MEDISPA.PRO
Ministry of Health code: A20.30.020 Axis M3 · Mitochondrial health and energy metabolism CEBM: Level B (Device-based physiotherapy and revitalisation)

Intermittent hypoxic-hyperoxic training (IHHT)

Interval Hypoxic-Hyperoxic Training (IHHT)

Industry clinical and economic procedure passport. Full biological mechanism (MoA), patient preparation protocol, first-choice equipment fleet, integration into the resort's master treatment rooms and market price benchmarks.

To the procedure catalogue Equipment fleet Integration treatment rooms Rates and economics
Session duration
45 min
Turnover: ~60 min
Recommended course
10 sessions
daily or every other day (10–14 treatments)
Throughput capacity
8 pts
per 8-hour shift
Median rate
3 500 ₽
3 000 ₽ – 4 000 ₽
Course cost
35 000 ₽
at market median
Publication volume
Level B
12 publ. in PubMed

Clinical profile

Mask breathing of gas mixtures alternating hypoxia (10–12 % O₂) and hyperoxia (30–35 % O₂) at rest, in a 3–7-week course. Studies in cardiac rehabilitation, geriatrics, prediabetes and long COVID show improved exercise tolerance, blood pressure and glycaemia; the data are still limited by small samples.

Every statement links to a publication in the list below. This is a snapshot of published research, not a final assessment of the method: international practice and integrated protocols often run ahead of official publications. Draft based on published research; requires review by a physician. Revision: 2026-10-17.

Mechanism of action

  • Replacing normoxia phases with moderate hyperoxia is thought to amplify the adaptive response to the hypoxic stimulus via reactive oxygen species and hypoxia-inducible genes (HIF). [10]
  • There is no direct evidence of increased lifespan in humans; the effect on ageing markers depends on the intensity and duration of hypoxic exposure. [4]

Where studies show an effect

  • Cardiac rehabilitation and secondary prevention in older patients with cardiovascular disease: lower resting heart rate and blood pressure without serious adverse events. [2, 8]
  • Prediabetes: lower fasting and OGTT glucose, total cholesterol and LDL; the effect persisted for a month after the course. [5]
  • Geriatric rehabilitation: improved cognitive test scores and 6-minute walk distance when added to multimodal training. [6]
  • Long COVID in inpatient rehabilitation: gains in 6-minute walk distance, functional status and quality of life. [9]
  • Older patients with cardiovascular or metabolic diseases or cognitive impairment: higher peak O₂ uptake and exercise tolerance. [1]

Open questions and study limitations

  • In geriatric patients, IHHT added to training did not improve mobility or well-being compared with training alone. [7]
  • For athletes: adding hypoxia to aerobic training does not raise VO₂max or performance beyond normal training (meta-analysis; publication bias found). [3]
  • Most studies are small and some are non-randomised; review authors call for large RCTs. [1, 2]

Safety

  • A meta-analysis of 14 studies (431 patients) found no serious complications or adverse events. [2]
  • An intensive session lowers cerebral oxygenation (StO₂ by 10 pp), which should be taken into account when choosing the regimen. [11]
  • A balanced ratio of hyperoxia and hypoxia phases was better tolerated and caused a lower cardiovascular load. [12]

Protocol in studies

  • Session: 4 cycles of 5 minutes of hypoxia (12 % O₂) and 3 minutes of hyperoxia (33 % O₂); 5 sessions a week for 3 weeks. [5]
  • In cardiac rehabilitation: hypoxia at 10 % O₂ and hyperoxia at 30 % O₂; in long COVID rehabilitation: 10–12 % and 30–35 % O₂ three times a week. [8, 9]
Contraindications. Contraindications are determined by the physician according to the equipment instructions and the patient's condition; they are not given in study abstracts.

Equipment fleet and fit-out

Certified first-choice medical equipment and compatible device systems

Equipment registry
Base configuration (Hero Device)
ReOxy AI Hypoxi-Hyperoxi System / Cellgym CellAir Geek

Device platform with proven validation of the biological response. Includes built-in biofeedback sensor systems, patient protection protocols and precision dosing of exposure.

Certification: Russian Ministry of Health registration certificate / CE Medical Device Directive Class IIa/IIb.
Compatible platforms in the MEDISPA.PRO registry
OXYTERRA "GIPO-OKSI-1".
Medical device, Roszdravnadzor registration certificate / CE
In the registry →
Breezelite
Medical device, Roszdravnadzor registration certificate / CE
In the registry →

Architectural integration and treatment rooms

Resort rooms housing the treatment station (with SanPiN norms and MEP loads)

All treatment rooms →
1.3.5 30.0 m² · Class B

Gas inhalation therapy room

General therapeutic interventions and high-tech therapy · Equipment: 11 976 600 ₽

Treatment room passport →
HMI.CELL.00 14.0 m² · Class V

Intermittent hypoxic therapy room (IHHT)

International flagship high-tech modalities · Equipment: 3 950 000 ₽

Treatment room passport →
HMI.CELL.01 15.0 m² · Class V

Intermittent hypoxic therapy room (IHHT)

International flagship high-tech modalities · Equipment: 4 300 000 ₽

Treatment room passport →

Unit economics and resort price benchmarks

Market analysis based on a sample of premium sanatoriums, wellness hotels and preventive medicine clinics

Market price corridor
25th percentile (P25) 3 000 ₽
Market median 3 500 ₽
75th percentile (P75) 4 000 ₽

Median of prices in industry facilities' price lists, 2026

Basis of the price benchmark

Prices for this procedure appear in the price lists of 5 industry facilities; the median and interquartile range across facilities are shown (each facility counts once).

