The paper presents materials on the emergence and development of the method of intermittent normobaric hypoxic therapy and provides data on the possible use of this method in various pathological conditions.
In physiology and medicine, the decisive role of hypoxia in the occurrence and progression of many diseases is recognized. Any pathological condition is associated with a violation of the body’s oxygen regime and its regulation; as a result, the importance of as deep and comprehensive a study of hypoxic conditions as possible is clear in order to develop effective science-based means and methods for the timely correction of the body’s reactions to oxygen deficiency, as well as studying the possibility of using hypoxic training for therapeutic, preventive and rehabilitation purposes [1, 2, 3, 16, 25, 23].
Mountain climatic therapy has traditionally been used in the treatment of various diseases; the history of its use goes back several dozen centuries. It is known that Hippocrates and Avicenna sent their patients to the mountains. Modern mountain resorts are also deservedly enjoying success; these institutions restore health to people with cardiorespiratory diseases, blood diseases, etc., and also provide rehabilitation courses for people who have received a dose of ionizing radiation, while mainly only one climatic factor is important – hypoxia [1, 10, 12, 16, 19, 30].
Adaptation of the body to a lack of oxygen and the ability to use the phenomenon of acclimatization to mountain conditions for therapeutic purposes have long attracted the attention of specialists. The nature of physiological reactions in humans under the influence of hypoxia and hypercapnia has been studied by many researchers [16, 18, 21].
A large amount of experimental and clinical material has been accumulated in our country and abroad, indicating the possibility of significantly increasing the resistance of the human body to a number of extreme influences and pathological conditions as a result of preliminary adaptation of the body to the effects of hypoxia. It has been shown that resistance to stress developed in mountain climates is nonspecific and can manifest itself under the influence of many pathogenic factors on the body, that is, it has the character of “cross adaptation.” However, imitation of “mountain climbing” in medical institutions using hypobaric hypoxia devices has limited indications associated with poor tolerance of low atmospheric pressure, which served as an impetus for the development of a new direction in physiotherapy – intermittent normobaric hypoxic therapy (INHT) [1, 3, 6, 13, 32].
In 1980 in our country N.A Agadzhanyan, R.B Strelkov, A.Ya. Chizhov proposed the concept of replacing mountain and pressure chamber hypobaric training with preventive, therapeutic and rehabilitation purposes by stimulating the human body with gas mixtures with a low oxygen content at normal atmospheric pressure, which was a continuation of the work carried out in the 30-40s by L.L. Shik and N.N. Golubov with employees. Based on this concept, the INHT method was developed [2, 14, 24, 30, 31].
Today, this method is becoming increasingly widespread in medical practice and is becoming a recognized technique in our country and abroad (in many European countries, North and South America). INHT as a method is officially approved by the Ministry of Health of the Russian Federation and approved by the Russian Academy of Medical Sciences. Its theoretical basis is 25 doctoral and more than 70 candidate dissertations.
The path to the development of this method was long, because hypoxia itself as a condition is present in almost all pathological processes. But still, numerous studies show that hypoxia is also present in physiological conditions: intrauterine development of the fetus, heavy physical work, hypoxia of vital organs after eating a large meal. In these cases, genetically programmed mechanisms for compensation of physiological hypoxia begin to operate in a healthy body, which play an important role in the formation of a complex of adaptive reactions [3, 7, 9, 24].
Why is hypoxia a universal factor that triggers both pathogenic and sanogenic mechanisms? These questions can be answered by tracing the evolution of life on earth.
Thanks to the emergence of photosynthesis, the oxygen content on earth gradually increased and at the beginning of the Paleozoic era reached 1.5 mm Hg. During this period, a large number of new species of organisms appear. The second “evolutionary explosion” occurred when the oxygen content on the earth’s surface reached 15 mm Hg. The presence of oxygen in the earth’s atmosphere is a consequence rather than a condition for the emergence of life. At the same time, oxygen becomes an indispensable condition for the life of many living organisms, which has made the possibility of the existence of animals closely dependent on the oxygen content in the atmospheric air.
Over the long course of phylogenesis, the aerobic pathway of energy exchange becomes dominant, i.e. the main energy supply for any body function is due to release in the presence of oxygen potential energy of the chemical compounds that make up the cell. The supply of oxygen to the body from the environment has become a necessary condition for maintaining life at almost all levels. And yet, anaerobic glycolysis, as the most ancient way of obtaining energy without oxygen, is activated during critical periods as a reserve mechanism that allows one to prolong the life of the body in situations associated with impaired aerobic oxidation [3, 6, 9, 23].
