avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2023-13-4-245-252AHXHPLavk-1635Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESВозможности и перспективы применения гипокситерапии в кардиологииPossibilities and Prospects of Hypoxytherapy Application in Cardiologyhttps://orcid.org/0000-0003-3611-1186ИгнатенкоГ. А.IgnatenkoG. A.

Донецк

Donetsk

https://orcid.org/0000-0003-2592-0906БагрийА. Э.BagriyA. E.

Донецк

Donetsk

https://orcid.org/0009-0001-2138-2277ИгнатенкоТ. С.IgnatenkoT. S.

Донецк

Donetsk

https://orcid.org/0009-0002-4586-3718ТолстойВ. А.TolstoyV. A.

Донецк

Donetsk

https://orcid.org/0009-0008-5989-7891ЕвтушенкоИ. С.EvtushenkoI. S.

Донецк

Donetsk

https://orcid.org/0000-0001-8625-1406МихайличенкоЕ. С.MykhailichenkoE. S.

Евгения Сергеевна Михайличенко

Донецк

Eugenia S. Mykhailichenko

Donetsk

klassiki@inbox.ruГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»РоссияSEI HPE State Donetsk S tate Medical University named after M. GorkyRussian Federation202316082023134245252Copyright © Игнатенко Г.А., Багрий А.Э., Игнатенко Т.С., Толстой В.А., Евтушенко И.С., Михайличенко Е.С., 20232023Игнатенко Г.А., Багрий А.Э., Игнатенко Т.С., Толстой В.А., Евтушенко И.С., Михайличенко Е.С.Ignatenko G.A., Bagriy A.E., Ignatenko T.S., Tolstoy V.A., Evtushenko I.S., Mykhailichenko E.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/1635

Несмотря на достижения современной кардиологии, заболеваемость и смертность от кардиоваскулярной патологии в большинстве стран мира остается высокой, что мотивирует более широкое использование дополнительных (альтернативных) профилактических и лечебных подходов, одним из которых является гипокситерапия. За несколько десятилетий использования этого метода накоплен обширный объем информации, позволяющий констатировать благоприятное воздействие различных режимов гипокситерапии на выраженность клинической картины сердечно-сосудистых заболеваний, что потенциально может улучшать их прогноз. Применение гипокситерапии ассоциируется с улучшением циркадного ритма артериального давления, поток-зависимой вазодилатации, со снижением инсулинорезистентности, уменьшением жесткости сосудистой стенки, улучшением реологии крови, функции эндотелия и системы оксида азота, снижением уровней провоспалительных и протромботических цитокинов. Ряд авторитетных экспертов рассматривают гипокситерапию в качестве доступного и перспективного метода профилактики и лечения сердечно-сосудистой патологии, эффективно дополняющего традиционные немедикаментозные и медикаментозные подходы. Накопленные данные свидетельствуют о серьезных перспективах расширенного изучения возможностей применения гипокситерапии у кардиологических больных, в том числе в рамках крупных государственных исследовательских программ. Настоящий обзор посвящен рассмотрению физиологических эффектов гипокситерапии, возможностей ее применения в кардиологической практике, в том числе с анализом собственных данных, а также мер предосторожности при ее проведении.

Despite the achievements of modern cardiology, the cardiovascular morbidity and mortality in most countries of the world remains high, which motivates the wider use of additional (alternative) preventive and therapeutic approaches, one of which is hypoxytherapy. Over several decades of 

using this method, a large amount of data has been accumulated that allows us to state the beneficial effect of various hypoxytherapy regimens on the clinical course of cardiovascular diseases and can potentially improve prognosis of them. The use of hypoxytherapy is associated with an improvement in blood pressure circadian rhythm, flow-dependent vasodilation, an insulin resistance decrease, a vascular wall stiffness redaction, an improvement in blood rheology, endothelial function and nitric oxide system, a decrease of proinflammatory and prothrombotic cytokines levels. A number of modern experts consider hypoxytherapy as an affordable and perspective method of prevention and treatment of cardiovascular disease, effectively supporting traditional non-drug and drug-based approaches. Contemporary data indicate serious future perspectives for an expanded study of the hypoxytherapy possibilities in cardiac patients, including through the State research programmes. This review is devoted to the discussion of the physiological effects of hypoxytherapy, the possibilities of its application in cardiological practice, including with the analysis of own data, as well as precautions during its implementation.

