Orthopedics 2018 | September 24-25, 2018 | Dubai, UAE | Keynote Speaker:  Malcolm R. Hooper

Hooper Dubai Abstract 2019.PNG

Hyperbaric Oxygen Therapy is 'tailored' to the individual athlete.

  • Hyperbaric Oxygen Therapy "preconditioning" elevates the athlete's immune response, stimulates stem cell production and circulation, regulates and modulates cytokine responses including reduction of inflammatory cytokines associated with chronic injury & slow recovery. HBO increases intracellular and extracellular oxygen tension.

  • Hyperbaric Oxygen Therapy is combined with 'neuronal priming' techniques to enhance 'brain performance plasticity' - the ability to execute specific function repetitively with power, minimising injury recurrence and enhanced recovery.

Undersea Hyperb Med. 2018 Nov-Dec;45(6):653-662.

The influence of hyperbaric environment on the skeletal muscle mitochondrial energetic of rats after induced muscle contusion.

Cervaens M1, Lumini-Oliveira J1,2, Ascensão A2, Magalhães J2, Camacho O3, Barata P1.

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Analyze the influence of the hyperbaric environment on skeletal muscle mitochondrial bioenergetic end-points of rats submitted to muscle contusion.


Twelve female Wistar rats were randomly assigned to three groups. All rats were submitted to muscle contusion in the right gastrocnemius through a standard protocol. The control group (C) remained under normobaric conditions without any treatment. The hyperbaric air (HB) and the hyperbaric oxygen (HBO2) groups had four sessions of HBO2 therapy 60 minutes, six, 12, 24 and 48 hours after the injury at 253.25 kPa (2.5 atmospheres absolute/ATA) with air or 100% oxygen, respectively. The animals were sacrificed 48 hours after muscle injury, and both muscles (injured and non-injured) were analyzed. Muscle mitochondrial bioenergetics and mitochondrial permeability transition pore (MPTP) susceptibility were evaluated.


Significant differences were found in all parameters between the injured and the non-injured gastrocnemius in the C group. In the HB group, significantly better results concerning bioenergetics-related end points with complex I and II substrates where found in the right gastrocnemius, whereas in the HBO2 group the time to Vmax (time that elapsed until the faster swelling kinetics starts) was significantly higher and the swelling amplitude was significantly smaller than in other groups, which suggest a lower susceptibility to MPTP opening.


The present data suggest that hyperbaric exposure, particularly with oxygen, positively modulates the efficiency of skeletal muscle mitochondria after muscle contusion.


Hyperbaric Oxygen Therapy is combined with other innovative strategies:

Ketogenic Diet and Ketone Supplements for Athletes change your fuel source for sustainable energy, peak performance and recovery.


Compartment Syndrome

Undersea Hyperb Med. 2018 Mar-Apr;45(2):209-215.

Hyperbaric oxygen therapy as treatment for bilateral arm compartment syndrome after CrossFit: case report and literature review.

Mendes AF Jr1,2, Neto JDM1,2, Heringer EM3, de Simoni LF1, Pires DD4, Labronici PJ5.

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CrossFit is a physical fitness program characterized by high-intensity workouts that can be associated with serious injury. Acute compartment syndrome in the upper limbs is a rare occurrence. It may occur after intense physical exercise, and its usual treatment is surgical. Hyperbaric oxygen therapy is a treatment described as adjunctive in cases of compartmental syndrome.


We describe the case of a CrossFit practitioner who, after intense training, developed progressive symptoms of rhabdomyolysis and acute bilateral arm compartment syndrome, who was successfully treated with hyperbaric oxygen therapy and required no fasciotomy as surgical treatment.


Acute compartment syndrome in the arms after intense physical exercise is a rare occurrence that should be suspected by practitioners of physical activity experiencing intense, disproportionate and progressive pain. In the case presented, hyperbaric oxygen therapy was successfully used in the treatment of the disorder, with satisfactory progress, and without the need for a surgical fasciotomy as therapy.

'Hyperbaric Oxygen Therapy is combined with Ketogenic Diet and Cytokine Gene Expression Testing'

Cytokine Gene Expression is the 'new frontier - the science behind recovery and performance'


High end athletes are confronted with a range of metabolic issues due to chronic hypoxia, fatigue, lactic acid overload and sheer exhaustion.

  • Performance, recovery, performance, recovery ... an endless cycle!

  • As tissue Oxygenation diminishes (hypoxia) the secondary inflammatory changes and range of injuries increases dramatically. Tissues chronically exposed to hypoxia "over express" (produce) pro-inflammatory cytokine gene expression. Over-expression of inflammatory cytokines spreads systematically throughout the body with a continuing elevation of inflammation. ​Please note - hypoxic altitude training - chronically "over expresses inflammatory cytokine production".


Hyperbaric Oxygen Therapy "resets cell modulation" (mitochondrial function):

  • HBO UP~REGULATES Circulating Stem Cells (CD34+), Growth Factors (VEGF, BDNF, GDNF), Anti-inflammatory Interleukins including IL4, IL10, IL12, IL13 and INFγ (positive feedback loop).

