Cardiovascular disease (CVD) is the leading cause of death in men and women worldwide (1). Additionally, coronary artery disease and hypertension are two of the most prevalent forms of CVD. Physical inactivity is one of the main risk factors of CVD. Therefore, it is important that we improve the methods used to combat this disease. 

Hypoxic exposures, and exercise (IHT) in a simulated altitude environment (hypoxic training) can provide greater improvements in CVD symptoms and the quality of life of CVD patients. (2)

Indeed, the benefits of hypoxic exposure and exercise have been shown to result in greater improvements than sea-level exercise and/or medication alone (3,4). Exercise in hypoxia can also be done with lower overall workloads and reduced physical effort for the same or greater aerobic training effect (1,5,6). Even for patients with advanced conditions or comorbidities that limit their ability to perform exercise, passive hypoxic exposure can improve many factors of CVD and increase exercise tolerance and capacity. For example, in older people with and without CVD, passive exposure improved resting heart rate, blood pressure, stress on the cardiac muscle (reduced rate pressure product), arterial oxygen content and peak workload compared to control groups (3). 


Altitude Training For Cardiovascular Disease – Evidence-Based Benefits 


Accumulated research over the past 50 years has demonstrated hypoxic exposure and exercise is safe, and effective for patients with varying levels of CVD (1,3,4) . Also, the research has shown the mechanisms underpinning why hypoxic exposure is more effective for CVD patients.

IHT increases mitochondrial metabolism and density (1,5), stimulates endothelial Nitric Oxide production enhancing vasodilation and increases capillary density. Indeed, these mechanisms result in numerous beneficial performance and CVD outcomes.

Clinically relevant improvements for hypertensive, CVD, and chronic heart failure patients that are greater than what would be seen with sea-level exercise or traditional interventions alone. These include:

  • Lower Resting Blood Pressure (1,3,4)
  • Lower Resting & Active HR (1,3,4)
  • Reduced Rate Pressure Product (Cardiac Stress) (3)
  • Fewer Hypertensive Episodes (4)
  • Increased Aerobic Capacity (2,3,5)
  • Increased Exercise Capacity & Tolerance (2,3)
  • Improved Quality of Life (2,4)

Protocols can be either passive or active and built for varying levels of exercise tolerance. For example, passive protocols involving intermittent hypoxic breathing (IHB)* are ideal for patients suffering from CVD or other co-morbidities who cannot tolerate exercise. Active protocols are designed to allow patients to ease into exercise without compromising performance benefit. 

*IHB involves breathing very low oxygen air from a stationary position (seated) in a series of intervals interspersed with sea-level breathing.


Opportunities for Physicians and Clinics


  1. Incorporate altitude training sessions during cardiac rehab
    • Minimize deconditioning
    • Reduce inflammation
    • Regain fitness quicker
    • Slowly increase training intensity without compromising fitness
  2. Offer solutions for individuals with advanced conditions or comorbidities that limit their ability to perform exercise
    • Prevent further decline in aerobic fitness 
    • Increase aerobic capacity, building toward increasing physical activity 
    • Increase exercise tolerance building toward future exercise programs 


Speak with one of our coaches about training options for cardiovascular disease to improve health outcomes and quality of life.

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(1) 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

(2) Improved Exercise Performance and Skeletal Muscle Strength After Simulated Altitude Exposure: A Novel Approach for Patients With Chronic Heart Failure

(3) Intermittent hypoxia increases exercise tolerance in elderly men with and without coronary artery disease

(4) Intermittent hypoxia training as non-pharmacologic therapy for cardiovascular diseases: Practical analysis on methods and equipment

(5) Training High- Living Low: Changes of Aerobic Performance and Muscle Structure with Training at Simulated Altitude

(6) Endurance Training in Normobaric Hypoxia Imposes Less Physical Stress for Geriatric Rehabilitation

(7) The effect of acute exercise in hypoxia on flow-mediated vasodilation