The mechanism of adaptation to hypoxia is that the hemoglobin content and the number of red blood cells increase [16, 17, 24], the oxygen transport properties of hemoglobin change, and the respiratory function of the blood becomes more efficient. Pulmonary ventilation increases, and the efficiency of pulmonary respiration increases. Blood microcirculation in the brain, heart, liver and reproductive organs improves. The ability of tissues to utilize oxygen from the blood with lower oxygen tension in it increases [3, 4, 23, 24].
The body’s resistance to various pathogenic agents arises as a result of the body’s preliminary adaptation to hypoxia, which develops in high altitude or pressure chamber conditions. The resulting resistance to various stressful situations can manifest itself in various pathological conditions. All of the above indicates the importance of correcting the body’s reactions to oxygen deficiency through training for hypoxia in order to create resistance to various extreme conditions and activate adaptive reserves [1, 4, 9,10, 11].
The INHT method developed and proposed for use meets the requirements for increasing the body’s resistance by adapting it to hypoxia [16, 25].
In accordance with the methodological recommendations of the Ministry of Health of Russia, during INHT, breathing is performed with gas mixtures with a low oxygen content (12.0 ± 2.0%), which is carried out in a cyclic-fractionated mode: breathing with a gas mixture (HGM) for 2-5 minutes, then breathing with atmospheric air also for 2-5 minutes. The number of sessions in one session, depending on the medical indications and individual characteristics of the patient, can vary from 1-2 to 5-6. Typically, the total breathing time of the HGM during one session is 20-30 minutes (4-6 cycles of 5 minutes each), while the total time of one session, including the break time for breathing atmospheric air, does not exceed 30-35 minutes.
The duration of the course of hypoxic therapy can also vary and range from one to two to three weeks.
The INHT method is indicated:
1. Practically healthy people: • to increase physical performance and resistance to emotional overload, • to increase resistance to poisons of animal and mineral origin, • to increase resistance to infectious diseases, • to prevent complications during childbirth and to reduce malnutrition and hypoxia of the fetus, • to increase the duration of physical and intellectual life.
2. For the treatment and rehabilitation of patients: • for chronic diseases of the cardiorespiratory system (stage I–II hypertension, coronary heart disease, post-infarction cardiosclerosis, chronic bronchitis, bronchial asthma), • for diseases of the hematopoietic system (hypoplastic and iron deficiency anemia, post-radiation hematopoietic disorders), • for diseases of the gastrointestinal tract (outside exacerbations), • with chronic inflammatory processes of the genital area, with toxicosis of the second half of pregnancy, • with metabolic disorders (for example, diabetes), • with a decrease in the body’s resistance to unfavorable environmental conditions – climatic, meteorological, environmental factors, distress, etc. • for asthenic and depressive conditions, neuroses, etc.
There are contraindications to the INHT method: acute somatic diseases and infectious diseases, sharp exacerbation and decompensation of chronic diseases [12, 15, 16,19,25, 26].
Domestic industry has mastered the production of stationary hypoxicators, devices that generate gas mixtures with a reduced oxygen content. Devices designed to simultaneously serve 10–20 people are produced by NPO Cryogenmash, Scientific Research and Production Center “Mountain Air”, for 4–8 patients – PA “Climbie”, NTO “Bio-Nova”, for 1–4 patients devices are produced by companies “Cosmos”, “Hypoxia Media” [23, 25, 26].
Devices for personal use – hypoxicators R.B. Strelkov – based on respiration, produced by MPKF “METOM” These devices allow hypoxic therapy to be carried out without specially equipped rooms, on an outpatient basis [23, 24, 25].
As an example of the successful application of the method in practice, we can cite the results obtained by many researchers.
According to R.B. Strelkov, obtained by analyzing the results of the mass use of INHT at enterprises in Russia and the former Soviet Union (more than 80 cities in total), 200 thousand people received a course of hypoxic therapy. During its use, a significant (2-4 times) reduction in morbidity and days of disability was noted. Thus, the use of the INHT method at the Center for Prevention, Rehabilitation and Rehabilitation Treatment (Astrakhan, 1995) in 218 children aged 3 to 15 years suffering from bronchial asthma and chronic bronchitis, the effectiveness of treatment with individual hypoxicators, according to E.A.
