Neuroscience Letters 794 (2023) 136991

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Neuroscience Letters
journal homepage: www.elsevier.com/locate/neulet

Research article

The effect of tDCS on improving physical performance and attenuating

effort perception during maximal dynamic exercise in non-athletes
Suruagy Isis a, b, 1, Dornelas Armele b, Gomes Luis Paulo c, Araújo Raylene a, Diniz Luam a, b,
Berenguer-Rocha Marina a, b, Baltar Adriana a, b, 1, Monte-Silva Katia a, b, *
a
Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil
b
Department of Physical Therapy, Universidade Federal de Pernambuco, Brazil
c
Bioscience of Human Movement Laboratory, Universidade Tiradentes, Aracaju, Sergipe, Brazil

A R T I C L E I N F O A B S T R A C T

Keywords: Objectives: This study aimed to test the effects of transcranial direct current stimulation (tDCS), using different
Physical performance electrode positioning and montages, on physical performance in maximum incremental tests of healthy non-
Transcranial direct current stimulation athlete subjects.
Exercise
Design: A double-blinded, crossover, sham-controlled study.
Cortical excitability
Method: Fifteen subjects (aged 25.8 ± 5 years, nine women) received one of five different tDCS protocols: (i)
anodal tDCS on the primary motor cortex (M1) (a-tDCS/M1), (ii) anodal tDCS on the left temporal cortex (T3) (a-
tDCS/T3), (iii) cathodal tDCS on M1 (c-tDCS/M1), (iv) cathodal on T3 (c-tDCS/T3), or (v) sham tDCS. The
protocols were assigned in a random order in separate sessions. After tDCS, the volunteers performed the
maximal incremental exercise test (MIT) on a cycle ergometer in each session. The following measures were used
to evaluate physical performance (primary outcome) during MIT: time to exhaustion (TE), maximum power
(MAX-P), and Borg Rating of Perceived Exertion (RPE) scale. In addition, as a secondary outcome measure, we
assessed the lower-limb corticospinal excitability and electrical muscular activity.
Results: tDCS applied over T3 or M1 did not influence electrical muscular activity or increase physical perfor­
mance during MIT in healthy non-athlete subjects. However, our data confirmed that a-tDCS on the M1 increases
lower-limb cortical excitability.
Conclusions: Our results suggest that tDCS is not effective in improving performance during maximal dynamic
exercise in non-athletes. However, we confirmed that the a-tDCS M1 protocol used in this study might increase
cortical excitability in the lower limb motor cortex.

1. Introduction
Classically, it has been proposed that metabolic capacity is a limiting
factor for exercise endurance. Given this paradigm, fatigue is a multi­
factorial process that involves physiological adjustments in the nervous
system and muscles throughout contraction [1]. However, there are
situations such as limitation to endurance exercise with large muscle
groups, which cannot be explained using this paradigm [2,3]. Thus, an
alternative and the current model of exercise physiology emphasizes the
role of the brain in the regulation of exercise performance [4,5]. In this
model, the brain determines the end of the exercise when some
sensations, such as the sense of effort, become more intense and toler­
able [6]. Thus, the perception of effort is a factor that limits exercise
tolerance. Consequently, modulation of cerebral areas involved in effort
perception regulation by noninvasive brain stimulation might influence
exercise performance. Indeed, Okano et al. [7] have demonstrated that
the time to exhaustion during incremental maximal cyclist test increased
when the transcranial direct current stimulation (tDCS) was applied
over the left temporal cortex (T3).
tDCS is a non-invasive brain stimulation technique that involves the
application of a weak direct electrical current (1–2 mA) in the scalp to
modulate spontaneous cortical electrical activity in the human brain

* Corresponding authors at: Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Department of Physical Therapy, Av. Prof. Moraes Rego s/n,
50670-900 Recife, Brazil.
E-mail address: monte.silva@ufpe.br (M.-S. Katia).
1
These authors contributed equally to this work.

