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S. Junges1, R. Dias Molina2, C. Bittencourt Jacondino1, M. Lopes Da Poian3, E. Tatsch4, R. Noal Moresco4, M.G. Valle Gottlieb1


1. Graduate Program in Biomedical Gerontology of the Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; 2. Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil; 3. Pharmacist, Graduate of the Lutheran University of Brazil, Porto Alegre, Brazil. 4. Department of Clinical and Toxicological Analysis, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil.

Corresponding Author: Maria Gabriela Valle Gottlieb, Avenida Ipiranga, 6681 – Prédio 81, 7º andar, sala 703, CEP: 90619-900, Porto Alegre, RS, Brasil, E-mail: maria.gottlieb@pucrs.br


J Aging Res Clin Practice 2017;6:80-87
Published online May 4, 2017, http://dx.doi.org/10.14283/jarcp.2017.7



Objective: To verify the effectiveness of Pilates and Camellia sinensis extract (CSE) supplementation on cardiometabolic risk factors and redox markers in postmenopausal women. Design: A placebo-controlled, randomized trial. Setting: community-dwelling postmenopausal women without disability. Participants: fifty postmenopausal women volunteers with cardiometabolic risk factors (high waist circumference, triglycerides, HDL-c, glucose and blood pressure). The volunteers participants were randomized in four groups: Pilates+CSE (14); Pilates+Placebo (11); CSE (11); and Placebo (14). Intervention: the CSE and Pilates+CSE intervention groups consumed one 500mg CSE capsule with excipient per day for 24 weeks. The Placebo group consumed one capsule with a placebo excipient per day for 24 weeks. Pilates training was performed twice weekly for 60 minutes each time, over 24 weeks. Measurements: cardiometabolic risk factors (glucose, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides, high-density lipoproteins-HDL-c) and oxidative metabolism markers (advanced oxidation protein products (AOPP), ferric-reducing ability of plasma (FRAP), nitrosative stress marker (NOx), ischemia modified albumin (IMA). Results: When baseline variables were adjusted, the WC of the Pilates + CSE was significantly lower than that of the CSE and Placebo groups after the intervention (p<0,001).The triglycerides levels of the Pilates + CSE and Pilates + Placebo groups were significantly lower than those of the Placebo group (p= 0,010) . The glucose levels of the Pilates + CSE group were significantly lower than those of the Placebo group (p= 0,041). Whitin-group pre and post intervention comparison showed that Pilates+CSE group presented the best effect in some cardiometabolic risk factors, with significant reductions in tree cardiometabolic risk factor: waist circumference, triglycerides, glucose and FRAP (P=0.003, P<0.001, P=0.021 and P=0.041, respectively). The Pilates+Placebo group was found to be effective in reducing triglycerides (P=0.002), while the CSE group presented increased post-intervention NOx levels (p= 0.009). Conclusion: Our results suggest that Pilates and Camellia sinensis extract intervention may help to reduce some cardiometabolic risk factors in postmenopausal women.


Key words: Cardiometabolic risk factor, Pilates method, camellia sinensis, oxidants, antioxidant, women.



Cardiovascular diseases (CVD) are the main cause of morbidity and mortality in developed countries and development, as is the case in Brazil (1). There are several cardiovascular risk factor, however due to its high morbidity burden and prevalence in populations, obesity, diabetes, dyslipidemia and sedentary lifestyle stand out (1-3). Additionally, cardiometabolic risk factors are those involved in the development of type 2 DM and CVD due to a set of modifiable risk factors (1-3). In this sense, several studies have demonstrated that sedentarism is one of the main risk factors that can contribute to the onset of metabolic disorders and CVD (4-7). In parallel, studies involving lifestyle modifications, such as adherence to a balanced and healthy diet and the practice of regular physical exercise, have presented beneficial results for both weight reduction and MetS components (8-10). The evidence for this has been demonstrated in research indicating that both physical exercise and bioactive dietary compounds are able to maintain the oxidation process within physiological limits, controlling damage to macromolecules, which can lead to systemic damage that is often irreversible (8-9, 11). In this context, the Pilates exercise method (an exercise that combines strength and endurance) has emerged as a physical exercise with high numbers of participants in several countries, focusing on postural correction and acting on the back and abdominal muscles, thus helping prevent or mitigate the risk factors for cardiovascular and metabolic diseases (8). An important principle of this method is the respiratory maneuvers technique that demands a constant energy expenditure for all movements, preventing excessive cardiac stress, which is, in turn, reflected in the hemodynamic parameters (12, 13). Moreover, some studies involving Pilates have demonstrated its effectiveness in improving the body composition of postmenopausal women (12, 14). Yet physical exercise alone is not enough to prevent cardiometabolic risk factor and CVD, being essential the combination of a diet rich in bioactive components. The consumption of certain functional foods rich in bioactive and antioxidant substances, such as green tea that comes from the Camellia sinensis plant, can also be a strongally, contributing to the prevention of cardiometabolic risk factors and/or MetS, as well reducing oxidative processes (8, 11, 13). The Camellia sinensis plant presents a high content of flavonoids (catechins), which have a thermogenic effect and oxidize body fat. This can result in weight loss and decreased abdominal adiposity, and is therefore considered a powerful resource for the prevention of MetS components (15, 16). The antioxidant activity of green tea, other than it being rich in flavonoids, lies in its content of carotenoids, tocopherol, ascorbic acids and minerals (Zn, Ca, K, Mn), which enhance its antioxidant potential. Green tea polyphenols have in vitro antioxidant activity that neutralizes reactive oxygen and nitrogen species (17). Furthermore, they have also shown an ability to chelate metals, such as iron, preventing their participation in reactions that generate free radicals like Fenton and Haber-Weiss, which are extremely harmful to lipids, proteins and DNA (17). There is a gap in knowledge about the effects and benefits of the pilates method on cardiometabolic risk factors, as well as the combination of the method with functional foods such as camellia sinensis. Based on this evidence, this study aimed to verify the effectiveness of the Pilates training method and the use of Camellia sinensis extract (CSE) on cardiometabolic risk factors and redox markers in postmenopausal women.


Materials and methods

Study design

A placebo-controlled, randomized clinical trial

Population and sample: The population investigated were community-dwelling postmenopausal women without disability living in Porto Alegre, the capital city of Rio Grande do Sul state, Brazil. All women had a cardiometabolic risk factors and no history of cardiovascular event at the start of the study. Based on previous studies the initial sample size was 60 women, culminating in a final sample of 50 volunteers (9,12,18). The research was submitted to and approved by the Ethics Committee of the Pontifical Catholic University of Rio Grande do Sul (protocol n°474.390). Data collection began after approval and complied with requirements set out in Resolution 466/2012 of the Ministry of Health in relation to research involving humans. All participants signed the Consent Form. The project was sent to the Brazilian Clinical Trials Registry (ReBEC) and registered under number RBR-2sgtn2.


