Psychophysiological rehabilitation with intermittent hypoxia-hyperoxia training in elderly patients with myocardial infarction and heart failure

Aim. To study the effect of rehabilitation using intermittent hypoxia-hyperoxia training (IHHT) on anxiety and depression, quality of life (QOL), and exercise tolerance in elderly patients with myocardial infarction (MI) and heart failure (HF).

Material and methods. This single-center, prospective, randomized, controlled, parallel-group study included 102 elderly patients with MI and HF. Patients were randomized into two groups: the experimental group (n=51) received standard rehabilitation combined with IHHT using the ReOxy device; the control group (n=51) received standard rehabilitation alone. All patients were assessed for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), quality of life using the EuroQol-5D questionnaire, and 6-minute walk test distance.

Results. The groups were comparable in clinical and demographic characteristics (p>0,05). In the experimental group, compared with the standard rehabilitation group, there was a more pronounced decrease in the HADS score (2,0 (0,0; 7,0) vs 1,0 (0,0; 4,0), p=0,040) and an improvement in QOL according to the European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L) visual analogue scale (20,0% (0,0; 30,0) vs 15,0% (-25,0; 30,0), p=0,044). This was accompanied by a greater increase in distance during the 6-minute walk test (up to 51,0 (33,0; 86,0) m in the experimental group vs 30,0 (22,5; 56,0) m, p=0,001).

Conclusion. Adding IHHT to a standard rehabilitation program for patients with MI and HF reduces anxiety, improves QOL, and improves exercise tolerance.

1. Galimzyanov AF, Galiullin AN, Galiullin DA, et al. Medical and social problems of management of risk factors of cardiovascular diseases leading to morbidity, disability and mortality. Emergency Medical Care. 2023;24(3):51-8. (In Russ.) doi:10.24884/2072-6716-2023-24-3-51-58.

2. Goldstein CM, Gathright EC, Garcia S. Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team. Patient Prefer Adherence. 2017;11:547-59. doi:10.2147/PPA.S127277.

3. Lian Y, Xiang J, Wang X, et al. Prevalence of Moderate to Severe Anxiety Symptoms among Patients with Myocardial Infarction: A Meta- Analysis. Psychiatr Q. 2022;93:161-80. doi:10.1007/s11126-021-09937-4.

4. Feng HP, Chien WC, Cheng WT, et al. Risk of Anxiety and Depressive Disorders in Patients with Myocardial Infarction: A Nationwide Population-Based Cohort Study. Medicine. 2016; 95(34):e4464. doi:10.1097/MD.0000000000004464.

5. Dyussenova L, Pivina L, Semenova Y, et al. Associations between depression, anxiety and medication adherence among patients with arterial hypertension: Comparison between persons exposed and non-exposed to radiation from the Semipalatinsk Nuclear Test Site. J Environ Radioact. 2018;195:33-9. doi:10. 1016/j.jenvrad.2018.09.016.

6. Lissåker CT, Norlund F, Wallert J, et al. Persistent emotional distress after a first-time myocardial infarction and its association to late cardiovascular and non-cardiovascular mortality. Eur J Prevent Cardiol. 2019;26(14):1510-8. doi:10.1177/2047487319841475.

7. Dibben GO, Faulkner J, Oldridge N, et al. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: A Meta-Analysis. Eur Heart J. 2023;44:452-69. doi:10.1093/eurheartj/ehac747.

8. Taylor RS, Dalal HM, McDonagh STJ. The Role of Cardiac Rehabilitation in Improving Cardiovascular Outcomes. Nat Rev Cardiol. 2021;19:180-94. doi:10.1038/s41569-021-00611-7.

9. Nekouei ZK, Yousefy A, Manshaee G, et al. Comparing anxiety in cardiac patients candidate for angiography with normal population. ARYA Atheroscler. 2011;7(3):93-6.

10. Bertolín-Boronat C, Marcos-Garcés V, Merenciano-González H, et al. Depression, Anxiety, and Quality of Life in a Cardiac Rehabilitation Program Without Dedicated Mental Health Resources Post-Myocardial Infarction. J Cardiovasc Dev Dis. 2025;12(3):92. doi:10.3390/jcdd12030092.

11. Neubauer JA. Invited review: Physiological and pathophysiological responses to intermittent hypoxia. J Appl Physiol (1985). 2001;90(4):1593-9. doi:10.1152/jappl.2001.90.4.1593.

12. Conway EM, Collen D, Carmeliet P. Molecular mechanisms of blood vessel growth. Cardiovasc Res. 2001;49(3):507-21. doi:10.1016/s0008-6363(00)00281-9.

13. Glazachev OS, Kryzhanovskaya SY, Zapara MA, et al. Safety and Efficacy of Intermittent Hypoxia Conditioning as a New Rehabilitation/Secondary Prevention Strategy for Patients with Cardiovascular Diseases: A Systematic Review and Metaanalysis. Curr Cardiol Rev. 2021;17(6):e051121193317. doi:10.2174/1573403X17666210514005235.

14. Bloch Y, Belmaker RH, Shvartzman P, et al. Normobaric oxygen treatment for mild-to-moderate depression: a randomized, double-blind, proof-of-concept trial. Sci Rep. 2021;11(1):189-211. doi:10.1038/s41598-021-98245-9.

15. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Russian Journal of Cardiology. 2019;(3):107-38. (In Russ.) doi:10.15829/1560-4071-2019-3-107-138.

16. Morozova MA, Potanin SS, Beniashvili AG, et al. Validation of the Russian version of the hospital anxiety and depression scale in the general population. The Russian Journal of Preventive Medicine. 2023;26(4):7-14. (In Russ.) doi:10.17116/profmed2023260417.

17. Aleksandrova EA, Khabibullina AR. Methodology for assessing health-related quality of life using the EQ-5D-3L questionnaire. Russian Medicine. 2019;25(4):202-9. (In Russ.) doi:10.18821/0869-2106-2019-25-4-202-209.

18. Zagaĭnaia E, Kopylov FIu, Glazachev OS, et al. Quality of life in patients with stable angina in application of intermittent hypoxic-hyperoxic training. Russian Journal of Cardiology and Cardiovascular Surgery. 2016;9(3):21‑7. (In Russ.) doi:10.17116/kardio20169321-27.

19. Pal'shina AM, Nikolaeva AM, Dmitrieva NG, et al. Statsionarnyy etap reabilitatsii bol'nykh s infarktom miokarda. CardioSomatics. 2015;6(1-1):77-8. (In Russ.) EDN: TPSMNH.

20. Prikhodko VA, Selizarova NO, Okovityĭ SV. Molecular mechanisms for hypoxia development and adaptation to it. Part I. Russian Journal of Archive of Pathology. 2021;83(2):52‑61. (In Russ.) doi:10.17116/patol20218302152.

21. Semenov DG, Belyakov AV. Hypoxic Conditioning as a Stimulus for the Formation of Hypoxic Tolerance of the Brain. Progress in Physiological Science. 2023;54(2):3-19. (In Russ.). doi:10.31857/S0301179823020066.

22. Budnevsky AV, Kravchenko AYa, Tokmachev RE, et al. Diagnostic, prognostic and therapeutic potential of 6-minute walk test in patients with heart failure. Cardiovascular Therapy and Prevention. 2020;19(6):2460. (In Russ.) doi:10.15829/1728-8800-2020-2460.

23. Zagaĭnaia E, Shchekochikhin DIu, Kopylov FIu, et al. Interval hypoxic training in cardiology practice. Russian Journal of Cardiology and Cardiovascular Surgery. 2014;7(6):28-34. (In Russ.) EDN: TJWTVJ.