ECP treatment originally developed for heart patients is now showing wide-ranging health benefits from increased muscle recovery and athletic performance to better skin and even improvements for men with erectile dysfunction. Anna Magee tries it
Frisbees were originally used as pie containers. Play-Doh was originally used as wallpaper cleaner.
Likewise in medicine, a treatment will often be developed for one thing but over time will show benefits for something else.
The hair restoration treatment Regaine for example was originally developed as a blood pressure treatment. Only after BP patients realised it was making their hair grow thicker and fuller was it marketed to balding people.
Similarly with External Counterpulsation (ECP) Therapy, a medical treatment that Healthista recently tested.
What is External Counterpulsation Therapy (ECP)?
Originally developed by Harvard University as a device to assist circulation and promote blood flow to areas of the heart muscle that were lacking adequate blood in cardiovascular disease (CVD) patients, ECP is now being used for lifestyle and preventative purposes.
Having been used on heart patients for over 20 years, a growing body of research is now showing ECP Therapy can help muscle recovery and fatigue, skin health and even erectile dysfunction. Some doctors also believe it may have a part to play in dementia prevention.
But how could something originally used to help heart patients provide benefits that seem so wide-ranging?
How ECP therapy works
During a typical session of ECP Therapy, the patient lies on a bed and from the waist down is strapped into a series of compression (cuffs) that wrap around the legs and pelvis.
From there a machine syncs with the patient’s own heartbeat and signals the (cuffs) into a series of on-off pressure on the patient’s legs and pelvis, mimicking the beating of the patient’s heart.
‘The (cuffs) act as an auxiliary heart (pumping blood from the body back to the heart) in effect giving the heart a break,’ says cardiologist Dr Robin Roberts who has been using ECP Therapy in his practice for more than ten years. ‘That efficiently delivers more oxygen to all organs than the heart normally would, without the heart having to (work harder to achieve this).
As a result, not only is the cardiovascular system strengthened, but waste products such as lactic acid are removed faster from the body, making it a useful therapy for athletes and people who exercise strenuously,’ says Dr Roberts.
To see how ECP Therapy works, follow this link or watch the video below to gain a detailed overview of exactly what a session of ECP looks like.
Increased circulation and blood flow
In short, ECP therapy gives the heart a break from working, and behaves a little more efficiently than the heart does, subsequently increasing circulation and therefore blood flow to the entire body by around 30 per cent.
To understand why this is a good thing, you need to understand the role nitric oxide plays in the body.
When the body is under stress – which occurs during exercise or when the heart pumps faster – it produces nitric oxide in what is known as the endothelium, a super thin lining of every blood vessel in the body.
From about the age of 25, our endothelium begins to deteriorate and is further damaged by stress, smoking, inactivity and conditions such as diabetes.
According to Dr Roberts, ECP therapy can help reverse the age of the endothelium, increasing the efficiency with which it produces nitric oxide.
During ECP therapy, it’s been found that the production of nitric oxide in the endothelium increases by (up to 64%). This is similar to the amount the body produces while exercising (cardiologists sometimes recommend ECP as a replacement for exercise for heart disease patients who are immobile – see below).
That nitric oxide then relaxes the blood vessels, causing them to enlarge and dilate, which subsequently lowers blood pressure and allows more blood to pass through, thus increasing circulation and oxygen delivery throughout the body.
Wide-ranging benefits of ECP therapy
So how can this lead to some of the widely different benefits seen with ECP therapy? That too is down to nitric oxide’s many functions in the body, says Dr Roberts.
‘Nitric oxide helps reduce inflammation in blood vessels and also reduces oxidative stress,’ Dr Roberts explains.
‘In the brain nitric oxide acts as a neurotransmitter enabling improved blood flow through the microcirculation which may have an important role in preventing vascular dementia (see below).
‘Produced in the white blood cells it therefore may also have an important role in fighting infections,’ Dr Roberts asserts.
Nitric oxide deficiency may have an important role in autoimmune diseases, gut health, blood sugar regulation and respiratory function too, he says.
In terms of energy, nitric oxide is also involved in the generation and regulation of mitochondria, which are the energy producing parts of every cell in the body.
It sounds like a panacea for well, everything. But while ECP Therapy is approved by the Federal Drug Administration (FDA) in the US for the treatment of heart problems, ECP therapy is likewise only available on the NHS in limited part of Britain and then only for patients with chronic angina (see below).
Now, thanks to growing evidence of its wide ranging effects, ECP therapy is entering the mainstream as a therapy for other problems.
5 health benefits of ECP therapy
Although ECP therapy was originally developed for patients with chronic angina, studies have shown its benefits are much wider.
Erectile dysfunction is often caused by conditions that block blood flow to the penis, most commonly artherosclerosis (blocked arteries) and diabetes, and stop the production of nitric oxide essential for a healthy erection. It therefore stands to reason that a treatment that increases blood flow and the health of the blood vessels could improve the condition,
There have been numerous studies published which show that ECP treatment improves erectile function. In one, published in 2007 in the International Journal of Clinical Practice measured the international index of erectile function in men with severe angina, both before and after a course of ECP treatment. There were significant improvements in these scores and also in measures of intercourse satisfaction and overall satisfaction.
In one study published in the European Journal of Clinical Investigation it was shown that during ECP treatment blood flow to the skin was increased, while carbon dioxide to the skin was reduced in effect helping to increase healing time and detoxification of the skin.
