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

Meta-analysis of the effect of hyperbaric oxygen therapy on exercise-induced fatigue in athletes after exercise | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Meta-analysis of the effect of hyperbaric oxygen therapy on exercise-induced fatigue in athletes after exercise Kai Chen, Cheng Chen, Jincheng Yang, Zhongdong Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8185331/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 21 You are reading this latest preprint version Abstract 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). 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. hyperbaric oxygen exercise-induced athletes Meta-analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 1 Introduction Competitive sports are about pushing and surpassing human limits [ 1 ] . High-intensity, heavy-load, and prolonged training sessions often result in exercise-induced fatigue [ 2 ] . In 1982, the 5th International Conference on Exercise Biochemistry defined exercise-induced fatigue as the physiological inability to maintain a specific level or sustain a predetermined exercise intensity [ 3 ] , which can be reversed with adequate rest. Recovery after training and during competitions is a key focus in sports science. As competitive sports grow globally [ 4 ] , the frequency of athletes' participation in competitions and training has risen [ 5 ] . Quick recovery of physical fitness and state adjustment after high-intensity events is crucial for entering the next competition or training session [ 6 ] . Hyperbaric oxygen therapy (HBOT) involves inhaling high-concentration oxygen in a pressurized environment [ 7 ] , increasing blood oxygen content [ 8 – 9 ] and partial pressure [ 10 – 11 ] . This enhances the oxygen pressure difference between blood and cells, extending the oxygen's effective diffusion distance [ 13 – 14 ] . Studies indicate that HBOT can boost endurance, aid in rapid recovery from exercise injuries, reduce post-exercise fatigue, and combat inflammation. HBOT applications in exercise-induced fatigue can be categorized by timing: pre-exercise preconditioning to delay fatigue onset and improve training quality [ 15 – 16 ] ; exercise under hyperbaric conditions to enhance oxygen supply and delay fatigue; and post-exercise intervention for treating injuries and fatigue [ 17 ] . However, there is debate about the specific effectiveness indicators, particularly regarding fatigue intervention effects. This study aims to systematically review the literature and conduct a meta-analysis on HBOT's effects on exercise-induced fatigue in athletes, providing scientific guidelines for recovery. 2 Materials and Methods The protocol has been registered with the International Prospective Register of Systematic Reviews (CRD42024587174). 2.1 Literature Search Searchers The first author and the third author independently conducted double-blind literature searches, strictly adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, Cochrane Library, and EBSCO-SPORTD full-text sports science databases. Search Terms : English search terms: "Hyperbaric oxygen," "HBO," "hyperbaric oxygen therapy," "athletes," "exercise fatigue," "eliminate recovery." Search Time Frame From the inception of each database to September 2025 (the last search was conducted on September 29, 2025). Literature Search Strategy For example, the search strategy for PubMed databases is shown in Table 1 . Table 1 Schematic Diagram of English Data Search Strategies PubMed Dataases #1 High pressure oxygen [Title/Abstract] #2 HBO [Title/Abstract] #3 Hyperbaric oxygen ation [Title/Abstract] #4 Hyperbaric oxygen chamber [Title/Abstract] #5 Hyperbaric oxygen intervention [Title/Abstract] #6 #1 OR #2 OR #3 OR #4 OR #5 #7 Athlete [Title/Abstract] #8 Sports crowd [Title/Abstract] #9 Sports fatigue [Title/Abstract] #10 Fatigued [Title/Abstract] #11 Eliminate recovery [Title/Abstract] #12 Restore the effect [Title/Abstract] #13 #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 #14 #6 AND #13 2.2 Inclusion and Exclusion Criteria Inclusion criteria were determined based on the PICOST principle, evaluating the type of literature, intervention subjects, intervention measures, and outcome indicators. Inclusion Criteria : ①Type of literature: All included articles must be clinical randomized controlled trials (RCTs) .②Intervention subjects: Athletes from various sports.③Intervention measures: The experimental group received hyperbaric oxygen therapy (HBOT) for post-exercise recovery, while the control group did not receive any intervention, ensuring baseline consistency between the experimental and control groups.④Outcome indicators: Primary indicators include heart rate (HR), serum creatine kinase (CK), and blood urea nitrogen (BUN). Secondary indicators include perceived exertion (RPE), testosterone (T), and cortisol (C). Exclusion Criteria ①Conference papers or review articles.②Duplicate publications or articles from which experimental data cannot be extracted.③Non-athletes.④Pre-exercise or intra-exercise HBOT interventions. 2.3 Literature Screening Relevant articles were imported into NoteExpress 3.2.0 software for deduplication. The first, fourth, and fifth authors read the titles and abstracts for initial screening. Full texts were then reviewed according to the inclusion and exclusion criteria to determine the final included articles. When there were discrepancies, the second and third authors were consulted for discussion. 2.4 Data Extraction The first author extracted the necessary data from the articles, which were then reviewed by the second author. Key information included: the first author's name, publication year, basic information about the participants, intervention methods and measures, and outcome indicators. Outcome indicator data were extracted in the form of Mean ± SD for the post-test values of the experimental and control groups, as well as the pre-test values of the experimental group. If outcome indicator data could not be directly obtained from the articles, the corresponding authors were contacted promptly for the required information. 2.5 Methodological Quality Assessment of Included Literature The Risk of Bias 2.0 tool (RoB 2.0) assessed bias in RCTs, considering randomization, intervention delivery, data completeness, outcome measurement, reporting selection, and overall bias. Quality was rated as high, unclear, or low risk. Authors independently evaluated articles blindingly. The PEDro scale (max 10 points) assessed study robustness, with scores defining literature quality. 2.6 Outcome Indicators Primary indicators include heart rate (HR), serum creatine kinase (CK), and blood urea nitrogen (BUN). Secondary indicators include perceived exertion (RPE), testosterone (T), and cortisol (C). 2.7 Statistical Analysis RevMan 5.4 and Stata 17 conducted meta-analyses, calculating pooled effect sizes, forest plots, heterogeneity, subgroup analyses, sensitivity analyses, and publication bias (Egger's test, funnel plots). Fixed or random effects models were used based on heterogeneity. Standardized mean differences (SMD) and 95% CIs were analyzed. Significance was set at p ≤ 0.05. Heterogeneity was assessed using I² (< 50% = low, 50–75% = moderate, ≥ 75% = high). Sensitivity used the Leave-One-Out method. Effect sizes were interpreted as trivial (SMD < 0.2), small (0.2 ≤ SMD < 0.5), medium (0.5 ≤ SMD < 0.8), or large (SMD ≥ 0.8). Publication bias was inferred from funnel plot asymmetry or Egger's test (p < 0.05). 3 Results 3.1 Literature Analysis A total of 4,610 articles were retrieved from five databases using the search terms. The following steps were taken for screening and exclusion:1. Removal of conference papers and duplicate articles: 1,867 articles were excluded.2. Reading titles and abstracts: 2,686 additional articles were excluded.3. Screening based on the PICOST principles: 40 articles that did not meet the inclusion criteria were excluded. Ultimately, a total of 15 articles were included(Fig. 1 ). 3.2 Basic Characteristics of Included Literature Among the 15 included articles, a total of 311 athletes from various sports were involved [18–32]. In all the experimental groups, hyperbaric oxygen therapy (HBOT) was used for the recovery of exercise-induced fatigue, with the main intervention protocol being: pressure at 1.3 ATA, duration of 60–90 minutes. The control groups generally adopted natural recovery methods for athletes, meaning no additional interventions were provided. The basic characteristics of the included literature are shown in Table 2 . Table 2 Basic Characteristics of Included Literature First Author year sample(E/T, n) gender(M/W, n) Interventions Intervention cycle Time Outcome measures Adverse event Experimental group Control group Zhu [ 12 ] 2022 8/8 8/8 1.3ATA Natural recovery 4 weeks/16 time 60min MDA,PC,SOD,CAT,GSH-PX,T-AOC, BU, CK,T, and C Not mentioned Si-Hwa [ 13 ] 2018 10/10 10/0 1.3ATA Natural recovery 3 weeks/3 times 30min HR、BLA、ALT Not mentioned Braulio [ 14 ] 2016 11/11 11/0 2.39ATA Natural recovery 6 weeks/1 time 100min CK、AST、ALT、LDH、RPE、RPR Not mentioned Widiyanto [ 15 ] 2018 20/10 30/0 1.8ATA Natural recovery 1 time 15min RPE、BLA Not mentioned Thibaud [22] 2021 12/12 12/0 1.3ATA Natural recovery 1 time 75min HRV、BLA、PE Not mentioned Chaoyi [ 23 ] 2024 12/12 12/0 1.29 ATA and 40%-50% oxygen Natural recovery 6 days / 2 times 60min RPE、HR、SpO2、SLJ、CK、BUN、SOD、MDA Not mentioned Jinhee [ 24 ] 2020 6/6 12/0 2.5 ATA, 100% oxygen Natural recovery 1 time 60 min BE、AH、CK、LDH、BAP Not mentioned Kormanovski [ 25 ] 2010 22/12 34/0 2.5 ATA Natural recovery 8 days / 2 times 75min Glu、TG、CK、HCT、PLT、AOC、GPx、SOD Not mentioned Ma [ 26 ] 2023 8/7 7/8 1.3ATA、28%-30% oxygen Natural recovery 6 weeks/18 times 60min HRV、WBC、T、T/C、BU、CK、Cr Not mentioned Li [ 27 ] 2012 10/10 20/0 1.2ATA Natural recovery 4 weeks/4 times 120min AST、LDH、HBDH、WBC、CK、Hb、PLT Not mentioned Tao [ 28 ] 2003 6/6 12/0 2.5 ATA, 100% oxygen Natural recovery 1 time 85min HR、RPE、BUN、BL Not mentioned Bi [ 29 ] 2020 15/15 0/30 2.5 ATA Natural recovery 1 time 85min HR、BLA、RPE、CK、BUN、T、C Not mentioned Liu [ 30 ] 2021 8/8 16/0 2.2ATA Natural recovery 1 time 85min HR、BLA、RPE、CK、BUN、T、C Not mentioned Zhang [ 31 ] 2023 10/10 10/10 1.3 ATA Natural recovery 4 weeks/16 times 60min HRV、WBC、T、T/C、BU、CK、Cr Not mentioned Bi [ 32 ] 2015 8/8 8/0 2.5 ATA-3.0 ATA Natural recovery 1 time 60min HR、BLA、BUN、T/C、CK Not mentioned Table Notes: ATA : Absolute atmospheric pressure. ALT : Alanine transaminase. AST : Aspartate transaminase. BAP : Bioactive peptides. BLA : Blood lactate. BU : Blood urea. C : Cortisol. CAT : Catalase. CK : Creatine kinase. Glu : Glucose. HR : Heart rate. HRV : Heart rate variability. LDH : Lactate dehydrogenase. MDA : Malondialdehyde. PC : Protein carbonyl. PE : Pulmonary embolism. PLT : Platelets. RPE : Rating of perceived exertion. SOD : Superoxide dismutase. SpO2 : Oxygen saturation. T : Testosterone. WBC : White blood cells. 