Method and adaptation mechanisms
Since 1970, a method of adaptation to oxygen deficiency, intermittent hypoxic training (IHT), has been introduced into clinical practice.
The method comprises several series of brief inhalation of a low-oxygen gas mixture, each alternating with an interval of atmospheric air breathing at normal oxygen concentration. Thus, hypoxic mixture breathing takes place intermittently at normal atmospheric pressure, excluding adverse effects associated with pressure changes.
The rationale for the hypoxic stimulus rests on known training responses: activation of every stage of oxygen transport to tissues, increased blood oxygen capacity, capillary dilatation and formation, and enhanced tissue respiration through greater oxygen affinity of cytochrome oxidase, the terminal respiratory-chain enzyme, and more mitochondria per cell.
IHT is used for prevention, treatment and rehabilitation in cardiovascular disease, including coronary artery disease, stage I–IIA hypertension and neurocirculatory dystonia; blood disorders, including hypoplastic and iron-deficiency anaemia and post-radiation haematopoietic disturbances; chronic nonspecific lung disease, including pneumonia, bronchitis and asthma; gastrointestinal disease, dermatitis and other conditions [6].
Chronic salpingo-oophoritis
IHT has demonstrated high effectiveness in treating and rehabilitating patients with chronic nonspecific salpingo-oophoritis [4]. The hypoxic stimulus not only improves general well-being and promotes recovery but is followed by an absence of exacerbations for one to two years after treatment.
Genital inflammatory disorders occupy a leading place in gynaecological morbidity. Chronic salpingo-oophoritis remains the most common inflammatory genital disease in reproductive-age women, accounting for 32–89% of such disorders. Relapses generally occur when resistance and adaptive reserves decline.
Methods increasing hypoxia adaptation are successfully used in gynaecology [1]. IHT was applied specifically in recurrent salpingo-oophoritis. Principal indications in longstanding recurrent disease were reduced nonspecific resistance, nonspecific disease aetiology, duration over four years, frequent relapses and failure of various treatments. The largest subgroup consisted of women ill for over four years with two inflammatory exacerbations annually.
A. Ya. Chizhov, L. S. Shutova and colleagues [5] examined 212 patients aged 20–35 with longstanding chronic nonspecific salpingo-oophoritis who had repeatedly received various outpatient and inpatient treatments without adequate benefit.
The effect was considered complete when general and mental state improved, pain disappeared, work capacity and sleep improved, uterine adnexal changes regressed, the menstrual cycle and ovarian function normalised, and no exacerbation occurred for one year. If even one of these parameters failed to improve, the effect was partial. Complete recovery after IHT occurred in 67.3±4.5% and partial recovery in 32±4.5% (Figure 1).
Complete effect: pain disappeared; uterine adnexal changes improved; the menstrual cycle and ovarian function normalised; sleep and work capacity improved; there were no exacerbations for one year.
After treatment, lower abdominal pain was reported in only 35.0±4.6% of women, compared with 96.3±1.9% beforehand. On a three-point scale, intensity declined from two points, moderate pain, to one point, mild pain. Pain disappeared entirely in 66.0±4.7% and decreased substantially in 29.1±4.5%; in 4.9±2.1%, its character and intensity were unchanged. Menstrual disturbances declined from 22.5±4.0% before hypoxic therapy to 9.9±2.9% afterward. Ovarian dysfunction had affected 78.9±3.9% before treatment; its frequency halved. Chizhov and colleagues’ findings show a positive influence of hypoxia adaptation on ovarian function and the condition of patients with salpingo-oophoritis.
Postoperative rehabilitation
E. N. Tkachuk [6] studied IHT effectiveness and patient condition after uterine fibroid removal. The study involved 120 women: seventy in the main group receiving hypoxic therapy and fifty controls receiving conventional treatment. The leading symptom in 80% was hyperpolymenorrhoea, a menstrual disturbance; 20% had cyclic bleeding of the metrorrhagia type. In the main group, 40% had chronic posthaemorrhagic anaemia, and 50% had chronic bronchitis, asthma, stage I or II hypertension, or drug allergy.
Tkachuk’s results [2] indicated that hypoxia adaptation effectively prevents postoperative complications: 85% required no antibacterial therapy after IHT, and all patients had primary-intention wound healing. Hospital stay was 34.5% shorter than without hypoxic therapy. General condition improved: blood pressure was more stable, pulse slower and stroke volume greater than in controls at corresponding stages of surgery.
Hypoxic therapy improved oxygen regimes by increasing vital capacity, inspiratory reserve volume, breathing reserve, alveolar and maximal ventilation, bronchial patency and blood respiratory function. Mental status normalised after IHT.
Morphological studies showed increased relative vascular volume in the myometrium and abdominal skin at the postoperative incision, substantially improving postoperative recovery. Enhanced microcirculation improved tissue oxygen supply and shortened oxygen diffusion distance. Oxygen regimes became more efficient and economical [3].
Accumulated experience supports IHT in general surgery during preoperative preparation and rehabilitation after surgical intervention.
Hypoxic–hyperoxic training
A newer adaptation method aims to improve effectiveness, shorten adaptive-response formation and reduce adverse reactions. Resistance is developed through intermittent exposure to gas environments with oxygen levels both below and above normal, alternating hypoxia with hyperoxia. This is termed normobaric intermittent hypoxic–hyperoxic training (IHHT).
Periodic hypoxia and hyperoxia increase the body’s compensatory capacity. Adaptation to the combined exposures has a pronounced protective effect and develops much earlier than with hypoxia periods alone. Recent experiments indicate a similar effect with a shorter adaptation course of eight to ten days.
In the domestic literature, O. S. Glazachev and colleagues used this method to correct individual components of metabolic syndrome.
Hypoxic–hyperoxic training was found to reduce body weight significantly, predominantly through fat loss, accompanied by lower total cholesterol and plasma glucose, optimisation of blood pressure, greater physical endurance and improved psychological status.
Conclusion
Thus, normobaric intermittent hypoxic training is a versatile and effective method for preventing and treating diverse diseases. Its effectiveness has increased through the advantages of combining hypoxia and hyperoxia.
References
1. Караш Ю.М., Стрелков Р.Б., Чижов А.Я. Нормобарическая гипоксия в лечении, профилактике и реабилитации. М.: Медицина, 1988. 352 с.
2. Колчинская А.З., Цыганова Т.Н., Остапенко Л.А. Нормобарическая интервальная гипоксическая тренировка в медицине и спорте. М.: Медицина, 2003. 407 с.
4. Цыганова Т.Н., Егорова Е.Б. Интервальная гипоксическая тренировка в акушерской и гинекологической практике. Методические рекомендации. М., 1993. 11 с.
5. Шутова Л.С. Лечебно-профилактическое применение прерывистой нормобарической гипоксии у больных хроническим неспецифическим сальпингоофоритом. Автореф. дис. канд. мед. наук. М., 1990.
6. Цыганова Т.Н., Братик А.В. Эффективность интервальной гипоксической тренировки в медицине и спорте. Вестник восстановительной медицины, электр. журн. 2013;1:2–31.
Full main-text translation of: Цыганова Т.Н. Использование интервальной гипоксической тренировки в гинекологии (обзорная статья). Авторский материал, 6 с.
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