гипокситерапиясердечно-сосудистые заболеванияишемическое прекондиционирование тканейартериальная гипертонияишемическая болезнь сердцаhypoxytherapycardiovascular diseasesischemic tissue preconditioningarterial hypertensionischemic heart diseaseReferencesMc Namara K., Alzubaidi H., Jackson J.K. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? Integrated pharmacy research and practice. 2019: 1-11. doi: 10.2147/IPRP.S133088.Mc Namara K., Alzubaidi H., Jackson J.K. Cardiovascular disease as a leading cause of death: how are pharmacists getting involved? Integrated pharmacy research and practice. 2019: 1-11. doi: 10.2147/IPRP.S133088.Timmis A., Vardas P., Townsend N. et al. European Society of Cardiology: cardiovascular disease statistics 2021. European Heart Journal. 2022; 43(8): 716-799. doi: 10.1093/eurheartj/ehab892.Timmis A., Vardas P., Townsend N. et al. European Society of Cardiology: cardiovascular disease statistics 2021. European Heart Journal. 2022; 43(8): 716-799. doi: 10.1093/eurheartj/ehab892.Mendis S. Global progress in prevention of cardiovascular disease. Cardiovascular Diagnosis and Therapy. 2017; 67: S32-S38. doi: 10.21037/cdt.2017.03.06.Mendis S. Global progress in prevention of cardiovascular disease. Cardiovascular Diagnosis and Therapy. 2017; 67: S32-S38. doi: 10.21037/cdt.2017.03.06.Rippe J.M. Lifestyle Strategies for Risk Factor Reduction, Prevention, and Treatment of Cardiovascular Disease. American Journal of Lifestyle Medicine. 2019; 13: 204–212. doi: 10.1177/1559827618812395.Rippe J.M. Lifestyle Strategies for Risk Factor Reduction, Prevention, and Treatment of Cardiovascular Disease. American Journal of Lifestyle Medicine. 2019; 13: 204–212. doi: 10.1177/1559827618812395.Moore S.C., Patel A.V., Matthews C.E. et al. Leisure time physical activity of moderate to vigorous intensity and mortality: A large pooled cohort analysis. PLoS Medicine. 2012; 9: e1001335. doi:10.1371/journal.pmed.1001335.Moore S.C., Patel A.V., Matthews C.E. et al. Leisure time physical activity of moderate to vigorous intensity and mortality: A large pooled cohort analysis. PLoS Medicine. 2012; 9: e1001335. doi:10.1371/journal.pmed.1001335.Piercy K.L., Troiano R.P., Ballard R.M. et al. The physical activity guidelines for Americans. JAMA. 2018; 320: 2020–2028. doi: 10.1001/jama.2018.14854.Piercy K.L., Troiano R.P., Ballard R.M. et al. The physical activity guidelines for Americans. JAMA. 2018; 320: 2020–2028. doi: 10.1001/jama.2018.14854.Verges S., Chacaroun S., Godin-Ribuot D. et al. Hypoxic Conditioning as a New Therapeutic Modality. Frontiers in Pediatrics. 2015; 3: 58. doi: 10.3389/fped.2015.00058.Verges S., Chacaroun S., Godin-Ribuot D. et al. Hypoxic Conditioning as a New Therapeutic Modality. Frontiers in Pediatrics. 2015; 3: 58. doi: 10.3389/fped.2015.00058.Serebrovskaya T.V., Xi L. Intermittent hypoxia training as nonpharmacologic therapy for cardiovascular diseases: Practical analysis on methods and equipment. Experimental Biology and Medicine. 2016; 241: 1708–1723. doi:10.1177/1535370216657614.Serebrovskaya T.V., Xi L. Intermittent hypoxia training as nonpharmacologic therapy for cardiovascular diseases: Practical analysis on methods and equipment. Experimental Biology and Medicine. 2016; 241: 1708–1723. doi:10.1177/1535370216657614.Millet G.P., Debevec T., Brocherie F. et al. Therapeutic Use of Exercising in Hypoxia: Promises and Limitations. Frontiers in Physiology. 2016; 7: 224. doi: 10.3389/fphys.2016.00224.Millet G.P., Debevec T., Brocherie F. et al. Therapeutic Use of Exercising in Hypoxia: Promises and Limitations. Frontiers in Physiology. 