3.3 Quality Evaluation of Included Literature The quality of the 15 included articles was evaluated based on the Physiotherapy Evidence Database (PEDro) standards. All articles were rated as relatively high-quality, with scores of 6 or higher, indicating strict inclusion criteria and reliable methodology. Most scored between 6 and 8 points. Detailed PEDro scores are presented in Table 3 . The overall high quality of the included literature ensures the credibility of the findings. Risk of bias assessment, following the Cochrane Collaboration's criteria, is depicted in Fig. 2 and Fig. 3 Table 3 PEDro Scores of Included Literature First Author year Subjects were included in the conditions Randomized Assign hidden The baseline is similar Subjects were blinded Participants were blinded Outcome measures were blinded More than 85% of people were given at least one primary outcome measure Intention-to-treat analysis Inter-group statistical report Outcome point test values and variant measurements PEDroscore Quality evaluation Zhu [ 18 ] 2022 + + - + - - - + + + + 6 High quality Si-Hwa [ 19 ] 2018 + + - + - + - + + + + 7 High quality Braulio [ 20 ] 2016 + + - + - - - + + + + 6 High quality Widiyanto [ 21 ] 2018 + + - + - + - + + + + 7 High quality Thibaud [22] 2021 + + - + - - - + + + + 6 High quality Chaoyi [ 23 ] 2024 + + - + - - - + + + + 6 High quality Jinhee [ 24 ] 2020 + + - + - + - + + + + 7 High quality Kormanovski [ 25 ] 2010 + + - + - + - + + + + 7 High quality Ma 26] 2023 + + - + - - - + + + + 6 High quality Li [ 27 ] 2012 + + - + - + - + + + + 7 High quality Tao [ 28 ] 2003 + + - + - - - + + + + 6 High quality Bi [ 29 ] 2020 + + - + - - - + + + + 6 High quality Liu [ 30 ] 2021 + + - + - - - + + + + 6 High quality Zhang [ 31 ] 2023 + + - + - - - + + + + 6 High quality Bi [ 27 ] 2015 + + - + - + - + + + + 7 High quality Table note: + indicates that the corresponding indicator is met; - The representative does not meet the corresponding indicators; Baseline similarity refers to the similarity of groups at baseline for important prognostic measures; Blinding refers to blinding; More than 85% of people were measured for at least one primary outcome, meaning that if not reported, they were taken as negative outcomes; Intention-to-treat analysis means that all participants complete trials and tests as required, with at least one primary outcome if not, and negative outcomes if not reported. 3.4 Meta-Analysis Results This study categorizes the effects of hyperbaric oxygen therapy (HBOT) on the recovery from exercise-induced fatigue based on the research by Zhu Huan (2022) [ 33 ] . The specific categories are as follows: Meta-Analysis of the Effects of Hyperbaric Oxygen on Post-Exercise Heart Rate in Athletes. Heart Rate : Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 7 articles involving a total of 71 cases examined the impact of heart rate recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P < 0.1, I² = 72%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -4.3, 95% CI = -5.91 to -2.69, P < 0.05). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig. 4 Meta-Analysis of the Effects of Hyperbaric Oxygen on Post-Exercise Blood Urea, Creatine Kinase, Testosterone, and Cortisol in Athletes Blood Urea : Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 6 articles involving a total of 59 cases examined the impact of blood urea recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P = 0.02, I² = 62%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -0.51, 95% CI = -0.73 to -0.30, P < 0.05). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig. 5 . Creatine Kinase : Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 11 articles involving a total of 107 cases examined the impact of creatine kinase recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P < 0.1, I² = 80%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated no significant difference between the two groups (SMD = -5.82, 95% CI = -16.34 to 4.70, P = 0.28). This result suggests that hyperbaric oxygen does not have a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig. 6 . Testosterone : Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 4 articles involving a total of 45 cases examined the impact of testosterone recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P = 0.12, I² = 80%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated no significant difference between the two groups (SMD = -5.82, 95% CI = -16.34 to 4.70, P = 0.28). This result suggests that hyperbaric oxygen does not have a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig. 7 Cortisol : Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 4 articles involving a total of 45 cases examined the impact of cortisol recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P = 0.08, I² = 55%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = 0.77, 95% CI = 0.16 to 1.37, P = 0.01). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig. 8 Testosterone/Cortisol Ratio : Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 4 articles involving a total of 45 cases examined the impact of the testosterone/cortisol ratio recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P = 0.03, I² = 68%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -2.38, 95% CI = -4.55 to -0.21, P = 0.03). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig. 9 Meta-Analysis of the Effects of Hyperbaric Oxygen on Post-Exercise Lactate and Other Metabolic Products in Athletes Blood Lactate : Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 7 articles involving a total of 69 cases examined the impact of blood lactate recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P < 0.1, I² = 90%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -1.19, 95% CI = -1.54 to -0.83, P < 0.05). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig. 10 . Meta-Analysis of the Effects of Hyperbaric Oxygen on Post-Exercise Subjective Fatigue Perception in Athletes Subjective Fatigue Perception : Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 5 articles involving a total of 56 cases examined the impact of subjective fatigue perception after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P < 0.1, I² = 81%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -1.89, 95% CI = -2.45 to -1.33, P < 0.05). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig. 11 . 3.5 Subgroup Analysis Results Subgroup analysis was conducted for creatine kinase with different hyperbaric oxygen interventions using moderator variables (see Fig. 12for detailed results). The study results showed that the I² values for intervention pressure, number of interventions, sample size, and intervention duration were all 0, indicating no heterogeneity in the analysis results. However, the P-values were all greater than 0.05, suggesting that hyperbaric oxygen does not have a significant effect on the recovery from post-exercise fatigue in athletes. The combined effect results support this evaluation. 3.6 Publication Bias Analysis Results In the included studies, the most commonly analyzed indicators for intervention effects were blood urea, creatine kinase, testosterone, and cortisol. Therefore, funnel plots were used to analyze publication bias for these indicators (see Fig. 13 . The funnel plots show that the distribution of the studies is roughly symmetrical, suggesting that there is no publication bias or other biases in the studies. 3.7 Sensitivity Analysis Results To verify the stability and reliability of the aforementioned meta-analysis results, sensitivity analyses were conducted by excluding each of the 15 included articles one by one and then performing the meta-analysis again. The results showed that the effects of hyperbaric oxygen therapy (experimental group) versus natural recovery (control group) on blood urea, testosterone, cortisol, heart rate, subjective fatigue perception, and lactate and other metabolic products did not change significantly, confirming the robustness of the study results. However, the results for creatine kinase in the recovery from post-exercise fatigue showed changes. When the data from Braulio's study were excluded, the P-value for the effect of hyperbaric oxygen on creatine kinase levels after exercise changed significantly (P < 0.05), indicating that these study data had a substantial impact on the overall effect size. See Fig. 14 for details. 4 Discussion 4.1 Evidence Summary This study included 15 articles to systematically investigate the effects of hyperbaric oxygen on the recovery from exercise-induced fatigue in athletes, focusing on blood urea, testosterone, cortisol, heart rate, creatine kinase, subjective fatigue perception, and lactate and other metabolic products. Quantitative comparisons were made with natural recovery. The results showed that hyperbaric oxygen has a significant impact on heart rate, blood urea, cortisol, blood lactate, and subjective fatigue perception, demonstrating significant fatigue recovery effects. However, the effects of hyperbaric oxygen on creatine kinase and testosterone were not significant. 