  • HBO DOWN~REGULATES Pro-inflammatory Interleukins IL1, IL2, IL6, IL7, IL8 and TNFα.

Prevention And Performance - Oxygen Tissue Banking

  • ​Hyperbaric Oxygen Therapy, Cryotherapy, VacuSports, Halo-Sports & Vibration Training are NOT WADA or ASADA banned.

  • HBO improves cellular Oxygenation, increasing the patient's own circulating stem cells, modulating gene expression, increasing plasma growth factors (vascular growth factors, brain derived growth factors), reducing bacterial and viral load and accelerating immune responses.


'Oxygen Banking minimises future breakdown'.

  • If you are constantly subjected to an 'impact injury'; the tissue that is Oxygen banked will respond with less consequence than tissues that are already compromised due to hypoxia. 

Tissue Oxygen Banking also enables greater tissue reserves at the 'business end' of the race or competition. 

  • The fact that your opponent has not tissue banked gives the individual an edge on the competition.

  • The brain and spinal cord also benefits. Approximately 20-30% of the body's consumption of Oxygen occurs within 3-5% of the body mass - the brain and spinal cord. These structures are also extremely sensitive to Oxygen deficiency, and can have the most dramatic results with the use of Hyperbaric Oxygen Therapy.


Key Benefits of Hyperbaric Oxygenation (HBO)

  • An absolute key component of optimal physical and mental health is Oxygen.

  • Oxygen therapy is a natural way to cope with the effects of ageing, illnesses, injury or overexertion.

  • Preconditioning against injury

  • Shortens recovery time after extreme exercise, injury or surgery

  • Revitalizes by improving blood flow and oxygen to all organs

  • Regenerates small blood vessels (capillaries), nerves and bones

  • Rejuvenates by releasing stem cells from bone marrow for tissue repair

  • Reduces pain, swelling, tingling, cramps, numbness

  • Suppresses inflammation

World Elite Athlete - at the 'business end' of a long and successful career

  • Cytokine Gene Expression Testing - note the 'over-expression' of pro-inflammatory cytokines.

  • Undoubtedly the physical and mental toll of competing at the high end level of sports culminates with the never ending list of chronic injuries. However when the athlete retires, instead of just sitting back and enjoying their success invariably they are increasingly confronted with managing potentially serious health issues as a results of years of cytokine abuse.

What happens when you are in 'Burn-Out'?

'Burn-out' is an over-expression of proinflammatory Cytokines due to 'hypoxia' (lack of tissue Oxygen).

- This athlete has levels greater than 2500  (normal reference 0-28). 

- Concussion syndrome and repetitive head injury can result in chronic overproduction of Il8, TNFa and other inflammatory cytokines.

Chemokine Interleukin-8 (IL-8) in Alzheimer’s and Other Neurodegenerative Diseases

  • Neuroinflammation is a critical component in the pathogenesis of neurodegenerative diseases.

  • Evidence suggests that activated microglia serve as a primary source for a host of inflammatory mediators which in assemblage can lead to neurotoxicity in inflamed brain.

  • Mobilization of chemokine factors is a response to changes in brain homeostatic conditions leading to localized accumulation of reactive microglia at target sites. In particular, levels of the chemokine IL -8 are significantly elevated in neurodegenerative disease. 

IL8 & Cardiovascular Disease

  • Inflammatory basis of atherosclerosis, several pro- or anti-inflammatory agents have been examined as potential mediators of the biochemical pathways of lesion formation. Interleukin (IL)-8 was first characterized in 1987. Since then, knowledge regarding its role in leucocyte trafficking and activation has advanced rapidly, especially in the field of cardiovascular disease.

  • In the scientific literature, there is sufficient evidence to support beyond any doubt the involvement of IL-8 in the establishment and preservation of the inflammatory micro-environment of the insulted vascular wall.

Tumor Necrosis Factor Alpha 

  • TNFα is a cytokine produced by white blood cells which acts as the master regulator of the human inflammatory response. Elevated levels of the cytokine tumor necrosis factor-alpha (TNF) is directly linked with chronic pain, arthritis, tendinitis.

  • The hippocampus, an area of the brain most notable for its role in learning and memory formation, plays a fundamental role in pain sensation. The hippocampus is responsible for the growth and development of neurons (neurogenesis) and the ability of nerves to regenerate after injury. 


  • The levels of S100B is commonly associated with brain injury including repetitive traumatic brain injury and concussion syndromes.

  • S100B is observed in many returning War Veterans suffering the effects of PTSD, TBI, and Shock Blast Injuries.

  • S100B elevation within the blood may function to predict the progress or the prognosis of many kinds of diseases, such as cerebrovascular diseases, neurodegenerative diseases, motor neuron diseases, traumatic brain injury, schizophrenia, depression, diabetes mellitus, myocardial infarction, cancer, and infectious diseases. 

  • S100B elevation is associated with repeated hypobaric (Long Haul Flights) hypoxic exposure resulting in blood-brain barrier dysfunction.

Elevated Proinflammatory Cytokines

  • Elevated levels of TNFα, IL8, S100B in the brain hippocampus results in atrophy (wasting) and is associated with many brain injuries including traumatic brain injuries, concussion syndrome and other conditions including depression, psychosis, addiction and dementia.