https://doi.org/10.1016/j.neulet.2022.136991
Received 23 November 2022; Accepted 24 November 2022
Available online 28 November 2022
0304-3940/© 2022 Published by Elsevier B.V.
S. Isis et al.
painlessly and reversibly [8]. The nature of these modulations depends
on stimulation polarity; anodal stimulation (a-tDCS) increases cortical
activity, which is decreased by cathodal tDCS (c-tDCS) [9]. There is
some evidence that tDCS-induced neuronal activity changes are associ­
ated with improvements in exercise performance [7] and fatigue resis­
tance [10,11]. These results highlight the potential use of this brain-
stimulation technology in exercise and sports science.
Modulation of two main cortical areas has been targeted to interfere
with exercise performance, the primary motor cortex (M1) and T3. The
mechanisms underlying the influence of M1 and T3 on exercise perfor­
mance remain unclear. Previous studies have suggested that electrical
stimulation applied over T3 could indirectly influence insular cortex
function and, consequently, influence autonomic cardiovascular control
during exercise [7]. The insular cortex has been implicated in the control
of cardiac autonomic function in humans [12]. Similarly, there is evi­
dence indicating that the application of tDCS on M1 interferes with a
motor drive from the cortex to the spinal motor pool and, consequently,
improves exercise performance in the upper limbs [11]. Recent studies
demonstrated that tDCS could improve exercise performance [13–15],
despite the potential use of tDCS systematics reviews suggested that
further exploration should de performed [13,14]. Thus, beyond the
obvious need for further studies to corroborate the efficacy of tDCS in
improving dynamic exercise performance, attention must also be
directed to determine which electrode positioning and montage of tDCS
are more effective in modulating the perception of effort and in
improving exercise performance.
In the present study, we tested tDCS effects using different electrode
positioning and montage on exercise tolerance in healthy non-athlete
subjects. We also investigated the effects of tDCS plus physical exer­
cise on lower-limb cortical excitability. We hypothesized that a-tDCS, in
both areas, would prolong the time to exhaustion relative to sham or
cathodal stimulation to reduce the perception of effort during the
maximum incremental test.
2. Experimental procedures
2.1. Subjects
Fifteen healthy, right-handed, adult subjects (aged 25.8 ± 5 years, 9
women), recruited from the university community, were included in the
study. All participants were informed of the procedures and risks before
they provided written informed consent to participate in the study. The
study procedures were approved by the Institutional Research Ethics
Committee and were performed in accordance with the Declaration of
Helsinki.
Before participation, each participant attended an orientation ses­
sion in which they completed a series of questionnaires to confirm that
they were free from any known neurologic disorder, cardiovascular
disease, or musculoskeletal injury in the lower extremities. None of the
patients had a history of pregnancy, cardiac pacemaker implantation, or
surgery involving metallic implants. All participants were right-handed
according to the Edinburgh Handedness Inventory [16]. The level of
physical activity of the subjects was categorized into very active (n = 5),
active (n = 5), and irregularly active (n = 5) according to the Interna­
tional Physical Activity Questionnaire (IPAQ) [17].
2.2. Experimental design
The experiment was conducted using a double-blind, crossover,
sham-controlled design. Volunteers visited the laboratory-five times
with a minimum interval of 48 h between each session. This time has
been suggested to be a good interval to minimize the carry-over effects
of tDCS [9] and the maximum incremental exercise test (MIT) [18].
