What HBOT actually treats.
The 14 UHMS-approved medical indications, the strong wellness-side signals (post-concussion, long COVID, stroke recovery, fibromyalgia, cognitive aging), and the conditions where HBOT is hyped but the evidence is thin. Honest, cited, no marketing spin.
How we grade the evidence
Strong = multiple RCTs and meta-analyses. Moderate = consistent RCTs. Emerging = positive smaller-scale trials. Weak / Hyped = marketed but evidence is thin or absent.
01
StrongPost-concussion syndrome & TBI
One of HBOT's most clinically meaningful applications — cognitive and quality-of-life gains in patients years post-injury.
Mild traumatic brain injury (mTBI) and persistent post-concussion symptoms have the most consistent positive HBOT signal outside the UHMS-approved indications. The Boussi-Gross 2013 PLOS ONE RCT randomised 56 patients with mTBI symptoms persisting more than four years post-injury to HBOT or a crossover control; the HBOT group showed significant cognitive and quality-of-life improvements, with SPECT imaging confirming reactivation of previously hypo-active brain regions.
Subsequent work from the Shamir Medical Center has treated thousands of post-concussion patients under research protocols and generated one of the largest clinical datasets in the field. The Hadanny / Efrati group's consistent finding: a 40-60 session protocol at 1.5–2.0 ATA produces meaningful, measurable improvement in chronic post-concussion symptoms.
Mechanism: angiogenesis in chronically hypoperfused regions surrounding the injury, plus stem cell mobilisation (Thom et al. 8× baseline at 20 sessions). The injury isn't reversed, but previously offline tissue comes back online.
Key studies
- • Boussi-Gross et al., PLOS ONE 8(11): e79995, 2013
- • Hadanny & Efrati, Brain Injury 30(13-14): 1693-1702, 2016
- • Harch et al., Med Gas Res 7(3): 156-174, 2017
02
StrongLong COVID & post-viral fatigue
The strongest sham-controlled trial blinding in HBOT history showed meaningful cognitive, energy and pain gains in long-COVID patients.
Zilberman-Itskovich et al. (2022, Scientific Reports 12: 11252) randomised 73 patients with long-COVID symptoms more than three months post-infection to either 40 sessions of HBOT or sham pressurisation. The HBOT group showed significant improvements in cognitive function, energy, sleep, psychiatric symptoms, and pain. The sham used a low-pressure increase with room air, the strongest blinding HBOT research has achieved.
The mechanism aligns with the broader HBOT story: improved cerebral perfusion, reduced neuro-inflammation, and angiogenesis. Long COVID appears to involve sustained micro-vascular and inflammatory changes that HBOT directly targets.
Clinical reality: long-COVID is heterogeneous — some patients have predominantly cognitive symptoms (brain fog, post-exertional malaise), others fatigue-dominant, others cardiac. The HBOT signal is strongest in cognitive and fatigue-dominant presentations. R1SE's post-COVID protocol is modelled on the Zilberman-Itskovich 40-session structure.
Key studies
- • Zilberman-Itskovich et al., Sci Rep 12: 11252, 2022 (RCT)
- • Robbins et al., Practical Neurology 21(2): 132-134, 2021
- • Cunha et al., Cureus 15(3): e35780, 2023
03
StrongStroke recovery (chronic phase)
HBOT has produced functional recovery in stroke patients years after the acute event, when conventional rehabilitation has plateaued.
Efrati et al. (2013, PLOS ONE 8(1): e53716) randomised 74 post-stroke patients (6 months to 3 years post-event) to immediate HBOT or a crossover control. The HBOT group showed significant improvements in neurological function and quality of life. SPECT scans showed reactivation of the “ischaemic penumbra” — tissue surrounding the stroke lesion that conventional medicine considers permanently damaged.
This is one of the most clinically meaningful HBOT findings: improvement in chronic, otherwise-stable stroke patients well after the acute window. HBOT doesn't regrow dead tissue, but it appears to revive under-perfused tissue that was offline.
R1SE's position: post-stroke HBOT is a complement to standard rehabilitation, not a replacement. We work with stroke patients whose acute care is complete and who are looking for additional gains. A 40–60 session protocol at 2.0 ATA is the standard modelled on the Efrati trial.
Key studies
- • Efrati et al., PLOS ONE 8(1): e53716, 2013
- • Mukherjee et al., Restor Neurol Neurosci 32(4): 553-563, 2014
- • Hadanny et al., PLOS ONE 15(2): e0228599, 2020
04
StrongDiabetic foot ulcers & wound healing
One of HBOT's 14 UHMS-approved medical indications. Cochrane-level evidence backs accelerated healing in non-healing diabetic wounds.
Kranke et al. (2015, Cochrane Database) reviewed the LLLT and HBOT wound-healing literature and concluded that HBOT significantly improves diabetic foot ulcer healing rates. The mechanism is direct: oxygen drives fibroblast proliferation, collagen synthesis, and angiogenesis — the three pillars of wound healing — in tissue that is functionally hypoxic.
R1SE doesn't replace hospital wound care; we don't treat active diabetic ulcers in our wellness setting because medical-grade clinical supervision is appropriate. But the underlying mechanism — oxygen delivery to hypoxic tissue, fibroblast and collagen response, angiogenesis — is what underwrites HBOT's broader recovery and skin literature.
If you have a non-healing wound, see your GP or wound clinic for proper assessment and medical-grade HBOT referral if appropriate.
