Intermittent Hypoxia-Hyperoxia Training.
You sit in a chair and breathe through a mask. The oxygen concentration drops to roughly what you would find at high altitude, then rises above room air, then drops again. Your body reads the cycling as a stimulus and adapts to it.
- Entirely passive. Seated at rest with no exertion at all
- Studied in double blind randomised controlled trials
- Monitored continuously with oxygen saturation tracked throughout
- Well tolerated in trial participants up to 92 years of age
Altitude, without the mountain.
Room air is about 21 percent oxygen. During the hypoxic phase the system delivers roughly 10 to 14 percent, comparable to being several thousand metres up. Your body notices immediately, even though you are sitting still.
Then the concentration is raised to 30 to 40 percent, above room air, for a shorter recovery interval. That hyperoxic phase is what distinguishes this from older altitude training methods. It speeds recovery between cycles, which allows more hypoxic exposure in a single session and makes the whole thing considerably more tolerable.
Seated and monitored · mask delivery throughout
Stress, then recovery.
The mechanism is hormetic. A controlled stressor, applied briefly and repeatedly with recovery between exposures, prompts an adaptive response that continuous exposure would not produce.
Oxygen Drops
Inspired oxygen falls to around 10 to 14 percent. Your saturation declines in a controlled way, chemoreceptors register the change, and the body begins responding as it would at altitude, without you having gone anywhere.
- Comparable to several thousand metres of elevation
- Saturation monitored continuously throughout
- Duration adjusted to how you respond
Oxygen Rises
Concentration is raised to 30 to 40 percent, above room air. This accelerates recovery of saturation between cycles, which is what allows the protocol to deliver more total hypoxic exposure than intermittent hypoxia alone.
- Faster recovery than returning to room air
- Permits more cycles within one session
- The feature that distinguishes IHHT from IHT
The Cycle Repeats
Alternating continues for the length of the session. The repetition is the mechanism. A single exposure produces little, which is why protocols are built as courses of sessions rather than one off visits.
- Repetition rather than intensity drives the response
- Trials typically run five to eight weeks
- Delivered as a course, not a single session
Screening Decides
This is a controlled physiological stressor. Reduced oxygen is not appropriate for everyone, and the profile of who should avoid it is specific rather than general. Screening before a first session is not a formality here.
- Not appropriate with certain cardiac or respiratory conditions
- Not appropriate during pregnancy
- Protocol adjusted to your measured response
What the trials found.
This modality has been tested in double blind randomised controlled trials with placebo groups breathing ambient air, which is a higher standard than most of what we operate.
Cognitive results in geriatric trials were substantial
In a double blind randomised trial of 34 patients aged 64 to 92, adding IHHT to a multimodal training programme produced significantly larger cognitive improvements than training alone. Dementia detection test scores rose 16.7 percent against 0.39 percent in the placebo group, and clock drawing test scores rose 10.7 percent while the control group declined 8 percent.
Functional capacity improved alongside it
The same trial measured six minute walk distance, which increased 24.1 percent in the IHHT group compared with 10.8 percent in the group receiving training and ambient air. The authors noted the protocol was easily applicable to and well tolerated by patients up to 92 years of age.
More recent trials are more measured
A 2025 randomised trial of intermittent hypoxic conditioning in 26 elderly participants found a trend toward improved endothelial function, significant only when normalised for artery diameter, and increased peak ventilation but no other significant changes in cardiorespiratory fitness. A separate 2025 trial found no enhancement of cerebrovascular reactivity. The picture is genuinely mixed, and we would rather show you that than only the favourable studies.
Who tends to use it.
Because it requires nothing physically, this suits people that conventional conditioning cannot reach.
Older members, where the strongest trial evidence sits
People interested in cognitive performance, the most studied outcome here
Anyone who cannot exercise, or cannot exercise enough to create a stimulus
Athletes adding an adaptive signal without adding mechanical or training load
Members working across both the Oxygen and Cellular Energy systems
Not appropriate with certain cardiac or respiratory conditions, or in pregnancy
What to expect.
Physically undemanding, monitored throughout, and easier than most people anticipate.
Preparation
- Screening confirms suitability before a first session
- Tell our team about any cardiac or respiratory condition
- Wear whatever you arrived in. Nothing needs changing
- Avoid a heavy meal immediately beforehand
The Session
- You sit comfortably with a mask fitted and a sensor on your finger
- Cycles alternate automatically, adjusted to your saturation
- Some people notice mild lightheadedness during hypoxic phases
- Read, work, or rest. Thirty to forty five minutes
Afterwards
- No recovery period. Return to normal activity immediately
- Some report feeling notably clear headed afterwards
- Delivered as a course rather than a single session
- Typically two to three times a week over several weeks
Cycles adjusted live · saturation monitored throughout
Framed as mechanisms, not promises.