  • Cytokine Dysregulation is the reason many retired athletes are combating depression and other mental health issues.

  • Immune cytokine dysregulation equals 'burn-out'

  • It requires more than 'replacing your coach' or getting another 'mind therapist'

  • It is more than simply 'training harder' or taking another 'tablet'


What are the dangers of repeated Hypoxic (Low Oxygen) Altitude Training?

  • Many elite athlete like many athletes are regular "over-users" of Hypoxic altitude training and many competing internationally requiring long haul flights with minimal rest period before and after competitions.

  • Have you wondered why you suffer chronic "jet lagg" or come down with "flu like symptoms" within 24-hours after long flights?

Hypoxic Altitude Training - Risks Associated

Crit Care 2015 Sep 1;19(1):307. doi: 10.1186/s13054-015-1034-2.

Oxygen - a limiting factor for brain recovery & performance

Hadanny A1,2, Efrati S3,4,5,6.

Author information

1Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, 70300, Israel.

Abstract Summary

  • Effective brain metabolism is highly dependent on a narrow therapeutic window of oxygen. In major insults to the brain (e.g., intracerebral hemorrhage), slight decrease in oxygen supply, as occurs in a hypobaric environment at high altitude, has devastating effects on the injured and performing brain tissue. Conversely, increasing brain oxygenation, by the use of hyperbaric oxygen therapy, can improve brain metabolism and its dependent regenerative & recovery processes.


In Flight Hypoxia (Long Haul Flights) Induces Pro-Inflammatory Cytokines "Over-production"


Dig Dis. 2016;34(1-2):78-83. doi: 10.1159/000442932. Epub 2016 Mar 16.

High Altitude Journeys, Flights and Hypoxia: Any Role for Disease Flares in Irritable Bowel Disease Patients?

Vavricka SR1, Rogler G, Biedermann L.

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1Division of Gastroenterology and Hepatology, Triemli Hospital, Zurich, Switzerland.


The importance of environmental factors in the pathogenesis including their disease-modifying potential are increasingly recognized in inflammatory bowel disease (IBD) patients, largely driven by the perception that the prevalence and incidence of IBD are on the rise within the last few years, especially in non-western countries.

One of those factors is believed to be hypoxia. The role of hypoxia as a modifying or even causative factor in the genesis and maintenance of inflammation has been increasingly elucidated in recent years. Hypoxia is believed to be a main inducing factor of inflammation. This has been studied in different animal experiments as well as in humans exposed to hypoxia.

In several studies - mainly in mice - animals exposed to short-term hypoxia accumulated inflammatory cells in multiple organs and showed elevated cytokines in the blood. Comparable studies were performed in humans, mainly in healthy mountaineers. Recently, we reported on the association between IBD flare-up episodes and antecedent journeys to high-altitude region and aircraft travels.

  • According to these findings, we concluded that flights and stays at high altitudes of >2,000 mg are a risk factor for increased disease activity in IBD. To evaluate the potential influence of hypoxia on the course of IBD on a biomolecular level and to test the effects of hypoxia under standardized conditions, we initiated a prospective and controlled investigation in both healthy controls and IBD patients in stable remission. The study participants underwent a 3-hour exposure to hypoxic conditions simulating an altitude of 4,000 m above sea level in a hyperbaric pressure chamber and clinical parameters as well as blood and stool samples were collected at several time points. The first results of this study are expected in the near future.

  • Lifestyle factors including 'Hypoxic Altitude training & Long Haul International Flights' result in a constant cascade of pro-inflammatory responses

Other Athletes in 'Burn Out'- note the 'over expression' of pro-inflammatory cytokines

Supporting Clinical Resource


Hyperbaric oxygen reduces inflammation, oxygenates injured muscle, and regenerates skeletal muscle via macrophage and satellite cell activation.

Sci Rep 2018 Jan 22;8(1):1288. Epub 2018 Jan 22.

Hyperbaric Medical Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan.

  • January 2018

Hyperbaric oxygen treatment (HBO) promotes rapid recovery from soft tissue injuries.

However, the healing mechanism is unclear. Here we assessed the effects of HBO on contused calf muscles in a rat skeletal muscle injury model. An experimental HBO chamber was developed and rats were treated with 100% oxygen, 2.5 atmospheres absolute for 2 h/day after injury.

  • HBO reduced early lower limb volume and muscle wet weight in contused muscles, and promoted muscle isometric strength 7 days after injury. HBO suppressed the elevation of circulating macrophages in the acute phase and then accelerated macrophage invasion into the contused muscle. This environment also increased the number of proliferating and differentiating satellite cells and the amount of regenerated muscle fibers. In the early phase after injury, HBO stimulated the IL-6/STAT3 pathway in contused muscles.

  • Our results demonstrate that HBO has a dual role in decreasing inflammation and accelerating myogenesis in muscle contusion injuries.

BMC Anesthesiol. 2017 Mar 23;17(1):49. doi: 10.1186/s12871-017-0342-2.

Effects of short-term hyperoxia on erythropoietin levels and microcirculation in critically Ill patients: a prospective observational pilot study.

