Meta-analysis of the effect of hyperbaric oxygen therapy on exercise-induced fatigue in athletes after exercise

Objective This study aimed to review the literature on exercise-induced fatigue recovery in athletes and to assess the impact of hyperbaric oxygen therapy (HBOT) on post-exercise recovery of blood-related and physical fatigue indicators through a systematic review and meta-analysis, aiming to inform the practical application of HBOT in athletic training. Methods We searched CNKI, PubMed, Web of Science, Cochrane Library, and EBSCO-SPORTD for randomized controlled trials (RCTs) on HBOT for athletes' post-exercise fatigue recovery up to September 30, 2025. Two reviewers independently evaluated the studies' quality using Cochrane Collaboration risk of bias tools. We conducted heterogeneity tests, pooled data, performed subgroup analyses, and created forest plots using RevMan 5.4. Funnel plots were generated to assess publication bias and sensitivity. Results Fifteen RCTs with 311 subjects were included, indicating high overall study quality. HBOT significantly affected heart rate (SMD = -4.3, 95% CI = -5.91 to -2.69, P < 0.05), blood urea (SMD = -0.51, 95% CI = -0.73 to -0.3, P < 0.05), cortisol (SMD = 0.77, 95% CI = 0.16 to 1.37, P = 0.01), and blood lactate (SMD = -1.19, 95% CI = -1.54 to -0.83, P < 0.05). No significant effects were observed for creatine kinase, testosterone, or subjective fatigue perception (P > 0.05). Subgroup analysis showed that intervention pressure, frequency, sample size, and duration did not significantly influence creatine kinase recovery post-exercise. Conclusion HBOT post-exercise may enhance recovery from muscle contusions, ligament injuries, and fatigue, reduce subjective fatigue, and improve performance. Further research is needed on its effects on creatine kinase, testosterone, cortisol, and oxidative-antioxidative system function. Given the limited number of studies, future high-quality RCTs across various sports and genders are necessary to validate these findings.