The recruitment campaign for community-dwelling post menopausal women with cardiometabolic risk factors was conducted via phone book, newspapers and were distributed of leaflets in pharmacies, health posts and supermarkets invited for the study. All women who presented clinical exams and a declared use of medications for diabetes, hypertension or dyslipidemia at the time of recruitment were considered to have cardiometabolic risk factors and were invited to participate in the study. After clarification of aspects related to the study, initial exams presented by the participants were analyzed in order to evaluate the cardiometabolic risk factors or MetS diagnosis, according to diagnostic criteria set by the National Cholesterol Education Program (NCEP), Expert Panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel) III NECP-ATPIII, of 2001 (2). After selection, volunteers were scheduled for blood collection and biochemical analysis to confirm the presence of the cardiometabolic risk factors or MetS components and to obtain anthropometric variables. The procedures for fasting blood collection, anthropometric measurements and blood pressure evaluation were explained to the participants and they were asked to sign the study Informed Consent Form. The inclusion criteria comprised: being in menopause for more than a year; and have cardiometabolic risk factors based on the NCEP-ATPIII (2001) criteria which include: altered WC: >102cm to man and >88cm (women), or dyslipidemia (TG ≥ 150mg/dl and HDL<40mg/dl (man), <50mg/dl (women);or systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg (or the use of antihypertensive medication);and/or fasting glycemia ≥ 110mg / dl (2). Women were excluded from the study if they reported previous cardiovascular events (acute myocardial infarction, stroke, angina, heart failure), suffered from liver, gastric or thyroid diseases, presented memory problems, anxiety or sleep disorders, had any physical condition that might make Pilates training impossible, had undertaken Pilates or any other form of regular physical exercise, habitually or regularly drink green tea, or took vitamin supplements.


All women with cardiometabolic risk factors were evaluated for exclusion criteria and those eligible were randomized, as shown in Figure 1. Randomization was performed through one-by-one drawing, using a box from which numbers corresponding to the women were randomly selected. In this way, the women were randomly divided into one of four groups: 1) Pilates+CSE (n=14); 2) Pilates+Placebo (n=11); 3) CSE (n=11); 4) Placebo (n=14).


Figure 1

Figure 1



Camellia sinensis extract and Placebo. Both the placebo and Camellia sinensis extract capsules were of the same size, raw material quantity (500 mg) and color, and were prepared in the same batch acquired from the manipulation pharmacy, Dapelle Ltd. Each placebo capsule contained 1.0000 q.s corn starch, 0.5% magnesium stearate, 0.5% Aerosil (pharmaceutical talc, light magnesium carbonate, light magnesium oxide, talc, dibasic calcium phosphate, etc.) and 29% microcrystalline cellulose, and contained no detectable levels of polyphenol ingredients. Each CSE capsule had 500 mg dry extract of Camellia sinensis, with a total of 4.24% polyphenols, 3.60% tannin and 0.70% caffeine. The Pilates+CSE and Pilates+Placebo intervention group participants took one capsule containing 500 mg CSE or placebo per day, one hour after the main meal, for 24 consecutive weeks.

Training protocol

Pilates exercises were performed and completed by 25 randomized women in the following groups: Pilates+CSE (n=14) and Pilates+Palcebo (n=11). The intervention lasted 24 weeks, with two 60 min sessions per week. Exercises were conducted using specialized equipment: Reformer, Cadillac, Wall unit, Ladder Barrel and Chair; and floor exercises, which were classified as being of a basic level. All exercises were performed in a progressive and educational form, respecting the fundamental principles of the Pilates method. Training was divided into initial, main and final phases, consisting of four macrocycles. All training sessions began with a 10 min warm-up on an ergometric treadmill (Movement RT 150 pro), at a speed of 5.0 Km/h. The first four-week macrocycle was composed of educational exercises at a basic level aimed at promoting neural adaptation and an introduction of exercise for breathing techniques. The second macrocycle of eight weeks included specific strengthening exercises of the spinal column extensors, serratus, serratus anterior, abdominals, quadriceps (vastus medialis) and rotator cuff, and stretching of the pectoral (major and minor), rhomboid, trapezius, triceps, iliopsoas, hamstring and adductor muscles. The third macrocycle also lasted eight weeks, with performance of the same series of exercises but with increased spring resistance. The fourth macrocycle included variation of joint angles and distances with maintenance of load and exercise series, and ending with relaxation techniques. In addition to these, stretching exercises for the shortened muscle groups were carried out using a “tonic-ball” and “Franklin Ball”.

Blood collection

Blood sample (8-hour fasting) collections were performed on two different occasions (pre- and post-intervention). The samples were acquired via direct peripheral venipuncture using silicone-coated vacutainer blood collection tubes (Becton-Dickinson) containing 0.5 ml EDTA solution, with gel and a 19G (25 x 10) disposable needle, in the cubital fossa and under aseptic conditions. All sharps materials were disposed off in special containers and the biological waste discarded in white bags. All samples were sent to the Laboratory of Biochemistry, Molecular Genetics and Parasitology of the Institute of Geriatrics and Gerontology-PUCRS for due processing (separation of plasma, serum and buffy coat), and were then stored in a freezer at -20ºC.


All researchers involved were blinded throughout this study. However, the pharmacist who distributed the CSE and placebo capsules, the Pilates group participants and instructors were not blinded for the Pilates training.

Evaluation of study adherence

The concept of adherence varies, but in general, a participant is understood to be adherent to a therapy using prescribed medications or other procedures when they observe the schedules, dosages and treatment durations for at least 80% of the total protocol. To evaluate the percentage of participant adherence in the Placebo, CSE and Pilates+CSE groups, participants were requested to present those capsules that were not consumed during the intervention period. Women who consumed less than 80% of capsules, together with those who failed to attend at least 80% of the Pilates training sessions, were excluded from the study (16,18). Four women (1 from the Pilates + CSE group and 4 from the Pilates + placebo group) were excluded from the study because they had a frequency of less than 80% in Pilates classes and/or in the use of the capsules. In addition, five women (4 CSE and 1 from placebo group) were excluded because they dropped out.

Evaluation of Adverse Effects

The study participants were asked to report adverse effects at any time in relation to the placebo, green tea or Pilates. None of the participants from any of the groups observed in this study complained of any adverse effects.