In each session, the subjects first rested for 10 min. Initially, cortical
excitability and electrical muscular activity were measured. Subse­
quently, they received one of the five tDCS protocols: (i) anodal tDCS on
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Neuroscience Letters 794 (2023) 136991
M1 (a-tDCS/M1), (ii) anodal tDCS on T3 (a-tDCS/T3), (iii) cathodal
tDCS on M1 (c-tDCS/M1), (iv) cathodal tDCS on T3 (c-tDCS/T3), or (v)
sham tDCS. The order of the stimulation protocols was randomized
among participants, and allocation concealment was guaranteed given
that sealed opaque envelopes were handled only by the researcher
responsible for the stimulation sessions. Cortical excitability was
measured again immediately after tDCS, and the volunteers performed
the maximal incremental exercise test (MIT). During MIT, the time to
exhaustion (TE), maximum power (MAX-P), and rating of perceived
exertion (RPE) were measured. Finally, cortical excitability and elec­
trical muscular activity were analyzed immediately after MIT. Cortical
excitability was also measured at 5, 10, and 15 min after MIT.
2.3. Transcranial direct current stimulation
Direct current (2 mA; 20 min) was transferred using saline-soaked
surface sponge electrodes and delivered by a clinical microcurrent
stimulator (NeuroConn, Germany) with a maximum output of 2 mA. For
a-tDCS/M1, the anode (35 cm2) was centered over Cz and the cathodal
electrode (35 cm2) over the inion (10–20 EGG system); for c-tDCS/M1,
the electrodeposition was inverted. This electrode arrangement is
known to result in significant excitability changes in the lower-limb
motor cortex of both hemispheres simultaneously [19]. For a-tDCS/
T3, the anodal electrode (35 cm2) was placed over T3 and the cathode
electrode (35 cm2) was placed over the contralateral supraorbital area
(Fp2). For c-tDCS/T3, the electrode position is inverted. In the sham
condition (sham-tDCS), the electrodes were placed in the same positions
as for the tDCS/T3 or tDCS/M1 montage randomly, but the current was
turned off after the 30 s [9]. The volunteers and researchers involved in
the evaluations were blinded to the tDCS protocols.
2.4. Maximal incremental exercise test (MIT)
For the test, participants sat on a cycle ergometer (ERGO-FIT® model
167 cycle, Pirmansens, Germany) in a similar riding position (saddle and
handlebar height and position) and were asked to begin cycling at 70
rpm during a warm-up phase (3 min) at a workload of 15 W. The work
rate was then increased by 25 W (women) or 50 W (men) per minute
until exhaustion, when participants could not maintain a cadence of 70
rpm for 5 s or when the subjects voluntarily terminated the test, which
was considered the TE. During the test, the researcher verbally
encouraged the subjects to continue for as long as possible. The MAX-P
was defined as the highest workload sustained by the subject for>1 min.
Heart rate (HR) was recorded using an HR monitor (S810i, PolarTM,
Finland) with an acquisition rate of 1000 Hz during all MIT. All exper­
imental sessions were performed during the same period of the day at
the same temperature (19 ± 1 ◦ C) to avoid any influence of circadian
rhythm and to minimize environmental influence.
In addition, during the MIT, the Borg 6–20 RPE scale was used to
estimate whole-body (WB) perceived exertion during exercise; WB RPE
[20] and the adapted Borg 0–10 RPE were used to estimate perceived
exertion in the lower extremities – local RPE [20]. Every minute during
exercise, the RPEs were displayed in front of the subjects, who were
asked to point out the number that best described their perceived
exertion. The subjects received strong verbal encouragement from the
same researcher during all the tests to achieve the highest possible
performance. In addition, they were instructed to refrain from vigorous
activities and avoid the consumption of caffeine, alcohol, and tobacco
for 24 h before each session.