4.2Effect of hyperbaric oxygen on sports fatigue in athletes Effects of Hyperbaric Oxygen on Heart Rate Recovery in Athletes Post-exercise heart rate recovery speed is an important indicator for evaluating exercise-induced fatigue [ 34 ] . Hyperbaric oxygen intervention can promote rapid heart rate recovery after exercise. Studies have found that both low-pressure hyperbaric oxygen (1.3–1.7 ATA) and high-pressure hyperbaric oxygen (2.5-3 ATA) have positive effects on post-exercise heart rate recovery. The mechanism may involve the upregulation of parasympathetic nervous system activity by hyperbaric oxygen, leading to a decrease in heart rate (HR) and enhanced autonomic nervous system balance [ 35 – 36 ] . Additionally, hyperbaric oxygen intervention helps to restore neurological function after intense exercise, improving heart rate variability [ 37 – 38 ] . Heart rate variability is a non-invasive indicator for monitoring athletes' training adaptation and fatigue status, and it serves as an early warning signal for physical fatigue damage [ 39 ] . Furthermore, mild hyperbaric oxygen intervention can also improve athletes' neurological function and promote fatigue elimination [ 40 ] . Research has shown that mild hyperbaric oxygen (1.3 ATA) intervention can improve sleep quality by balancing sympathetic and vagal nerve tension in boxers [ 41 ] . Although both hyperbaric oxygen and mild hyperbaric oxygen interventions can enhance the function of the vagal nervous system and increase heart rate variability, the individual variability in heart rate variability is significant. Therefore, when evaluating the recovery effects of hyperbaric oxygen using heart rate variability, individual differences should be fully considered. Effects of Post-Exercise Hyperbaric Oxygen Intervention on Blood Urea, Creatine Kinase, Testosterone, and Cortisol Blood Urea Blood urea is the final product of protein metabolism in the body [ 42 ] . After prolonged exercise, the energy balance within muscles is disrupted, leading to increased protein and amino acid catabolism, which elevates blood urea levels [ 43 – 44 ] . Studies have found that hyperbaric oxygen intervention can accelerate the recovery of blood urea levels in athletes after exercise. Moreover, hyperbaric oxygen rehabilitation therapy not only reduces blood urea levels associated with exercise fatigue but also increases brain hemoglobin and hemoglobin content [ 45 ] . In animal experiments, hyperbaric oxygen intervention has been shown to improve renal hypoxia in fatigued rats, promoting kidney function recovery and accelerating urea excretion, thereby reducing blood urea levels [ 46 ] . In summary, hyperbaric oxygen helps to expedite the recovery of blood urea levels in athletes, thereby alleviating exercise-induced fatigue. Creatine Kinase Creatine kinase is an enzyme directly related to muscle contraction [ 47 ] . Under normal circumstances, exercise can cause muscle cell damage or changes in permeability, forcing an increase in creatine kinase levels in the blood, and this change is related to the intensity and duration of exercise [ 48 ] . Therefore, creatine kinase is often used as an indicator of muscle damage after exercise. Studies have found that hyperbaric oxygen is not effective in intervening in delayed-onset muscle soreness [ 49 – 50 ] . The conclusions regarding the effects of hyperbaric oxygen on creatine kinase levels are inconsistent. Most studies show that hyperbaric oxygen therapy can help recover creatine kinase levels, but a few studies have found that hyperbaric oxygen is less effective than natural recovery in restoring creatine kinase levels. Some scholars suggest that this may be related to the type of muscle cell membrane damage [ 33 ] . When mechanical stretching causes physiological damage to muscle fibers, the damage can naturally recover after rest, and hyperbaric oxygen intervention does not further enhance recovery. However, when hypoxia induces increased permeability of the muscle cell membrane, hyperbaric oxygen intervention can promote membrane repair and reduce creatine kinase levels in the blood, although the exact physiological mechanisms require further research [ 51 ] . Testosterone and Cortisol Testosterone promotes protein synthesis and enhances muscle function in athletes [ 52 – 53 ] , while cortisol has the opposite effect [ 54 ] . The ratio of testosterone to cortisol is a good indicator of metabolic status. Studies have found that hyperbaric oxygen does not accelerate the recovery of testosterone levels in athletes after exercise but can help recover cortisol levels. The differences in study results may be related to factors such as the type of sport, athletic level, health status, and the timing of sample collection [ 55 – 56 ] . Additionally, the effects of hyperbaric oxygen on testosterone may also be gender-related. As a sex hormone, testosterone is closely associated with gender, and the effects of hyperbaric oxygen on testosterone may differ between genders, requiring further research to confirm [ 57 ] . Effects of Post-Exercise Hyperbaric Oxygen Intervention on Lactate and Other Metabolic Products Lactate is a product of anaerobic metabolism of glycogen in the body after exercise, which occurs to rapidly replenish energy [ 58 – 59 ] . After exercise, the rapid removal of lactate and other metabolic products is crucial for the recovery of physical function. Studies have shown that hyperbaric oxygen therapy helps to accelerate the clearance of lactate and other metabolic products. Both hyperbaric oxygen and mild hyperbaric oxygen interventions can enhance the clearance of lactate after intense exercise, promoting lactate breakdown and reducing lactate levels in the blood [ 60 ] . Effects of Post-Exercise Hyperbaric Oxygen Intervention on Subjective Fatigue Perception and Psychological State Subjective fatigue perception is a common indicator for evaluating the state of exercise-induced fatigue in athletes [ 61 ] . In the included studies, subjective fatigue perception was primarily measured using self-perceived exertion scales. The results indicate that hyperbaric oxygen has a significant effect on subjective fatigue perception in athletes. Additionally, hyperbaric oxygen recovery may have a beneficial psychological soothing effect, reducing subjective fatigue perception through its placebo effect. Beyond this, researchers have also used traditional Chinese medicine techniques such as acupuncture [62] and moxibustion [ 63 ] to alleviate subjective fatigue perception. 4.3 Limitations of the Study Despite the rigorous screening and careful exclusion of the included studies, certain limitations still exist: ①Literature Search: Unpublished literature documents were not included in the search, and some of the included studies lacked data. ②Gender Bias: Fewer female participants were included in the studies, which could introduce bias. ③Variability in Study Design: There were significant differences in study design among the included studies, particularly in terms of training intensity. Some studies did not provide specific training regimens. ④Lack of Standardization: While hyperbaric oxygen therapy has been shown to aid in the recovery from exercise-induced fatigue, there is no unified standard for its application. Differences in training protocols and testing methods across various interventions led to heterogeneity in some data, potentially introducing bias into the results. 4.4 Applicability and Implications for the Future This article uses a meta-analysis approach to further validate the effectiveness of hyperbaric oxygen in managing exercise-induced fatigue in athletes. By comparing hyperbaric oxygen intervention with natural recovery, significant differences were observed in several indicators post-intervention. The findings suggest that hyperbaric oxygen is applicable for promoting healing, reducing inflammation, and improving energy metabolism, thereby alleviating exercise-induced fatigue in athletes. However, some uncertainties remain in the results, such as the inconsistency in the effects on creatine kinase, an important indicator of exercise-induced fatigue. For future research, it would be beneficial to deepen the investigation into the effects of hyperbaric oxygen on different types of sports and various athlete populations. Personalized hyperbaric oxygen treatment plans should be developed based on the unique characteristics of individual athletes. Additionally, integrating hyperbaric oxygen therapy with other recovery techniques (such as cold therapy, massage, and nutritional recovery) to form comprehensive recovery programs could enhance the overall recovery from exercise-induced fatigue in athletes. 5 Conclusion The primary applications of hyperbaric oxygen in sports include pre-exercise preconditioning, exercise under hyperbaric conditions, and post-exercise intervention (for treating sports injuries and eliminating exercise-induced fatigue). Pre-exercise hyperbaric oxygen preconditioning has anti-fatigue and performance-enhancing effects, improving the body's adaptation to hypoxia. Hyperbaric conditions enhance the body's oxygen supply, delaying the onset of exercise-induced fatigue and improving performance. Post-exercise hyperbaric oxygen intervention promotes the recovery from muscle contusions and ligament injuries, eliminates exercise-induced fatigue, reduces subjective fatigue perception, and enhances athletic performance. However, further research is needed to clarify the specific effects of hyperbaric oxygen on creatine kinase, testosterone, cortisol, and the oxidative-antioxidant system. Declarations Ethics approval and consent to participate ： The protocol has been registered with the International Prospective Register of Systematic Reviews (CRD42024587174). Consent for publication All our participants agreed to publish this article Availability of data and materials The data in the article can be obtained from public websites Competing interests None of the authors of this article have a conflict of interest Funding Statement: This study received no financial support from any sponsor. Authors' contributions The authors’ contributions to this work are as follows: Kai Chen: Conceptualization, Methodology, Investigation, Data Curation, Formal Analysis, Writing – Original Draft. Cheng Chen †: Software, Validation, Visualization, Data Curation, Writing – Review & Editing. **Zhongdong Li ***: Conceptualization, Resources, Funding Acquisition, Supervision, Project Administration, Writing – Review & Editing. Jincheng Yang: Investigation, Resources, Validation, Writing – Review & Editing. † These authors contributed equally to this work. ***** Corresponding author Acknowledgements We thank all the authors for their efforts References Gheorghe CM. 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Athletes.