear and sinus pain
  • Middle ear injuries, including tympanic membrane rupture

The use of high concentrations of oxygen can pose fire risks. As such, the FDA recommends utilizing an accredited facility. There has been a history of exploding chambers in unreviewed and non-FDA accredited facilities.

What Can a HBOT Patient Expect?

Going for a hyperbaric “dive” is a comfortable experience for most. You should be able to relax, watch TV, or even take a nap. Each treatment can last up to hours or more, for five or six days a week for up to four to six weeks, totaling 20-40 sessions! (You are really committing to this!). The good news is the effects of this treatment last 8 to 10 months. Insurance will typically cover conditions or diseases for which this therapy has been approved.

While hyperbaric oxygen therapy has its roots in the 1600s, its uses are ever-expanding. The FDA’s approved it for a number of medical conditions and now it’s making its mark on the sports and fitness scene to help athletes stay on top of their game.


References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382683/

https://nationalhyperbaric.com/

Hadanny, A., Hachmo, Y., Rozali, D. et al. Effects of Hyperbaric Oxygen Therapy on Mitochondrial Respiration and Physical Performance in Middle-Aged Athletes: A Blinded, Randomized Controlled Trial. Sports Med – Open 8, 22 (2022). https://link.springer.com/article/10.1186/s40798-021-00403-w#citeas

https://www.fda.gov/consumers/consumer-updates/hyperbaric-oxygen-therapy-get-facts#:~:text=HBOT%20involves%20breathing%20100%25%20(pure,the%20lungs%20collect%20more%20oxygen.

https://uihc.org/health-topics/frequently-asked-questions-about-hyperbaric-oxygen-therapy