Variables and collection tools

The following variables were investigated for all study participants: age, marital status, education and income. Data were collected through use of a structured questionnaire. The cardiometabolic risk factors, such as fasting glucose and lipid profile, were measured using Labtest kits and analyzed by spectrophotometry, in accordance with manufacturer instructions. Weight was measured using a calibrated anthropometric balance scale with a 150kg capacity, graduated in 100g increments. Participants were weighed barefoot wearing a bathing suit only, with results recorded in kilograms (kg). Participant height was recorded using the measuring rod of the scales. Body Mass Index was then calculated through the equation, weight (kg) divided by height (m) squared. The minimum abdominal or waist circumference (WC) was recorded at the level of the iliac crest and values up to 80cm were considered normal for women. Above this value, individuals were considered to have central obesity (2). Evaluation of the levels of advanced oxidation protein products (AOPP) was performed according to Witko-Sarsat et al. (19), in a Cobas MIRA® analyzer (Roche Diagnostics, Basel, Switzerland). Nitrosative stress (NOx) were assessed based on the technique described by Tatsch et al. (20), in a Cobas MIRA® analyzer (Roche Diagnostics, Basel, Switzerland). The ferric reducing ability of plasma (FRAP) was performed following the technique described by Benzie et al. (21), in a Cobas MIRA® analyzer (Roche Diagnostics, Basel, Switzerland). Ischemia modified albumin (IMA) was measured by colorimetric assay with cobalt, described by Bar-Or et al. (22).
A nurse measured arterial blood pressure, recording systolic blood pressure (SBP) and diastolic blood pressure (DBP) using a mercury sphygmomanometer (Erka, Germany), equipped with an appropriately sized cuff for the right arm circumference.
Each participant remained at rest (sitting) for at least 5 min before the measurement was taken. Two measurements were recorded with an approximate interval of 30 min between them. The appearance of sounds was used for identification of SBP and their disappearance (Korotkoff phase V) for DBP. The Osler maneuver for measurement of systolic arterial blood pressure (considered positive when the radial artery is still palpable after inflating the cuff above the SBP level) was concomitantly used due to the possibility of pseudohypertension caused by stiffening of the brachial artery, secondary to atherosclerosis (can increase arterial blood pressure by 30 mmHg or more). These cases were excluded from the study. Blood pressure levels up to 130/85 mmHg were considered normal in accordance with recommendations from the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III) (2). Diagnosis of MetS was made according to the NCEP-ATP III diagnostic criteria (2).

Statistical Analysis

Data were recorded using an Excel spreadsheet and analyzed through the IBM statistics package, SPSS, version 21.0. Continuous variables were expressed as mean and standard deviation/standard error or median and interquartile range. Categorical variables were described by absolute and relative frequencies. One-way analysis of variance (ANOVA) was applied followed by Tukey’s post hoc test to compare the mean values. The Kruskal-Wallis test was used in the case of asymmetry. The Analysis of Covariance (ANCOVA), complemented by the Bonferroni test, was applied to adjust for differences concerning baseline measurements. Intragroup comparisons were evaluated using Student’s t test for paired samples (symmetrical distribution) or the Wilcoxon test (asymmetric distribution). A significance level of 5% was adopted (p<0.05).



The sample comprised of 50 volunteers with a cardiometabolic risk factors, with a mean age of 61.3±6.6 years (range 51-77 yr). The mean age did not differ between the groups, being respectively: Pilates + CSE group (60.5±6.2 yr), Pilates + Placebo group (62.6±6.7 yr), CSE group (59.1±4.7 yr) and Placebo group (62.9 ± 8.0 yr), with p= 0.462. No statistically significant differences between the investigated groups were observed for the sociodemographic variables of race, income and education (p> 0.05).
Investigation of the components of MetS for the 50 study participants revealed that 35 (70%) were verified as presenting three MetS diagnostic criteria components and 15 (30%) presented two (NCEP ATP III). All participants recorded a waist circumference >88 cm. A comparison was made between the initial measurement results for the four groups in all the recorded variables (Table 1). The triglyceride (TG) levels for those patients from the Camellia sinensis group were observed to be significantly lower than the other groups. No statistically significant differences between the groups were seen for the remaining variables before the intervention began.

Table 1 Comparison of cardiometabolic risk factors (CRF) and redox markers between the groups in the pre-intervention period

Table 1
Comparison of cardiometabolic risk factors (CRF) and redox markers between the groups in the pre-intervention period

CRF: cardiometabolic risk factors; CSE: Camellia sinensis extract; WC: waist circumference; SBP: systolic blood pressure; DBP: diastolic blood pressure; TG: triglycerides; HDL: high-density lipoproteins; AOPP: advanced oxidation protein products; FRAP: ferric-reducing ability of plasma; NOx: nitrosative stress marker; IMA: ischemia modified albumin; * Described by median (Percentis 25-75)


The post-intervention variables between the four groups are compared in Table 2. After adjustment for the baseline measurements, the post-intervention WC variable for the Pilates+CSE group was significantly lower than the CSE and Placebo groups.

Table 2 Comparison between groups of cardiometabolic risk factors (CRF) and redox markers in the post-intervention period

Table 2
Comparison between groups of cardiometabolic risk factors (CRF) and redox markers in the post-intervention period

*adjusted for baseline measurement; a,b, Equal letters are not significantly different using the Tukey test with a significance level of 5%; **variables underwent log-transformation for conducting ANOVA.CRF: cardiometabolic risk factors; CSE: Camellia sinensis extract; WC: waist circumference; SBP: systolic blood pressure; DBP: diastolic blood pressure; TG: triglycerides; HDL: high-density lipoproteins; AOPP: advanced oxidation protein products; FRAP: ferric-reducing ability of plasma; NOx: nitrosative stress marker; IMA: ischemia modified albumin.


The TG levels for the Pilates+CSE and Pilates+Placebo groups were significantly lower than the Placebo group. Blood glucose for the Pilates+CSE group were significantly lower than the Placebo group. No statistically significant differences were observed in the redox markers.
Table 3 compares intragroup variables. A significant reduction in WC, TG, blood glucose levels and FRAP was found in the Pilates+CSE group. In the Pilates+Placebo group, a significant reduction was seen only in the TG variable. A significant increase in NOx levels was verified in the CSE group, while in the Placebo group a significant increase in WC and FRAP and significant reduction of triglycerides was observed.

Table 3 Intragroup comparison of cardiometabolic risk factors (CRF) and redox markers, pre- and post-intervention

Table 3
Intragroup comparison of cardiometabolic risk factors (CRF) and redox markers, pre- and post-intervention

* Described by median (Percentile 25-75); CRF: cardiometabolic risk factors; CSE: Camellia sinensis extract; WC: waist circumference; SBP: systolic blood pressure; DBP: diastolic blood pressure; TG: triglycerides; HDL: high-density lipoproteins; AOPP: advanced oxidation protein products; FRAP: ferric-reducing ability of plasma; NOx: nitrosative stress marker; IMA: ischemia modified albumin