\u003c/p\u003e","description":"","filename":"Fig7.png","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/7f372448a146b09e0684e393.png"},{"id":98424148,"identity":"52e0b64d-0b15-4772-a46d-d40a99db6ceb","added_by":"auto","created_at":"2025-12-17 16:33:00","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":108020,"visible":true,"origin":"","legend":"\u003cp\u003eForest Plot of the Effects of Hyperbaric Oxygen on Post-Exercise Cortisol Recovery in Athletes\u003c/p\u003e","description":"","filename":"Fig8.png","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/889156acd5c06ec36a24225b.png"},{"id":98426087,"identity":"28bca40b-cc18-4b6d-8cb4-e2fe421159d4","added_by":"auto","created_at":"2025-12-17 16:35:36","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":110077,"visible":true,"origin":"","legend":"\u003cp\u003eForest Plot of the Effects of Hyperbaric Oxygen on Post-Exercise Testosterone/Cortisol Ratio Recovery in Athletes\u003c/p\u003e","description":"","filename":"Fig9.png","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/4f3c35216881173ad4af8bc8.png"},{"id":98425558,"identity":"87062128-e350-4d4b-a977-fdb88c144bcb","added_by":"auto","created_at":"2025-12-17 16:34:56","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":133270,"visible":true,"origin":"","legend":"\u003cp\u003eForest Plot of the Effects of Hyperbaric Oxygen on Post-Exercise Blood Lactate Recovery in Athletes\u003c/p\u003e","description":"","filename":"Fig10.png","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/b179def71b3d89c3e73a7f9b.png"},{"id":98424186,"identity":"f3a3d42b-b462-46e1-91eb-574f193bcef1","added_by":"auto","created_at":"2025-12-17 16:33:03","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":117055,"visible":true,"origin":"","legend":"\u003cp\u003eForest Plot of the Effects of Hyperbaric Oxygen on Post-Exercise Subjective Fatigue Perception in Athletes.\u003c/p\u003e","description":"","filename":"Fig11.png","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/4320185f37e4dcb0104121ec.png"},{"id":98424196,"identity":"eff35bee-0dcc-48bc-b1c2-99531b2140c3","added_by":"auto","created_at":"2025-12-17 16:33:04","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":307938,"visible":true,"origin":"","legend":"\u003cp\u003eForest Plot of Subgroup Analysis for Creatine Kinase Based on Different Testing Indicators\u003c/p\u003e","description":"","filename":"Fig12.png","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/f492207e0ac2a9bb70cbee58.png"},{"id":98426085,"identity":"a0c535f9-81e9-4aaf-8453-8ce6921ab59b","added_by":"auto","created_at":"2025-12-17 16:35:36","extension":"png","order_by":13,"title":"Figure 13","display":"","copyAsset":false,"role":"figure","size":104810,"visible":true,"origin":"","legend":"\u003cp\u003eFunnel Plots for Publication Bias Analysis of Included Study Indicators\u003c/p\u003e","description":"","filename":"Fig13.png","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/9198d97ef76bdc2639e91a2c.png"},{"id":98002637,"identity":"f40eafcc-ab3a-425a-8007-766ae24d1355","added_by":"auto","created_at":"2025-12-11 16:32:02","extension":"png","order_by":14,"title":"Figure 14","display":"","copyAsset":false,"role":"figure","size":172542,"visible":true,"origin":"","legend":"\u003cp\u003eForest Plot of the Effects of Hyperbaric Oxygen on Post-Exercise Creatine Kinase Levels (Sensitivity Analysis)\u003c/p\u003e","description":"","filename":"Fig14.png","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/3783bf8f979eaba7f7d5dd50.png"},{"id":98622051,"identity":"42a4a4d7-54e8-4215-8c70-4fb1b0817bc8","added_by":"auto","created_at":"2025-12-19 16:43:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3604402,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/228a5b40-3399-4e23-a9f4-6f12567f2962.pdf"},{"id":98002621,"identity":"cf8058c7-110b-4d67-bb05-e53f8fca002a","added_by":"auto","created_at":"2025-12-11 16:32:02","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":11131,"visible":true,"origin":"","legend":"","description":"","filename":"S1Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/cff4493df7e221f0d7f503d6.docx"},{"id":98424160,"identity":"0a876683-d163-4c0e-8811-d56907cb27c9","added_by":"auto","created_at":"2025-12-17 16:33:01","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16723,"visible":true,"origin":"","legend":"","description":"","filename":"S2Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/8b98e824e72bde18c1d35128.docx"},{"id":98424897,"identity":"a765dcb8-6491-4c61-a5ce-6af8dd333a64","added_by":"auto","created_at":"2025-12-17 16:34:01","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":17234,"visible":true,"origin":"","legend":"","description":"","filename":"S3Table.docx","url":"https://assets-eu.researchsquare.com/files/rs-8185331/v1/f0cddf2982696177b2acc454.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Meta-analysis of the effect of hyperbaric oxygen therapy on exercise-induced fatigue in athletes after exercise","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eCompetitive sports are about pushing and surpassing human limits\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. High-intensity, heavy-load, and prolonged training sessions often result in exercise-induced fatigue\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. In 1982, the 5th International Conference on Exercise Biochemistry defined exercise-induced fatigue as the physiological inability to maintain a specific level or sustain a predetermined exercise intensity\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, which can be reversed with adequate rest. Recovery after training and during competitions is a key focus in sports science. As competitive sports grow globally\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, the frequency of athletes' participation in competitions and training has risen\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Quick recovery of physical fitness and state adjustment after high-intensity events is crucial for entering the next competition or training session\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHyperbaric oxygen therapy (HBOT) involves inhaling high-concentration oxygen in a pressurized environment\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, increasing blood oxygen content\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e and partial pressure\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. This enhances the oxygen pressure difference between blood and cells, extending the oxygen's effective diffusion distance\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Studies indicate that HBOT can boost endurance, aid in rapid recovery from exercise injuries, reduce post-exercise fatigue, and combat inflammation. HBOT applications in exercise-induced fatigue can be categorized by timing: pre-exercise preconditioning to delay fatigue onset and improve training quality\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e; exercise under hyperbaric conditions to enhance oxygen supply and delay fatigue; and post-exercise intervention for treating injuries and fatigue\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. However, there is debate about the specific effectiveness indicators, particularly regarding fatigue intervention effects. This study aims to systematically review the literature and conduct a meta-analysis on HBOT's effects on exercise-induced fatigue in athletes, providing scientific guidelines for recovery.\u003c/p\u003e"},{"header":"2 Materials and Methods","content":"\u003cp\u003eThe protocol has been registered with the International Prospective Register of Systematic Reviews (CRD42024587174).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Literature Search\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eSearchers\u003c/strong\u003e\u003cp\u003eThe first author and the third author independently conducted double-blind literature searches, strictly adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDatabases\u003c/strong\u003e\u003cp\u003eChina National Knowledge Infrastructure (CNKI), PubMed, Web of Science, Cochrane Library, and EBSCO-SPORTD full-text sports science databases.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSearch Terms\u003c/b\u003e: English search terms: \"Hyperbaric oxygen,\" \"HBO,\" \"hyperbaric oxygen therapy,\" \"athletes,\" \"exercise fatigue,\" \"eliminate recovery.\"\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSearch Time Frame\u003c/strong\u003e\u003cp\u003eFrom the inception of each database to September 2025 (the last search was conducted on September 29, 2025).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eLiterature Search Strategy\u003c/strong\u003e\u003cp\u003eFor example, the search strategy for PubMed databases is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSchematic Diagram of English Data Search Strategies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePubMed Dataases\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e#1 High pressure oxygen [Title/Abstract]\u003c/p\u003e\u003cp\u003e#2 HBO [Title/Abstract]\u003c/p\u003e\u003cp\u003e#3 Hyperbaric oxygen ation [Title/Abstract]\u003c/p\u003e\u003cp\u003e#4 Hyperbaric oxygen chamber [Title/Abstract]\u003c/p\u003e\u003cp\u003e#5 Hyperbaric oxygen intervention [Title/Abstract]\u003c/p\u003e\u003cp\u003e#6 #1 OR #2 OR #3 OR #4 OR #5\u003c/p\u003e\u003cp\u003e#7 Athlete [Title/Abstract]\u003c/p\u003e\u003cp\u003e#8 Sports crowd [Title/Abstract]\u003c/p\u003e\u003cp\u003e#9 Sports fatigue [Title/Abstract]\u003c/p\u003e\u003cp\u003e#10 Fatigued [Title/Abstract]\u003c/p\u003e\u003cp\u003e#11 Eliminate recovery [Title/Abstract]\u003c/p\u003e\u003cp\u003e#12 Restore the effect [Title/Abstract]\u003c/p\u003e\u003cp\u003e#13 #6 OR #7 OR #8 OR #9 OR #10\u003c/p\u003e\u003cp\u003eOR #11 OR #12\u003c/p\u003e\u003cp\u003e#14 #6 AND #13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Inclusion and Exclusion Criteria\u003c/h2\u003e\u003cp\u003eInclusion criteria were determined based on the PICOST principle, evaluating the type of literature, intervention subjects, intervention measures, and outcome indicators.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion Criteria\u003c/b\u003e: ①Type of literature: All included articles must be clinical randomized controlled trials (RCTs) .②Intervention subjects: Athletes from various sports.③Intervention measures: The experimental group received hyperbaric oxygen therapy (HBOT) for post-exercise recovery, while the control group did not receive any intervention, ensuring baseline consistency between the experimental and control groups.④Outcome indicators: Primary indicators include heart rate (HR), serum creatine kinase (CK), and blood urea nitrogen (BUN). Secondary indicators include perceived exertion (RPE), testosterone (T), and cortisol (C).