2.5. Monitoring of motor corticospinal excitability
Corticospinal excitability was assessed using MEPs elicited by
transcranial magnetic stimulation (TMS). The subjects were seated in a
comfortable chair with heads and arm rests. Single-pulse TMS was
applied using a figure-eight magnetic coil (7 cm diameter) connected to
S. Isis et al.
a magnetic stimulator (Neurosoft ltd., Russia; peak magnetic field = 2.2
T). Surface EMG was recorded from the right quadriceps muscle (vastus
lateralis) with AgCl electrodes in a belly tendon montage. The coil was
centered over Cz. The optimal position was defined as the site where
stimulation resulted in the largest MEPs. When single-pulse TMS was
applied, the volunteer was asked to realize knee extension at 120◦ with a
weight of 2 % of their body mass in the ankle. Between pulses, the
volunteer could rest their feet on a support to avoid fatigue. The signals
were amplified and filtered with a time constant of 80 ms and a low-pass
filter (5.0 Hz), then digitized at an analog-to-digital rate of 20 kHz, and
further relayed into a laboratory computer using Neuro-MEP-Micro
software (Neurosoft Company, Russia). Twenty MEPs were recorded at
a frequency of 0.25 Hz at baseline, immediately after tDCS, and 5, 10,
and 15 min after MIT.
For each experimental session, the intensity of the stimulator was
adjusted to 170 % of the active-motor threshold (aMT). The aMT is
defined as the minimum stimulus intensity that produces a liminal EMG
response (>200 V) during isometric contraction [21]. TMS motor
threshold assessment software (https://clinicalresearcher.org/software.
ht) was used to determine the aMT.
2.6. Surface electromyography assessment
Electromyography (EMG) signals were recorded for 60 s from the
active right quadriceps femoris muscle (rectus femoris, vastus lateralis,
and vastus medialis) using a bipolar configuration. The technique of
electrode placement followed the standards recommended by SENIAM
(SENIAM, 2011). A reference electrode was positioned over the patella.
To evaluate the EMG signals, the volunteers were asked to sit on a fixed
chair and perform an extension of the right leg with a charge of 10 % of
their body mass. EMG was recorded at baseline and immediately after
MIT. The signals were amplified (1,000 × ), band-pass filtered (10–500
Hz), and sampled at 2,000 Hz using a 16-bit data-acquisition system
(EMG system, SP). For analysis of the EMG signal, the last 30 s of the
register was considered, and the root mean square (RMS) of muscle
activity was used.
2.7. Additional measurements
Before each session, subjects provided daily self-reports of sleep
duration and quality, fasting time, motivation to participate, and
tiredness level.
Sleep quality was measured on a scale from 10 (excellent) to
0 (terrible), motivation to participate on a scale from 0 (no motivation)
to 5 (extremely motivated), and tiredness level measured by a scale from
10 (completely rest) to 0 (very tired).
2.8. Statistical analysis
All analyses were performed using the SPSS software (version 20.0,
Chicago, USA). Data are reported as mean and standard deviation (SD)
for continuous variables and frequency for categorical variables. The
distribution of all data was analyzed using the Shapiro–Wilk test.
To verify any differences among the conditions before each session,
depending on whether the variables were categorical or continuous, the
chi-square test or Kruskal-Wallis test was employed. For the analysis of
cortical excitability and electromyography signals, the post-MEPs and
post-RMS were normalized intra-individually and are given as baseline
ratios. The Friedman test was performed to verify differences in MEPs
among sessions, and when necessary, the Wilcoxon test was used as a
post-hoc test. For RMS, a repeated-measures ANOVA 5 × 2 (5 conditions
vs 2 times) was performed, a paired t-test was applied when necessary,
and the maximum power and time to exhaustion were analyzed by one-