This study verified the effectiveness of Pilates training and the use of Camellia sinensis extract on the cardiometabolic risk factors of postmenopausal women. The results suggested that the combination of Pilates+CSE can be the most effective method for reducing three important cardiometabolic risk factor, being waist circumference, triglycerides and blood glucose, and for increasing levels of FRAP. In addition, supplementation with CSE alone suggested increase NOx levels. Furthermore, the Pilates+Placebo combination also seemed to be effective in reducing triglyceride levels. Researches on this topic are relatively recent and yet inconclusive, especially in relation to the use of Pilates training. Most studies focused on this method have investigated its effectiveness in chronic low back pain, postural correction and improvement of dynamic balance, flexibility, strength and endurance, increasing muscle mass and reducing fat mass, rehabilitation, and improvements in quality of life (12, 14, 18, 23). The effects of Pilates on cardiometabolic risk factors has been investigated more recently, however, the literature is still scarce (8, 9, 24). Studies are more abundant in relation to the consumption of Camellia sinensis extract, with reports on its beneficial effects on adipogenesis, mitigation of MetS, particularly with regard to hyperglycemia, hypercholesterolemia, and waist circumference, as well as in lessening oxidative stress (11, 15, 16). These effects have been observed in human and nonhuman experimental models, and for its consumption both in the form of tea (infusion) and capsules (extract).
Pilates combined with CSE supplementation presented better efficacy in mitigating three components of MetS that have a high level of morbidity and mortality (waist circumference, blood levels of triglyceride and glucose) in postmenopausal women. Double-blind randomized clinical trials, such as the Heart Outcomes Prevention Evaluation (HOPE), have already shown that obesity, especially abdominal, worsens the prognosis of patients with cardiovascular diseases. This study demonstrated that abdominal obesity alone is associated with a 20-23% increase in relative risk for myocardial infarction, 38% for heart failure, and 17% for total mortality (25). Abdominal obesity, which is metabolically active, produces chronic low-grade inflammation, increased flow of free fatty acids and an increase in LDL-c plasma levels (26). The union of Pilates and CSE can promote a better distribution of adipose tissue through increased mobilization of fat deposited in the abdominal region (12, 14, 15, 27). In addition, studies have demonstrated that catechins (EGCG) of Camellia sinensis promote weight loss, affect fat distribution, inhibit adipogenesis and cause apoptosis in mature adipocytes (12, 14, 15, 27). The findings of the present study reinforce the hypothesis that Pilates exercises involve a considerable energy expenditure through the performance of multidimensional and resistance exercises, which are of low and moderate intensity, contributing to the burning of lipids and preventing or decreasing their accumulation in adipose tissue (28). This in turn may contribute to the prevention of cardiovascular diseases (8,9,28). One study analyzed the effect of Pilates on a diabetic group but found no statistical difference in the mean glycated hemoglobin and daily doses of subcutaneous insulin between the intervention and control groups (24). A hypothesis proposed by the authors suggested that participants increased their carbohydrate intake prior to the physical activity due to the risk of hypoglycemia while performing the exercise. However, their caloric intake was not evaluated (24). In relation to lipid profile, no statistically significant differences were found in the mean levels of triglycerides, HDL-c, LDL-c and total cholesterol (24) in the Pilates intervention group. Nonetheless, the findings of the present study demonstrated that both Pilates+CSE (reduction of three components of MetS) and Pilates+Placebo were able to reduce at least one of the diagnostic criterion of MetS.
With regard to effects of intervention on the redox markers, the present study noted an increase in FRAP levels in the Pilates+CSE group and in NOx levels in the CSE group. According to Benzie et al., individuals that present high levels of FRAP have a higher antioxidant capacity in reducing iron (21). An in vitro study with CSE conducted by Sohrab et al., exhibited the ability of CSE polyphenols to chelate metals, such as iron, preventing their participation in reactions that generate free radicals like Fenton and Haber-weiss (29). Besides the antioxidant properties of CSE, according to Steinbacher and Eckl, oxidative stress induced by exercise serves as an important signal to stimulate muscle adaptation to antioxidant systems through activation of redox-sensitive signaling pathways (30). While an intense contraction is sufficient to activate these pathways, the upregulation of protein synthesis requires cumulative effects of repetitive exercise movements, which Pilates provides. This formation and adaptation also allows the cell to incorporate high levels of exogenous antioxidants in the form of dietary supplementation. This corroborates the results of the present study, in which only the Pilates+CSE group showed increases in FRAP levels. In relation to NOx findings, the bioactive components and antioxidant and anti-inflammatory activity of CSE may contribute to raise NO levels, thus increasing its metabolites.
Despite the beneficial results presented with respect to the cardiometabolic risk factors, it is important to consider some limitations of the present research. The first concerns is to reduced sample sizes. The second relates to the non-assessment of the macro- and micronutrient intake of the sample, which could have affected the obtained results, as well as causing unexpected results in the Placebo group, especially in relation to triglycerides and FRAP. Nevertheless, despite the limitations of the present trial, our results suggest that Pilates and supplementation with Camellia sinensis decrease cardiometabolic risk factors and increase FRAP levels in postmenopausal women, which may positively influence the global health of this sample. Additionally, the study reinforces the recommendation of Pilates method exercises for this age group and a diet rich in bioactive compounds, such as the flavonoids of Camellia sinensis, not only as an adjuvant treatment, but also for the prevention cardiometabolic risk factors.



The presented results suggest the effectiveness of the Pilates method with CSE supplementation on cardiometabolic risk factors, such as triglycerides, blood glucose and waist circumference, as well as on FRAP. However, the Pilates+Placebo group also appear to be effective in reducing triglycerides. In addition, ingestion of CSE also appear to be effective in increasing NOx levels. Our results suggest that this type of intervention, combining Pilates and Camellia sinensis may help to reduce some cardiometabolic risk factors in postmenopausal women.


Acknowledgements: Our thanks to the National Postdoctoral Program of the Coordination for the Improvement of Higher Education Personnel (PNPD/CAPES) and the Dapelle manipulation pharmacy for providing the extracts, and to the women who participated in the study. Trial registration: RBR-2sgtn2 (Brazilian Clinical Trials Registry- ReBEC)

Conflict of interest: The authors declare no conflict of interest involving this study.

Ethical standards: The study followed all the ethical recommendations of Resolution 466/12 of the Brazilian Ministry of Health on Research involving human beings. The investigators undertook to respect the protocol in all respects.



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M. Lemaire1, F. Barbier2


1. Air Liquide Sante International, Paris Saclay Research Center, Jouy-en-Josas, France, 2. Air Liquide R&D, Paris Saclay Research Center, Jouy-en-Josas, France.

Corresponding Author: Marc Lemaire, Air Liquide Sante International, Paris Saclay Research Center, 1, route de la porte des loges, Les Loges-en-Josas, 78354, Jouy-en-Josas, France. Tel: +33139076212; Fax:+33139076199; email: Marc.lemaire@airliquide.com

J Aging Res Clin Practice 2017;6:14-22

Published online January 6, 2017, http://dx.doi.org/10.14283/jarcp.2017.2


Persistent oxidative stress plays an important role in a variety of pathologies, and the search for an effective and well tolerated antioxidant agent continues. Molecular hydrogen acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals. The non-specific mechanism of hydrogen as a therapeutic antioxidant gives it broad therapeutic potential across a wide range of medical applications, as has been shown by a substantial volume of preclinical data, as well as a growing body of clinical evidence. This review provides an overview of the therapeutic potential of hydrogen, in ageing and wellness applications as well as medical applications, including acute ischemia/reperfusion injury, inflammation and ulceration, metabolic disorders, neurodegenerative disorders, and cancer (anti-cancer effects, radiation toxicities, and side effects of cisplatin) with an emphasis on clinical data. Overall, this review shows that hydrogen is an effective antioxidant, anti-inflammatory and cytoprotective agent.

