Can molecular hydrogen supplementation enhance physical performance in healthy adults? A systematic review and meta-analysis

Background

Physical exertion during exercise often leads to increased oxidative stress and inflammatory responses, significantly affecting physical performance. Current strategies to mitigate these effects are limited by their effectiveness and potential side effects. Molecular hydrogen (H₂) has gained attention for its antioxidant and anti-inflammatory properties. Studies have suggested that H2 supplementation contributes to antioxidant potential and anti-fatigue during exercise, but the variance in the observations and study protocols is presented across those studies.

Objective

This systematic review and meta-analysis aimed to comprehensively characterize the effects of H₂ supplementation on physical performance (i.e., endurance, muscular strength, and explosive power), providing knowledge that can inform strategies using H2 for enhancing physical performance.

Methods

We conducted a literature search of six databases (PubMed, Web of Science, Medline, Sport-Discus, Embase, and PsycINFO) according to the PRISMA guidelines. The data were extracted from the included studies and converted into the standardized mean difference (SMD). After that, we performed random-effects meta-analyses and used the I 2 statistic to evaluate heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of the evidence obtained from this meta-analysis.

Results

In total, 27 publications consisting of 597 participants were included. The search finally included aerobic endurance, anaerobic endurance, muscular strength, lower limb explosive power, rating of perceived exertion (RPE), blood lactate (BLA), and average heart rate (HRavg) in the effect size (ES) synthesis. The ES of H2 on aerobic endurance, including V̇O2max (SMD = 0.09, p = 0.394; I 2 = 0%) and aerobic endurance exercise (SMD = 0.04, p = 0.687; I 2 = 0%), were not significant and trivial; the ES of H2 on 30 s maximal anaerobic endurance (SMD = 0.19, p = 0.239; I 2 = 0%) was not significant and trivial; the ES of H2 on muscular strength (SMD = 0.19, p = 0.265; I 2 = 0%) was not significant and trivial; but the ES of H2 on lower limb explosive power (SMD = 0.30, p = 0.018; I 2 = 0%) was significant and small. In addition, H2 reduces RPE (SMD = -0.37, p = 0.009; I 2 = 58.0%) and BLA (SMD = -0.37, p = 0.001; I 2 = 22.0%) during exercise, but not HRavg (SMD = -0.27, p = 0.094; I 2 = 0%).

Conclusion

These findings suggest that H2 supplementation is favorable in healthy adults to improve lower limb explosive power, alleviate fatigue, and boost BLA clearance, but may not be effectively improving aerobic and anaerobic endurance and muscular strength. Future studies with more rigorous designs are thus needed to examine and confirm the effects of H2 on these important functionalities in humans.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO.

Acute effect of hydrogen-rich water on physical, perceptual and cardiac responses during aerobic and anaerobic exercises: a randomized, placebo-controlled, double-blinded cross-over trial

Molecular hydrogen (H2 gas) dissolved in water to produce Hydrogen-Rich Water. Hydrogen-Rich Water (HRW) is considered as ergogenic aid in different exercise modes. However, acute pre-exercise HRW ingestion effect is unclear regarding athlete performance. This study aimed at investigating acute effect of HRW ingestion on aerobic and anaerobic exercise performance. Twenty-two male amateur middle-distance runners volunteered to participate in this study. In a randomized, double-blind study design, all players ingested 500 mL of HRW or placebo (PLA) supplement 30 min before the start of the tests. Over 4 days, maximal aerobic speed of Vameval test (MAS), time to exhaustion at MAS (Tlim), squat jump (SJ), counter-movement jump (CMJ) and five jump test (5JT) were evaluated. Also, rate of perceived exertion (RPE) and peak heart rate (HRpeak) were measured during the aerobic tests. For Vameval test, HRW ingestion improved MAS, HRpeak and RPE compared with the placebo condition. For Tlim test, HRW ingestion demonstrated improvements in time to exhaustion, RPE and HRpeak. However, no significant change was observed between HW and placebo conditions in SJ, CMJ, 5JT. 500 mL of HRW can significantly improve HRpeak, time to exhaustion, RPE, with no significant effect on MAS, jumping performance in amateur endurance athletes.

Effects of molecular hydrogen supplementation on fatigue and aerobic capacity in healthy adults: A systematic review and meta-analysis

Background

Fatigue is oftentimes induced by high-intensity exercise potentially via the exceeded amount of reactive oxygen species, leading to diminished functions (e.g., aerobic capacity) and increased risk of injuries. Studies indicate that molecular hydrogen (H₂), with antioxidant and anti-inflammatory properties, may be a promising strategy to alleviate fatigue and improve aerobic capacity. However, such effects have not been comprehensively characterized.

Objective

To systematically assess the effects of in taking H₂ on fatigue and aerobic capacity in healthy adults.

Methods

The search was conducted in August 2022 in five databases. Studies with randomized controlled or crossover designs that investigated the rating of perceived exertion (RPE), maximal oxygen uptake (VO_2max), peak oxygen uptake (VO_2peak), and endurance performance were selected. The data (mean ± standard deviation and sample size) were extracted from the included studies and were converted into the standardized mean difference (SMD). Random-effects meta-analyses were performed. Subgroup analysis was used to analyze potential sources of heterogeneity due to intervention period, training status, and type of exercise.

