INTRODUCTION: It has been suggested that repeated compression-decompression cycles reduce diver susceptibility to decompression sickness (DCS). This study examined whether intensive scuba dive training would reduce bubble formation and modulate endothelial function as shown by skin circulation. METHODS: There were 22 military divers who were studied before and after a 90-d program of physical training and open-sea air diving (mean 67 dives total). Skin blood flow in the forearm was measured at rest (baseline), during post-occlusive hyperemia (endothelium-dependent vasodilatation), and with local heating to 42 degrees C (maximal vasodilatation). Subjects were also examined by pulsed Doppler for venous bubbles 30, 60, and 90 min after surfacing from a hyperbaric exposure to 400 kPa (30 msw) for 30 min in a dry chamber. RESULTS: None of the divers experienced DCS during the training period. There was no change in weight, body mass index, maximal oxygen uptake, or endothelial function. Bubble grades by the Kisman Integrated Severity Score were significantly decreased immediately after the diving training period (3.6 +/- 9.2 vs. 16.4 +/- 14.3) and increased 3 mo after this period (10.3 +/- 13.9 vs. 3.6 +/- 9.2). DISCUSSION: The results highlight that repeated scuba dives and regular physical exercise activity reduce bubble formation and probably have a protective effect against DCS risk. Although this phenomenon has been observed for decades, the mechanism remains complex and the results cannot elucidate the effects of physical exercise and NO production. Bubble formation could activate the stress response which could be the basis for diving acclimatization.