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e\u003cp\u003e①Conference papers or review articles.②Duplicate publications or articles from which experimental data cannot be extracted.③Non-athletes.④Pre-exercise or intra-exercise HBOT interventions.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Literature Screening\u003c/h2\u003e\u003cp\u003eRelevant articles were imported into NoteExpress 3.2.0 software for deduplication. The first, fourth, and fifth authors read the titles and abstracts for initial screening. Full texts were then reviewed according to the inclusion and exclusion criteria to determine the final included articles. When there were discrepancies, the second and third authors were consulted for discussion.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Data Extraction\u003c/h2\u003e\u003cp\u003eThe first author extracted the necessary data from the articles, which were then reviewed by the second author. Key information included: the first author's name, publication year, basic information about the participants, intervention methods and measures, and outcome indicators. Outcome indicator data were extracted in the form of Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD for the post-test values of the experimental and control groups, as well as the pre-test values of the experimental group. If outcome indicator data could not be directly obtained from the articles, the corresponding authors were contacted promptly for the required information.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Methodological Quality Assessment of Included Literature\u003c/h2\u003e\u003cp\u003eThe Risk of Bias 2.0 tool (RoB 2.0) assessed bias in RCTs, considering randomization, intervention delivery, data completeness, outcome measurement, reporting selection, and overall bias. Quality was rated as high, unclear, or low risk. Authors independently evaluated articles blindingly. The PEDro scale (max 10 points) assessed study robustness, with scores defining literature quality.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Outcome Indicators\u003c/h2\u003e\u003cp\u003ePrimary indicators include heart rate (HR), serum creatine kinase (CK), and blood urea nitrogen (BUN). Secondary indicators include perceived exertion (RPE), testosterone (T), and cortisol (C).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.7 Statistical Analysis\u003c/h2\u003e\u003cp\u003eRevMan 5.4 and Stata 17 conducted meta-analyses, calculating pooled effect sizes, forest plots, heterogeneity, subgroup analyses, sensitivity analyses, and publication bias (Egger's test, funnel plots). Fixed or random effects models were used based on heterogeneity. Standardized mean differences (SMD) and 95% CIs were analyzed. Significance was set at p\u0026thinsp;\u0026le;\u0026thinsp;0.05. Heterogeneity was assessed using I\u0026sup2; (\u0026lt;\u0026thinsp;50% = low, 50\u0026ndash;75% = moderate, \u0026ge;\u0026thinsp;75% = high). Sensitivity used the Leave-One-Out method. Effect sizes were interpreted as trivial (SMD\u0026thinsp;\u0026lt;\u0026thinsp;0.2), small (0.2\u0026thinsp;\u0026le;\u0026thinsp;SMD\u0026thinsp;\u0026lt;\u0026thinsp;0.5), medium (0.5\u0026thinsp;\u0026le;\u0026thinsp;SMD\u0026thinsp;\u0026lt;\u0026thinsp;0.8), or large (SMD\u0026thinsp;\u0026ge;\u0026thinsp;0.8). Publication bias was inferred from funnel plot asymmetry or Egger's test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Literature Analysis\u003c/h2\u003e\u003cp\u003eA total of 4,610 articles were retrieved from five databases using the search terms. The following steps were taken for screening and exclusion:1. Removal of conference papers and duplicate articles: 1,867 articles were excluded.2. Reading titles and abstracts: 2,686 additional articles were excluded.3. Screening based on the PICOST principles: 40 articles that did not meet the inclusion criteria were excluded. Ultimately, a total of 15 articles were included(Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Basic Characteristics of Included Literature\u003c/h2\u003e\u003cp\u003eAmong the 15 included articles, a total of 311 athletes from various sports were involved [18\u0026ndash;32]. In all the experimental groups, hyperbaric oxygen therapy (HBOT) was used for the recovery of exercise-induced fatigue, with the main intervention protocol being: pressure at 1.3 ATA, duration of 60\u0026ndash;90 minutes. The control groups generally adopted natural recovery methods for athletes, meaning no additional interventions were provided. The basic characteristics of the included literature are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBasic Characteristics of Included Literature\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFirst Author\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eyear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003esample(E/T, n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003egender(M/W, n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eInterventions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003cp\u003ecycle\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOutcome measures\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAdverse\u003c/p\u003e\u003cp\u003eevent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExperimental group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhu \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 weeks/16 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eMDA,PC,SOD,CAT,GSH-PX,T-AOC, BU, CK,T, and C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSi-Hwa \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10/10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3 weeks/3 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eHR、BLA、ALT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBraulio \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11/11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.39ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 weeks/1 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e100min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCK、AST、ALT、LDH、RPE、RPR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidiyanto \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20/10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.8ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRPE、BLA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThibaud \u003csup\u003e[22]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12/12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e75min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eHRV、BLA、PE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChaoyi \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12/12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.29 ATA and 40%-50% oxygen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 days / 2 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eRPE、HR、SpO2、SLJ、CK、BUN、SOD、MDA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJinhee \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6/6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.5 ATA, 100% oxygen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60 min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBE、AH、CK、LDH、BAP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKormanovski \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22/12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.5 ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8 days / 2 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e75min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eGlu、TG、CK、HCT、PLT、AOC、GPx、SOD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMa \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8/7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3ATA、28%-30% oxygen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6 weeks/18 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eHRV、WBC、T、T/C、BU、CK、Cr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLi \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10/10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.2ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 weeks/4 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e120min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eAST、LDH、HBDH、WBC、CK、Hb、PLT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTao \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6/6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.5 ATA, 100% oxygen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e85min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eHR、RPE、BUN、BL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBi \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15/15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0/30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.5 ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e85min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eHR、BLA、RPE、CK、BUN、T、C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiu \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.2ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e85min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eHR、BLA、RPE、CK、BUN、T、C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhang \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10/10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10/10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3 ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 weeks/16 times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eHRV、WBC、T、T/C、BU、CK、Cr\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBi \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8/8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8/0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.5 ATA-3.0 ATA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNatural recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1 time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eHR、BLA、BUN、T/C、CK\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eNot mentioned\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable Notes: ATA\u003c/b\u003e: Absolute atmospheric pressure. \u003cb\u003eALT\u003c/b\u003e: Alanine transaminase. \u003cb\u003eAST\u003c/b\u003e: Aspartate transaminase. \u003cb\u003eBAP\u003c/b\u003e: Bioactive peptides. \u003cb\u003eBLA\u003c/b\u003e: Blood lactate. \u003cb\u003eBU\u003c/b\u003e: Blood urea. \u003cb\u003eC\u003c/b\u003e: Cortisol. \u003cb\u003eCAT\u003c/b\u003e: Catalase. \u003cb\u003eCK\u003c/b\u003e: Creatine kinase. \u003cb\u003eGlu\u003c/b\u003e: Glucose. \u003cb\u003eHR\u003c/b\u003e: Heart rate. \u003cb\u003eHRV\u003c/b\u003e: Heart rate variability. \u003cb\u003eLDH\u003c/b\u003e: Lactate dehydrogenase. \u003cb\u003eMDA\u003c/b\u003e: Malondialdehyde. \u003cb\u003ePC\u003c/b\u003e: Protein carbonyl. \u003cb\u003ePE\u003c/b\u003e: Pulmonary embolism. \u003cb\u003ePLT\u003c/b\u003e: Platelets. \u003cb\u003eRPE\u003c/b\u003e: Rating of perceived exertion. \u003cb\u003eSOD\u003c/b\u003e: Superoxide dismutase. \u003cb\u003eSpO2\u003c/b\u003e: Oxygen saturation. \u003cb\u003eT\u003c/b\u003e: Testosterone. \u003cb\u003eWBC\u003c/b\u003e: White blood cells.