Key words: Hydrogen, ageing, wellness, inflammation, antioxidant.



Hydrogen, a single proton and a lone electron, is the lightest and most abundant element in the universe. On Earth, hydrogen generally exists in compounds with other elements, and is not found by itself. The most common sources of hydrogen are hydrocarbons, water and carbohydrates from which molecular hydrogen can be produced (1).
With more than 50 million tons produced globally each year, hydrogen is one of the oldest known molecules that is used extensively by many industries. Most of its uses are based on its physical properties, such as its very low molecular weight (2.0159 g/mol H2) and density (0.084 g/l at 20°C and 1 atm), and its chemical properties such as its reactivity, forming compounds or preventing oxidation of metals due to its reducing properties (1). Hydrogen has the potential to become an important future energy solution due its high calorific value and its environmentally friendly properties, generating only water vapor when used in fuel cells to produce electricity. The benefits of molecular hydrogen in therapeutic applications have been discovered relatively recently, and remain to be completely elucidated. Many consider hydrogen to have healing properties, with its role as the fundamental antioxidant for every cell. Reactive oxygen species (ROS) are generated in the bodies of all aerobic organisms as by-products of energy metabolism via oxidative phosphorylation (2). Excess production of ROS or impaired endogenous antioxidant capacity result in a build-up of ROS, known as oxidative stress (2). It is widely accepted that persistent oxidative stress plays an important role in a variety of pathologies, including lifestyle-related diseases such as atherosclerosis and diabetes mellitus, hypertension, chronic inflammation, neurodegenerative diseases, cancer, decreased vascular function and the ageing process (2-7). However, the majority of prospective controlled clinical trials of antioxidant therapy to prevent oxidative stress-related diseases, mostly cardiovascular indications, have failed (8). Therefore, the search for an effective and well tolerated antioxidant agent continues.

Table 1 Solubility of hydrogen in water

Table 1
Solubility of hydrogen in water

*From Young C.L., 1981 (18).

Hydrogen is an odorless, tasteless gas that has demonstrated many biological effects against oxidative stress in almost all organs (9, 10). Molecular hydrogen acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals (11). Hydrogen has a number of characteristics that suggest it might be an ideal antioxidant agent for use in humans. These include its ability to neutralize hydroxyl radicals (•OH) in living cells (including penetration into organelles such as mitochondria) and to cross the blood-brain barrier, as well as its stability at room temperature and low solubility in water (1.9 mL H2/100 mL H2O at 20°C and 1 atm, Table 1) and a favorable tolerability profile (2, 10, 12). The advantageous physical and chemical properties of hydrogen, in relation to its therapeutic benefits are summarized in Table 2. Therefore, hydrogen may be potentially useful in the many human diseases known to be associated with oxidative stress, and may have an important role in the prevention of ageing and in many wellness applications.

Table 2 Summary of the therapeutic advantages of hydrogen as an antioxidant

Table 2
Summary of the therapeutic advantages of hydrogen as an antioxidant

•OH = hydroxyl radical; ROS = reactive oxygen species; ●O2- = superoxide; H2O2: hydrogen peroxide; ONOO-: peroxynitrite

In addition to its role as an anti-oxidant, there is also evidence to suggest that molecular hydrogen has anti-inflammatory properties, via its reaction with the hydroxyl radical (•OH), which is generated during inflammation (13, 14). There is also evidence to suggest that hydrogen acts more directly on inflammation, via the inhibition of lipopolysaccharide/interferon γ-induced nitric oxide production, via modulation of signal transduction in macrophages (15). Hydrogen may therefore also be therapeutically useful in the many inflammatory human diseases. Moreover, hydrogen has also been shown to prevent apoptosis, possibly via its ability to reduce or eliminate the hydroxyl radical (•OH) and peroxynitrite (ONOO-) (16).
Importantly, there are a wide variety of options for the administration of hydrogen, including inhalation as a medical gas, drinking of hydrogen-enriched water (dissolved hydrogen gas, created by exposing water to magnesium, by dissolving electrolyzed hydrogen into water, or by using high pressure to dissolve molecular hydrogen in water (16, 17)), taking a hydrogen bath, injection of hydrogen-enriched saline and use of hydrogen-enriched saline eye drops (12).
It is important to note that due to the low solubility of hydrogen in water (18), the resulting concentration of hydrogen less than 2 % v/v is much lower than the concentration of hydrogen (4% v/v) needed to react with oxygen (1). As a result, hydrogen can be considered as safe and inert within the human body.
This review provides an overview of the therapeutic potential of hydrogen. Ageing and wellness applications are discussed first, followed by a variety of medical applications.



Free radicals and reactive oxygen species (ROS) produced by aerobic metabolism play important roles in signal transduction, but also cause damage in biological systems (19). These free radicals and ROS are known to play a role in many human diseases and to be involved in premature ageing (Sun X, 2015).
The search for a simple method to delay or halt the ageing process has been going on for centuries based on efficient anti-oxidant products. Growing evidence of the ability of hydrogen, either as a gas or solution, to scavenge and selectively inactivate ROS suggest that it could exert protective effects (20). Bathing every day for 3 months in waters containing molecular hydrogen (N=18) has been shown to decrease the oxidation-reduction potential (ORP) and increased the elasticity of human skin (21, 22).
The ORP of the skin is increased by sun exposure and by ageing (23), suggesting that a reduction in the ORP might have anti-ageing effects.



Hydrogen has been shown to be alkaline in water (24, 25). Hydrogen-rich alkaline water obtained by adding H2 to electrolyzed water reduces the pH, but the hydrogen itself that can be expected to be of benefit (26). This has important implications for the wellness industry leading to the development of a beverage or food supplement that is able to take advantage of this hydrogen-associated alkalinity.

Exercise performance and sports injury

Exercise-induced production of free radicals is now a well-known phenomenon (27). The increased oxidative stress associated with exercise has the potential to diminish the overall beneficial effects that exercise has on wellbeing.
An open-label pilot study in 19 young, healthy men showed that daily intake of 2 L of hydrogen-enriched water (1.1 mM of dissolved hydrogen) for 7 days increased fasting and post-exercise blood pH, reflecting a reduction in exercise-associated acidosis, with no adverse effects (28). Athletes receiving 1 L of hydrogen water daily showed a significant decrease in the rates of perceived exertion during exercise testing (29), and an attenuation of increases in blood lactate levels and prevention of the post-exercise decrease in peak torque, an indicator of muscle fatigue (30).
To investigate the effects of hydrogen in the management of sports injuries, 12 professional athletes presenting within the first 24 hours after a muscle and tendon strain were randomized in a double-blind study to receive standard care alone (control) or in combination with oral hydrogen tables (2 g/day) and topical hydrogen-enriched packs (6 times per day for 20 minutes). Follow-up after 7 days showed that the addition of hydrogen significantly reduced plasma viscosity (p=0.002) and limb circumference (p=0.04). These results indicate that the addition of oral and topical molecular hydrogen to traditional first-line treatment is effective in the management of musculotendinous injuries (31).

