Therapeutic Potential of Hypoxic Conditioning Technology in Post-Stroke Recovery: From Molecular and Physiological Mechanisms to Clinical Practice (A Narrative Review)

Acute cerebral circulatory failure (ACCF) remains one of the leading causes of disability and mortality, retaining the risks of development and progression of cognitive and functional impairment even in the late recovery period. The acuteness of the problem actualizes the necessity to search for innovative approaches to rehabilitation and maintenance of a satisfactory quality of life for such patients. The technology of hypoxic conditioning (HC) in interval modes, in particular, in the form of a course of procedures of interval hypoxic-hyperoxic exposures (IHHE), is a promising non-pharmacological approach capable of potentiating the processes of neuroplasticity, synaptogenesis, and cerebral hemodynamics. This review aims to analyse the therapeutic potential of IHHE in the context of post-ACCF rehabilitation, including its effects on molecular mechanisms of adaptation, angiogenesis and functional recovery. The methodology includes a systematic search in PubMed, Scopus, eLIBRARY.RU and other databases, with a focus on studies related to hypoxic preconditioning, neuroprotection and clinical outcomes. The results demonstrate that IHHE activates HIF-1α-dependent pathways, stimulating angiogenesis via VEGF and neurogenesis via BDNF, which is supported by experimental and clinical data. Moderate hypoxia (9-16% O₂) optimizes redox balance by suppressing pro-inflammatory cytokines (IL-6, TNF-α) and enhancing antioxidant defence via Nrf2, which correlates with a reduction in ischaemic damage volume. Clinically, IGGE improves cognitive performance (memory, attention) and motor function, especially when combined with aerobic exercise training, improving exercise tolerance (15-20% increase in 6MWT distance) and quality of life. Cardioprotective effects include normalization of blood pressure and reduction of oxidative stress markers (malonyl dialdehyde), which is significant in patients with polymorbidity. Integrating IHHE into multimodal rehabilitation programmes promotes synergistic methods, enhancing neurovascular remodeling. Although promising, optimization of personalized protocols, considering age and comorbid pathologies, and randomized trials to assess long-term safety are required. This review is addressed to neurologists, molecular biologists and rehabilitation specialists, emphasising the translational potential of IHHE into clinical practice, subject to further validation of its efficacy.