Donati A1, Damiani E2, Zuccari S2, Domizi R2, Scorcella C2, Girardis M3, Giulietti A4, Vignini A4, Adrario E2, Romano R2, Mazzanti L4, Pelaia P2, Singer M5.

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The normobaric oxygen paradox states that a short exposure to normobaric hyperoxia followed by rapid return to normoxia creates a condition of 'relative hypoxia' which stimulates erythropoietin (EPO) production. Alterations in glutathione and reactive oxygenspecies (ROS) may be involved in this process. We tested the effects of short-term hyperoxia on EPO levels and the microcirculation in critically ill patients.


In this prospective, observational study, 20 hemodynamically stable, mechanically ventilated patients with inspired oxygenconcentration (FiO2) ≤0.5 and PaO2/FiO2 ≥ 200 mmHg underwent a 2-hour exposure to hyperoxia (FiO2 1.0). A further 20 patients acted as controls. Serum EPO was measured at baseline, 24 h and 48 h. Serum glutathione (antioxidant) and ROS levels were assessed at baseline (t0), after 2 h of hyperoxia (t1) and 2 h after returning to their baseline FiO2 (t2). The microvascular response to hyperoxia was assessed using sublingual sidestream dark field videomicroscopy and thenar near-infrared spectroscopy with a vascular occlusion test.


EPO increased within 48 h in patients exposed to hyperoxia from 16.1 [7.4-20.2] to 22.9 [14.1-37.2] IU/L (p = 0.022). Serum ROS transiently increased at t1, and glutathione increased at t2. Early reductions in microvascular density and perfusion were seen during hyperoxia (perfused small vessel density: 85% [95% confidence interval 79-90] of baseline). The response after 2 h of hyperoxia exposure was heterogeneous. Microvascular perfusion/density normalized upon returning to baseline FiO2.


A two-hour exposure to hyperoxia in critically ill patients was associated with a slight increase in EPO levels within 48 h. Adequately controlled studies are needed to confirm the effect of short-term hyperoxia on erythropoiesis.

Eur J Appl Physiol. 2017 May;117(5):901-912. doi: 10.1007/s00421-017-3574-4. Epub 2017 Mar 9.

Determinants of curvature constant (W') of the power duration relationship under normoxia and hypoxia: the effect of pre-exercise alkalosis.

Deb SK1, Gough LA1, Sparks SA1, McNaughton LR2.

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This study investigated the effect of induced alkalosis on the curvature constant (W') of the power-duration relationship under normoxic and hypoxic conditions.


Eleven trained cyclists (mean ± SD) Age: 32 ± 7.2 years; body mass (bm): 77.0 ± 9.2 kg; VO2peak: 59.2 ± 6.8 ml·kg-1·min-1completed seven laboratory visits which involved the determination of individual time to peak alkalosis following sodium bicarbonate (NaHCO3) ingestion, an environment specific ramp test (e.g. normoxia and hypoxia) and four x 3 min critical power (CP) tests under different experimental conditions. Participants completed four trials: alkalosis normoxia (ALN); placebo normoxia (PLN); alkalosis hypoxia (ALH); and placebo hypoxia (PLH). Pre-exercise administration of 0.3 BM of NaHCO3 was used to induce alkalosis. Environmental conditions were set at either normobaric hypoxia (FiO2: 14.5%) or normoxia (FiO2: 20.93%).


An increase in W' was observed with pre-exercise alkalosis under both normoxic (PLN: 15.1 ± 6.2 kJ vs. ALN: 17.4 ± 5.1 kJ; P = 0.006) and hypoxic conditions (ALN: 15.2 ± 4.9 kJ vs. ALN: 17.9 ± 5.2 kJ; P < 0.001). Pre-exercise alkalosis resulted in a larger reduction in bicarbonate ion (HCO3-) concentrations during exercise in both environmental conditions (p < 0.001) and a greater blood lactate accumulation under hypoxia (P = 0.012).


Pre-exercise alkalosis substantially increased W' and, therefore, may determine tolerance to exercise above Critical Power (CP) under normoxic and hypoxic conditions. This may be due to NaHCO3 increasing HCO3- buffering capacity to delay exercise-induced acidosis, which may, therefore, enhance anaerobic energy contribution.

Neurol Sci. 2016 Apr;37(4):533-9. doi: 10.1007/s10072-016-2521-1. Epub 2016 Feb 29.

Re-exposure to the hypobaric hypoxic brain injury of high altitude (long haul flights): plasma S100B levels and the possible effect of acclimatisation on blood-brain barrier dysfunction.

Winter CD1,2, Whyte T3, Cardinal J4,5, Kenny R6, Ballard E7.