2016; 7: 224. doi: 10.3389/fphys.2016.00224.Neubauer J.A. Invited Review: Physiological and pathophysiological responses to intermittent hypoxia. Journal of Applied Physiology. 2001; 90: 1593–1599. doi: 10.1152/jappl.2001.90.4.1593.Neubauer J.A. Invited Review: Physiological and pathophysiological responses to intermittent hypoxia. Journal of Applied Physiology. 2001; 90: 1593–1599. doi: 10.1152/jappl.2001.90.4.1593.Behrendt T., Bielitzki R., Behrens M. et al. Effects of intermittent hypoxia–hyperoxia on performance-and health-related outcomes in humans: A systematic review. Sports Medicine-Open. 2022; 8(1): 1-28. doi: 10.1186/s40798-022-00450-x.Behrendt T., Bielitzki R., Behrens M. et al. Effects of intermittent hypoxia–hyperoxia on performance-and health-related outcomes in humans: A systematic review. Sports Medicine-Open. 2022; 8(1): 1-28. doi: 10.1186/s40798-022-00450-x.Riley C.J., Gavin M. Physiological Changes to the Cardiovascular System at High Altitude and its Effects on Cardiovascular Disease. High Altitude Medicine & Biology. 2017; 18: 102–113. doi: 10.1089/ham.2016.0112.Riley C.J., Gavin M. Physiological Changes to the Cardiovascular System at High Altitude and its Effects on Cardiovascular Disease. High Altitude Medicine & Biology. 2017; 18: 102–113. doi: 10.1089/ham.2016.0112.Rimoldi S.F., Sartori C., Seiler C. et al. High-altitude exposure in patients with cardiovascular disease: risk assessment and practical recommendations. Progress in Cardiovascular Diseases. 2010; 52: 512–524. doi: 10.1016/j.pcad.2010.03.005.Rimoldi S.F., Sartori C., Seiler C. et al. High-altitude exposure in patients with cardiovascular disease: risk assessment and practical recommendations. Progress in Cardiovascular Diseases. 2010; 52: 512–524. doi: 10.1016/j.pcad.2010.03.005.Savla J.J., Levine B.D., Sadek H.A. The Effect of Hypoxia on Cardiovascular Disease: Friend or Foe? High Altitude Medicine & Biology. 2018; 19: 124–130. doi: 10.1089/ham.2018.0044.Savla J.J., Levine B.D., Sadek H.A. The Effect of Hypoxia on Cardiovascular Disease: Friend or Foe? High Altitude Medicine & Biology. 2018; 19: 124–130. doi: 10.1089/ham.2018.0044.Wee J., Climstein M. Hypoxic training: Clinical benefits on cardiometabolic risk factors. Journal of Science and Medicine in Sport. 2015; 18: 56–61. doi: 10.1016/j.jsams.2013.10.247.Wee J., Climstein M. Hypoxic training: Clinical benefits on cardiometabolic risk factors. Journal of Science and Medicine in Sport. 2015; 18: 56–61. doi: 10.1016/j.jsams.2013.10.247.Bailey D.M., Davies B., Baker J. Training in hypoxia: modulation of metabolic and cardiovascular risk factors in men. Medicine and Science in Sports and Exercise. 2000; 32: 1058–1066.Bailey D.M., Davies B., Baker J. Training in hypoxia: modulation of metabolic and cardiovascular risk factors in men. Medicine and Science in Sports and Exercise. 2000; 32: 1058–1066.Muangritdech N., Hamlin M.J., Sawanyawisuth K. et al. Hypoxic training improves blood pressure, nitric oxide and hypoxia-inducible 7 factor-1 alpha in hypertensive patients. European Journal of Applied Physiology. 2020; 120: 1815–1826. doi: 10.1007/s00421-020-04410-9.Muangritdech N., Hamlin M.J., Sawanyawisuth K. et al. Hypoxic training improves blood pressure, nitric oxide and hypoxia-inducible 7 factor-1 alpha in hypertensive patients. European Journal of Applied Physiology. 2020; 120: 1815–1826. doi: 10.1007/s00421-020-04410-9.Park H., Kim J., Park M. et al. Exposure and Exercise Training in Hypoxic Conditions as a New Obesity Therapeutic Modality: A Mini Review. Journal of Obesity & Metabolic Syndrome. 