Evidence base

Systematic reviews and a meta-analysis report favourable results for blood pressure, heart rate and exercise tolerance in patients with CVD, but the studies are small and partly non-randomised; some RCTs showed no effect.

Publication level B · Some data
  1. 1.
    Effects of Intermittent Hypoxia-Hyperoxia on Performance- and Health-Related Outcomes in Humans: A Systematic Review.
    Sports Med Open, 2022 · Systematic review · PMID 35639211
    IHHT is a promising non-drug method for raising peak VO₂, exercise tolerance and cognitive function and lowering glucose and blood pressure in older people with cardiovascular and metabolic diseases; large RCTs are needed.
  2. 2.
    Safety and Efficacy of Intermittent Hypoxia Conditioning as a New Rehabilitation/ Secondary Prevention Strategy for Patients with Cardiovascular Diseases: A Systematic Review and Meta-analysis.
    Curr Cardiol Rev, 2021 · Systematic review and meta-analysis · PMID 33992064
    In older people with CVD, hypoxic conditioning lowered heart rate (−5.4 bpm), SBP (−13.7) and DBP (−7.9 mmHg) without serious complications; no effect on lipids or blood counts was found.
  3. 3.
    Aerobic Intermittent Hypoxic Training Is Not Beneficial for Maximal Oxygen Uptake and Performance: A Systematic Review and Meta-Analysis.
    Scand J Med Sci Sports, 2025 · Systematic review and meta-analysis · PMID 40548904
    Aerobic training in hypoxia offers no advantage in VO₂max or performance over normal training; publication bias was found.
  4. 4.
    Effects of Intermittent Hypoxia in Training Regimes and in Obstructive Sleep Apnea on Aging Biomarkers and Age-Related Diseases: A Systematic Review.
    Front Aging Neurosci, 2022 · Systematic review · PMID 35677200
    There are no direct data on increased lifespan; the direction of the effect on ageing markers depends on the intensity and duration of hypoxia.
  5. 5.
    Intermittent Hypoxia/Hyperoxia Versus Intermittent Hypoxia/Normoxia: Comparative Study in Prediabetes.
    High Alt Med Biol, 2019 · RCT, placebo-controlled · PMID 31589074
    Prediabetes, 55 patients: IHHT and intermittent hypoxia lowered glucose, cholesterol and LDL equally; the effect lasted a month.
  6. 6.
    Intermittent hypoxic-hyperoxic training on cognitive performance in geriatric patients.
    Alzheimers Dement (N Y), 2017 · RCT · PMID 29067323
    34 patients aged 64–92: IHHT added to multimodal training improved cognitive tests and the 6-minute walk (+24.1 % vs +10.8 %); it was well tolerated.
  7. 7.
    Effects of intermittent hypoxia-hyperoxia on mobility and perceived health in geriatric patients performing a multimodal training intervention: a randomized controlled trial.
    BMC Geriatr, 2019 · RCT · PMID 31200649
    Geriatrics: IHHT added to multimodal training did not improve mobility or well-being beyond training alone.
  8. 8.
    Adaptations following an intermittent hypoxia-hyperoxia training in coronary artery disease patients: a controlled study.
    Clin Cardiol, 2017 · Controlled study · PMID 28323322
    Coronary heart disease, 46 patients: improved exercise tolerance, lower blood pressure and glycaemia, higher ejection fraction; the effect was comparable to 8-week standard rehabilitation.
  9. 9.
    Intermittent Hypoxic-Hyperoxic Training During Inpatient Rehabilitation Improves Exercise Capacity and Functional Outcome in Patients With Long Covid: Results of a Controlled Clinical Pilot Trial.
    J Cachexia Sarcopenia Muscle, 2024 · Controlled study · PMID 39559920
    Long COVID, 145 patients: IHHT in inpatient rehabilitation improved functional capacity and quality of life and was safe.
  10. 10.
    Effectiveness of Intermittent Hypoxia-Hyperoxia Therapy in Different Pathologies with Possible Metabolic Implications.
    Metabolites, 2023 · Review · PMID 36837800
    A review of IHHT use across conditions; hypothesis of enhanced adaptation via ROS and hypoxia-inducible genes.
  11. 11.
    Cerebral Hypoxia During Intermittent Hypoxic-Hyperoxic Training (IHHT): A Case Study Using Cerebral Oximetry Based on Time-Domain Near-Infrared Spectroscopy.
    Adv Exp Med Biol, 2024 · Case report · PMID 39400813
    An intensive IHHT session reduced cerebral oxygenation by 10 pp on TD-NIRS.
  12. 12.
    Optimizing Intermittent Hypoxic-Hyperoxic Training for Safety and Feasibility: An Exploratory Pilot Study.
    J Funct Morphol Kinesiol, 2026 · Pilot study · PMID 42496397
    A balanced hyperoxia-to-hypoxia regimen was better tolerated and imposed a lower cardiovascular load.

Publications were found in PubMed; titles and journals are given verbatim, conclusions are a brief summary of the abstracts under the conditions of the specific studies. The level shows the volume of published data, not the value of the method: A — Plenty of data: consistent systematic reviews and meta-analyses of RCTs; B — Some data: reviews or several RCTs, results are heterogeneous; C — Little data: single RCTs or controlled studies; D — Scarce data: mainly reviews, observational and experimental studies. The passport is updated as new work is published and with regard to international practice.