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Hypobaric hypoxic brain injury results in elevated peripheral S100B levels which may relate to blood-brain barrier (BBB) dysfunction. A period of acclimatisation or dexamethasone prevents altitude-related illnesses and this may involve attenuation of BBB compromise. We hypothesised that both treatments would diminish the S100B response (a measure of BBB dysfunction) on re-ascent to the hypobaric hypoxia of high altitude, in comparison to an identical ascent completed 48 h earlier by the same group. Twelve healthy volunteers, six of which were prescribed dexamethasone, ascended Mt Fuji (summit 3700 m) and serial plasma S100B levels measured. The S100B values reduced from a baseline 0.183 µg/l (95 % CI 0.083-0.283) to 0.145 µg/l (95 % CI 0.088-0.202) at high altitude for the dexamethasone group (n = 6) and from 0.147 µg/l (95 % CI 0.022-0.272) to 0.133 µg/l (95 % CI 0.085-0.182) for the non-treated group (n = 6) [not statistically significant (p = 0.43 and p = 0.82) for the treated and non-treated groups respectively]. [These results contrasted with the statistically significant increase during the first ascent, S100B increasing from 0.108 µg/l (95 % CI 0.092-0.125) to 0.216 µg/l (95 % CI 0.165-0.267) at high altitude].

In conclusion, an increase in plasma S100B was not observed in the second ascent and this may relate to the effect of acclimatisation (or hypoxic pre-conditioning) on the BBB. An exercise stimulated elevation of plasma S100B levels was also not observed during the second ascent. The small sample size and wide confidence intervals, however, precludes any statistically significant conclusions and a larger study would be required to confirm these findings.

For  More S100B

Front Physiol. 2017 Feb 7;8:24. doi: 10.3389/fphys.2017.00024. eCollection 2017.

Hypoxic Repeat Sprint Training Improves Rugby Player's Repeated Sprint but Not Endurance Performance.

Hamlin MJ1, Olsen PD2, Marshall HC2, Lizamore CA1, Elliot CA1.

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This study aims to investigate the performance changes in 19 well-trained male rugby players after repeat-sprint training (six sessions of four sets of 5 × 5 s sprints with 25 s and 5 min of active recovery between reps and sets, respectively) in either normobaric hypoxia (HYP; n = 9; FIO2 = 14.5%) or normobaric normoxia (NORM; n = 10; FIO2 = 20.9%). Three weeks after the intervention, 2 additional repeat-sprint training sessions in hypoxia (FIO2 = 14.5%) was investigated in both groups to gauge the efficacy of using "top-up" sessions for previously hypoxic-trained subjects and whether a small hypoxic dose would be beneficial for the previously normoxic-trained group.

Repeated sprint (8 × 20 m) and Yo-Yo Intermittent Recovery Level 1 (YYIR1) performances were tested twice at baseline (Pre 1 and Pre 2) and weekly after (Post 1-3) the initial intervention (intervention 1) and again weekly after the second "top-up" intervention (Post 4-5). After each training set, heart rate, oxygen saturation, and rate of perceived exertion were recorded. Compared to baseline (mean of Pre 1 and Pre 2), both the hypoxic and normoxic groups similarly lowered fatigue over the 8 sprints 1 week after the intervention (Post 1: -1.8 ± 1.6%, -1.5 ± 1.4%, mean change ± 90% CI in HYP and NORM groups, respectively). However, from Post 2 onwards, only the hypoxic group maintained the performance improvement compared to baseline (Post 2: -2.1 ± 1.8%, Post 3: -2.3 ± 1.7%, Post 4: -1.9 ± 1.8%, and Post 5: -1.2 ± 1.7%). Compared to the normoxic group, the hypoxic group was likely to have substantially less fatigue at Post 3-5 (-2.0 ± 2.4%, -2.2 ± 2.4%, -1.6 ± 2.4% Post 3, Post 4, Post 5, respectively). YYIR1 performances improved throughout the recovery period in both groups (13-37% compared to baseline) with unclear differences found between groups. The addition of two sessions of "top-up" training after intervention 1, had little effect on either group. Repeat-sprint training in hypoxia for six sessions increases repeat sprint ability but not YYIR1 performance in well-trained rugby players.

Acta Physiol (Oxf). 2017 Jan 19. doi: 10.1111/apha.12851. [Epub ahead of print]

Repeated maximal-intensity hypoxic exercise superimposed to hypoxic residence boosts skeletal muscle transcriptional responses in elite team-sport athletes.

Brocherie F1, Millet GP1, D'Hulst G2, Van Thienen R3, Deldicque L3,2, Girard O1,4.

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To determine whether repeated maximal-intensity hypoxic exercise induces larger beneficial adaptations on the hypoxia-inducible factor-1α pathway and its target genes than similar normoxic exercise, when combined with chronic hypoxic exposure.


Lowland elite male team-sport athletes underwent 14 days of passive normobaric hypoxic exposure [≥14 h·day-1 at inspired oxygen fraction (Fi O2 ) 14.5-14.2%] with the addition of six maximal-intensity exercise sessions either in normobaric hypoxia (Fi O2 ~14.2%; LHTLH; n = 9) or in normoxia (Fi O2 20.9%; LHTL; n = 11). A group living in normoxia with no additional maximal-intensity exercise (LLTL; n = 10) served as control. Before (Pre), immediately after (Post-1) and 3 weeks after (Post-2) the intervention, muscle biopsies were obtained from the vastus lateralis.