‘This may explain why ECP has been shown to improve healing of chronic leg ulcers in diabetic patients,’ says Dr Roberts. ‘My own experience is anecdotal – I treated a man in his 80s who had refractory angina as well as drug resistant psoriasis throughout his adult life. By the end of 35 hours of treatment with ECP, the psoriasis has almost completely disappeared.’
Heart conditioning if you’re immobile
‘ECP Therapy enhances the pumping of blood round the body,’ says John Buckley, professor of Applied science at University Centre Shrewsbury. ‘It’s like having a second heart, working between beats when the heart is at rest.
‘Like exercise, over time ECP Therapy can improve the mechanical operation and the blood flow to the heart creating a more efficient circulatory system.’
Whilst ECP is not a replacement for exercise (as in, for lazy people), Prof. Buckley asserts that for those who have a low level of movement capability, it provides a boost to their circulation.
‘This could include not only people with weakened hearts but those with lung problems or limitations due to loss of muscle function. Our research is now focusing on groups of people bed bound, waiting for surgery and with poor exercise tolerance.
Muscle recovery and athletic performance
On the other end of the spectrum, ECP therapy is also being used to shorten recovery time and performance in athletes and very active people.
In November 2017, UK Active undertook a review of the research relating to ECP and concluded that it ‘has the potential to offer physiological benefits when used as part of a preventative model of healthcare delivery or sports recovery programmes, as well demonstrating a positive outcome on those with cardiovascular disease.’
In a recent experiment with Australian Rugby League team, the Brisbane Broncos, researchers at the University of Queensland gave half the team ECP Therapy and half cryotherapy for their muscle recovery programmes.
‘The Broncos have used the ECP device as a form of recovery in a variety of settings and the results have been encouraging,’ said Lecturer in Sports Medicine Vince Kelly, who led the research.
‘Perceptions of player soreness and wellbeing were significantly better over a four-week period, particularly for the upper body, hamstrings, calves and quadriceps,’ Dr Kelly continued.
‘In another study, power output and stress hormone levels were improved when players used ECP the same day as a high-intensity conditioning session.
‘It produced favourable outcomes when compared to using ice baths in isolation as a means of recovery,’ Mr Kelly said.
‘There has been so much concentration in previous decades around training to get faster or stronger or fitter, that recovery has perhaps been overlooked to an extent’.
The next step, Dr Kelly said, would be individualising recovery by using ECP therapy with other recovery systems.
After Alzeimher’s Disease, vascular dementia is the second most common cause of dementia, accounting for about ten per cent of cases.
‘Vascular dementia is almost certainly closely linked to microvascular blood flow problems within the brain and points to the role of the endothelium and the influence of nitric oxide on cerebral blood flow,’ says Dr Roberts.
Studies are ongoing in many parts of the world, but early research – albeit on very small patient numbers – are showing promising results in the prevention of vascular dementia.
In one study, published in 2016 in the Austin Journal of Clinical Medicine four patients with mild cognitive impairment were treated for seven weeks with ECP and all showed significant signs of improved brain function.
Although the authors conceded that their study was small, they said results were promising and pointed to the need for a randomised controlled trial looking at ECP and brain function.
What does ECP Therapy feel like?
For cardiac patients a course of 35, one hour sessions of ECP therapy over six weeks has been proven to improve not only their symptoms but also their vitality and quality of life.
But for those of us without heart problems, wanting to enhance their muscle recovery or exercise performance or gain other benefits 20 ECP sessions each 45 minutes long will be enough to get results in performance and enhanced vitality, says Dr Roberts.
So what does it feel like? Firstly, a full medical is required of anyone having the treatment as it can pose risks for those with certain heart conditions such as arrhythmia.
I had mine at the Lyca Clinic in Canary Wharf, a favourite of wealthy fit bankers and Premiership footballers and more like a five star hotel than a medical clinic.
There, I was given abdominal and heart ultrasound scans and ECG tests to check for any heart abnormalities such as arrhythmia that might interfere with the ECP Therapy.
After getting the all clear, I was told to lay on a bed and strapped into the ECP compression suit. Inflatable cuffs, similar to blood pressure cuffs, were wrapped tightly around my calves, thighs and hips.
Then the suit was attached to a computer which registered my heartbeat and signalled the cuffs to sequentially inflate and deflate in time with my heartbeats.
It felt like getting an extremely tight hug to my entire body – each limb squeezed tightly and suddenly in an on off movement. It wasn’t painful or unpleasant, just really tight which was at first disorientating but I got quite used to it and after about ten minutes found the strong on-off pressure on my lower body quite relaxing.
The inflation of the cuffs squeezes blood from the lower legs up toward the heart, thus instantly boosting blood flow in and around the heart.
Once it was over, I was warned by Dr Roberts that I might be tired the next day because the treatment is in effect working your heart as hard as it would work during a round of strenuous exercises, at least in circulatory terms.
Well, that was an understatement. I felt like I had run a 10K. Twice. Before breakfast. My leg muscles in particular were very very sore, but the soreness only lasted a day.
‘The treatment you had was equivalent to a hard workout in the gym,’ says Dr Roberts.
‘Tiredness in the first few hours of treatment is typical in all age groups, but after 10 or so sessions, most of my patients report improvements in their energy levels and vitality.
Costs and availability of ECP Therapy in the UK:
ECP for lifestyle, muscle recovery and preventative purposes is available at private clinics in Wimbledon, Harley Street and Canary Wharf. The costs for a course of 10-20 hour-long sessions is £300 per hour, for heart patients the private cost is £10,500 for 35 sessions in six weeks.
For more information: Renewtherapy.co.uk
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