{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T16:10:09Z","timestamp":1788365409712,"version":"build-2803163510"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"25","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2023,12,19]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Despite advances in medical and cardiac resynchronization therapy (CRT), individuals with chronic congestive heart failure (CHF) have persistent symptoms, including exercise intolerance. Optimizing cardio-locomotor coupling may increase stroke volume and skeletal muscle perfusion as previously shown in healthy runners. Therefore, we tested the hypothesis that exercise stroke volume and cardiac output would be higher during fixed-paced walking when steps were synchronized with the diastolic compared with systolic portion of the cardiac cycle in patients with CHF and CRT.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>\n              Ten participants (58\u00b117 years of age; 40% female) with CHF and previously implanted CRT pacemakers completed 5-minute bouts of walking on a treadmill (range, 1.5\u20133 mph). Participants were randomly assigned to first walking to an auditory tone to synchronize their foot strike to either the systolic (0% or 100\u00b115% of the R-R interval) or diastolic phase (45\u00b115% of the R-R interval) of their cardiac cycle and underwent assessments of oxygen uptake (V\u0307\n              <jats:sc>o<\/jats:sc>\n              <jats:sub>2<\/jats:sub>\n              ; indirect calorimetry) and cardiac output (acetylene rebreathing). Data were compared through paired-samples\n              <jats:italic>t<\/jats:italic>\n              tests.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              V\u0307\n              <jats:sc>o<\/jats:sc>\n              <jats:sub>2<\/jats:sub>\n              was similar between conditions (diastolic 1.02\u00b10.44 versus systolic 1.05\u00b10.42 L\/min;\n              <jats:italic>P<\/jats:italic>\n              =0.299). Compared with systolic walking, stroke volume (diastolic 80\u00b128 versus systolic 74\u00b126 mL;\n              <jats:italic>P<\/jats:italic>\n              =0.003) and cardiac output (8.3\u00b13.5 versus 7.9\u00b13.4 L\/min;\n              <jats:italic>P<\/jats:italic>\n              =0.004) were higher during diastolic walking; heart rate (paced) was not different between conditions. Mean arterial pressure was significantly lower during diastolic walking (85\u00b112 versus 98\u00b120 mm\u2009Hg;\n              <jats:italic>P<\/jats:italic>\n              =0.007).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In patients with CHF who have received CRT, diastolic stepping increases stroke volume and oxygen delivery and decreases afterload. We speculate that, if added to pacemakers, this cardio-locomotor coupling technology may maximize CRT efficiency and increase exercise participation and quality of life in patients with CHF.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.123.066170","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T09:01:35Z","timestamp":1697187695000},"page":"2008-2016","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["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 Cardio-Locomotor Coupling for Heart Failure"],"prefix":"10.1161","volume":"148","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4200-3790","authenticated-orcid":true,"given":"Denis J.","family":"Wakeham","sequence":"first","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."},{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7094-2454","authenticated-orcid":true,"given":"Erika","family":"Ivey","sequence":"additional","affiliation":[{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie A.","family":"Saland","sequence":"additional","affiliation":[{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua S.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Palmer","sequence":"additional","affiliation":[{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5240-2393","authenticated-orcid":true,"given":"Margot","family":"Morris","sequence":"additional","affiliation":[{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery L.","family":"Bleich","sequence":"additional","affiliation":[{"name":"Pulson, Inc., Mountain View, CA (J.L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0588-0321","authenticated-orcid":true,"given":"Peter G.","family":"Weyand","sequence":"additional","affiliation":[{"name":"Locomotor Performance Laboratory, Department of Applied Physiology &amp; Wellness, Southern Methodist University, Dallas, TX (P.G.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8215-2144","authenticated-orcid":true,"given":"Tiffany L.","family":"Brazile","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."},{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Christopher M.","family":"Hearon","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."},{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satyam","family":"Sarma","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."},{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2795-6021","authenticated-orcid":true,"given":"James P.","family":"MacNamara","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."},{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3434-6184","authenticated-orcid":true,"given":"Michinari","family":"Hieda","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."},{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9064-7251","authenticated-orcid":true,"given":"Benjamin D.","family":"Levine","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, Dallas (D.J.W., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."},{"name":"Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas (D.J.W. E.I., S.A.S., J.S.L., D.P., M.M., T.L.B., C.M.H., S.S., J.P.M., M.H., B.D.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000950"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.05.019"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/HHF.0b013e318291329a"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.08.074"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-019-09829-7"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000096580.26969.9A"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartjsupp\/suad046"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000146336.92331.D1"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032423"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050496"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.113.001420"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.457"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.454"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.05.023"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2000.106916"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1920.sp001920"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1037\/h0067228"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1989.66.1.323"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.1993.tb04732.x"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000001515"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.ph.39.030177.001425"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960010201"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(78)90700-3"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.68.11.469"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.11909\/j.issn.1671-5411.2016.05.004"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1139\/h94-003"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.01106.2006"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.015794"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.03696"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00895.2011"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1935.sp003326"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1139\/h93-032"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1993.75.4.1815"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-002-0784-0"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0000000000001515"},{"key":"e_1_3_3_37_2","first-page":"286","article-title":"Oxygen pulse is not predictive of stroke volume in heart failure.","volume":"46","author":"McConnell TR","year":"2006","unstructured":"McConnell, TR, Shearn, WM, Klinger, TA, Strohecker, K. Oxygen pulse is not predictive of stroke volume in heart failure. J Sports Med Phys Fitness. 2006;46:286\u2013292.","journal-title":"J Sports Med Phys Fitness"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2005.11.002"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.15420\/cfr.2017:4:2"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.07.054"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000461"}],"updated-by":[{"DOI":"10.1161\/cir.0000000000001249","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T00:00:00Z","timestamp":1713139200000}}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.123.066170","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:51:55Z","timestamp":1715586715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.123.066170"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,19]]},"references-count":40,"journal-issue":{"issue":"25","published-print":{"date-parts":[[2023,12,19]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.123.066170"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.123.066170","relation":{"correction":[{"id-type":"doi","id":"10.1161\/CIR.0000000000001249","asserted-by":"object"}]},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,19]]},"assertion":[{"value":"2023-06-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}