Hypoxia-inducible factor-1α subunit, vascular endothelial growth factor, myoglobin, peroxisome proliferator-activated receptor-gamma coactivator 1-α and mitochondrial transcription factor A mRNA levels increased at Post-1 (all P ≤ 0.05) in LHTLH, but not in LHTL or LLTL, and returned near baseline levels at Post-2. The protein expression of citrate synthase increased in LHTLH (P < 0.001 and P < 0.01 at Post-1 and Post-2, respectively) and LLTL (P < 0.01 and P < 0.05 at Post-1 and Post-2, respectively), whereas it decreased in LHTL at Post-1 and Post-2 (both P < 0.001).


Combined with residence in normobaric hypoxia, repeated maximal-intensity hypoxic exercise induces short-term post-intervention beneficial changes in muscle transcriptional factors that are of larger magnitude (or not observed) than with similar normoxic exercise. The decay of molecular adaptations was relatively fast, with most of benefits already absent 3 weeks post-intervention.

Front Physiol. 2017 Mar 23;8:175. doi: 10.3389/fphys.2017.00175. eCollection 2017.

High-Intensity Interval Training in Normobaric Hypoxia Improves Cardiorespiratory Fitness in Overweight Chinese Young Women.

Kong Z1, Shi Q2, Nie J2, Tong TK3, Song L1, Yi L4, Hu Y4.

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Previous studies have investigated the effects of high-intensity interval training (HIIT) on cardiorespiratory fitness and body composition in overweight populations. However, the additive effect of HIIT and hypoxia on health parameters is not clear. This study compared the effects of HIIT under hypoxic conditions on cardiometabolic function with that under normoxia in overweight Chinese young women. Methods: A double-blind randomized controlled experimental design was applied. Twenty-four sedentary overweight Chinese young women (weight: 68.8 ± 7.0 kg, BMI: 25.8 ± 2.3 kg·m-2) participated in the HIIT under either normoxia (NORM, n = 13, PIO2: 150 mmHg, FIO2: 0.21) or normobarichypoxia (HYP, n = 11, PIO2: 117 mmHg, FIO2: 0.15) for 5 weeks. HIIT was composed of 60 repetitions of 8 s maximal cycling effort interspersed with 12-s recovery per day, for 4 days per week. Cardiorespiratory fitness [peak oxygen uptake ([Formula: see text]O2peak), and peak oxygen pulse (peak O2 pulse)], serum lipid profile [triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)], and body composition (regional and whole-body), were assessed at pre- and post-intervention during the days beyond the self-reported menstrual phase of the participants. Habitual physical activity and diary behavior were maintained during the intervention period. Results: With similar daily energy intake and physical activity, the increases in [Formula: see text]O2peak [NORM: 0.26 ± 0.37 L·min-1 (+11.8%) vs. HYP: 0.54 ± 0.34 L·min-1 (+26.1%)] and peak O2 pulse (NORM: +13.4% vs. HYP: +25.9%) for HYP were twice-larger than for NORM (p < 0.05). Although the 5-wk HIIT led to significant improvements in the ratios of TC/HDL-C (p = 0.035) and TG/HDL-C (p = 0.027), no significant group effects were found on the serum variables. Further, no significant changes in body composition or serum fasting leptin were observed in either group. Conclusion: 5-wk of HIIT improved cardiorespiratory fitness and blood lipids in overweight Chinese young females, while the additive effect of the HIIT under normobaric hypoxia solely enhanced cardiorespiratory fitness, but not body composition or serum lipid profile.

Sports Med. 2017 Apr 27. doi: 10.1007/s40279-017-0733-z. [Epub ahead of print]

Effects of Altitude/Hypoxia on Single- and Multiple-Sprint Performance: A Comprehensive Review.

Girard O1,2, Brocherie F3,4, Millet GP4.

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Many sport competitions, typically involving the completion of single- (e.g. track-and-field or track cycling events) and multiple-sprint exercises (e.g. team and racquet sports, cycling races), are staged at terrestrial altitudes ranging from 1000 to 2500 m. Our aim was to comprehensively review the current knowledge on the responses to either acute or chronic altitude exposure relevant to single and multiple sprints. Performance of a single sprint is generally not negatively affected by acute exposure to simulated altitude (i.e. normobaric hypoxia) because an enhanced anaerobic energy release compensates for the reduced aerobic adenosine triphosphate production.

Conversely, the reduction in air density in terrestrial altitude (i.e. hypobaric hypoxia) leads to an improved sprinting performance when aerodynamic drag is a limiting factor. With the repetition of maximal efforts, however, repeated-sprint ability is more altered (i.e. with earlier and larger performance decrements) at high altitudes (>3000-3600 m or inspired fraction of oxygen <14.4-13.3%) compared with either normoxia or low-to-moderate altitudes (<3000 m or inspired fraction of oxygen >14.4%). Traditionally, altitude training camps involve chronic exposure to low-to-moderate terrestrial altitudes (<3000 m or inspired fraction of oxygen >14.4%) for inducing haematological adaptations. However, beneficial effects on sprint performance after such altitude interventions are still debated. Recently, innovative 'live low-train high' methods, in isolation or in combination with hypoxic residence, have emerged with the belief that up-regulated non-haematological peripheral adaptations may further improve performance of multiple sprints compared with similar normoxic interventions.

