Described herein are systems and methods of guiding a user to achieve musculoskeletal counterpulsation. A method may include receiving a cardiovascular cycle signal from a first sensor; determining a heart rate of the user based on the cardiovascular cycle signal; receiving a rhythmic musculoskeletal activity timing signal from a second sensor; determining an actual musculoskeletal activity cycle (MSKC) to cardiovascular cycle (CC) timing relationship; comparing the actual MSKC to CC timing relationship to a target MSKC to CC timing relationship; providing a recurrent prompt to the user as a timing indication for performance of a rhythmic musculoskeletal activity to guide the user to achieve a musculoskeletal activity cycle rate (MSKR) that approaches the target MSKC to CC timing relationship; and altering a feature of the recurrent prompt based on a determined alignment between the actual MSKC to CC timing relationship and the target MSKC to CC timing relationship.