way ANOVA. The analysis of local and WB RPE was performed using the
Kruskal-Wallis test, considering each period corresponding to 25 %, 50
%, 75 %, and 100 % of the total duration of the MIT. The Mauchly test of
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Neuroscience Letters 794 (2023) 136991
sphericity was performed, and the Greenhouse-Geisser correction was
performed, if necessary. A p-value of less than 0.05 was considered
significant for all statistical analyses.
3. Results
Measurements of the number of hours and quality of sleep (p = 0.643
and p = 0.758, respectively), fasting time (p = 0.99), motivation for
session (p = 0.386), tiredness level (p = 0.812), and MEP amplitude (p
= 0.482) were similar at baseline.
One-way ANOVA showed no difference between the sessions for
MAX-P (p = 0.99) and TE in MIT (p = 0.67) (Table 1).
Table 2 shows the baseline-standardized RMS obtained by EMG of
the vastus lateralis (VL), vastus medialis (VM), and rectus femoris (RF)
muscles after MIT for each experimental session. Repeated measures
ANOVA revealed a difference in the VL (p = 0.00; F = 11.36), VM (p =
0.04; F = 5.06), and RF (p = 0.00; F = 17.54). However, in comparison
to baseline, the post hoc analysis showed a difference for a-tDCS M1 (P
= 0.03) and a-tDCS T3 (P = 0.01) only for RF (Table 2).
Fig. 1 shows the median and interquartile range for local RPE (A) and
WB RPE (B) at 25 %, 50 %, 75 %, and 100 % of the total MIT duration in
all experimental sessions. The Kruskal Wallis test showed that the local
and WB RPE did not differ across the sessions when plotted against
perceptual exercise duration (p > 0.05).
For MEP data, the Friedman test (χ2 = 66.2, p = 0.000) revealed a
significance difference. Compared to baseline, for a-tDCS/M1, the post
hoc demonstrated increases lower limb cortical excitability for all times.
For c-tDCS/T3, the post hoc demonstrated difference for post-exercise,
5, 10, and 15 min and only after 5 min for a-tDCS/T3 with increases
of cortical excitability after MIT in comparison to baseline. Compared to
the sham condition, it was only observed increases in MEP amplitude for
the a-tDCS/M1 after tDCS application (Fig. 2).
4. Discussion
Contrary to our hypothesis, we found that tDCS (cathodal or anodal)
applied over T3 or M1 in healthy non-athlete subjects was not able to
increase performance and time to exhaustion during MIT. However, our
data confirmed that a-tDCS over the M1 increases lower-limb cortical
excitability.
These results are inconsistent with previous studies that have
demonstrated that anodal tDCS over the primary motor cortex improves
performance in specific tasks involving voluntary contraction
[10,11,22–25]. It is important to note that these studies differ from ours
in several respects. For example, Cogiamanian et al. [10] observed tDCS
effects on the performance of a submaximal isometric motor task at 35 %
of maximum voluntary contraction. Tanaka et al. [23] demonstrated
that tDCS enhances the maximal pinch force of the toe, and Williams
et al. [11] found an enhancement in the time to task failure of a sus­
tained submaximal contraction. Thus, tDCS on the M1 would be effec­
tive in improving muscle performance assessed by low-intensity
exercises or very specific tests, but not on the maximal performance of
Table 1
Mean (±SD) of maximum power (MAX-P) and time to exhaustion (TE) in
maximal incremental test (MIT) for each experimental sessions (anodal tDCS on
M1 and T3, cathodal tDCS on M1 and T3 and sham tDCS).
c-tDCS/ c-tDCS/ a-tDCS/ a-tDCS/ Sham P
T3 M1 M1 T3 tDCS value
MAX-P 201.7 ± 198.3 ± 200 ± 198.3 ± 203.3 ± 0.99#
(W) 68.4 60.1 55.9 59.4 71.9
TE (s) 362.1 ± 365.5 ± 203.3 ± 366.5 ± 368.4 ± 0.67#
71.6 68.5 71.9 83.3 76.3
#
univariate ANOVA. W = watts, s = seconds, T3 = left temporal cortex, M1 =
motor cortex, tDCS = transcranial direct current stimulation, c = cathodal, a =
anodal.
S. Isis et al. Neuroscience Letters 794 (2023) 136991