J Nutr Metab. 2016;2016:5647407. doi: 10.1155/2016/5647407. Epub 2016 Dec 19.

Effects of Exercise Training under Hyperbaric Oxygen on Oxidative Stress Markers and Endurance Performance in Young Soccer Players: A Pilot Study.

Burgos C1, Henríquez-Olguín C1, Andrade DC1, Ramírez-Campillo R2, Araneda OF3, White A4, Cerda-Kohler H5.

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The aim of the present study was to determine the effects of three weeks of hyperbaric oxygen (HBO2) training on oxidative stress markers and endurance performance in young soccer players.

Participants (18.6 ± 1.6 years) were randomized into hyperbaric-hyperoxic (HH) training (n = 6) and normobaric normoxic (NN) training (n = 6) groups. Immediately before and after the 5th, 10th, and 15th training sessions, plasma oxidative stress markers (lipid hydroperoxides and uric acid), plasma antioxidant capacity (6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid [TROLOX]), arterial blood gases, acid-base balance, bases excess (BE), and blood lactate analyses were performed. Before and after intervention, maximal oxygen uptake (VO2max) and peak power output (PPO) were determined. Neither HH nor NN experienced significant changes on oxidative stress markers or antioxidant capacity during intervention. VO2max and PPO were improved (moderate effect size) after HH training. The results suggest that HBO2 endurance training does not increase oxidative stress markers and improves endurance performance in young soccer players. Our findings warrant future investigation to corroborate that HBO2 endurance training could be a potential training approach for highly competitive young soccer players.

Extrem Physiol Med. 2016 Feb 29;5:5. doi: 10.1186/s13728-016-0046-0. eCollection 2016.

'Blood doping' from Armstrong to prehabilitation: manipulation of blood to improve performance in athletes and physiological reserve in patients.

Plumb JO1, Otto JM2, Grocott MP1.

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Haemoglobin is the blood's oxygen carrying pigment and is encapsulated in red blood corpuscles. The concentration of haemoglobin in blood is dependent on both its total mass in the circulation (tHb-mass) and the total plasma volume in which it is suspended. Aerobic capacity is defined as the maximum amount of oxygen that can be consumed by the body per unit time and is one measure of physical fitness. Observations in athletes who have undergone blood doping or manipulation have revealed a closer relationship between physical fitness (aerobic capacity) and total haemoglobin mass (tHb-mass) than with haemoglobin concentration ([Hb]). Anaemia is defined by the World Health Organisation (WHO) as a haemoglobin concentration of <130 g/L for men and <120 g/L for women. Perioperative anaemia is a common problem and is associated with increased mortality and morbidity following surgery. Aerobic capacity is also associated with outcome following major surgery, with less fit patients having a higher incidence of mortality and morbidity after surgery. Taken together, these observations suggest that targeted preoperative elevation of tHb-mass may raise aerobic capacity both directly and indirectly (by augmenting preoperative exercise initiatives - 'prehabilitation') and thus improve postoperative outcome. This notion in turn raises a number of questions. Which measure ([Hb] or tHb-mass) has the most value for the description of oxygen carrying capacity? Which measure has the most utility for targeting therapies to manipulate haemoglobin levels? Do the newer agents being used for blood manipulation (to increase tHb-mass) in elite sport have utility in the clinical environment? This review explores the literature relating to blood manipulation in elite sport as well as the relationship between perioperative anaemia, physical fitness and outcome following surgery, and suggests some avenues for exploring this area further.

Can J Physiol Pharmacol. 2016 Jul;94(7):695-8. doi: 10.1139/cjpp-2015-0425. Epub 2016 Mar 5.

Abdominal fat reducing outcome of exercise training: fat burning or hydrocarbon source redistribution?

Kuo CH1,2, Harris MB3.

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Fat burning, defined by fatty acid oxidation into carbon dioxide, is the most described hypothesis to explain the actual abdominal fat reducing outcome of exercise training. This hypothesis is strengthened by evidence of increased whole-body lipolysis during exercise. As a result, aerobic training is widely recommended for obesity management. This intuition raises several paradoxes: first, both aerobic and resistance exercise training do not actually elevate 24 h fat oxidation, according to data from chamber-based indirect calorimetry. Second, anaerobic high-intensity intermittent training produces greater abdominal fat reduction than continuous aerobic training at similar amounts of energy expenditure. Third, significant body fat reduction in athletes occurs when oxygen supply decreases to inhibit fat burning during altitude-induced hypoxia exposure at the same training volume. Lack of oxygen increases post-meal blood distribution to human skeletal muscle, suggesting that shifting the postprandial hydrocarbons towards skeletal muscle away from adipose tissue might be more important than fat burning in decreasing abdominal fat. Creating a negative energy balance in fat cells due to competition of skeletal muscle for circulating hydrocarbon sources may be a better model to explain the abdominal fat reducing outcome of exercise than the fat-burning model.

Eur J Sport Sci. 2016 Nov;16(8):1047-54. doi: 10.1080/17461391.2015.1123776. Epub 2015 Dec 22.

Effect of repeat-sprint training in hypoxia on post-exercise interleukin-6 and F2-isoprostanes.