2018; 27: 93–101. doi: 10.7570/jomes.2018.27.2.93.Park H., Kim J., Park M. et al. Exposure and Exercise Training in Hypoxic Conditions as a New Obesity Therapeutic Modality: A Mini Review. Journal of Obesity & Metabolic Syndrome. 2018; 27: 93–101. doi: 10.7570/jomes.2018.27.2.93.Urdampilleta A., González-Muniesa P., Portillo M.P. et al. Usefulness of combining intermittent hypoxia and physical exercise in the treatment of obesity. Journal of Physiology and Biochemistry. 2012; 68: 289–304. doi: 10.1007/s13105-0110115-1.Urdampilleta A., González-Muniesa P., Portillo M.P. et al. Usefulness of combining intermittent hypoxia and physical exercise in the treatment of obesity. Journal of Physiology and Biochemistry. 2012; 68: 289–304. doi: 10.1007/s13105-0110115-1.Rybnikova E.A., Nalivaeva N.N., Zenko M.Y. et al. Intermittent Hypoxic Training as an Effective Tool for Increasing the Adaptive Potential, Endurance and Working Capacity of the Brain. Front. Neurosci. 2022; 16: 941740. doi: 10.3389/fnins.2022.941740.Rybnikova E.A., Nalivaeva N.N., Zenko M.Y. et al. Intermittent Hypoxic Training as an Effective Tool for Increasing the Adaptive Potential, Endurance and Working Capacity of the Brain. Front. Neurosci. 2022; 16: 941740. doi: 10.3389/fnins.2022.941740.Prabhakar N.R., Peng Y., Kumar G.K. et al. Peripheral chemoreception and arterial pressure responses to intermittent hypoxia. Comprehensive Physiology. 2015; 5: 561–577. doi: 10.1002/cphy.c140039.Prabhakar N.R., Peng Y., Kumar G.K. et al. Peripheral chemoreception and arterial pressure responses to intermittent hypoxia. Comprehensive Physiology. 2015; 5: 561–577. doi: 10.1002/cphy.c140039.Park H.Y., Kim S.W., Jung W.S. et al. Hypoxic Therapy as a New Therapeutic Modality for Cardiovascular Benefit: A Mini Review. Rev. Cardiovasc. Med. 2022; 23(5): 161. doi: 10.31083/j.rcm2305161.Park H.Y., Kim S.W., Jung W.S. et al. Hypoxic Therapy as a New Therapeutic Modality for Cardiovascular Benefit: A Mini Review. Rev. Cardiovasc. Med. 2022; 23(5): 161. doi: 10.31083/j.rcm2305161.Sinex J.A., Chapman R.F. Hypoxic training methods for improving endurance exercise performance. Journal of Sport and Health Science. 2015: 4(4): 325-332. doi: 10.1016/j.jshs.2015.07.005.Sinex J.A., Chapman R.F. Hypoxic training methods for improving endurance exercise performance. Journal of Sport and Health Science. 2015: 4(4): 325-332. doi: 10.1016/j.jshs.2015.07.005.Игнатенко Г.А., Дубовая А.В., Науменко Ю.В. Возможности применения нормобарической гипокси-терапии в терапевтической и педиатрической практиках. Российский вестник перинатологии и педиатрии. 2022; 67(6): 46-53. doi: 10.21508/1027-4065-2022-67-6-46-53.Ignatenko G.A., Dubovaya A.V., Naumenko Yu.V. Treatment potential of normobaric hypoxic therapy in therapeutic and pediatric practice. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2022; 67(6): 46-53. doi: 10.21508/1027-4065-2022-67-6-46-53 [In Russian].Faeh D., Gutzwiller F., Bopp M. Lower Mortality from Coronary Heart Disease and Stroke at Higher Altitudes in Switzerland. Circulation. 2009; 120: 495–501. doi: 10.1161/CIRCULATIONAHA.108.819250.Faeh D., Gutzwiller F., Bopp M. Lower Mortality from Coronary Heart Disease and Stroke at Higher Altitudes in Switzerland. Circulation. 2009; 120: 495–501. doi: 10.1161/CIRCULATIONAHA.108.819250.Faeh D., Moser A., Panczak R. et al. Independent at heart: persistent association of altitude with ischaemic heart disease mortality after consideration of climate, topography and built environment. Journal of Epidemiology and Community Health. 2016; 70: 798–806. doi: 10.1136/jech-2015-206210.Faeh D., Moser A., Panczak R. et al. Independent at heart: persistent association of altitude with ischaemic heart disease mortality after consideration of climate, topography and built environment. Journal of Epidemiology and Community Health. 