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Effects of Intermittent Calf Muscle Electrical Stimulation on Walking Capacity in Claudicants Living with Type 2 Diabetes

Christian Ellul Department of Podiatry, University of Malta, Faculty of Health Sciences, Msida, Malta

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Cynthia Formosa Department of Podiatry, University of Malta, Faculty of Health Sciences, Msida, Malta

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Alfred Gatt Department of Podiatry, University of Malta, Faculty of Health Sciences, Msida, Malta

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Background:

First-line therapy for diabetic patients presenting with intermittent claudication includes supervised exercise programs to improve walking distance. However, exercise comes with a variety of barriers and may be contraindicated in certain conditions. The aim of this study was to evaluate whether calf muscle electrostimulation improves claudication distance.

Methods:

A prospective, one-group, pretest-posttest study design was used on 40 participants living with type 2 diabetes mellitus, peripheral artery disease (ankle brachial pressure index, <0.90), and calf muscle claudication. Calf muscle electrostimulation of varying frequencies (1–250 Hz) was prescribed on both limbs for 1-hour daily sessions for 12 consecutive weeks. The absolute claudication distance (ACD) was measured at baseline and after the intervention.

Results:

The recruited cohort (30 men and ten women; mean age, 71 years; mean ankle brachial pressure index, 0.70) registered a mean ± SD baseline ACD of 333.71 ± 208 m. After a mean ± SD of 91.68 ± 6.23 days of electrical stimulation, a significant mean ± SD increase of 137 ± 136 m in the ACD (P = .001, Wilcoxon signed rank test) was registered. Improvement was found to be sex independent, but age was negatively correlated with proportion of improvement (r = –0.361; P = .011, Pearson correlation test).

Conclusions:

Electrical stimulation of varying frequencies on ischemic calf muscles significantly increased the maximal walking capacity in claudicants with type 2 diabetes. This therapeutic approach should be considered in patients with impaired exercise tolerance or as an adjunct treatment modality.

Corresponding author: Cynthia Formosa, PhD, Department of Podiatry, University of Malta, 14, Faculty of Health Sciences, Msida, SGN 3051, Malta. (E-mail: cynthia.formosa@um.edu.mt)