Is Supplemental Oxygen a Performance-Enhancing Drug?

You often see a football player on the sidelines breathing oxygen after running a long distance or having worked hard during a long series of plays.

Have you ever wondered if it works? Does breathing a high concentration of oxygen help an athlete recover from exertion faster?

The answer is a resounding “No,” and here’s why…

In healthy people, such as college and professional football players, nearly all of the oxygen in the blood is carried by hemoglobin. Only a very small percentage is dissolved in blood. Saturation defines the oxygen that is attached to hemoglobin and partial pressure of oxygen is that which is dissolved in blood.

Definitions: SaO₂ = arterial oxygen saturation, Hb = hemoglobin, 1.34 mL is the amount of oxygen a fully saturated gram of hemoglobin can carry, Pa0₂ = partial pressure of oxygen or the amount of oxygen dissolved in blood.

If an athlete has a normal Hb level of 15 gm, a SaO₂ of 100% and a PaO₂ of 100 mmHg, the formula used to calculate his blood oxygen content is:

[Hb X 1.34 X (SaO₂/100)] + 0.003 X PaO₂ or [15 X 1.34 X 100/100] + 0.003 X 100 so 20.1 + 0.3 = 20.4 mL/100 mL of blood

Only about 1.5% of the oxygen content of blood is dissolved.

If an athlete raises his PaO₂ to 400 mmHg by breathing pure oxygen the calculation is:

[Hb X 1.34 X (SaO₂/100)] + 0.003 X PaO₂ or [15 X 1.34 X 100/100] + 0.003 X 400

20.1 + 1.2 = 21.3 mL/100 mL of blood

Even at a PaO₂ of 400 mmHg, only 5.6% of the oxygen content of blood is dissolved. Note that hemoglobin cannot be more than 100% saturated with oxygen.

Very soon after the athlete stops breathing the pure oxygen, its minimal effect disappears. It’s simply not enough to affect recovery or performance.

Possibly because the basic science is well-understood, there have not been too many papers on this subject.

A study from JAMA looked at 12 soccer players given 100% oxygen or placebo after exertion. Then they had to exercise again. “The administration of enriched oxygen during the recovery period had no effect on plasma lactate levels [an objective measure of recovery] or on performance during the second period of exercise. The subjects were unable to identify which gas they received.”

A similar study of 13 athletes from Medicine & Science in Sports & Exercise concluded: “These findings offer no support for the use of supplemental oxygen in athletic events requiring short intervals of submaximal or maximal exertion.”

Another from the European Journal of Applied Physiology found that giving athletes supplemental oxygen during the recovery periods of interval-based exercise improves the recovery time of SpO₂ (equivalent to SaO₂), but it did not improve post-exercise markers of reactive oxygen species or inflammatory responses because the improvement in saturation was clinically insignificant.

The situation is explained in simple terms in an excerpt from the book “Exercise Physiology: Integrating Theory and Application.” It concludes that supplemental oxygen may have a placebo effect, but there is “no real physiologic benefit.”

If you Google “supplemental oxygen and athletes,” you will find a number of websites touting the supposed benefits of inhaled oxygen. They are almost all supported by companies that sell oxygen.

Bottom line: Supplemental oxygen is not considered a performance-enhancing drug because it doesn’t work.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 800 page views per day, and he has over 5100 followers on Twitter.