2016; 70: 798–806. doi: 10.1136/jech-2015-206210.Ezzati M., Horwitz M.E., Thomas D.S. et al. Altitude, life expectancy and mortality from ischaemic heart disease, stroke, COPD and cancers: national population-based analysis of us counties. Journal of Epidemiology and Community Health. 2012; 66: e17. doi: 10.1136/jech.2010.112938.Ezzati M., Horwitz M.E., Thomas D.S. et al. Altitude, life expectancy and mortality from ischaemic heart disease, stroke, COPD and cancers: national population-based analysis of us counties. Journal of Epidemiology and Community Health. 2012; 66: e17. doi: 10.1136/jech.2010.112938.Winkelmayer W.C., Hurley M.P., Liu J. et al. Altitude and the risk of cardiovascular events in incident us dialysis paients. Nephrology, Dialysis, Transplantation. 2012; 27: 2411– 2417. doi: 10.1093/ndt/gfr681.Winkelmayer W.C., Hurley M.P., Liu J. et al. Altitude and the risk of cardiovascular events in incident us dialysis paients. Nephrology, Dialysis, Transplantation. 2012; 27: 2411– 2417. doi: 10.1093/ndt/gfr681.Vedam H, Phillips CL, Wang D, Barnes DJ, Hedner JA, Unger G, et al. Short-term hypoxia reduces arterial stiffness in healthy men. European Journal of Applied Physiology. 2009; 105: 19– 8 25.Vedam H, Phillips CL, Wang D, Barnes DJ, Hedner JA, Unger G, et al. Short-term hypoxia reduces arterial stiffness in healthy men. European Journal of Applied Physiology. 2009; 105: 19– 8 25.Leuenberger U.A., Johnson D., Loomis J. et al. Venous but not skeletal muscle interstitial nitric oxide is increased during hypobaric hypoxia. European Journal of Applied Physiology. 2008; 102: 457–461. doi: 10.1007/s00421-007-0601-x.Leuenberger U.A., Johnson D., Loomis J. et al. Venous but not skeletal muscle interstitial nitric oxide is increased during hypobaric hypoxia. European Journal of Applied Physiology. 2008; 102: 457–461. doi: 10.1007/s00421-007-0601-x.Tremblay J.C., Ainslie P.N., Turner R. et al. Endothelial function and shear stress in hypobaric hypoxia: time course and impact of plasma volume expansion in men. American Journal of PhysiologyHeart and Circulatory Physiology. 2020; 319: H980–H994. doi: 10.1152/ajpheart.00597.2020.Tremblay J.C., Ainslie P.N., Turner R. et al. Endothelial function and shear stress in hypobaric hypoxia: time course and impact of plasma volume expansion in men. American Journal of PhysiologyHeart and Circulatory Physiology. 2020; 319: H980–H994. doi: 10.1152/ajpheart.00597.2020.Lyamina N.P., Lyamina S.V., Senchiknin V.N. et al. Normobaric hypoxia conditioning reduces blood pressure and normalizes nitric oxide synthesis in patients with arterial hypertension. Journal of Hypertension. 2011; 29: 2265–2272. doi: 10.1097/HJH.0b013e32834b5846.Lyamina N.P., Lyamina S.V., Senchiknin V.N. et al. Normobaric hypoxia conditioning reduces blood pressure and normalizes nitric oxide synthesis in patients with arterial hypertension. Journal of Hypertension. 2011; 29: 2265–2272. doi: 10.1097/HJH.0b013e32834b5846.Burtscher M., Pachinger O., Ehrenbourg I. et al. Intermittent hypoxia increases exercise tolerance in elderly men with and without coronary artery disease. International Journal of Cardiology. 2004; 96: 247–254. doi: 10.1016/j.ijcard.2003.07.021.Burtscher M., Pachinger O., Ehrenbourg I. et al. Intermittent hypoxia increases exercise tolerance in elderly men with and without coronary artery disease. International Journal of Cardiology. 2004; 96: 247–254. doi: 10.1016/j.ijcard.2003.07.021.Valle M.D.P., García-Godos F., Woolcott O.O. et al. Improvement of myocardial perfusion in coronary patients after intermittent hypobaric hypoxia. Journal of Nuclear Cardiology. 