Your body's natural two-pump system performs best in sync.

At rest, a healthy heart is fully capable of meeting the circulatory needs of your body. During exercise however, your heart cannot keep up with your body’s dramatic increase in oxygen demand. Fortunately, during rhythmic movement such as running, walking or cycling, skeletal muscles throughout your body act as an equally important blood pump. Skeletal muscles drive large amounts of both arterial and venous blood from your extremities back to your heart with each muscle contraction. Because there are no valves in peripheral arteries, skeletal muscle also helps drive arterial blood away from the heart. These two pumps work together to meet the increased oxygen demand of the body.

Optimal timing of this two-pump system during exercise improves blood flow dramatically - significantly lowering heart rate and blood pressure. This leads to higher performance, and lower perceived effort during exercise.

This optimal timing between the heart and muscle pumps occurs when the muscle pump sends blood back towards the heart precisely during the heart’s relaxation phase. In practice, this means an athlete’s step rate is equal to their heart rate - and the steps occur between heartbeats. We call this Tempo Science®.

Elite athletes already do this. Research shows that the world’s top marathon finishers typically step precisely at their heart rates. These elite runners find the optimal timing of heart and muscle pumps intuitively - which helps propel them to such outstanding performances.

For better or worse, the explosion of cultural and technological advances in recent human history has led to a very sedentary lifestyle. As a result, most of us have lost the ability to reliably achieve this zone of optimal efficiency. Counterpace guidance makes it easy to enter this zone every time you exercise.

Counterpace inspiration - external counterpulsation

In late 2009, Counterpace founder Jeffery Bleich, a physician and entrepreneur, was researching a remarkable non-invasive treatment for heart disease known as external counterpulsation (ECP). Long-used in clinical settings with well understood benefits for cardiac health, this technique utilizes circumferential compression cuffs to externally squeeze a patient's legs between each heart contraction. The cuffs rapidly deflate as the heart beats and squeezes blood back towards the extremities. This coordination of the heart and external pumps decreases the heart's workload, reduces oxygen demand and improves both arterial and venous blood flow to the heart. Dr. Bleich was so excited by the data and concept that he began to explore ways to bring the benefits of this non-invasive (yet cumbersome and expensive) therapy to more people at a lower cost. 

His key insight came when he realized that properly timed skeletal muscle contraction must also provide these same benefits. Jeff and a small team of engineers, cardiologists and excited friends named this new field of physiological counterpulsation "Tempo Science." They immediately turned his garage into an exercise-lab, and set out to develop a suite of sensors, apps and algorithms to support scientific discovery in this new scientific space, while also enabling safer, easier, more effective exercise for all of us.

Fifteen years and MANY failed prototypes later, Counterpace guidance is laboratory proven to naturally achieve the same type of improved blood circulation during exercise as external medical counterpulsation devices do in a hospital setting. The potential value of guided natural counterpulsation to general health and athletic performance is supported by recent groundbreaking research results with elite athletes, as well as with heart failure patients. Additionally, unpublished run data collected by the company on a wide variety of individuals, including professional and Division I college distance runners, suggests that the more successful the runner, the more likely they are to naturally and unconsciously lock into stepping during the relaxation phase of their heart's pump cycle.

Review our published Tempo Science research here, including:

"Synchronizing Gait with Cardiac Cycle Phase Alters Heart Rate Response During Running" 
- ACSM's MSSE Journal 2018

"Effects of Synchronizing Foot Strike and Cardiac Phase on Exercise Hemodynamics in Patients With Cardiac Resynchronization Therapy: A Within-Subjects Pilot Study to Fine-Tune CardioLocomotor Coupling for Heart Failure"
- AHA's Circulation Journal 2023


Guided natural counterpulsation with Counterpace has the potential to dramatically increase exercise efficiency - which would provide benefits for health and longevity, body composition and weight loss, as well as athletic performance.

Enhanced Performance and Experience

Reduced physiological and cardiac stress during guided counterpulsation should allow an individual to run or walk at a given pace with greater comfort and endurance. The concurrent decrease in heart rate and breathing effort can also be beneficial to endurance performance. The hemodynamic efficiencies of natural counterpulsation may provide an important competitive advantage in athletic training and competition.

Lower Blood Pressure and Cardiac Stess

Improved systolic, diastolic, and pulse pressure during diastolic stepping, as occurs during guided counterpulsation, has been demonstrated in multiple studies (3, 11, 13). The lower heart rate during diastolic stepping, combined with decreases in systolic blood pressure (lower cardiac ventricular afterload) strongly suggests that the cardiac stress is reduced. An unpublished placebo-controlled study performed by the company also clearly demonstrated increased brain blood flow (middle cerebral artery velocity) during guided counterpulsation. If Counterpace guidance indeed leads to an increase in heart and brain blood flow and oxygen delivery, individuals should be able to exercise at a given intensity with less effort and improved physical and mental performance while using Counterpace guidance.

Increased Fat Burn

Oxygen delivery is required in order to burn fat, our most plentiful fuel. In low oxygen environments, or when effort exceeds lactate threshold, energy must be drawn from our much more limited muscle glycogen stores via anaerobic metabolism. The sugar stored as glycogen is our primary booster fuel that allows us to accelerate to efforts above our lactate threshold. Because ideal step timing improves oxygen delivery, fat should be a more readily accessible energy source while using Counterpace guidance. In addition to potentially helping individuals burn fat more effectively, the preservation of glycogen stores will likely support athletic endeavors that require sudden increases in effort above lactate threshold (as in a late race “kick”).

Long-Term Health

Diastolic stepping may lead to long-term health benefits similar to those of medical counterpulsation. Similar to external medical counterpulsation, stepping in sync with your heart should promote nutrient-rich blood flow to the coronary arteries that delivery oxygen to the heart muscle. It has been proven in studies of medical counterpulsation (17,18,19) that increasing blood flow during the relaxation phase of the heart’s pump cycle also stimulates the growth of new collateral coronary arteries, improving cardiac health and physical stamina. Because diastolic stepping drives hemodynamic counterpulsation, Counterpace guidance may offer long term heart and brain health benefits to the general population and elite athletes alike.

Faster Recovery

The same mechanisms that enhance performance can lead to faster recovery from daily training exercises by preserving glycogen, lowering cardiac stress, and diminishing lactate production. Also, any increase in skeletal muscle blood flow during a slow post run jog or walk with Counterpace guidance can be a nice way to cool down while optimizing circulation. Anecdotally, users have described reduced soreness following Counterpace guided runs.

Getting started with Counterpace

Stepping in sync with your heart can take some time to perfect. We recommend that you begin by walking or running on a treadmill, as this will allow you to more easily adjust step rate and heart rate using speed and incline.

Our heart rate during strenuous physical activity naturally decreases as we age, so matching step rate to heart rate during running will frequently require that older athletes adopt a lower step rate. Adapting to these changes in natural stride frequency can be challenging, but with practice and coaching in healthy ergonomics at varying stride lengths, almost anyone can step in sync with Counterpace guidance.


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