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Quality Evaluation of Included Literature\u003c/h2\u003e\u003cp\u003eThe quality of the 15 included articles was evaluated based on the Physiotherapy Evidence Database (PEDro) standards. All articles were rated as relatively high-quality, with scores of 6 or higher, indicating strict inclusion criteria and reliable methodology. Most scored between 6 and 8 points. Detailed PEDro scores are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The overall high quality of the included literature ensures the credibility of the findings. Risk of bias assessment, following the Cochrane Collaboration's criteria, is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePEDro Scores of Included Literature\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"15\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst Author\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eyear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSubjects were included in the conditions\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRandomized\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAssign hidden\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eThe baseline is similar\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSubjects were blinded\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eParticipants were blinded\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOutcome measures were blinded\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eMore than 85% of people were given at least one primary outcome measure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eIntention-to-treat analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003eInter-group statistical report\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eOutcome point test values and variant measurements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003ePEDroscore\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003eQuality evaluation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhu\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSi-Hwa\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBraulio\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidiyanto\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThibaud\u003csup\u003e[22]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChaoyi\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJinhee\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKormanovski\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMa \u003csup\u003e26]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLi \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTao \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBi \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiu \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZhang \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBi\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c14\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003eHigh quality\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable note: + indicates that the corresponding indicator is met; - The representative does not meet the corresponding indicators; Baseline similarity refers to the similarity of groups at baseline for important prognostic measures; Blinding refers to blinding; More than 85% of people were measured for at least one primary outcome, meaning that if not reported, they were taken as negative outcomes; Intention-to-treat analysis means that all participants complete trials and tests as required, with at least one primary outcome if not, and negative outcomes if not reported.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Meta-Analysis Results\u003c/h2\u003e\u003cp\u003eThis study categorizes the effects of hyperbaric oxygen therapy (HBOT) on the recovery from exercise-induced fatigue based on the research by Zhu Huan (2022) \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. The specific categories are as follows:\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeta-Analysis of the Effects of Hyperbaric Oxygen on Post-Exercise Heart Rate in Athletes. Heart Rate\u003c/b\u003e: Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 7 articles involving a total of 71 cases examined the impact of heart rate recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P\u0026thinsp;\u0026lt;\u0026thinsp;0.1, I\u0026sup2; = 72%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -4.3, 95% CI = -5.91 to -2.69, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMeta-Analysis of the Effects of Hyperbaric Oxygen on Post-Exercise Blood Urea, Creatine Kinase, Testosterone, and Cortisol in Athletes\u003c/p\u003e\u003cp\u003e\u003cb\u003eBlood Urea\u003c/b\u003e: Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 6 articles involving a total of 59 cases examined the impact of blood urea recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P\u0026thinsp;=\u0026thinsp;0.02, I\u0026sup2; = 62%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -0.51, 95% CI = -0.73 to -0.30, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCreatine Kinase\u003c/b\u003e: Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 11 articles involving a total of 107 cases examined the impact of creatine kinase recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P\u0026thinsp;\u0026lt;\u0026thinsp;0.1, I\u0026sup2; = 80%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated no significant difference between the two groups (SMD = -5.82, 95% CI = -16.34 to 4.70, P\u0026thinsp;=\u0026thinsp;0.28). This result suggests that hyperbaric oxygen does not have a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTestosterone\u003c/b\u003e: Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 4 articles involving a total of 45 cases examined the impact of testosterone recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P\u0026thinsp;=\u0026thinsp;0.12, I\u0026sup2; = 80%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated no significant difference between the two groups (SMD = -5.82, 95% CI = -16.34 to 4.70, P\u0026thinsp;=\u0026thinsp;0.28). This result suggests that hyperbaric oxygen does not have a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCortisol\u003c/b\u003e: Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 4 articles involving a total of 45 cases examined the impact of cortisol recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P\u0026thinsp;=\u0026thinsp;0.08, I\u0026sup2; = 55%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD\u0026thinsp;=\u0026thinsp;0.77, 95% CI\u0026thinsp;=\u0026thinsp;0.16 to 1.37, P\u0026thinsp;=\u0026thinsp;0.01). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTestosterone/Cortisol Ratio\u003c/b\u003e: Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 4 articles involving a total of 45 cases examined the impact of the testosterone/cortisol ratio recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P\u0026thinsp;=\u0026thinsp;0.03, I\u0026sup2; = 68%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -2.38, 95% CI = -4.55 to -0.21, P\u0026thinsp;=\u0026thinsp;0.03). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMeta-Analysis of the Effects of Hyperbaric Oxygen on Post-Exercise Lactate and Other Metabolic Products in Athletes\u003c/p\u003e\u003cp\u003e\u003cb\u003eBlood Lactate\u003c/b\u003e: Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 7 articles involving a total of 69 cases examined the impact of blood lactate recovery after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P\u0026thinsp;\u0026lt;\u0026thinsp;0.1, I\u0026sup2; = 90%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -1.19, 95% CI = -1.54 to -0.83, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMeta-Analysis of the Effects of Hyperbaric Oxygen on Post-Exercise Subjective Fatigue Perception in Athletes\u003c/p\u003e\u003cp\u003e\u003cb\u003eSubjective Fatigue Perception\u003c/b\u003e: Among the 15 articles included in the study on the effects of hyperbaric oxygen on post-exercise fatigue in athletes, 5 articles involving a total of 56 cases examined the impact of subjective fatigue perception after exercise in the experimental group (hyperbaric oxygen) compared to the control group (natural recovery). The heterogeneity test results showed: P\u0026thinsp;\u0026lt;\u0026thinsp;0.1, I\u0026sup2; = 81%, indicating high heterogeneity. Therefore, a random-effects model was used for the meta-analysis. The meta-analysis results indicated a significant difference between the two groups (SMD = -1.89, 95% CI = -2.45 to -1.33, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This result suggests that hyperbaric oxygen has a significant effect on the recovery from post-exercise fatigue in athletes. For more details, see Fig.\u0026nbsp;\u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e11\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Subgroup Analysis Results\u003c/h2\u003e\u003cp\u003eSubgroup analysis was conducted for creatine kinase with different hyperbaric oxygen interventions using moderator variables (see Fig.\u0026nbsp;12for detailed results). The study results showed that the I\u0026sup2; values for intervention pressure, number of interventions, sample size, and intervention duration were all 0, indicating no heterogeneity in the analysis results. However, the P-values were all greater than 0.05, suggesting that hyperbaric oxygen does not have a significant effect on the recovery from post-exercise fatigue in athletes. The combined effect results support this evaluation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Publication Bias Analysis Results\u003c/h2\u003e\u003cp\u003eIn the included studies, the most commonly analyzed indicators for intervention effects were blood urea, creatine kinase, testosterone, and cortisol. Therefore, funnel plots were used to analyze publication bias for these indicators (see Fig.