A healthy heart easily delivers enough blood to meet the metabolic needs of a person at rest. However, during intense physical activity, energy consumption increases so dramatically that the heart alone cannot deliver sufficient oxygen to meet the needs of the exercising muscle. During physical activity, our skeletal muscles become a critical second blood pump, powerfully driving both arterial and venous blood back towards the heart.

Our heart pumps oxygenated blood to our periphery via the same blood vessels (e.g. aorta) through which our skeletal muscles pump the same oxygenated blood back towards the heart muscle. Skeletal muscles also pump venous blood towards the heart with each step. The timing of these two pumps can be well-coordinated, or they can fight one another.  

During rhythmic activities, such as running, walking or biking, favorable coordination between the timing of the heart cycle to each rhythmic movement improves blood flow and lowers heart rate and blood pressure dramatically.

In fact, research suggests that many elite runners push off the ground consistently during the relaxation phase of the heart's pump cycle, providing the following benefits:

• The leg muscles squeeze blood towards the heart exactly when it's relaxing and most able to receive it
• The heart, in turn, contracts while the legs are relaxing, delivering oxygen to the leg muscles when they’re most receptive to blood flow
• This favorable timing has been shown to lower central blood pressure and increase brain blood flow velocity*

On the other hand, worst-case step timing can occur when the heart rate approaches the step rate, but phase timing is unfavorable. In fact, researchers have proposed that pumping blood towards a contracting heart (systolic stepping) not only can lead to rapid fatigue, but may even cause unhealthy cardiac stress and even injury due to the simultaneous increase in blood pressure and heart rate and decrease in oxygen delivery.

The Counterpace® app delivers audible prompts during rhythmic activity to allow easy access to advantageous step timing.

 

Medical vs. Natural Counterpulsation

The heart-to-muscle pump synchronization achieved during guided natural counterpulsation is nearly identical to medical forms of mechanical counterpulsation, which have been shown to increase blood flow to the heart, skeletal muscles, and brain. For example, intra-aortic balloon counterpulsation (IABP) improves cardiac perfusion while decreasing cardiac afterload and myocardial stress. External counterpulsation (ECP) provides those benefits, while also increasing venous return and cardiac preload.

The potential value of guided natural counterpulsation during athletic training and performance is supported by recent groundbreaking research results with elite athletes. Additionally, baseline run data collected by the company on of 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 step predominately during the relaxation phase of the heart. The hemodynamic efficiencies of natural counterpulsation may provide an important competitive advantage in athletic training and competition.

 

BENEFIT HYPOTHESIS

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.

Lower Blood Pressure and Cardiac Stess

Improved systolic, diastolic, and pulse pressure during diastolic stepping 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.

Blood pressure, heart rate, and cardiac stress appear to decrease during guided counterpulsation. If this 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 with 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 at the end of a race ("kick"). If ideal step timing preserves glycogen, imagine the competitive advantage late in the race. On the other hand, glycogen depletion is no fun and best avoided, as anyone who has ever "hit the wall" can attest, when simply standing up can feel difficult or even impossible.

Long-Term Health

Diastolic stepping may lead to health benefits similar to those of medical counter-pulsation. External counterpulsation (ECP) is a non-invasive technology that has been used for decades in the treatment of cardiac patients (17, 18, 19).  By rapidly squeezing a patient’s arms and legs with balloon cuffs, ECP pumps blood from a patient’s extremities exactly when the heart muscle relaxes during each heart beat cycle.

Similar to diastolic stepping, this allows the heart’s chambers to optimally fill with blood and serves as a well-timed secondary pump that promotes nutrient-rich blood flow to the coronary arteries. The increase in 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.

Therefore, in addition to improving physical and cognitive performance during physical activity, diastolic stepping drives hemodynamic counterpulsation, which 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. This may include counterpulsation's ability to increase arterial blood flow and oxygen delivery at lower blood pressure and heart rates, thereby potentially 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.