Each item describes what this modality is studied in relation to. None is a guaranteed outcome, and the trial populations were mostly older adults.
Cognitive performance, the most studied outcome in controlled trials
Functional exercise capacity, measured by six minute walk distance
Exercise tolerance when combined with a training programme
Endothelial function, where recent trials show a trend rather than certainty
Peak ventilation, which increased in a 2025 randomised trial
Mitochondrial adaptation, proposed as a pathway in the underlying literature
A stimulus achievable without exertion, joint load, or cardiovascular strain
Tolerability demonstrated in participants up to 92 years of age
A course, not a session.
Every trial that found an effect delivered this over several weeks. Trying it once tells you almost nothing, which is why we schedule it as a block.
We measure and screen
VO₂ max and InBody establish your baseline, and screening determines whether hypoxic exposure is appropriate for you before anything is scheduled.
We set the course
Sessions are planned across several weeks, in line with the trial protocols, with cycle parameters adjusted to your measured response rather than applied uniformly.
We retest
Your markers are measured again at a defined point. What continues or changes is decided on data rather than on how a session felt.
Randomised, placebo controlled.
This modality has been tested against placebo groups breathing ambient air. These are the trials, including the ones with less favourable findings.
Breathing 10 to 14 percent oxygen for four to seven minutes, followed by two to four minutes at 30 to 40 percent oxygen, repeated across the session. The hyperoxic phase speeds recovery, which allows greater total hypoxic exposure.
IHHT and cognitive performance in geriatric patients
Effects on mobility and perceived health
Vascular function and cardiorespiratory fitness
Cerebrovascular function in the elderly
Real trials, and an honest picture
This modality clears a bar most wellness equipment does not, having been tested against placebo in double blind randomised trials with meaningful effect sizes. Two things to carry as you read. The strongest findings come from geriatric populations receiving IHHT alongside a training programme, so how well they transfer to a healthy forty year old is genuinely unknown. And the more recent trials are more measured, with one finding no cerebrovascular benefit at all. We include that study deliberately. If we only showed you the favourable results you would have no way to judge the rest of this page.
Questions answered.
Is it uncomfortable to breathe low oxygen?
Less than most people expect. Some notice mild lightheadedness or a sense of breathing a little deeper during hypoxic phases. Your saturation is monitored continuously and cycles adjust to your response. Trials found it well tolerated by patients up to 92 years old.
Is this the same as altitude training?
Related but more controlled, and with an important addition. Altitude training means living or exercising at elevation for extended periods. This delivers precise oxygen concentrations in short cycles while you sit, and adds a hyperoxic recovery phase that altitude cannot provide.
Why the hyperoxic phase?
It speeds recovery of your oxygen saturation between hypoxic intervals. That allows more total hypoxic exposure within a session and makes the protocol more tolerable. It is the feature that distinguishes IHHT from older intermittent hypoxic training.
Will it improve my cognition?
The trial results in older adults were substantial, with dementia detection scores improving 16.7 percent against essentially nothing in the placebo group. Those participants were geriatric patients also doing a training programme. We cannot promise the same in a healthy adult, and we will not extrapolate on your behalf.
Is it safe?
It is a controlled physiological stressor delivered under continuous monitoring, and it was well tolerated across the trials. It is not appropriate for everyone. Certain cardiac and respiratory conditions and pregnancy are contraindications, which is what screening exists to identify.
How does this differ from EWOT or hyperbaric?
Hyperbaric uses pressure to raise dissolved oxygen. EWOT raises inspired oxygen during exercise. This alternates below and above room air while you rest. All three sit in the same system and work the same chain from different directions.
How many sessions do I need?
More than a few. Trials ran five to eight weeks with sessions two to three times a week. The adaptive response depends on repeated exposure, so this is delivered as a course rather than something you try once.
Can I train on the same day?
Usually yes, and in the trials it was deliberately combined with training. Our team sequences it within your week rather than leaving the timing to chance.
Is it included in membership?
Access depends on your tier. Circuits are the unit of membership, and because this works as a course, it is scheduled as a block within your protocol rather than booked individually.
Sequenced deliberately.
Modalities in this system address different parts of the same chain. These are the ones most often paired with it.
Hyperbaric Oxygen
Oxygen under pressure at rest, working the same adaptive signalling from the opposite direction.
EWOT
Enriched oxygen during exertion, using movement rather than cycling to drive the stimulus.
Oxygen & Capacity
See how this modality sits alongside the others addressing delivery, extraction, and utilization.
Reserve Your Consultation.
Because this works as a course and requires screening, it starts with a conversation. In it we will:
- Understand what you are actually trying to change
- Screen for cardiac and respiratory considerations
- Set a course rather than a single session
- Explain what the trials found and in whom
- Build a protocol across the systems that matter for you