title: Transcutaneous calf-muscle electro-stimulation: A prospective treatment for diabetic claudicants?
abstract: First-line therapy for claudicants with diabetes include supervised exercise programmes to improve walking distance. However, exercise comes with a number of barriers and may be contraindicated in certain conditions. The aim of this study was to evaluate whether calf-muscle electro-stimulation improves claudication distance.
  
  
  
  A prospective, one-group, pretest-posttest study design was employed on 40 participants living with type 2 diabetes mellitus, peripheral artery disease (ankle-brachial pressure index < 0.90) and calf-muscle claudication. Calf-muscle electro-stimulation of varying frequencies (1-250 Hz) was applied on both ischaemic limbs (N = 80) for 1 h per day for 12 consecutive weeks. The absolute claudication distance was measured at baseline and following the intervention.
  
  
  
  The cohort (n = 40; 30 males; mean age = 71 years; mean ankle-brachial pressure index = 0.70) registered a mean baseline absolute claudication distance of 333.71 m (standard deviation = 208). Following 91.68 days (standard deviation = 6.23) of electrical stimulation, a significant mean increase of 137 m (standard deviation = 136) in the absolute claudication distance was registered (p = 0.000, Wilcoxon signed rank test).
  
  
  
  Electrical stimulation of varying low to high frequencies on ischaemic calf muscles significantly increased the maximal walking capacity in claudicants with type 2 diabetes. This therapeutic approach may be considered in patients with impaired exercise tolerance or as an adjunct treatment modality.
authors.affiliation: Faculty of Health Sciences, University of Malta, Msida, Malta christian.ellul@um.edu.mt.
authors.forename: Christian
authors.initials: C
authors.lastname: Ellul
authors.affiliation: Faculty of Health Sciences, University of Malta, Msida, Malta.
authors.forename: Alfred
authors.initials: A
authors.lastname: Gatt
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D003920:Diabetes Mellitus / Q000175:diagnosis; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007866:Leg; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome; D016138:Walking
keywords: Peripheral artery disease; electrical stimulation; intermittent claudication; type 2 diabetes mellitus