Table 2 researchers, the basic idea of performance improvement during MIT

Mean (±SE) of baseline-standardized root mean square (RMS) after maximal may be explained by factors such as lower RPE during exercise,
incremental test (MIT) obtained by surface electromyography assessment for the increased time to complete vagal withdrawal during exercise, and
vastus lateralis (VL), rectus femoris (RF) and vastus medialis (VM) muscles after increased cortical excitability of the area stimulated by a-tDCS. The
experimental sessions (anodal tDCS on M1 and T3, cathodal tDCS on M1 and T3 difference between the results of these studies could be, in part,
and sham tDCS).
explained by the hypothesis that when compared with athletes, there
c-tDCS/ c-tDCS/ a-tDCS/ a-tDCS/ Sham P would be a ceiling effect of tDCS on performance in healthy subjects.
T3 M1 M1 T3 tDCS value
Indeed, studies have suggested that the reasons for cessation of exercise
VL 0.99 ± 1.26 ± 1.28 ± 1.17 ± 1.22 ± 0.00 in non-athletes can be different from those in athletes [6,26]. Since
0.44 0.65 0.65 0.48 0.42 maximal metabolic capacity is generally not reached in non-athletes at
the end of exercise (below maximum cardiovascular capacity and no
RF 1.44 ± 1.1 ± 1.4 ± 1.52 ± 1.43 ± 0.00
1.33 0.48 0.65* 0.67* 0.79 indirect evidence of muscular fatigue), other reasons must be proposed,
such as an unusually strong perceived exertion that led to the cessation
VM 1.23 ± 1.21 ± 1.47 ± 0.96 ± 1.19 ± 0.04 of exercise [6]. In these subjects, the sensation related to the exercise
0.68 0.51 1.03 0.36 0.64
may have led their central nervous system to impose an “early” switch-
T3 = left temporal cortex, M1 = motor cortex, tDCS = transcranial direct current off. One could simply call this “lack of motivation” to drive full muscle
stimulation, c = cathodal, a = anodal. recruitment [4]. Thus, the fact that athletes were not used in this study,
unlike Okano’s study, may explain the lack of improvement in perfor­
larger muscle groups, as used in our study. mance and RPE reduction in MIT.
Also, different results from ours, an improvement of exercise per­ In addition to the populations of studies, research suggests that
formance (4 %) during MIT, were observed after single sessions of single-session a-tDCS may be more effective when combined with
anodal tDCS over T3 in cyclist athletes [7]. According to these rehabilitation programs for individuals with performance deficits after

Fig. 1. Local rating of perceived exertion (local RPE), and wholly body rating of perceived exertion (WB RPE) data in median and interquartile range during maximal
incremental test (MIT) in the experimental sessions (anodal tDCS on M1 and T3, cathodal tDCS on M1 and T3 and sham tDCS) versus %exercise duration (25 %, 50 %,
75 % and 100 % of total duration of the MIT). T3 = left temporal cortex, M1 = motor cortex, tDCS = transcranial direct current stimulation, c = cathodal, a = anodal.

Fig. 2. Mean (±SEM) of baseline-standardized motor

evoked potential (MEP) amplitudes before (baseline),
after tDCS and after maximal incremental test (MIT),
5 (T5), 10 (T10) and 15 (T15) min after MIT for each
experimental session (anodal on M1 and T3, cathodal
on M1 and T3, and sham). Filled symbols indicate
significant deviations of the post-tDCS, and after MIT
MEP amplitudes from baseline values. *significant
deviations of sham condition. T3 = left temporal
cortex, M1 = motor cortex, tDCS = transcranial direct
current stimulation, c = cathodal, a = anodal.

