Pilot Study: Electrical Muscle Stimulation Improves Circulation and Strength in Patients With Leg Ischemia on Hemodialysis

Background: Patients with lower extremity arterial disease (LEAD) undergoing hemodialysis for end-stage renal disease (ESRD) often experience reduced limb muscle strength and impaired circulation. Conventional exercise is often unfeasible due to pain or immobility. Electrical muscle stimulation (EMS) provides a non–weight-bearing alternative for improving muscular and vascular function. This pilot study evaluated the effects of EMS on lower limb muscle strength and peripheral blood flow in older adult patients with diabetes with LEAD undergoing hemodialysis. Methods: Six patients (mean age: 78.7 y) with LEAD and ESRD on maintenance hemodialysis, including 4 with diabetes mellitus, received EMS using the SIXPAD Foot Fit device in the supine position during dialysis (23 min/session, 3 times/wk, for 8 wk). Muscle strength (plantar flexion, dorsiflexion, toe-grasping, and soleus muscle thickness) and hemodynamic parameters (skin perfusion pressure, peak venous velocity, time-averaged mean velocity, and flow volume) were assessed at baseline, 4 weeks, and 8 weeks. Venous flow was measured at rest, during voluntary contraction, and during EMS. Mixed-effect models were used in this study. Results: Plantar flexion strength improved at 8 weeks (15.4 ± 2.1 kg) compared with baseline (13.0 ± 3.0 kg, P < 0.001). Dorsal skin perfusion pressure increased significantly at 4 and 8 weeks ( P < 0.05). EMS significantly elevated time-averaged mean velocity and flow volume compared with rest and voluntary contraction at all time points ( P < 0.01). Conclusions: EMS during dialysis improves muscle strength and peripheral circulation in older adult patients with diabetes, LEAD, and ESRD. Thus, EMS may be a feasible adjunct therapy. Therefore, further randomized studies are warranted.