Hyperbaric Oxygen Therapy for Physical and Cognitive Performance in Older Adults: A Systematic Review.

Abstract

Background and objective: Hyperbaric oxygen therapy (HBOT) has been investigated as a potential intervention to counteract age-related declines in cognitive and physical performance. This systematic review aimed to evaluate the effects of HBOT on these domains in older adults.

Methods: A systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (ID: CRD420251122497). A comprehensive search from inception to November 2025 was performed in PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, and Google Scholar to identify studies evaluating HBOT in individuals aged ≥50 years. Eligible studies assessed cognitive and/or physical outcomes using validated measures, adverse events when reported, and risk of bias was evaluated using the modified Downs and Black checklist.

Results: Seven studies with 502 participants aged 51-85 years met the inclusion criteria. HBOT protocols varied in pressure (2.0-2.2 absolute atmospheres), duration (60-90 min), and frequency (five to six sessions/week). Two high-quality studies in healthy older adults reported significant improvements in global cognition, attention, executive function, and processing speed as well as enhanced aerobic capacity and pulmonary function. In clinical populations including Parkinson's disease, cerebral small vessel disease, and vascular dementia, moderate-quality studies reported that HBOT combined with pharmacological treatments yielded greater cognitive gains than monotherapy. Physical improvements in these groups were mainly inferred from quality of life and symptom scores. Four studies reported HBOT-related adverse events, which were generally mild and self-limiting. Follow-up intervals ranged from 1 to 4 weeks to ≈12 weeks, limiting conclusions about durability of effects.

Conclusion: HBOT may improve cognitive performance in both healthy and clinical older adults and may offer modest benefits for physical performance, although physical improvements were sometimes inferred from functional or indirect measures. However, these findings remain preliminary given the limited number of studies, protocol heterogeneity, and moderate methodological quality. Reported adverse events were generally mild.

Implications: HBOT may offer a novel therapeutic option to enhance cognitive performance and potentially improve physical and functional outcomes in older adults thereby supporting healthier aging and greater independence in daily life.