Greater EMS Rate Causes Greater Blood Flow with Peripheral Artery Disease

Calf muscle stimulation with the Veinoplus device results in a significant increase in lower limb inflow without generating limb ischemia or pain in patients with peripheral artery disease. J Vasc Surg. 2013 Mar;57(3):714-9. Abraham P1, Mateus V, Bieuzen F, Ouedraogo N, Cisse F, Leftheriotis G.

Abstract
OBJECTIVE:
Increase in arterial inflow to the lower limbs is important to obtain functional improvement in peripheral artery disease (PAD) patients with claudication. The aim of this study was to assess the effect of electrical stimulation of calf muscles on arterial inflow and tissue oxygen content in PAD in the area of stimulation.
METHODS:
Fifteen adult patients [mean (standard deviation) age, 62 (12 ) years; height, 165 (8)cm; weight, 76 (13) kg; lowest ankle-brachial index 0.66 (0.19)] with stable arterial claudication were recruited. All patients performed a treadmill test (3.2 km/h, 10% slope) associated with a transcutaneous oximetry test expressed as decrease from rest of oxygen pressure (DROP) index values (calf changes minus chest changes from rest) with a maximum walking distance (median [25th/75th percentiles]) of 295 [133-881] m. The DROP index on the symptomatic side was -25 [-18/-34] mm Hg. On another day the patients underwent electrical stimulation in the seated position on the leg that was the most symptomatic on the treadmill. After resting values were recorded, the gastrocnemius was stimulated for 20minutes at increasing contraction rates at 5-minute steps of 60, 75, 86, and 100bpm on the most symptomatic side. Arterial blood inflow with duplex Doppler ultrasound scanning of the femoral artery, DROP transcutaneous oxygen pressure value, and oxygen concentration (O2Hb) from the near-infrared spectroscopic signal of the calf were recorded on both sides. Patients were instructed to report eventual contraction-induced pain in the stimulated calf. Results are given as mean (standard deviation) or median [25th/75th percentiles] according to distribution, and the level of statistical significance was set at P < .05 on two-tailed tests.
RESULTS:
Lower limb inflow (mL/min) was 64 [48/86] vs 63 [57/81] (P> .05) before stimulation, 123 [75/156] vs 57 [44/92] (P < .01) at 60bpm, 127 [91/207] vs 49 [43/68] (P < .01) at 75bpm, 140 [84/200] vs 57 [45/71] (P < .01) at 86bpm, and 154 [86/185] vs 55 [46/94] (P < .01) at 100bpm on the stimulated vs nonstimulated limb, respectively. No apparent decrease or significant leg difference was observed in DROP index or O2Hb values. None of the patients reported contraction-induced pain in the leg.
CONCLUSIONS:
Electrical stimulation of calf muscle with the Veinoplus device results in a significant increase of arterial inflow without measurable muscle ischemia or pain. Potential use of this device as an adjuvant treatment to improve walking capacity in PAD patients remains to be evaluated.

My comments:

  • Parameters in this study were:
  • Waveform: symmetrical biphasic
  • Rate: 60 to 100 pulses per minute (pretty slow)
  • Pulse duration: modulated, up to 240 uS
  • Intensity: increased to a visible but comfortable contraction
  • Treatment time: 20 minutes
  • electrodes: larger 8 cm x 13 cm ovals placed laterally on gastrocnemius muscle bellies

Not a lot of data with regards to function but they did note higher beats per minute (bpm) led to greater increases in LE bloodflow.  60 bpm caused 123 mL/min of bloodflow while 100 bpm increased bloodflow to 154 mL/min. However, 60 bpm is only 1 hz and 100 bpm is 1.67 Hz, so it is hard to say how that applies to most other electric stimulation units where the rate can reach well over 100 Hz.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

4 thoughts on “Greater EMS Rate Causes Greater Blood Flow with Peripheral Artery Disease

    • Hi Salvatore,

      I can’t comment with certainty about the Veinoplus because they don’t advertise the exact parameters they use on their website. If they were exceptional, I expect they would flaunt it. However, if the capabilities of the Veinoplus are the same as the settings used in the above paper than I think the Globus can do everything the Veinoplus can do, plus a LOT, LOT more. For starters the Globus is a 4 channel machine, meaning have 8 pads, 4 of which can be placed on each leg. In contrast the Veinoplus has only a single channel, thus can run only 2 pads. The Veinoplus appears to have a pulse width of 250 uS, while the Globus has almost twice that at 450 uS, which if everything else is identical the Globus should have nearly double the power of the Veinoplus with each of its individual channels. The veinoplus rate appears to top out at 1.65 Hz, which is less than 1/3 of my preferred rate of 5 Hz with the Globus. With the Globus you could to up to 150 Hz if you wanted, but I think circulation is optimized with 5 Hz. Near as I can tell, the VeinoPlus has a few programs on it, while the Globus Genesy 300 has 91 preset programs, plus the 7 or 8 I write in myself, and write in new ones if new research or experience leads us to think there might be something better to try. I think the Globus Genesy 300 PRO is the strongest, most versatile EMS units available in the US, only being topped with higher dollar Globus models. I think the sweet spot of bang per buck with the Globus units is the 300 PRO because it has 100% of the power and has the same channels of the upper level models and I don’t use any of the preset programs anyway. I prefer the ones I write.

      The Veinoplus is cheaper, but I think you are getting considerably less capability and versatility, and they charge a pretty penny for replacement electrodes, which, because they are the sticky kind will regularly wear out. Which is just one of the reasons I prefer rubber carbon electrodes. The Globus is what I use for pretty much everything in my office from back pain, to plantar fasciitis, to even headaches. I think EMS sellers do a lot of marketing to sell these specialized EMS or TENS units to focus on a particular problem, in this case circulation, when the truth is that the EMS currents really aren’t that different. I just want a biphasic symmetrical square wave current, that’s really powerful, has a lot of channels, that I can program myself. That way I can copy and I think often improve upon what is done in studies like the one above. The Globus gives me all that. Hope that helps.

  1. Chad:

    Is the output on the two connector leads of each cable the same and does it matter which connector lead goes to which electrode?

    • Hi Salvadore,

      With the Globus machines the EMS current is biphasic symmetrical alternating current. That means the current coming out of each end of the lead is identical. One electrode might ‘feel’ stronger though if it is over a larger muscle, or closer to a nerve, but the current coming out is still the same.

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