\u0026nbsp;\u003cspan refid=\"Fig13\" class=\"InternalRef\"\u003e13\u003c/span\u003e. The funnel plots show that the distribution of the studies is roughly symmetrical, suggesting that there is no publication bias or other biases in the studies.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.7 Sensitivity Analysis Results\u003c/h2\u003e\u003cp\u003eTo verify the stability and reliability of the aforementioned meta-analysis results, sensitivity analyses were conducted by excluding each of the 15 included articles one by one and then performing the meta-analysis again. The results showed that the effects of hyperbaric oxygen therapy (experimental group) versus natural recovery (control group) on blood urea, testosterone, cortisol, heart rate, subjective fatigue perception, and lactate and other metabolic products did not change significantly, confirming the robustness of the study results. However, the results for creatine kinase in the recovery from post-exercise fatigue showed changes. When the data from Braulio's study were excluded, the P-value for the effect of hyperbaric oxygen on creatine kinase levels after exercise changed significantly (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), indicating that these study data had a substantial impact on the overall effect size. See Fig.\u0026nbsp;\u003cspan refid=\"Fig14\" class=\"InternalRef\"\u003e14\u003c/span\u003e for details.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Evidence Summary\u003c/h2\u003e\u003cp\u003eThis study included 15 articles to systematically investigate the effects of hyperbaric oxygen on the recovery from exercise-induced fatigue in athletes, focusing on blood urea, testosterone, cortisol, heart rate, creatine kinase, subjective fatigue perception, and lactate and other metabolic products. Quantitative comparisons were made with natural recovery. The results showed that hyperbaric oxygen has a significant impact on heart rate, blood urea, cortisol, blood lactate, and subjective fatigue perception, demonstrating significant fatigue recovery effects. However, the effects of hyperbaric oxygen on creatine kinase and testosterone were not significant.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003e4.2Effect of hyperbaric oxygen on sports fatigue in athletes\u003c/h2\u003e\u003cp\u003eEffects of Hyperbaric Oxygen on Heart Rate Recovery in Athletes\u003c/p\u003e\u003cp\u003ePost-exercise heart rate recovery speed is an important indicator for evaluating exercise-induced fatigue \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Hyperbaric oxygen intervention can promote rapid heart rate recovery after exercise. Studies have found that both low-pressure hyperbaric oxygen (1.3\u0026ndash;1.7 ATA) and high-pressure hyperbaric oxygen (2.5-3 ATA) have positive effects on post-exercise heart rate recovery. The mechanism may involve the upregulation of parasympathetic nervous system activity by hyperbaric oxygen, leading to a decrease in heart rate (HR) and enhanced autonomic nervous system balance \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. Additionally, hyperbaric oxygen intervention helps to restore neurological function after intense exercise, improving heart rate variability \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. Heart rate variability is a non-invasive indicator for monitoring athletes' training adaptation and fatigue status, and it serves as an early warning signal for physical fatigue damage \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. Furthermore, mild hyperbaric oxygen intervention can also improve athletes' neurological function and promote fatigue elimination \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. Research has shown that mild hyperbaric oxygen (1.3 ATA) intervention can improve sleep quality by balancing sympathetic and vagal nerve tension in boxers \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. Although both hyperbaric oxygen and mild hyperbaric oxygen interventions can enhance the function of the vagal nervous system and increase heart rate variability, the individual variability in heart rate variability is significant. Therefore, when evaluating the recovery effects of hyperbaric oxygen using heart rate variability, individual differences should be fully considered.\u003c/p\u003e\u003cp\u003eEffects of Post-Exercise Hyperbaric Oxygen Intervention on Blood Urea, Creatine Kinase, Testosterone, and Cortisol\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eBlood Urea\u003c/strong\u003e\u003cp\u003eBlood urea is the final product of protein metabolism in the body \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. After prolonged exercise, the energy balance within muscles is disrupted, leading to increased protein and amino acid catabolism, which elevates blood urea levels \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. Studies have found that hyperbaric oxygen intervention can accelerate the recovery of blood urea levels in athletes after exercise. Moreover, hyperbaric oxygen rehabilitation therapy not only reduces blood urea levels associated with exercise fatigue but also increases brain hemoglobin and hemoglobin content \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e. In animal experiments, hyperbaric oxygen intervention has been shown to improve renal hypoxia in fatigued rats, promoting kidney function recovery and accelerating urea excretion, thereby reducing blood urea levels \u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e. In summary, hyperbaric oxygen helps to expedite the recovery of blood urea levels in athletes, thereby alleviating exercise-induced fatigue.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCreatine Kinase\u003c/strong\u003e\u003cp\u003eCreatine kinase is an enzyme directly related to muscle contraction \u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e. Under normal circumstances, exercise can cause muscle cell damage or changes in permeability, forcing an increase in creatine kinase levels in the blood, and this change is related to the intensity and duration of exercise \u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e. Therefore, creatine kinase is often used as an indicator of muscle damage after exercise. Studies have found that hyperbaric oxygen is not effective in intervening in delayed-onset muscle soreness \u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e. The conclusions regarding the effects of hyperbaric oxygen on creatine kinase levels are inconsistent. Most studies show that hyperbaric oxygen therapy can help recover creatine kinase levels, but a few studies have found that hyperbaric oxygen is less effective than natural recovery in restoring creatine kinase levels. Some scholars suggest that this may be related to the type of muscle cell membrane damage \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e. When mechanical stretching causes physiological damage to muscle fibers, the damage can naturally recover after rest, and hyperbaric oxygen intervention does not further enhance recovery. However, when hypoxia induces increased permeability of the muscle cell membrane, hyperbaric oxygen intervention can promote membrane repair and reduce creatine kinase levels in the blood, although the exact physiological mechanisms require further research \u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTestosterone and Cortisol\u003c/strong\u003e\u003cp\u003eTestosterone promotes protein synthesis and enhances muscle function in athletes \u003csup\u003e[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e, while cortisol has the opposite effect \u003csup\u003e[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e. The ratio of testosterone to cortisol is a good indicator of metabolic status. Studies have found that hyperbaric oxygen does not accelerate the recovery of testosterone levels in athletes after exercise but can help recover cortisol levels. The differences in study results may be related to factors such as the type of sport, athletic level, health status, and the timing of sample collection \u003csup\u003e[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/sup\u003e. Additionally, the effects of hyperbaric oxygen on testosterone may also be gender-related. As a sex hormone, testosterone is closely associated with gender, and the effects of hyperbaric oxygen on testosterone may differ between genders, requiring further research to confirm \u003csup\u003e[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eEffects of Post-Exercise Hyperbaric Oxygen Intervention on Lactate and Other Metabolic Products\u003c/p\u003e\u003cp\u003eLactate is a product of anaerobic metabolism of glycogen in the body after exercise, which occurs to rapidly replenish energy \u003csup\u003e[\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/sup\u003e. After exercise, the rapid removal of lactate and other metabolic products is crucial for the recovery of physical function. Studies have shown that hyperbaric oxygen therapy helps to accelerate the clearance of lactate and other metabolic products. Both hyperbaric oxygen and mild hyperbaric oxygen interventions can enhance the clearance of lactate after intense exercise, promoting lactate breakdown and reducing lactate levels in the blood \u003csup\u003e[\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eEffects of Post-Exercise Hyperbaric Oxygen Intervention on Subjective Fatigue Perception and Psychological State\u003c/p\u003e\u003cp\u003eSubjective fatigue perception is a common indicator for evaluating the state of exercise-induced fatigue in athletes \u003csup\u003e[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e61\u003c/span\u003e]\u003c/sup\u003e. In the included studies, subjective fatigue perception was primarily measured using self-perceived exertion scales. The results indicate that hyperbaric oxygen has a significant effect on subjective fatigue perception in athletes. Additionally, hyperbaric oxygen recovery may have a beneficial psychological soothing effect, reducing subjective fatigue perception through its placebo effect. Beyond this, researchers have also used traditional Chinese medicine techniques such as acupuncture \u003csup\u003e[62]\u003c/sup\u003e and moxibustion \u003csup\u003e[\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/sup\u003e to alleviate subjective fatigue perception.