Treatment & Procedure

Oxygen multistep therapy (after von Ardenne)

Biohacking

Oxygen multistep therapy is one of the classics of German preventive and naturopathic practice. The Dresden physicist Manfred von Ardenne developed it from a simple observation: the oxygen pressure in arterial blood falls with age. His answer was a three-step combination of medication, oxygen breathing and exercise that was meant to raise this value permanently. The idea can still be found in practices today; it was last tested under controlled conditions more than 30 years ago.

In brief

During oxygen breathing, the oxygen pressure in the blood rises, and the accompanying exercise is genuine training; neither point is disputed. Von Ardenne went further: the treatment was supposed to flip a switch mechanism in the finest blood vessels and raise the resting oxygen pressure for weeks to years. Studies from his circle reported exactly that, for example 17 percent more performance in 20 healthy men. Independent controlled studies, by contrast, found no lasting rise in arterial oxygen pressure and, in 82 men, the same gain in performance with compressed air instead of oxygen. There are no randomized trials, and the Federal Joint Committee has excluded the method from statutory health insurance.

What it is and how it is meant to work

In its classic form, the therapy has three steps. First, you take agents meant to improve oxygen utilization in the tissues; the descriptions mention vitamin B1, magnesium orotate and the cardiovascular drug dipyridamole, among others. Then oxygen is inhaled through a mask or nasal cannula, at a much higher concentration than in room air. Finally, exercise is added, usually on a bicycle ergometer, or mental activity instead for people who cannot exercise. Von Ardenne described more than 20 variants, from a short form with a quarter of an hour of oxygen under exertion to longer series of sessions at rest, sometimes combined with baths, thymus preparations or autologous blood procedures.

The rationale is physiological in spirit. Von Ardenne measured that arterial oxygen pressure falls with age and suspected a capillary-wall switch mechanism behind it: when oxygen supply is poor, the cells of the vessel wall swell, the finest vessels narrow and supply falls further. A strong burst of oxygen together with exercise was supposed to flip this switch back, with an effect that, according to his measurements, lasts weeks, months or even years. As his measure he used the resting oxygen pressures in arterial and venous blood. Incidentally, the systemic cancer multistep therapy with whole-body hyperthermia comes from the same workshop.

Why the idea is convincing

The method combines three things that each make sense on their own: oxygen as the basis of energy production in cells, exercise as a demonstrably effective means against loss of performance in old age, and a clearly structured programme with measurements before and after treatment. Then there was the name. Von Ardenne was a respected natural scientist with his own research institute in Dresden, who published his results in scientific journals and relied on blood gas measurements and ergometry, not on experience alone.

That carried the method for a long time. Several device manufacturers offered their own oxygen systems for it, and as late as the end of the 1990s insured people were still fighting over reimbursement in the social courts. Precisely because von Ardenne made measurable claims, it is easy today to trace what the measurements showed.

How it differs from the pressure chamber, EWOT and altitude training

Pressure chamber. In hyperbaric oxygen therapy you breathe pure oxygen at markedly increased pressure; only this makes a multiple of the usual amount of oxygen dissolve physically in the blood plasma. Multistep therapy works at normal air pressure. With healthy lungs, haemoglobin is already almost fully loaded in room air; extra oxygen then raises the oxygen pressure in the blood, but the amount transported only slightly. The pressure chamber has an indication for which statutory health insurance pays in Germany, severe diabetic foot syndrome; multistep therapy has none.

EWOT. Training with an oxygen mask, as offered today under the name Exercise With Oxygen Therapy, resembles von Ardenne’s short form in its procedure: oxygen through the mask with simultaneous endurance exercise. What has been measured for training with an increased oxygen fraction is set out in the tip on EWOT; the only fitting randomized trial in healthy people found no effect on maximal oxygen uptake there. Multistep therapy goes beyond this in two respects: it combines the oxygen with medication and promises an effect that lasts long after treatment.

Hypoxia training. IHHT takes the opposite route and uses phases of low-oxygen air as the stimulus. In practice, multistep therapy was often combined with ozone therapy, but they are separate procedures.

What is well supported

What is well supported are the building blocks, not the method as a whole. That oxygen breathing raises the oxygen pressure in the lungs and arterial blood during inhalation is physiology. That exercise on the ergometer improves performance was shown, of all things, by the largest controlled study of the method: all four groups improved, including those with compressed air and a dummy tablet.

