Medical Gases as an Emerging Topic in Sports Medicine

Hydrogen Gas as an Exotic Performance-Enhancing Agent: Challenges and Opportunities

BACKGROUND

Hydrogen gas (H₂) has entered the world of experimental therapeutics approximately four and a half decades ago. Over the years, this simple molecule appears to drive more scientific attention, perhaps due to a dualism of H₂ affirmative features demonstrated in numerous in vitro, animal and human studies on one side, and still puzzling mechanism(s) of its biological activity on the other. Up to this point, H₂ was scrutinized for more than 170 different disease models and pathologies, and many research groups across the world have lately started to dynamically investigate its conceivable performance-enhancing potential.

METHODS

We outlined here the studies indexed in leading research databases (PubMed, Web of Science, SCOPUS, JSTORE) that explored the effects of hydrogen on exercise performance, and also addressed important restraints, open questions, and windows of opportunities for forthcoming research and possible H₂ enactment in exercise physiology. About two dozen trials have been identified in this domain, with most of the trials published during the past 5 years, while drinking hydrogen-rich water recognized as the most convenient method to deliver H₂ in both animal and human studies.

RESULTS

Either administered as an inhalational gas, enteral hydrogen-rich water, or intravenous hydrogen-rich saline, H₂ seems to favorably affect various exercise performance outcomes and biomarkers of exercise-associated fatigue, inflammation, and oxidative stress. Not all studies have shown corroborative effects, and it appears that the gold-standard protocol for applying H₂ in the field of exercise science does not exist at the moment, with studies markedly differ in the dose of H₂ administered, the duration of treatment, and the source of hydrogen.

CONCLUSION

H₂ is a newfangled and rather effective performance-enhancing agent, yet its promising ergogenic potency has to be further validated and characterized in more well-controlled, appropriately sampled and longterm mechanistic trials. Also, appropriate regulation of hydrogen utilization in sport as an exotic medical gas may require distinctive legislative actions of relevant regulatory agencies in the future.

Short-term H2 inhalation improves running performance and torso strength in healthy adults

In this randomized, double-blind, placebo-controlled, crossover pilot trial, we evaluated the effects of 7-day H2 inhalation on exercise performance outcomes and serum hormonal and inflammation profiles in a cohort of young men and women. All participants (age 22.9 ± 1.5 years; body mass index 23.4 ± 2.5 kg m-2; 10 women and 10 men) were allocated to receive either gaseous hydrogen (4%) or placebo (room air) by 20-min once-per-day inhalation for 7 days, with a wash-out period of 7 days to prevent the residual effects of interventions across study periods. The primary treatment outcome was the change in running time-to-exhaustion in the incremental maximal test from baseline to day 7. Additionally, assessment of other exercise performance endpoints and clinical chemistry biomarkers was performed at baseline and at 7 days after each intervention. The trial was registered at ClinicalTrials.gov (ID NCT03846141). Breathing 4% hydrogen for 20 min per day resulted in increased peak running velocity (by up to 4.2%) as compared to air inhalation (P = 0.05). Hydrogen inhalation resulted in a notable drop in serum insulin-like growth factor 1 (IGF-1) by 48.2 ng/mL at follow-up (95% confidence interval [CI]: from -186.7 to 89.3) (P < 0.05), while IGF-1 levels were elevated by 59.3 ng/mL after placebo intervention (95% CI; from -110.7 to 229.5) (P < 0.05). Inhalational hydrogen appears to show ergogenic properties in healthy men and women. Gaseous H2 should be further evaluated for its efficacy and safety in an athletic environment.