Key studies
- • Kranke et al., Cochrane Database Syst Rev (6): CD004123, 2015
- • Liu et al., Mayo Clin Proc 88(2): 166-175, 2013
- • UHMS Indications Committee, Hyperbaric Oxygen Therapy Indications, 14th Edition
05
ModerateFibromyalgia
Two trials from the Efrati group show meaningful symptom and quality-of-life improvements in fibromyalgia patients.
Efrati et al. (2015, PLOS ONE 10(5): e0127012) randomised 60 women with fibromyalgia to HBOT or a crossover control. After 40 sessions over 8 weeks at 2.0 ATA, the HBOT group showed significant improvements in pain, tenderness, and quality of life, with SPECT showing increased brain activity in regions associated with pain modulation.
Subsequent work has explored the mechanism: HBOT appears to influence the central sensitisation thought to underlie fibromyalgia, possibly through neuroplasticity in pain-processing brain regions. This is novel for a condition where pharmaceuticals have offered limited durable relief.
R1SE position: HBOT is a credible complement to fibromyalgia care but not a cure. We've seen members with fibromyalgia respond well to extended protocols (40-60 sessions). Start with a discovery conversation with our team.
Key studies
- • Efrati et al., PLOS ONE 10(5): e0127012, 2015
- • Hadanny & Efrati, Front Med (Lausanne) 7: 158, 2020
06
ModerateHealthy-aging cognitive enhancement
The Hadanny 2020 trial demonstrated meaningful cognitive gains in healthy older adults — this is not just for people with deficits.
Hadanny et al. (2020, Aging 12(13): 13740-13761) ran the cognitive arm of the Hachmo telomere protocol. 35 healthy adults aged 64+ completed 60 HBOT sessions at 2.0 ATA. Eight of nine cognitive domains showed statistically significant improvement: attention, information processing speed, executive function, and global cognitive score were the largest movers.
Crucially, these were participants with no baseline cognitive deficit. HBOT didn't restore lost function — it enhanced existing function. This positions HBOT as a credible cognitive-performance intervention for healthy adults, not just a recovery tool.
The R1SE Longevity Protocol (60 sessions at 2.0 ATA over ~3 months) replicates the Hadanny / Hachmo trial structure. It's the same dose that delivered the telomere and cognitive effects in the original studies.
Key studies
- • Hadanny et al., Aging 12(13): 13740-13761, 2020
- • Hachmo et al., Aging 12(22): 22445-22456, 2020
07
EmergingAthletic recovery & performance
Top-level athletes use HBOT widely. The peer-reviewed evidence is positive but smaller and less rigorous than the clinical conditions above.
Michael Phelps, LeBron James, Cristiano Ronaldo, and most of the top NFL teams have invested in HBOT for recovery. The peer-reviewed evidence is positive though smaller-scale: improved post-training inflammation markers, faster soft-tissue recovery, and acute power-output preservation across heavy training blocks.
Mechanism: HBOT's anti-inflammatory effect, the angiogenesis signal supporting damaged tissue, and the stem cell mobilisation (Thom 2006, 8× CD34+ baseline at 20 sessions) all align with athletic recovery goals. The catch is that cold immersion within an hour of strength training blunts hypertrophy — the same caution may apply to HBOT, so we recommend scheduling HBOT 4+ hours after heavy strength work.
R1SE's athletic recovery protocol: 60-min HBOT 1.5–1.75 ATA, 1–2× weekly during heavy training blocks, scheduled within 24 hours of high-load workouts. Pair with red light therapy for the full recovery stack.
Key studies
- • Branco et al., Lasers Med Sci 31(7): 1411-1417, 2016
- • Ishihara et al., Med Hypotheses 132: 109358, 2019
08
Weak / HypedWhat HBOT WON'T treat — the honest section
There is a lot of HBOT marketing online for conditions where the evidence is thin or absent. R1SE will tell you what we won't treat — and why.
Autism in children. Some HBOT clinics market it as an autism intervention. The peer-reviewed evidence is mixed-to-negative; the most rigorous trial (Granpeesheh et al. 2010) found no improvement over sham. R1SE does not market HBOT for autism, and we don't treat children for elective wellness HBOT generally.
Cancer treatment. HBOT has specific approved roles in cancer care (radiation-induced tissue damage, soft-tissue radionecrosis — these are UHMS-approved indications under medical supervision). It is NOT a treatment for cancer itself, and the “HBOT cures cancer” claims online are dangerous and false. If you have cancer, talk to your oncologist, not a wellness HBOT provider.
Anti-aging promises beyond the cited evidence. The Hachmo telomere finding is real and the strongest aging signal HBOT has produced. But it is one trial in a specific population at a specific dose. We don't market HBOT as an “anti-aging treatment” in any unqualified sense. We do offer the Hachmo protocol — with full transparency about what it's based on and what we know and don't.
Chronic conditions without acute medical guidance. If you have a serious chronic condition (active cardiac disease, advanced COPD, active cancer, severe neurological disease), please talk to your GP or specialist before booking wellness HBOT. We screen aggressively for contraindications, but there are situations where medical-grade HBOT under hospital supervision is more appropriate.
Key studies
- • Granpeesheh et al., Research in Autism Spectrum Disorders 4(2): 268-275, 2010
- • UHMS Indications Committee, 14th Edition (defines approved medical indications)
Common questions
Talk to the team before you book.
If you have a specific condition or goal, we'll review the evidence with you, recommend a protocol, and tell you honestly if HBOT isn't the right tool.
Continue Reading
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