In people with a genuine lack of oxygen in the blood, for example in severe lung disease, oxygen is an established therapy. A critical review in the journal Versicherungsmedizin stated in 1998 that diseases with chronic or intermittent hypoxaemia can be treated effectively with conventional oxygen therapy. Multistep therapy, by contrast, targets people whose oxygen supply is adequate in the usual sense.

What the studies show

Lippmann 1980 – first clinical evaluation

46 patients without restriction to any particular condition received the therapy in series of ten or 15 sessions. In about two thirds, resting arterial oxygen pressure rose, on average from 10.66 to 11.98 kilopascals 24 hours after the end of therapy, and the effect reportedly lasted more than three months. There was no control group. According to the Federal Committee’s evaluation, only 9 patients remained for the three-month values, and it classified the remaining calculations as exploratory.

von Ardenne 1984 – performance in healthy people

20 healthy men at two centres received two 15-minute rapid processes or a sham treatment with compressed air. Two weeks later, performance at a heart rate of 130 had risen in the therapy group from 115.2 to 134.3 watts, on average by 17 percent, and in the sham group by 5.7 watts or 5 percent. The authors saw this as confirming the lasting effect. Allocation was not random, and the paper contains no direct statistical comparison of the two groups.

Heß 1986 – four groups, 82 men

82 largely healthy men in their fifth to eighth decade of life were divided into four groups: oxygen with active tablet, oxygen with dummy tablet, compressed air with active tablet and compressed air with dummy tablet, each with three 15-minute rapid processes one week apart. The tablet was double-blinded, the gas single-blinded. Resting arterial and venous oxygen pressure remained unchanged on average in all groups, and performance rose similarly in all groups. The authors interpreted this as a training effect of the ergometer tests and considered the method unsuitable for improving performance in healthy men. Whether allocation was random is not stated (evaluation in the Federal Committee’s report).

Nolte 1980 – oxygen pressure in lung patients

14 patients aged 55 to 72 with chronic lung disease breathed oxygen over seven nights, 56 hours in total; some additionally received the method’s medication, the others oxygen only. Mean arterial oxygen pressure of 68.1 Torr did not change significantly, and there was no directional change in either group. Follow-up lasted only seven days, and allocation was not random. The authors themselves wrote that their study could not refute the method as a whole.

von Ardenne 1989 – mental performance

59 patients were tested by computer before and after therapy with accompanying brain training and compared with 14 control persons. Calculated short-term storage capacity rose by 19 to 23 percent, and perception and reaction tests were completed 12 to 18 percent faster. Short-term memory itself did not improve compared with the control group, and because brain training was part of the treatment, the contribution of oxygen cannot be separated out.

Wolf 1991 – sudden hearing loss

28 patients with sudden hearing loss of no identifiable cause received short processes of 15 minutes each. The authors saw better results than with other treatments and than with spontaneous recovery, which is common in sudden hearing loss. The analysis was retrospective and had no control group; the Federal Committee regarded it only as a basis for a future controlled study.

Where the data stop

The central claim, a resting oxygen pressure raised for weeks to years, did not show up in the independent controlled studies. The positive findings come mostly from studies without a control group or without random allocation, usually from the developer’s circle. Added to this is the basic problem of any combination treatment: if medication, oxygen and training are given together, it is impossible to say which part works without clean comparison groups. The four-group study tried exactly that and found only the training effect.

In 2001 the Federal Committee stated that nothing stood in the way of good studies; the method could readily be tested in randomized and blinded fashion. No relevant new work has appeared since about 1990; the most recent publication on the method listed in Europe PMC dates from 1992 (as of October 2026). For endpoints that matter for longevity, such as life expectancy, heart attack or dementia, there are no data.

Status, approval and legal

Oxygen multistep therapy is not covered by statutory health insurance. The then Federal Committee of Physicians and Health Insurance Funds decided on December 4, 1990 not to recognize it and confirmed this on February 6, 2001 after a renewed, indication-by-indication review requested by the AOK federal association: for none of the indications reviewed did it find robust evidence of benefit and medical necessity. To this day it is listed as number 6 in Annex II of the Directive on Methods in Outpatient Care, the list of methods that may not be provided at the expense of the health insurance funds (version in force since September 9, 2026). Anyone who uses it pays out of pocket.

The committee found no guidelines, consensus papers or HTA reports naming the method as a treatment option. In 2000 it asked the manufacturers of the oxygen devices about their CE marking. One building block of the classic variants, dipyridamole, is prescription-only in Germany. We did not find a separate assessment of oxygen multistep therapy by the IGeL-Monitor.