Endothelial function

The results of a study in healthy volunteers suggest that hydrogen might contribute to wellness via modulation of vascular vasomotor function secondary to suppression of subclinical vascular inflammation (32). Thirty minutes after drinking 530 mL of hydrogen-enriched water (each 500 mL containing 3.5 mg of H2), healthy volunteers showed significantly improved flow-mediated dilation in the brachial artery compared with subjects who drank placebo water (p=0.0221). Potential mechanisms proposed for this effect were neutralization of ROS to preserve NO bioavailability, and suppression of inflammatory pre-atherosclerotic events.


Medical applications

Major syndromes

Acute ischemia/reperfusion injury

Stroke and myocardial infarction

For both stroke and myocardial infarction the successful treatment strategies to restore blood flow to ischemic tissue are associated with reperfusion injury. One mechanism thought to contribute to this negative outcome is the generation of ROS (33).
In an animal model, inhalation of 2% hydrogen prior to reperfusion has been shown to attenuate ischemia/reperfusion injury (IRI) occurring during coronary artery reperfusion, with a significant reduction in infarct size, (41.6% vs 21.2%: p<0.05) (34). Hydrogen-rich saline (0.6 mM) reduced the apoptosis IRI, (TUNEL-positive cells: 15% vs 24%: p<0.05), decreased infarct size (9.8% vs 32.1%: p<0.01) and improved heart function parameters 24 hours after reperfusion (35). Hydrogen-enriched saline (0.6 mM) has also been shown to decrease infarct size (p<0.05) as well as both oxidative stress and inflammation (36). In mice, inhalation of hydrogen (2%), alone and in combination with nitric oxide (NO), reduced infarct size after IRI. The hydrogen/NO combination was also associated with preservation of cardiac function after IRI (37). These findings suggest that patients may benefit from hydrogen inhalation as an add-on to percutaneous coronary intervention procedures.
ROS are generated during cerebral IRI and contribute significantly to brain injury. Inhalation of hydrogen at 2% to 4% during reperfusion decreased infarct volume in rats after middle cerebral artery occlusion and reperfusion (p<0.001); inhalation of hydrogen during ischemia had no effect on infarct size in this model (11), hence to have an effect, hydrogen must be used following reperfusion, as is the case for all organ protective molecules.
In experimental hepatic IRI, inhalation of hydrogen (1% to 4%) and intraperitoneal injection of hydrogen-enriched saline (2.5, 5 or 10 mL/kg) have both been associated with reductions in the severity of liver injury, improved liver function and decreases in markers of lipid peroxidation and inflammation (38, 39). Similar findings have been reported after treatment with hydrogen-rich saline (>0.6 mM) in rats subjected to renal IRI (40).
In a clinical setting, the addition of intravenous hydrogen-rich saline (>250 μmol/L) to treatment with the hydroxyl radical scavenger/neuroprotective agent edaravone in acute brainstem infarction patients was associated with incremental improvements in magnetic resonance imaging (MRI) findings compared with the natural course: relative diffusion-weighted images (rDWIs), regional apparent diffusion coefficients (rADCs), and pseudo-normalization time of rDWI and rADC were all improved with the combined infusion of hydrogen and edaravone (41).

Cardiac arrest and hemorrhagic shock

Intraperitoneal injection of hydrogen (10 or 20 mL/kg) reduced neuronal injury and inhibited neuronal apoptosis in a rabbit model of cardiac arrest; these effects appeared to occur via reductions in oxidative stress indicators and enhanced antioxidant enzyme activity (42). Similar beneficial effects have been observed with inhalation of hydrogen (2% H2 and 98% O2) during cardiopulmonary resuscitation in a rat model of cardiac arrest, with treated animals having improved survival and fewer neurological deficits compared with animals who underwent therapeutic hypothermia (43).
The anti-inflammatory, antioxidant and beneficial effects of hydrogen have also been documented in a number of other acute oxidative stress settings, including a rat model of uncontrolled hemorrhagic shock, where hydrogen-rich saline (>0.6 mM) had better activity when administered via the intravenous versus intraperitoneal route (44).

Organ transplantation

Preclinical data show that the antioxidant effects of hydrogen therapy are evident in organ transplantation models. In a rat model of renal transplant, treatment with hydrogen-enriched water versus regular water reduced chronic allograft nephropathy and improved overall post-transplant survival; these effects appeared to be secondary to reductions in oxidative stress-induced tissue damage (45). Hydrogen-enriched water (0.5 or 0.6 mM) has also been shown to protect rat cardiac allografts from oxidative injury and inflammation-associated deterioration, with significant reductions in markers of oxidative injury and of inflammation (p<0.05), thereby increasing allograft survival (46). Moreover, hydrogen-enriched water (0.55–0.65 mM) inhibited intimal hyperplasia and reduced oxidative damage in arterialized vein grafts in rats (47). Inhaled hydrogen (2%) appears to have beneficial effects in models of lung and intestinal transplantation, including improved spontaneous muscle contractile activity, reduced expression of inflammatory mediators and oxidative injury, prevention of IRI and improved graft survival (48, 49).

Inflammation and ulceration

The anti-inflammatory effect of hydrogen is related to the inhibition of the production of ROS and the release of pro-inflammatory cytokines.
In a rat model of ulcerative colitis (UC), intraperitoneal injection of hydrogen-enriched saline (0.6 mM) was shown to reduce weight loss and diarrhea, as well as alleviate colonic mucosal damage (50). Furthermore, hydrogen-enriched saline was also associated with inhibition of the increased expression of vascular endothelial growth factor seen in this UC model.
In another study, four patients with acute erythematous skin disease were found to experience rapid and significant improvements in symptoms after intravenous treatment with 500 mL of hydrogen-enriched water, with no subsequent recurrence (51).
Hydrogen enriched water (600 mL/day: 0.8–1.3 ppm) improved pressure ulcers in 12/22 (55%) of hospitalized elderly patients. The responders had a significant reduction in hospital stay (113.3 days vs 155.4 days; p<0.05) and in the number of pressure ulcers (28.1% reduction) compared with the subgroup of patients for whom hydrogen treatment was not effective. Both groups of hydrogen-treated patients showed a significant reduction in wound size from baseline, which was greater in the effective group. The results of parallel in vitro studies led study investigators to suggest that the beneficial effects of hydrogen therapy were secondary to type-I collagen construction in dermal fibroblasts and/or promoted mitochondrial reducing ability and ROS repression in epidermal keratinocytes (52).
Twenty patients with rheumatoid arthritis (RA), drank 530 mL of hydrogen-rich water (4–5 ppm) every day for 4 weeks in addition to regular RA medication. This treatment period was followed by a 4-week washout then another 4 weeks of treatment (53). There was a mean decrease of 14.3% from baseline in 8-hydroxyguanine (8-OHdG is a standard biomarker for oxidative stress) during the first 4 weeks of treatment (p<0.01) and after the second period of hydrogen-enriched water therapy the reduction in 8OHdG levels was 15.1% (p<0.01 vs baseline). Disease activity scores significantly decreased in 18/20 patients during the first 4-weeks (p<0.01) and remained lower than baseline levels at the end of the 4-week washout phase. At study end, 16 patients had improved disease activity scores and nine patients achieved remission. Four patients had not received any previous RA treatment and all achieved remission during the 12-week study. Apart from increased urinary frequency due to an increased fluid intake, no adverse effects of hydrogen were observed, suggesting that hydrogen water might be a useful addition to conventional therapy in patients with RA (53, 54).