* based on unpublished placebo-controlled analysis of middle cerebral artery velocity with guided counterpulsation

 

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REFERENCES

CARDIOLOCOMOTOR SYNCHRONIZATION

1. Coleman WM; The psychological significance of bodily rhythms. Journal of Comparative Psychology, 1921, 1(3), 213-220.
2. O’Rourke M, Avolio A. Improved cardiovascular performance with optimal entrainment between heart rate and step rate during running in humans. Coron Artery Dis. 1992;3(9):863–869.
3. O’Rourke M, Avolio A, Stelliou V, Young J, Gallagher D. The rhythm of running: can the heart join in? Aust N Z J Med. 1993;23(6):708–710.
4. Kirby RL, Nugent ST, Marlow RW, MacLeod D, Marble A. Coupling of cardiac and locomotor rhythms. J Appl Physiol. 1989;66(1):323–329.
5. Niizeki K, Kawahara K, Miyamoto Y. Interaction among cardiac, respiratory, and locomotor rhythms during cardiolocomotor synchronization. J Appl Physiol. 1993;75(4):1815–1821.
6. Niizeki K, Saitoh, T Review Article Cardiolocomotor phase synchronization during rhythmic exercise;  J Phys Fitness Sports Med, 3(1): 11-20 (2014).
7. Nomura K, Takei Y, Yanagida Y. Analysing entrainment of cardiac and locomotor rhythms in humans using the surrogate data technique. Eur J Appl Physiol. 2001;84(5):373–378.
8. Nomura K, Takei Y, Yanagida Y. Comparison of cardio-locomotor synchronization during running and cycling. Eur J Appl Physiol. 2003;89(3–4):221–229.
9. Nomura K, Takei Y, Yoshida M, Yanagida Y. Phase-dependent chronotropic response of the heart during running in humans. Eur J Appl Physiol. 2006;97(2):240–247.
10. Niizeki K. Intramuscular pressure-induced inhibition of cardiac contraction: implications for cardiac-locomotor synchronization. Am J Physiol-Regul Integr Comp Physiol. 2005;288(3):R645–R650.
11. Nichols W, O’Rourke M, Vlachopoulos C. McDonald’s blood flow in arteries: theoretical, experimental and clinical principles. 6th ed. Boca Raton (FL): CRC Press; 2011. 768 p.
12. Ballard RE, Watenpaugh DE, Breit GA, Murthy G, Holley DC, Hargens AR. Leg intramuscular pressures during locomotion in humans. J Appl Physiol. 1998;84(6):1976– 1981.
13. Palatini P, Mos L, Mormino P, Di Marco A, Munari L, Fazio G, et al. Blood pressure changes during running in humans: the“ beat” phenomenon. J Appl Physiol. 1989;67(1):52–59.
14. Phillips B, Jin Y. Effect of adaptive paced cardiolocomotor synchronization during running: a preliminary study. J Sports Sci Med. 2013;12(3):381.
15. Rådegran G. Ultrasound Doppler estimates of femoral artery blood flow during dynamic knee extensor exercise in humans. J Appl Physiol. 1997 Oct 1;83(4):1383–8.
16. Zhang D, Celler BG, Lovell NH. The effect of heartbeat-synchronised running on the cardiovascular system. In: Proceedings of the Second Joint EMBS/BMES Conference. Houston (TX): IEEE; 2002. p. 1295–1296.
    
    

EXTERNAL COUNTERPULSATON

1. Capoccia M, Bowles C, Pepper J, Banner N, Simon A. Evidence of clinical efficacy of counterpulsation therapy methods. Heart Fail Rev. 2015;20(3):323–335.
2. Nichols, P et. al. Enhanced External CounterpulsationTreatment Improves Arterial Wall Properties and Wave Reflection Characteristics in Patients WithRefractory Angina; Journal of the American College of Cardiology Vol. 48, No. 6, 2006.
3. Kanaya T, Matsuda R, Kuga H, Nakatsugawa M. Effects of enhanced external counterpulsation on hemodynamics and its mechanism. Circ J. 2004;68(11):1030– 1034.