Sixty patients with intermittent claudication and type 2 diabetes mellitus. Their age will ranged from 45-55 years old. They recruited from internal department at Damanhour Medical National Institute (DMNI), Damanhour, Beheira Governorate, Egypt. Patients randomly assigned into three equal groups:

Group (A):

Upper limb exercises group consist of 20 patients. They received arm cranking exercise three times per week for three consecutive months plus routine physiotherapy program.

Group (B):

Lower limb exercises group consist of 20 patients. They received bicycling exercise three times per week for three consecutive months plus routine physiotherapy program.

Group (C):

The control group consisted of 20 patients. They received only routine physiotherapy program.

1. Subjects:

   Sixty patients with intermittent claudication and type 2 diabetes mellitus. Their age ranged from 45-55 years old. They recruited from internal department at Damanhour Medical National Institute (DMNI), Damanhour, Beheira Governorate, Egypt. Patients randomly assigned into three equal groups:

   Group (A):

   Upper limb exercises group consist of 20 patients. They received arm cranking exercise three times per week for three consecutive months plus routine physiotherapy program.

   Group (B):

   Lower limb exercises group consist of 20 patients. They received bicycling exercise three times per week for three consecutive months plus routine physiotherapy program.

   Group (C):

   The control group consisted of 20 patients. They received only routine physiotherapy program.

2. Equipment:

Measurement equipment:

1. The Treadmill:

   All patients were tested Maximum walking distance and Pain free walking distance by walking in the treadmill.

2. Ankle/brachial indices (ABI) Doppler Ultrasound Machine

3. All patients were tested HbA1C before and after the treatment in medical analysis lab department at Damanhour Medical National Institute (DMNI).

Therapeutic equipment:

1. The arm crank ergometer
2. bicycle ergometer

Inclusion Criteria:

• Sixty patients with type 2 diabetes mellitus and intermittent claudication.
• Patients with diabetes at least 5 years.
• Both genders were included.
• Their age will be ranged from 45-55 years old.
• Patients referred from physician of internal medicine diagnosed as controlled type 2 diabetes (HbA1c 7-7.5%) for the previous 3 months.
• Their body mass index will be ranged from 25.0 to 34.9 kg/m2.

Exclusion Criteria:

• Pregnant women.
• Malignancy.
• Other medical conditions such as uncontrolled hypertension and osteoporosis.
• Past medical history included conditions that may influence the provision of physiotherapy interventions such as (severe asthma, chronic airflow limitation, bronchiectasis, ankylosing spondylitis or lumbar disc prolapse).