Metabolic disorders

Oxidative stress plays a role in the development of type 2 diabetes mellitus, suggested by accumulation of molecular hydrogen in the liver with glycogen after oral administration of hydrogen water in rats (55), making this another possible target for hydrogen therapy. The consumption of hydrogen-enriched water reduced oxidative stress in the liver, improved fatty liver in mice with diabetes and in those with diet-induced obesity reduced plasma glucose and triglyceride levels, attenuated body weight gain, and stimulation of energy metabolism (55).
Patients with type 2 diabetes or impaired glucose tolerance were included an 8-week randomized, double-blind, crossover study of hydrogen-enriched water (1.2 ± 0.1 mg/L) (56). Hydrogen was associated with significant reductions in levels of modified LDL cholesterol, small dense LDL and urinary 8-isoprostanes, plus smaller reductions in serum levels of oxidized LDL and free fatty acids and increased plasma levels of adiponectin and extracellular-superoxide dismutase (56).
Hydrogen-enriched water or saline (>0.6 mM) has been shown to contribute to atherosclerosis prevention in apolipoprotein-E knockout mice (57, 58) and improved plaque stability (59). Additionally, ad libitum access to hydrogen-enriched water (>0.8 mM) ameliorated pulmonary arterial hypertension in a rat model (60), and intraperitoneal administration of hydrogen-enriched saline (>0.6 mM) reduced oxidative stress and attenuated left ventricular hypertrophy in spontaneously hypertensive rats (61).
Three clinical trials have assessed the effects of hydrogen treatment in the metabolic syndrome setting. After 10 weeks of hydrogen water (0.2–0.25 mM), significant reductions from baseline were seen in serum levels of total and low-density lipoprotein (LDL) cholesterol, apolipoproteins B and E, and malondialdehyde (MDA; an indicator of lipid peroxidation). Improvements were also seen in oxidation of LDL and high-density lipoprotein (HDL), and in LDL-mediated inflammation (62). In a similar group of potential metabolic syndrome patients, consumption of 1.5–2L of hydrogen-enriched water (0.55–0.65 mM) per day for 8 weeks increased HDL cholesterol levels and decreased the total cholesterol/HDL cholesterol ratio compared with baseline (63).

Neurodegenerative diseases

Evidence of increased levels of ROS have been found in post-mortem samples of brain tissue samples from patients with neurodegenerative diseases (3). There are a number of factors that make the brain particularly susceptible to oxidative stress, including its high metabolic rate and reduced capacity for cellular regeneration compared with other organs (3, 64).
Consumption of hydrogen-enriched water (>0.6 mM) ad libitum suppressed increases in oxidative stress markers and improved the proliferation of neural progenitor cells in a mouse chronic physical restraint model (65). Hydrogen-enriched saline reduced oxidative stress, inflammatory responses and amyloid-beta-induced astrocyte activation while improving learning and memory in a rat model of Alzheimer’s disease (66).
In Parkinson’s disease addition of hydrogen to drinking water (>0.4 mM or 0.08–1.5 ppm) prevented the development and progression of nigrostriatal degeneration and dopaminergic neuron loss (67, 68).
The efficacy of hydrogen-enriched water was assessed in a randomized, placebo-controlled, double-blind, parallel clinical trial conducted as a pilot study in levodopa-treated patients with Parkinson’s disease (69). Participants drank 1 L per day of hydrogen-enriched water (prepared by dissolving 0.8 mM H2; n=9) or placebo water (n=8) for 48 weeks. Total Unified Parkinson’s Disease Rating Scale (UPDRS) scores in the hydrogen-enriched water group improved during the study, whereas UPDRS scores in the placebo group worsened (p<0.05 at 48 weeks). Hydrogen-enriched water was well tolerated during the study and no adverse events were reported.

Spinal cord and brain injury

Intraperitoneal administration of hydrogen-enriched saline (0.6 mM) to rats at the time of spinal cord injury, and at 24 and 48 hours after injury was associated with a reduction in the number of apoptotic cells, decreased oxidative stress, increased release of brain-derived neurotrophic factor, and improved locomotor function (70). Similar beneficial effects were observed in a rat model of traumatic brain injury (TBI) after treatment with 2% inhaled hydrogen in air (71). Hydrogen was administered from 5 minutes to 5 hours after TBI, and significantly attenuated TBI-induced increases in blood-brain barrier permeability, brain edema, lesion volume and neurological dysfunction. These effects were thought to occur via increases in endogenous antioxidant enzyme activities (71). Reduction in brain edema and protection from the neurodegenerative changes associated with TBI has also been documented when hydrogen is added to drinking water (>1.6 mM), starting 24 hours before TBI. In particular, expression of genes relating to oxidation, neuroinflammation and carbohydrate metabolism was effectively reversed by hydrogen water (72).


Anti-cancer effects

The production of ROS by human cancer cells is higher than that for normal cell lines (73). In addition, elevated levels of ROS appear to play a role in the signaling cascades that trigger and maintain the oncogenic phenotype of cancer cells (74), and may contribute to DNA damage, and cell proliferation, migration and survival (75). Therefore, the possible anticancer effects of hydrogen, alone or in combination with traditional therapy, are the subject of growing research (76).
In an in vitro study, hydrogen-enriched water (1.0–1.3 ppm) supplemented with platinum nanocolloid showed rapid antioxidant effects and preferentially inhibited clonal growth of human tongue carcinoma cells compared with normal cells (77). Hydrogen-enriched water has also been shown to increase the inhibitory effects of the chemotherapy agent fluorouracil on colon cancer cells (76). In a mouse model of colon cancer, hydrogen-enriched water (≈0.8 mM) significantly increased survival compared with placebo water treatment, and survival was increased to an even greater extent when hydrogen-enriched water was combined with fluouracil (76).