2006; 13: 69–74. doi: 10.1016/j.nuclcard.2005.11.008.Valle M.D.P., García-Godos F., Woolcott O.O. et al. Improvement of myocardial perfusion in coronary patients after intermittent hypobaric hypoxia. Journal of Nuclear Cardiology. 2006; 13: 69–74. doi: 10.1016/j.nuclcard.2005.11.008.Серебровская Т.В., Шатило В.Б. Опыт использования интервальной гипоксии для предупреждения и лечения заболеваний сердечно-сосудистой системы. Обзор. Кровообіг та гемостаз. 2014; 1-2: 16-33.Serebrovskaja T.V., Shatilo V.B. Experience in the use of interval hypoxia for the prevention and treatment of diseases of the cardiovascular system. Review. Krovoobіg ta gemostaz. 2014; 1-2: 16-33. [In Russian].Игнатенко Г.А., Денисова Е.М., Сергиенко Н.В. Гипокситерапия как перспективный метод повышения эффективности комплексного лечения коморбидной патологии. Вестник неотложной и восстановительной хирургии. 2021; 6(4): 73-80.Ignatenko G.A, Denisova E.M., Sergienko N.V. Hypoxytherapy as a promising method of increasing the effectiveness of complex treatment of comorbid pathology. Bulletin of urgent and recovery surgery. 2021; 6(4): 73-80. [In Russian].Игнатенко Г.А., Мухин И.В., Джоджуа Р.А. Влияние разных режимов терапии на частоту гипертензивных кризов и суточные профили артериального давления у молодых больных генетически индуцированной гипертонической болезнью. Вестник гигиены и эпидемиологии. 2020; 24(2): 159-163.Ignatenko G.A., Muhin I.V., Dzhodzhua R.A. The effect of different therapy regimens on the frequency of hypertensive crises and daily blood pressure profiles in young patients with genetically induced hypertension. Vestnik of hygiene and epidemiology. 2020; 24(2): 159-163. [In Russian].Игнатенко Г.А., Контовский Е.А., Дубовик А.В. и др. Применение интервальной нормобарической гипокситерапии у больных с кардиопульмональной патологией. Вестник гигиены и эпидемиологии. 2018;22(4):22-25.Ignatenko G.A., Kontovskij E.A., Dubovik A.V. et al. The use of interval normobaric hypoxytherapy in patients with cardiopulmonary pathology. Vestnik of hygiene and epidemiology. 2018; 22(4):22-25. [In Russian].Игнатенко Г.А., Мухин И.В., Паниева Н.Ю. Качество жизни у гипертензивных больных гипотиреозом на фоне разных режимов терапии. Вестник гигиены и эпидемиологии. 2020; 24(2): 185-188.Ignatenko G.A., Muhin I.V., Panieva N.Ju. Quality of life in hypertensive patients with hypothyroidism against the background of different therapy regimens. Vestnik of hygiene and epidemiology. 2020; 24(2): 185-188. [In Russian].Montero D., Lundby C. Effects of Exercise Training in Hypoxia Versus Normoxia on Vascular Health. Sports Med. 2016; 46: 1725–1736. doi: 10.1007/s40279-016-0570-5.Montero D., Lundby C. Effects of Exercise Training in Hypoxia Versus Normoxia on Vascular Health. Sports Med. 2016; 46: 1725–1736. doi: 10.1007/s40279-016-0570-5.Casey D.P., Joyner M.J. Local control of skeletal muscle blood flow during exercise: influence of available oxygen. Journal of Applied Physiology. 2011; 111: 1527–1538. doi: 10.1152/japplphysiol.00895.2011.Casey D.P., Joyner M.J. Local control of skeletal muscle blood flow during exercise: influence of available oxygen. Journal of Applied Physiology. 2011; 111: 1527–1538. doi: 10.1152/japplphysiol.00895.2011.Wang J., Wu M., Mao T. et al. Effects of normoxic and hypoxic exercise regimens on cardiac, muscular, and cerebral hemodynamics suppressed by severe hypoxia in humans. Journal of Applied Physiology. 2010; 109: 219–229. doi: 10.1152/japplphysiol.00138.2010.Wang J., Wu M., Mao T. et al. Effects of normoxic and hypoxic exercise regimens on cardiac, muscular, and cerebral hemodynamics suppressed by severe hypoxia in humans. Journal of Applied Physiology. 