Safety

There are no systematic safety data on the method; the existing studies were small and short. The risks of the individual building blocks are known. In people with chronic oxygen deficiency, for example in severe COPD with carbon dioxide retention, the low oxygen level drives breathing; if extra oxygen removes this drive, breathing can become shallower and carbon dioxide can build up, as a critical analysis pointed out back in 1989. More oxygen in the inhaled gas also constricts blood vessels, so it does not automatically mean more blood flow; the measurements on this are in the tip on EWOT.

Exercise on the ergometer requires a heart that can cope with exertion; von Ardenne himself intended the short form with exercise for people with healthy hearts. Dipyridamole is a medicine with its own contraindications and interactions and belongs in the hands of a physician. Anyone who experiences shortness of breath, dizziness or chest pain during exertion needs a medical evaluation first.

BK-Score Long used, barely studied

Human evidence		3
Mechanism		3
Safety data		4
Hype gap		2
Track record of use		6

Evidence 3, because there are only small controlled but non-randomized studies from the 1980s and none new since about 1990: work from von Ardenne’s circle reports higher resting oxygen pressures and more performance (20 healthy men, performance at heart rate 130 plus 17 percent, without a direct group comparison), while independent studies found no lasting rise in arterial oxygen pressure (Nolte 1980, 14 patients) and equal performance gains in all four groups, including with compressed air instead of oxygen (Heß 1986, 82 men). Mechanism 3, because oxygen transport in the blood is well understood, but the claimed capillary-wall switch mechanism for an effect lasting weeks to years has never been independently demonstrated. Safety 4, because short-term oxygen breathing is well known from medicine, but systematic safety data on the combination of oxygen, medication and exercise are lacking. Hype 2, because the method was promoted as almost universally effective against ageing and many diseases, yet in 2001 the Federal Committee found no robust evidence of benefit for any of the indications reviewed. Use 6, because it has been offered in practices since the 1980s. Direction mixed.

The score rates the state of knowledge, not the substance. “Safety data 9” means well studied – not harmless. “Track record of use 9” means used for a long time and widely – that is not evidence of efficacy.
Subjective assessment by Biohacking Kompakt based on published scoring rules – not a scientific rating and not a medical recommendation. Rules and all ratings (German)

Frequently asked questions about oxygen multistep therapy

What is oxygen multistep therapy?

A procedure developed by Manfred von Ardenne with three steps: taking vitamins and medication, breathing oxygen-enriched air and physical exercise. It was meant to raise the oxygen pressure in the blood, which falls with age, permanently. There are more than 20 variants, including a short form with a quarter of an hour of oxygen on the ergometer.

Does the therapy permanently raise oxygen in the blood?

That has not been shown. Studies from von Ardenne’s circle reported higher resting values, but without a control group or without random allocation. Independent controlled studies found no lasting rise in arterial oxygen pressure in 14 lung patients and in 82 healthy men.

What is the difference from hyperbaric oxygen therapy?

The pressure chamber works at markedly increased pressure, which makes a multiple of the usual amount of oxygen dissolve in the blood plasma. Multistep therapy works at normal air pressure; with healthy lungs, the amount of oxygen transported then rises only slightly. The pressure chamber is covered by statutory health insurance for severe diabetic foot syndrome; multistep therapy is not.

Is it the same as EWOT?

The short form resembles EWOT in its procedure: oxygen through the mask with simultaneous endurance exercise. Multistep therapy additionally combines this with medication and promises a long-lasting effect. For both, evidence of a benefit in healthy people is lacking.

Does health insurance pay for oxygen multistep therapy?

No. The Federal Joint Committee lists it among the methods that may not be provided at the expense of statutory health insurance; the decision dates from 1990 and was confirmed in 2001 after a renewed review. It is a self-pay service.

Is oxygen multistep therapy dangerous?

For healthy people, short oxygen sessions are usually unproblematic, but systematic safety data on the method are lacking. In chronic lung disease with carbon dioxide retention, extra oxygen can suppress breathing, the exercise requires a healthy heart, and the dipyridamole used is prescription-only.

Related topicHyperbaric oxygen therapy (HBOT)
Related topicEWOT – Exercise With Oxygen Therapy
Related topicIHHT – hypoxia training
Related topicOzone therapy
Related topicWhole-body hyperthermia

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Information only, not medical advice and not a usage or dosage recommendation. Prescription-only and unapproved substances belong in the hands of a physician. Last updated: 2026-10-15.