Radiation toxicities

Radiotherapy is associated with radiolysis of H2O to •OH, which contributes to a range of adverse effects (33). The results of one preclinical study showed that hydrogen-enriched saline (>0.6 mM) protects cells against radiation-induced toxicity and ameliorates intestinal injury caused by radiation (78). Another showed that hydrogen-enriched saline (>0.6 mM) markedly reduced ROS levels after radiation and protected against radiation-induced immune dysfunction (79), while a third indicated that treatment with hydrogen-enriched saline (0.6 mM) before ionizing radiation could provide partial protection of both spermatogenesis and hematopoiesis (80). Hydrogen has been proposed as a possible preventive strategy for radiation pneumonitis because of its ability to quickly scavenge free radicals produced by irradiation of the lungs (81).
The effects of drinking hydrogen-enriched water were investigated in a randomized, placebo-controlled study of patients receiving radiotherapy for liver tumors (82). Treatment with 1.5–2L hydrogen-enriched (0.55–0.65 mM) or placebo water was started on the first day of radiation treatment and continued for 6 weeks. Drinking hydrogen-enriched water prevented the marked increase in total serum hydroperoxide associated with radiotherapy, and attenuated the radiation-related reduction in serum antioxidant activity. Patients in the hydrogen-enriched water group reported significantly less loss of appetite and fewer taste disorders compared with those receiving placebo. Importantly, hydrogen-enriched water had no effect on the efficacy of radiotherapy (82).

Side effects of cisplatin

Based on the results of an in vivo study, hydrogen also has the potential to alleviate chemotherapy-associated toxicity. Two administration routes (oral hydrogen-enriched drinking water [0.8 mM] and inhaled hydrogen [1%]) were assessed in mice receiving cisplatin (83). Both forms of hydrogen improved survival, reduced body weight loss and ameliorated cisplatin-induced nephrotoxicity compared with control, although the effects of drinking hydrogen-enriched water appeared to be less than those of inhaled hydrogen with respect to prevention of severe nephrotoxicity. The anti-tumor efficacy of cisplatin was unaffected by concomitant administration of hydrogen by either route (83).

Other medical applications

Dermatomyositis and mitochondrial disease

The effects of drinking hydrogen-enriched water (0.5 ppm) were assessed in patients with muscle diseases (84). An open-label study was conducted in 14 patients who drank 1 L/day of hydrogen-enriched water for 12 weeks. Patients with mitochondrial myopathies (MM) and patients with progressive muscular dystrophy showed decreases in the lactate-to-pyruvate ratio (p<0.05), and those with polymyositis/dermatomyositis had a decrease in serum matrix metalloproteinase-3 and triglyceride levels (84). Subsequently, a randomized, double-blind, placebo-controlled, crossover study in 22 patients with dermatomyositis (n=10) or MM (n=12) investigated the effects of drinking 0.5 L/day of hydrogen-enriched water for 8 weeks. Treatment was associated with significant improvement in serum lactate in MM patients, but there were no objective changes in clinical symptoms in this or the open-label study (84). Some patients did report subjective improvements in fatigue, diarrhea and myalgia, but these were not consistent or statistically significant suggesting that the hydrogen dosage used may have been insufficient. It was suggested that >1 L/day of hydrogen-enriched water may be required to achieve beneficial effects (84).


The effects of using hydrogen-enriched water as a hemodialysis solution have been investigated in two clinical trials. In the first, regular hemodialysis patients received one month of treatment using a standard solution followed by another month of treatment using hydrogen-enriched water (99 parts per billion [ppb]) as the dialysis solution (85). Hemodialysis with both the standard and hydrogen-enriched water solutions was effective at reducing blood pressure. Compared with standard solution, hydrogen-enriched water was associated with preserved cellular viability of polymorphonuclear leukocytes, resulting in better ability to generate superoxide anions. Use of hydrogen-enriched water during hemodialysis was feasible and well tolerated, with no symptomatic adverse events observed during the study period (85). The second clinical trial included a larger number of patients (n=21) dialyzed with hydrogen-enriched solution (average H2 levels ranged from 48 ppb to 210 ppb) over a longer period of time (6 months) (24). Once again, hemodialysis with hydrogen water had a good tolerability profile and was feasible, and significant reductions in blood pressure were achieved after each hemodialysis session; these were greater when hemodialysis was performed with hydrogen versus standard solution. Significant decreases were also observed in the oxidant markers plasma myeloperoxidase and monocyte chemoattractant protein-1 (24). These results suggest that use of hydrogen-enriched solutions during hemodialysis has the potential to ameliorate inflammatory reactions and improve blood pressure control.

Liver disease

Lipid peroxidation plays an important role in the pathology of viral hepatitis and has been suggested as a major cause of liver injury (86). The addition of hydrogen-enriched water (0.55–0.65 mM; three times daily) to standard treatment for 6 weeks in patients with chronic hepatitis B was associated with significant improvements in a number of oxidative stress parameters, including superoxide dismutase, glutathione S transferase, xanthine oxidase and malondialdehyde compared with both baseline (p<0.05) and the standard treatment only group (p<0.01) (87). There were trends towards improvements in liver function and reductions in hepatitis B virus DNA load in the hydrogen treatment versus routine treatment group, but these did not reach statistical significance (87).

Respiratory system

The role of oxidative stress in the development of acute lung injury is well established (33). In animal models, hydrogen-enriched saline and inhaled hydrogen (2%) reduced apoptosis, neutrophil infiltration, lipid membrane peroxidation, nuclear factor kappa B activation and proinflammatory cytokine levels (88-90).

Ocular effects

There are a number of ocular diseases that have been shown to benefit from hydrogen treatment in preclinical studies. Hydrogen-enriched saline has been shown to have antioxidant effects and to protect against blue light-induced retinal damage (91) and retinopathy associated with hyperoxia or diabetes (92, 93), and to prevent selenite-induced cataract (94).



Hydrogen is an effective antioxidant, anti-inflammatory and cytoprotective agent that selectively scavenges potent oxidants such as •OH and peroxynitrite in cells without affecting redox homeostasis. Key features of hydrogen as a therapeutic agent include selective reaction with highly reactive ROS, rapid diffusion into cells and onset of action, inert characteristics at body temperature in mammalian cells, an almost adverse event-free tolerability profile, the ability to administer therapy in a variety of ways to best suit the patient or indication being treated, and low cost. The non-specific nature of the effects of hydrogen mean that it has therapeutic potential across a wide range of medical applications, as has been shown by a good volume of preclinical data and a growing body of clinical evidence.
Accumulating data also show the potential for hydrogen as an anti-ageing solution and in wellness applications, particularly sports and injury. It is possible that drinking hydrogen-enriched water may become a novel and beneficial new rehydration strategy for athletes. Data from future clinical studies will help to better define the role of hydrogen in medical applications, exercise physiology and wellness strategies. Hydrogen has the potential to become a hugely important agent in many aspects of human health, particularly in reducing the effects of ageing.

Disclosure: Marc Lemaire and Françoise Barbier are employees of Air Liquide.

Acknowledgements: The authors would like to thank Marie Cheeseman and Nicola Ryan who provided medical writing assistance on behalf of Springer Healthcare Communications. This assistance was funded by Air Liquide.



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