4
S. Isis et al.
injury or disease, where there may be greater potential to further
enhance performance due to suboptimal cortical excitability, inhibition,
and descending drive [24,27]. Silva et al. [28], in the study of the case
report, also found an improvement in exercise tolerance in the MIT on
the arm crank ergometer after a-tDCS M1 in individuals with spinal cord
injury. Therefore, it is feasible to think that the a-tDCS effect is more
likely to occur in subjects with diseases characterized by hypoexcit­
ability of motor areas than in healthy populations. This may also explain
the lack of significant results in improving performance in maximal
dynamic exercise in healthy non-athletes. Another possible explanation
for the lack of tDCS effects on the time to exhaustion in MIT is that the
benefits of a single session of tDCS might not be sufficient to improve
performance in non-athletes. Several consecutive sessions of tDCS may
produce a cumulative effect with performance benefits or could be
applied during (and not before) the exercise performed until fatigue, as
there is preliminary evidence demonstrating that tDCS would be effec­
tive to bolster the capacity to exercise under such conditions [11,29].
In summary, since the physical performance was not influenced by
tDCS over M1 or T3 in the present study, in contrast to most studies, it is
reasonable to suggest that the effectiveness of such stimulation may
depend on several factors, such as the type of contraction demand (i.e.,
isometric vs dynamic), muscle mass recruited (large vs small muscle
groups), level of activity (athletes vs non-athletes), health status
(healthy vs sick), the number of sessions of tDCS (single vs several), and
timing (before vs during exercise), which can influence the magnitude of
motor cortex requirements. Such factors might help explain the
controversial results regarding the effects of tDCS on physical perfor­
mance. A more thorough investigation of these factors would provide a
comprehensive understanding of the underlying mechanisms of tDCS
that contribute to the improvement of performance during dynamic
exercise.
The second purpose of this study was to use single-pulse TMS to
evaluate the changes in cortical excitability after tDCS in the lower limb
motor cortex. While it is a common experimental approach to evoke
MEPs in the upper limb, a few studies have reported the effects of tDCS
applied over the lower limb primary motor cortex M1, largely because of
difficulties in evaluating tDCS effects of tDCS on this area [30].
Our data confirmed that atDCS of M1 increased cortical excitability
compared to sham tDCS, but no changes were found after c-tDCS. This
study shows that similar to previous studies on the hand corticospinal
tract [31,32], a-tDCS M1 can be used to increase excitability of the leg
corticospinal. In contrast to the hand, marked decreases in the strength
of corticospinal projections to the leg did not occur when using equiv­
alent intensities of cathodal stimulation [33]. These findings are in line
with those of Jeffery et al. [33], who concluded that a-tDCS applied near
the vertex induced an increase in motor excitability, while Kim et al.
[34] used fMRI to examine the modulating effects of a-tDCS on lower-
limb motor cortex responses and also showed modulated cerebral
cortical activity in healthy individuals.
On the other hand, also similar to our data Jeffery et al. [33] not
finding changes in MEP amplitudes after cathodal stimulation. The
hyperpolarizing current weld applied across leg motor areas probably
failed to reduce intracortical facilitation and increase intracortical in­
hibition, two factors associated with the suppression of MEPs in the
hand motor cortex in response to c-tDCS [35]. The difficulty in reducing
cortical excitability by c-tDCS may be because the leg motor cortex has
fewer inhibitory circuits than the hand motor cortex, or cathodal current
might be less effective in the leg motor cortex because of the different
orientation and position of the leg motor cortex relative to the scalp
[36]. Thus, further experiments in which the electrode position and
current intensity are modified are required to resolve these issues.
No change in the MEPs amplitude was observed after a-tDCS T3 or c-
tDCS T3. Since the primary aim of the present study was to determine
whether tDCS improves exercise tolerance in healthy subjects, and
previous studies suggest that non-invasive brain stimulation over T3
modulates the perception of effort and exercise performance [7], we
5
Neuroscience Letters 794 (2023) 136991
hypothesized that there could be communicating vias between the
temporal or insular cortex and the primary motor cortex (M1), which
could increase its excitability in this area; however, this hypothesis has
not been confirmed.
In conclusion, tDCS did not increase the time to exhaustion or the
RPE during MIT in healthy individuals. These results suggest that this
technique would not be effective in improving the performance of
maximal dynamic exercise in nonathletes. In practical terms, although
some evidence suggests that tDCS might be effective in improving
physical performance and attenuating effort perception during sub­
maximal static exercise in healthy and unhealthy subjects, our data
suggest that this is not true during maximal dynamic exercise in healthy
and non-athlete subjects. However, our data confirmed that the a-tDCS
M1 protocol used in this study might increase cortical excitability in the
lower limb motor cortex.
In this context, more systematic studies are needed to explore the
dynamic interaction between exercise and tDCS to achieve adequate
combinations of brain stimulation to increase the performance of dy­
namic exercise in healthy subjects and try to understand the contem­
porary paradigm of fatigue where exercise starts and ends in the brain
with the perception of effort as an important factor that limits exercise.
Furthermore, a better understanding of the neurophysiological mecha­
nisms of healthy subjects associated with movement has become
essential because of the emergence of tDCS in research settings with the
cortical excitability of the lesioned motor system. This knowledge can
guide the development of effective physical rehabilitation interventions.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Data availability
Data will be made available on request.
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