Goods PS1, Dawson B1, Landers GJ1, Gore CJ2,3, Croft K4, Peeling P1.

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This investigation examined the oxidative stress (F2-Isoprostane; F2-IsoP) and inflammatory (interleukin-6; IL-6) responses to repeat-sprint training in hypoxia (RSH). Ten trained male team sport athletes performed 3(sets)*9(repetitions)*5 s cycling sprints in simulated altitude (3000 m) and sea-level conditions. Mean and peak sprint power output (MPO and PPO) were recorded, and blood samples were collected pre-exercise, and again at 8 and 60 min post-exercise. Both MPO and PPO were significantly reduced in hypoxia (compared to sea-level) in the second (MPO: 855 ± 89 vs. 739 ± 95 W, p = .006; PPO: 1024 ± 114 vs. 895 ± 112 W, p = .010) and third (MPO: 819 ± 105 vs. 686 ± 83 W, p = .008; PPO: 985 ± 125 vs. 834 ± 99 W, p = .008) sets, respectively. IL-6 was significantly increased from pre- to 1 h post-exercise in both hypoxia (0.7 ± 0.2 vs. 2.4 ± 1.4 pg/mL, p = .004) and sea-level conditions (0.7 ± 0.2 vs. 1.6 ± 0.3 pg/mL, p < .001), with a large effect (d = 0.80) suggesting higher IL-6 levels of post-hypoxia. F2-IsoP was significantly lower 1 h post-exercise in both the hypoxic (p = .005) and sea-level (p = .002) conditions, with no differences between trials. While hypoxia can impact on exercise intensity and may result in greater post-exercise inflammation, it appears to have little effect on oxidative stress. These results indicate that team sport organisations with ready access to hypoxic training facilities could confidently administer RSH without significantly increasing the post-exercise inflammatory or oxidative stress response.

  • Unfortunately this article does not map the long term effects of Hypoxic Training and the Cytokine dysregulation.

J Pharm Biomed Anal. 2016 Mar 20;121:181-7. doi: 10.1016/j.jpba.2016.01.029. Epub 2016 Jan 15.

Detection by LC-MS/MS of HIF stabilizer FG-4592 used as a new doping agent: Investigation on a positive case.

Buisson C1, Marchand A2, Bailloux I3, Lahaussois A3, Martin L3, Molina A3.

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Stabilizing the labile factor HIF (hypoxia inducible factor) for therapeutic use has led to the development of various molecules by pharmaceutical companies. These HIF stabilizers show promising erythropoiesis stimulating capacities and are of great interest for patients with chronical kidney disease and anemia. Amongst them FG-4592 from FibroGen is now under phase 3 of clinical studies. While this drug is still under investigation, a parallel market already allows to buy this product, which could be tempting for some athletes willing to increase their performances. To avoid such a use for doping purpose, WADA has listed HIF stabilizers and FG-4592 in particular as prohibited substances since 2011 and some anti-doping laboratories have developed a technique of identification of FG-4592 in urine. Here, we described the first case ever identified by an anti-doping laboratory of an athlete using FG-4592. Detection and confirmation in urinary samples was performed by LC-MS/MS. In addition, potential indirect markers erythropoietin (EPO) and hematological parameters followed in the Athlete Biological Passport (ABP) were analyzed during and after the period of use but showed no profound alterations. Only ABPS (abnormal blood profile score) reached (but did not exceed) the upper limit proposed by the ABP adaptive model just after the period of use of FG-4592. Altogether this case sends a warning for anti-doping laboratories which now must strengthen surveillance on HIF stabilizers and develop sensitive methods of detection for this new class of drugs.

Diving Hyperb Med. 2012 Jun;42(2):67-71.

The 'normobaric oxygen paradox': does it increase haemoglobin?

De Bels D1, Theunissen SDevriendt JGermonpré PLafere PValsamis JSnoeck TMeeus PBalestra C.

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A novel approach to increasing erythropoietin (EPO) using oxygen (O2) (the 'normobaric oxygen paradox') has been reported in healthy volunteers. We investigated whether the EPO increase is sufficient to induce erythropoiesis by comparing two protocols of O2 administration.


We compared the effect of daily versus alternate days 100% O2, breathed for 30 minutes, on haemoglobin concentrations during a 12-day period. Nine subjects underwent the two protocols six weeks apart.


We observed a significant increase in haemoglobin (as a percentage of baseline) in the alternate-days group compared to the daily group and to baseline after four days (105.5 ∓ 5.7 % vs. 99.6 ∓ 3.3 % difference from baseline; P < 0.01). At the end of the experimental period, haemoglobin values increased significantly compared to baseline in both groups. There was a significant percentage rise in reticulocyte count  (new red blood cells) in the alternate-days group compared to the daily group (182 ∓ 94 % vs. 93 ∓ 34 %; P < 0.001).


The normobaric oxygen paradox seems effective in increasing haemoglobin in non-anaemic, healthy volunteers, providing sufficient time is allowed between O2 applications. The exact time interval is not clearly defined by this study but should probably be at least or greater than two days. Further studies are needed to define more precisely clinical applications in the use of O2 as a pharmaceutical agent.

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