2010; 109: 219–229. doi: 10.1152/japplphysiol.00138.2010.Jung K., Seo J., Jung W.S. et al. Effects of an Acute Pilates Program under Hypoxic Conditions on Vascular Endothelial Function in Pilates Participants: A Randomized Crossover Trial. International Journal of Environmental Research and Public Health. 2020; 17: 258. doi: 10.3390/ijerph17072584.Jung K., Seo J., Jung W.S. et al. Effects of an Acute Pilates Program under Hypoxic Conditions on Vascular Endothelial Function in Pilates Participants: A Randomized Crossover Trial. International Journal of Environmental Research and Public Health. 2020; 17: 258. doi: 10.3390/ijerph17072584.Katayama K., Fujita O., Iemitsu M. et al. The effect of acute exercise in hypoxia on flowmediated vasodilation. European Journal of Applied Physiology. 2013; 113: 349–357. doi: 10.1007/s00421-0122442-5.Katayama K., Fujita O., Iemitsu M. et al. The effect of acute exercise in hypoxia on flowmediated vasodilation. European Journal of Applied Physiology. 2013; 113: 349–357. doi: 10.1007/s00421-0122442-5.Nishiwaki M., Kawakami R., Saito K. et al. Vascular adaptations to hypobaric hypoxic training in postmenopausal women. The Journal of Physiological Sciences. 2011; 61: 83–91. doi: 10.1007/s12576010-0126-7.Nishiwaki M., Kawakami R., Saito K. et al. Vascular adaptations to hypobaric hypoxic training in postmenopausal women. The Journal of Physiological Sciences. 2011; 61: 83–91. doi: 10.1007/s12576010-0126-7.Park H., Jung W., Kim J. et al. Twelve weeks of exercise modality in hypoxia enhances health-related function in obese older Korean men: a randomized controlled trial. Geriatrics & Gerontology International. 2019; 19: 311–316. doi: 10.1111/ggi.13625.Park H., Jung W., Kim J. et al. Twelve weeks of exercise modality in hypoxia enhances health-related function in obese older Korean men: a randomized controlled trial. Geriatrics & Gerontology International. 2019; 19: 311–316. doi: 10.1111/ggi.13625.Jung K., Kim J., Park H. et al. Hypoxic Pilates Intervention for Obesity: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2020; 17: 7186. doi: 10.3390/ijerph17197186.Jung K., Kim J., Park H. et al. Hypoxic Pilates Intervention for Obesity: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2020; 17: 7186. doi: 10.3390/ijerph17197186.Zembron-Lacny A., Tylutka A., Wacka E. et al. Intermittent Hypoxic Exposure Reduces Endothelial Dysfunction. Biomed Res Int. 2020; 2020: 6479630. doi: 10.1155/2020/6479630.Zembron-Lacny A., Tylutka A., Wacka E. et al. Intermittent Hypoxic Exposure Reduces Endothelial Dysfunction. Biomed Res Int. 2020; 2020: 6479630. doi: 10.1155/2020/6479630.Korkushko O.V., Shatilo V.B., Ishchuk V.A. Effectiveness of intermittent normabaric hypoxic trainings in elderly patients with coronary artery disease Advances in Gerontology. 2010;23:476–482.Korkushko O.V., Shatilo V.B., Ishchuk V.A. Effectiveness of intermittent normabaric hypoxic trainings in elderly patients with coronary artery disease Advances in Gerontology. 2010;23:476–482.Levine B.D. Going High with Heart Disease: The Effect of HighAltitude Exposure in Older Individuals and Patients with Coronary Artery Disease. High Altitude Medicine & Biology. 2015; 16: 89–96. doi: 10.1089/ham.2015.0043.Levine B.D. Going High with Heart Disease: The Effect of HighAltitude Exposure in Older Individuals and Patients with Coronary Artery Disease. High Altitude Medicine & Biology. 2015; 16: 89–96. doi: 10.1089/ham.2015.0043.

The authors declare that there are no conflicts of interest present.