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Limitations of the Study\u003c/h2\u003e\u003cp\u003eDespite the rigorous screening and careful exclusion of the included studies, certain limitations still exist: ①Literature Search: Unpublished literature documents were not included in the search, and some of the included studies lacked data. ②Gender Bias: Fewer female participants were included in the studies, which could introduce bias. ③Variability in Study Design: There were significant differences in study design among the included studies, particularly in terms of training intensity. Some studies did not provide specific training regimens. ④Lack of Standardization: While hyperbaric oxygen therapy has been shown to aid in the recovery from exercise-induced fatigue, there is no unified standard for its application. Differences in training protocols and testing methods across various interventions led to heterogeneity in some data, potentially introducing bias into the results.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003e4.4 Applicability and Implications for the Future\u003c/h2\u003e\u003cp\u003eThis article uses a meta-analysis approach to further validate the effectiveness of hyperbaric oxygen in managing exercise-induced fatigue in athletes. By comparing hyperbaric oxygen intervention with natural recovery, significant differences were observed in several indicators post-intervention. The findings suggest that hyperbaric oxygen is applicable for promoting healing, reducing inflammation, and improving energy metabolism, thereby alleviating exercise-induced fatigue in athletes. However, some uncertainties remain in the results, such as the inconsistency in the effects on creatine kinase, an important indicator of exercise-induced fatigue.\u003c/p\u003e\u003cp\u003eFor future research, it would be beneficial to deepen the investigation into the effects of hyperbaric oxygen on different types of sports and various athlete populations. Personalized hyperbaric oxygen treatment plans should be developed based on the unique characteristics of individual athletes. Additionally, integrating hyperbaric oxygen therapy with other recovery techniques (such as cold therapy, massage, and nutritional recovery) to form comprehensive recovery programs could enhance the overall recovery from exercise-induced fatigue in athletes.\u003c/p\u003e\u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThe primary applications of hyperbaric oxygen in sports include pre-exercise preconditioning, exercise under hyperbaric conditions, and post-exercise intervention (for treating sports injuries and eliminating exercise-induced fatigue). Pre-exercise hyperbaric oxygen preconditioning has anti-fatigue and performance-enhancing effects, improving the body\u0026apos;s adaptation to hypoxia. Hyperbaric conditions enhance the body\u0026apos;s oxygen supply, delaying the onset of exercise-induced fatigue and improving performance. Post-exercise hyperbaric oxygen intervention promotes the recovery from muscle contusions and ligament injuries, eliminates exercise-induced fatigue, reduces subjective fatigue perception, and enhances athletic performance. However, further research is needed to clarify the specific effects of hyperbaric oxygen on creatine kinase, testosterone, cortisol, and the oxidative-antioxidant system.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol has been registered with the International Prospective Register of Systematic Reviews (CRD42024587174).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll our participants agreed to publish this article\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data in the article can be obtained from public websites\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors of this article have a conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no financial support from any sponsor.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors\u0026rsquo;\u0026nbsp;contributions to this work are as follows:\u003c/p\u003e\n\u003cp\u003eKai Chen: Conceptualization, Methodology, Investigation, Data Curation, Formal Analysis, Writing\u0026nbsp;\u0026ndash;\u0026nbsp;Original Draft.\u003c/p\u003e\n\u003cp\u003eCheng Chen\u0026nbsp;\u0026dagger;: Software, Validation, Visualization, Data Curation, Writing\u0026nbsp;\u0026ndash;\u0026nbsp;Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e**Zhongdong Li ***: Conceptualization, Resources, Funding Acquisition, Supervision, Project Administration, Writing\u0026nbsp;\u0026ndash;\u0026nbsp;Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eJincheng Yang: Investigation, Resources, Validation, Writing\u0026nbsp;\u0026ndash;\u0026nbsp;Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003e\u0026dagger;\u0026nbsp;These authors contributed equally to this work.\u003c/p\u003e\n\u003cp\u003e***** Corresponding author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the authors for their efforts\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGheorghe CM. 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PMID: 25785701.\u003c/li\u003e\n\u003cli\u003eYu P, Zhu Z, He J, Gao B, Chen Q, Wu Y, Zhou J, Cheng Y, Ling J, Zhang J, Shi A, Huang H, Sun R, Gao Y, Li W, Liu X, Yan Z. Effects of high-intensity interval training, moderate-intensity continuous training, and guideline-based physical activity on cardiovascular metabolic markers, cognitive and motor function in elderly sedentary patients with type 2 diabetes (HIIT-DM): a protocol for a randomized controlled trial. Front Aging Neurosci. 2023 Aug 15;15:1211990. doi: 10.3389/fnagi.2023.1211990. PMID: 37649720; PMCID: PMC10465302.\u003c/li\u003e\n\u003cli\u003eTeng J, Yuan C, Guo Y, et al. Effect of Hyperbaric Oxygen on Blood Biochemical Parameters in Rats with Exercise Fatigue[J]. 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Journal of Traditional Chinese Medicine, 2019, 30(09): 2197-2199.:doi:103969/jissn1008-0805201909049\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hyperbaric oxygen, exercise-induced, athletes, Meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-8185331/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8185331/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFifteen 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\u0026thinsp;\u0026lt;\u0026thinsp;0.05), blood urea (SMD = -0.51, 95% CI = -0.73 to -0.3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), cortisol (SMD\u0026thinsp;=\u0026thinsp;0.77, 95% CI\u0026thinsp;=\u0026thinsp;0.16 to 1.37, P\u0026thinsp;=\u0026thinsp;0.01), and blood lactate (SMD = -1.19, 95% CI = -1.54 to -0.83, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant effects were observed for creatine kinase, testosterone, or subjective fatigue perception (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Subgroup analysis showed that intervention pressure, frequency, sample size, and duration did not significantly influence creatine kinase recovery post-exercise.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eHBOT 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.\u003c/p\u003e","manuscriptTitle":"Meta-analysis of the effect of hyperbaric oxygen therapy on exercise-induced fatigue in athletes after exercise","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 16:31:57","doi":"10.21203/rs.3.rs-8185331/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-23T09:29:00+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-22T20:57:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"317582278714636821897958223163610696812","date":"2025-12-22T00:14:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-21T17:30:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337390530969504160861036574571401695479","date":"2025-12-21T17:25:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229126091249350712796946398558959597950","date":"2025-12-21T00:24:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311384237031639947012130984203608578383","date":"2025-12-20T15:44:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"330708176820504971210626712918560082359","date":"2025-12-19T16:44:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-19T04:58:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76553298695156443998543223119906664065","date":"2025-12-19T04:17:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-18T17:03:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200562202442086952148200143158874258537","date":"2025-12-18T16:19:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252411741282818929680501627984639057293","date":"2025-12-18T16:18:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-18T14:29:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294693124316345063410882062146189643995","date":"2025-12-16T01:25:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101024457324026877307074793967545929881","date":"2025-12-12T06:56:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311071125679950529634464233584906708609","date":"2025-12-07T09:55:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-07T09:27:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-01T23:23:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-01T23:23:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Sports Science, Medicine and Rehabilitation","date":"2025-11-23T12:21:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-sports-science-medicine-and-rehabilitation","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssmr","sideBox":"Learn more about [BMC Sports Science, Medicine and Rehabilitation](http://bmcsportsscimedrehabil.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ssmr/default.aspx","title":"BMC Sports Science, Medicine and Rehabilitation","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"526fb837-3cb5-4224-9bb4-49b6f8c96baa","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T10:08:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 16:31:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8185331","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8185331","identity":"rs-8185331","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}