Khasyanov and colleagues was 86.7 ± 2.3% [23, 16].
Breathing with hypoxic gas mixtures can be used as one of the methods of bronchosanitation therapy for bronchitis of various etiologies [5, 18, 32], since according to research, the deepening of breathing that occurs during INHT sessions activates the surfactant system of the lungs, which leads to acceleration of mucociliary transport. In addition, the initial period of adaptation to hypoxia is accompanied by excitation of the sympathetic nervous system and an increase in the concentration of blood catecholamines, which promotes bronchodilation and increased function of the bronchial glands [20]. According to N.N. Bayrak and L.M.
Bogatyrchuk (medical and health center “Elbrus”, Zhitomir), obtained during the treatment and examination of 321 patients, breathing with hypoxic mixtures helps improve the drainage of the bronchial tree and this effect after a month’s course persists for 5-6 months [23].
M.V. Evsegneeva et al. examined 121 patients with diseases of the cardiovascular system. Against the background of hypoxic therapy, in some patients who did not receive drug therapy, the condition objectively improved; in patients receiving medications, they were able to stop them or significantly reduce the dose of the drugs. Adaptation to INHT led to an improvement in electrocardiographic parameters in 82.2% of patients with coronary artery disease and hypertension; signs of myocardial ischemia and rhythm disturbances disappeared; intraatrial, atrioventricular and intraventricular conduction improved. In patients with coronary artery disease and hypertension after INHT, normalization of central and intracardiac hemodynamics was noted, and a normalizing effect of the method on the kinetics of oxygen metabolism in tissues was noted [16, 23].
Currently, there are reports in the press about the use of INHT not only in the treatment of internal diseases, but also in neurological practice. For example, A. M. Kan and co-authors (Department of Neurology and Neurosurgery of the Russian State Medical University, Research Institute of Pharmacology of the Russian Academy of Medical Sciences) used the method of hypoxic therapy in patients with clinical epilepsy. 8 patients were examined. After a course of INHT, four patients experienced the absence of seizures for 4 months against the background of a gradual reduction in the dose of anticonvulsants, up to their complete withdrawal.
The rest experienced a significant reduction in the frequency and severity of attacks [23].
Intermittent hypoxic therapy is successfully used for the treatment of rheumatoid arthritis, anemia, vegetative-vascular dystonia, in obstetric practice for the treatment of gestosis, in gynecology for the prevention of postoperative complications, etc. [8, 9, 14, 15, 21,26,28, 30].
The radioprotective properties of normobaric hypoxic therapy are known. In 1970 R.B. Strelkov and his colleagues conducted the first experiments to determine the radioprotective properties of hypoxia that develops when breathing gas mixtures. Subsequently, the INHT method found application in oncological practice in patients receiving radiation therapy, and it was noted that the gas mixture used protects the lymphoid and reticuloendothelial systems and promotes the creation of functional activity of tissues not affected by the tumor process [22, 31].
Hypoxic therapy as a method is used not only as a therapeutic technique, but also often as a strong adaptogen. Also Academician N.N. Sirotin proposed using adaptation to low oxygen levels as a means of increasing resistance to various types of harmful influences and increasing performance. Hypoxia is often used for these purposes in sports practice. The successful use of hypoxia has been noted in the training of pilots, cosmonauts, and climbers [1, 2, 7, 9, 13, 23].
The method of hypoxic stimulation of nonspecific resistance of the body, developed by R.B. Strelkov and A.Ya Chizhov [18, 32], occupies an increasingly strong place among naturopathic effects on the human body, such as balanced nutrition, physical activity, herbal medicine, etc. A feature of INHT is the optimal combination of urgent adaptive reactions with long-term restructuring of the body’s energy supply systems.
Currently, in conditions of deteriorating ecology, it is unlikely that the population can count on changing this situation, but it is possible to increase the resistance of the body itself, which will lead to an improvement in the quality of life, a decrease in morbidity, and a decrease in the number of exacerbations of chronic nosologies.
Thus, the use of intermittent normobaric hypoxic therapy makes it possible to enable and use genetically programmed mechanisms aimed at increasing the body’s nonspecific resistance, which makes it possible to recommend the method in complexes used in treatment, prevention and rehabilitation for various nosological forms of diseases and in various stressful situations.
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