Results

Seventeen publications (19 studies) consisting of 402 participants were included. The pooled effect sizes of H₂ on RPE (SMD_pooled = -0.38, 95%CI -0.65 to -0.11, p = 0.006, I ² = 33.6%, p = 0.149) and blood lactate (SMD_pooled = -0.42, 95% CI -0.72 to -0.12, p = 0.006, I ² = 35.6%, p = 0.114) were small yet significant with low heterogeneity. The pooled effect sizes of H₂ on VO_2max and VO_2peak (SMD_pooled = 0.09, 95% CI -0.10 to 0.29, p = 0.333, I ² = 0%, p = 0.998) and endurance performance (SMD_pooled = 0.01, 95% CI -0.23 to 0.25, p = 0.946, I ² = 0%, p > 0.999) were not significant and trivial without heterogeneity. Subgroup analysis revealed that the effects of H₂ on fatigue were impacted significantly by the training status (i.e., untrained and trained), period of H₂ implementation, and exercise types (i.e., continuous and intermittent exercises).

Conclusions

This meta-analysis provides moderate evidence that H₂ supplementation alleviates fatigue but does not enhance aerobic capacity in healthy adults.

Systematic review registration

www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022351559.

Acute pre-exercise hydrogen rich water intake does not improve running performance at maximal aerobic speed in trained track and field runners: A randomized, double-blind, placebo-controlled crossover study

PURPOSE

This study investigated the effects of acute, pre-exercise, hydrogen rich water (HRW) ingestion on running time to exhaustion at maximal aerobic speed in trained track and field runners.

METHODS

Twenty-four, male runners aged 17.5 ± 1.8 years, with body mass index = 21.0 ± 1.3 kg⋅m-2, and maximal oxygen uptake = 55.0 ± 4.6 ml⋅kg-1⋅min-1 (mean ± standard deviation) participated in this randomized, double-blind, placebo-controlled crossover study. All runners ingested 1260 ml of HRW which was divided into four doses and taken at 120 min (420 ml), 60 min (420 ml), 30 min (210 ml), and 10 min (210 ml) prior to exercise. The running protocol consisted of three phases: warm-up performed at 10 km⋅h-1 for 3 min, followed by a transition phase performed at an individually determined speed (10 km⋅h-1 + maximal aerobic speed)/2 for 1 min, and finally the third phase performed at individual maximal aerobic speed until exhaustion. Time to exhaustion, cardiorespiratory variables, and post-exercise blood lactate concentration were measured.

RESULTS

When running to exhaustion at maximal aerobic speed, compared with placebo, HRW had no significant effects on the following variables: time to exhaustion (217 ± 49 and 227 ± 53 s, p = 0.20), post-exercise blood lactate concentration (9.9 ± 2.2 and 10.1 ± 2.0 mmol⋅L-1, p = 0.42), maximal heart rate (186 ± 9 and 186 ± 9 beats⋅min-1, p = 0.80), and oxygen uptake (53.1 ± 4.5 and 52.2 ± 4.7 ml⋅kg-1⋅min-1, p = 0.33). No variable assessed as a candidate moderator was significantly correlated with time to exhaustion (Spearman's correlation coefficients ranged from -0.28 to 0.30, all p ≥ 0.16).

CONCLUSIONS

Pre-exercise administration of 1260 ml of HRW showed no ergogenic effect on running performance to exhaustion at maximal aerobic speed in trained track and field runners.

Short-Term Consumption of Hydrogen-Rich Water Enhances Power Performance and Heart Rate Recovery in Dragon Boat Athletes: Evidence from a Pilot Study

(1) Background: Exercise that exceeds the body’s accustomed load can lead to oxidative stress and increased fatigue during intense training or competition, resulting in decreased athletic performance and an increased risk of injury, and the new medicinal H₂ may be beneficial as an antioxidant. Therefore, we explored the effect of short-term supplementation of hydrogen-rich water (HRW) on the work performance and fatigue recovery of dragon boat athletes after training. (2) Methods: Eighteen dragon boat athletes who trained for 4 h a day (2 h in the morning and 2 h in the afternoon) were divided into an HRW group (n = 9) and a placebo water (PW) group (n = 9), drinking HRW or PW for 7 days. Each participant completed 30 s rowing dynamometer tests, monitoring the heart rate at baseline (i.e., Day 1) and after the intervention (on Day 8). (3) Result: Drinking HRW increased the maximum power and average power of the 30 s rowing test and decreased the maximum heart rate during the period. After the rowing test, the HRW group’s heart rate dropped significantly after 2 min of recovery, while the PW group’s heart rate did not drop. There was no significant difference between the 30 s rowing distance and the predicted duration of rowing 500 m. (4) Conclusions: Drinking HRW in the short term can effectively improve the power performance of dragon boat athletes and is conducive to the recovery of the heart rate after exercise, indicating that HRW may be a suitable means of hydration for athletes.

