Operator reference

Programme Design

This page is operator guidance for designing ethical, evidence-based HBOT programmes in the longevity and wellness context. It is not a clinical protocol and does not replace clinician-led patient assessment. Programmes designed for wellness use sit outside FDA- approved indications; the framing throughout this page is consistent with that scope.

Patient screening

Programme entry should follow a structured pre-assessment that addresses the same safety considerations applied in clinical HBOT (see the Safety & Contraindications page). At minimum:

  • Comprehensive medical history (cardiac, pulmonary, neurological, oncological).
  • Current medication review (chemotherapeutic agents, disulfiram, insulin and sulphonylureas).
  • Tympanic membrane and Eustachian tube assessment.
  • Pregnancy status where applicable.
  • Claustrophobia / anxiety screening.
  • Goal definition: cognitive, athletic recovery, fatigue / sleep, general wellness — distinct goals carry different protocol implications.
  • Realistic-expectations conversation: HBOT in wellness is not a treatment for any FDA-approved condition; effects are modest, individual-variable, and require sustained adherence.

Protocol selection

Programme protocols should be aligned to the evidence base for the goal being addressed. Select the source-cited protocol rather than improvising:

  • Cognitive enhancement — 60 sessions, 2.0 ATA, 90 min, 5×/week (Hadanny 2020 RCT in healthy older adults).
  • Telomere lengthening / cellular senescence — 60 sessions, 2.0 ATA, 90 min, 5×/week.
  • Athletic recovery — short courses (10–20 sessions per cycle, post-exercise or daily); evidence is preliminary.
  • General wellness / fatigue — no validated wellness-specific protocol exists; if undertaken, the cognitive/longevity protocol is the closest source-cited reference.
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Frequency and duration norms

  • Standard wellness programme: 40–60 sessions over 12–14 weeks at 5×/week, 90 min per session, 2.0 ATA.
  • Maintenance phase: not standardised. Some operators offer monthly maintenance sessions; evidence for maintenance benefit is not established.
  • Cycle structure: continuous 5-day weeks with weekend rest is the most cited cadence; daily 7-day cadence is not better-supported and increases adverse-event risk.

Outcome measurement

What an operator can ethically measure depends on what the underlying evidence supports. Track conservatively; report honestly.

  • Cognitive programmes: validated cognitive batteries (information processing speed, attention, memory) measured pre and post.
  • Telomere / senescence programmes: laboratory telomere-length measurement is feasible but expensive; most operators do not offer it routinely. Self-reported energy/sleep is not a substitute for biological markers.
  • Athletic recovery: subjective recovery scales, lactate clearance where measurable, sleep tracking.
  • General wellness: validated patient-reported outcome measures (e.g. SF-36, PROMIS); avoid bespoke questionnaires that are not psychometrically validated.

Claim boundaries

The following claims should not be made about a wellness HBOT programme. Each is either explicitly outside the evidence base or actively contraindicated by current literature:

  • "Anti-cancer" effects — HBOT is contraindicated with several chemotherapeutic agents and is not an oncological treatment.
  • Treatment of autism spectrum disorder, multiple sclerosis, cerebral palsy, or Lyme disease — none of these are evidence-supported HBOT indications.
  • "Detox", "anti-aging cure", or "DNA repair" framings — marketing language without scientific basis.
  • Specific lifespan-extension or "biological age reversal" claims — the underlying telomere-length data does not translate to lifespan claims.
  • Treatment of psychiatric conditions other than where evidence exists (e.g. PTSD evidence is mixed).
  • Use during the first trimester of pregnancy except for emergency indications.

Compliance and adherence

  • Adherence below ~80% of scheduled sessions reduces likelihood of measurable benefit; this should be set as a programme expectation at consent.
  • Drop-out reasons should be tracked: middle-ear barotrauma, anxiety, scheduling difficulty, perceived lack of benefit.
  • Re-entry policy: a paused programme may resume within 4–6 weeks without significant cycle reset; longer pauses warrant restart from baseline assessment.
  • Documentation: every session logged with pressure, duration, time started, adverse events, and patient-reported tolerability.

This guidance reflects current evidence and practice norms. It is operator reference, not regulatory advice. Local healthcare and consumer-protection regulations apply and may impose additional requirements on programme design and claim language.