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.

Hydrogen Rich Water Consumption Positively Affects Muscle Performance, Lactate Response, and Alleviates Delayed Onset of Muscle Soreness After Resistance Training

ABSTRACT

Botek, M, Krejčí, J, McKune, A, Valenta, M, and Sládečková, B. Hydrogen rich water consumption positively affects muscle performance, lactate response, and alleviates delayed onset of muscle soreness after resistance training. J Strength Cond Res XX(X): 000-000, 2021-Positive outcomes of hydrogen rich water (HRW) supplementation on endurance performance have been shown, but the effects of HRW in resistance training are unclear. The aim of this study was to assess the effects of 1,260 ml of HRW intake on physiological, perceptual, and performance responses to a resistance training and after 24 hours of recovery. This randomized, double-blinded placebo-controlled cross-over study included 12 men aged 23.8 ± 1.9 years. Subjects performed a half squat, knee flexion, and extension exercises with the load set at 70% of 1 repetition maximum for 3 sets (10 reps/set). Lunges were performed with a load of 30% of body mass for 3 sets (20 reps/set). Time of each set, lactate, and ratings of perceived exertion were assessed mid-way through exercise and immediately after the exercise. Creatine kinase, muscle soreness visual analog scale ratings, countermovement jump, and heart rate variability were evaluated before the training and at 30 minutes, 6, and 24 hours of recovery. Lunges were performed faster with HRW compared with placebo (p < 0.001). Hydrogen rich water reduced lactate at mid-way and immediately after the exercise (HRW: 5.3 ± 2.1 and 5.1 ± 2.2, placebo: 6.5 ± 1.8 and 6.3 ± 2.2 mmol·L-1, p ≤ 0.008). Visual analog scale ratings were significantly lower with HRW (26 ± 11 vs. 41 ± 20 mm, p = 0.002) after 24 hours of recovery. In conclusion, an acute intermittent HRW hydration improved muscle function, reduced the lactate response, and alleviated delayed onset of muscle soreness.

Molecular hydrogen downregulates acute exhaustive exercise-induced skeletal muscle damage

Physical exercise-induced skeletal muscle damage may be characterized by increased oxidative stress, inflammation, and apoptosis which may be beneficial when exercise is regular, but it is rather harmful when exercise is exhaustive and performed acutely by unaccustomed individuals. Molecular hydrogen (H₂) has emerged as a potent antioxidant, anti-inflammatory, and anti-apoptotic agent, but its action on the deleterious effects of acute exhaustive exercise in muscle damage remain unknown. Therefore, we tested the hypothesis that H₂ decreases acute exhaustive exercise-induced skeletal muscle damage of sedentary rats. Rats ran to exhaustion on a sealed treadmill inhaling an H₂-containing mixture or the control gas. We measured oxidative stress (SOD, GSH, and TBARS), inflammatory (TNF-α, IL-1β, IL-6, IL-10, and NF-κB phosphorylation), and apoptotic (expression of caspase-3, Bcl-2, and HSP70) markers. Exercise caused no changes in SOD activity but increased TBARS levels. H₂ caused increases in exercise-induced SOD activity and blunted exercise-induced increased TBARS levels. We observed exercise-induced TNF-α and IL-6 surges as well as NF-κB phosphorylation, which were blunted by H₂. Exercise increased cleaved caspase-3 expression, and H₂ reduced this response. In conclusion, H₂ effectively downregulates muscle damage, reducing oxidative stress, inflammation, and apoptosis after acute exhaustive exercise performed by an unaccustomed organism.

Application of Molecular Hydrogen as a Novel Antioxidant in Sports Science

Molecular hydrogen (H₂) is a colorless, tasteless, odorless, and minimal molecule with high flammability. Although H₂ has been thought to be an inert gas in living bodies for many years, an animal study reported that inhalation of H₂ gas decreased oxidative stress and suppressed brain injury caused by ischemia and reperfusion injury due to its antioxidant action. Since then, the antioxidant action of H₂ has attracted considerable attention and many studies have reported on its benefits. Most studies have reported the effects of H₂ on diseases such as cancer, diabetes, cerebral infarction, and Alzheimer's disease. However, little is known regarding its effects on healthy subjects and exercise. Thus far, including our study, only 6 studies have explored the effect of H₂ on exercise. H₂ is the smallest molecule and therefore can easily penetrate the cellular membrane and rapidly diffuse into organelles. H₂ is thought to be able to selectively reduce hydroxyl radicals and peroxynitrite and does not affect physiologically reactive species. H₂ can be supplied to the body through multiple routes of administration, such as oral intake of H₂ water and H₂ bathing. Therefore, H₂ may be a potential alternative strategy for conventional exogenous antioxidant interventions in sports science. The purpose of this review is to provide evidence regarding the effects of H₂ intake on changes in physiological and biochemical parameters, centering on exercise-induced oxidative stress, for each intake method. Furthermore, this review highlights possible future directions in this area of research.