The effect of transcranial direct current stimulation on dynamic balance after an endurance exhausting activity in mental fatigue condition

Document Type : Research Paper


1 Faculty of Sport Sciences, Razi University, Kermanshah, Iran

2 Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Iran

3 Department of Physical Education, Federal University of Rio Grande do Norte, Natal, RN, Brazil


Background: Anodal transcranial direct current stimulation (a-tDCS) is a new neuro-modulatory technique.
Aim: This study aimed to investigate the effect of a-tDCS on dynamic balance after exhaustion.
Material and Methods: Fifteen endurance-trained men voluntarily attended five separate sessions. In the first session, Maximal aerobic speed (MAS) was measured. Then, the participants were randomly assigned to four different conditions: 1. Mental fatigue (MF)+a-tDCS, 2. MF+sham (s-tDCS), 3. a-tDCS, and 4. s-tDCS. In each session, after dynamic balance measurement, the participants were exposed to the conditions and received 20 min of anodal tDCS over the dorsolateral prefrontal cortex (DLPFC). Then, the participants performed a submaximal endurance activity at 70% of MAS until exhaustion. Immediately after exhaustion, dynamic balance was measured again.
Results: After exhaustion, the dynamic balance of the right leg under the a-tDCS condition was significantly higher than the MF+s-tDCS (P= 0.008). The dynamic balance significantly decreased from pre- to post-test in MF+s-tDCS and s-tDCS conditions (P= 0.0001). In the left leg, the dynamic balance under the a-tDCS condition was significantly higher than MF+s-tDCS (P= 0.025).
Conclusions: Anodal stimulation of the DLPFC could be beneficial for the dynamic balance and may have a protective effect against the negative consequence of exhausting activity on the dynamic balance in endurance-trained men.


[1] Davis NJ. "Neurodoping: brain stimulation as a performance-enhancing measure". Sports Medicine. 2013; 43(8): 649-53. doi: 10.1007/s40279-013-0027-z.
[2] Amiri E, Gharakhanlou R, Rajabi H, Rezasoltani Z, Azma K, Kavehee A. "Changes in corticospinal excitability and motoneurones responsiveness during and within a time-course after submaximal fatiguing contractions". Sport Physiology. 2018; 10(39): 33-50. doi: 10.22089/SPJ.2018.1362.
[3] Ramezani H, Fallah Mohammadi Z, Namdar Tajari S, Khanbabaie R. "The acute effect of post-activation potentiation with transcranial random noise stimulation on some electrophysiological and functional variables of athletic men". Sport Physiology. 2020; 11(44): 31-54.
[4] Okano AH, Fontes EB, Montenegro RA, Farinatti PdTV, Cyrino ES, Li LM, et al. "Brain stimulation modulates the autonomic nervous system, rating of perceived exertion and performance during maximal exercise". British Journal of Sports Medicine. 2015; 49(18): 1213-8. doi: 10.1136/bjsports-2012-091658.
[5] Colzato LS, Nitsche MA, Kibele A. "Noninvasive brain stimulation and neural entrainment enhance athletic performance—a review". Journal of Cognitive Enhancement. 2017; 1(1): 73-9. doi: 1. 10.1007/s41465-016-0003-2.
[6] Machado DGdS, Unal G, Andrade SM, Moreira A, Altimari LR, Brunoni AR, et al. "Effect of transcranial direct current stimulation on exercise performance: a systematic review and meta-analysis". Brain Stimulation. 2019; 12(3): 593-605. doi: 10.1016/j.brs.2018.12.227.
[7] Vitor-Costa M, Okuno NM, Bortolotti H, Bertollo M, Boggio PS, Fregni F, et al. "Improving cycling performance: transcranial direct current stimulation increases time to exhaustion in cycling". PLoS One. 2015; 10(12): e0144916. doi: 10.1371/journal.pone.0144916.
[8] Baldari C, Buzzachera CF, Vitor-Costa M, Gabardo JM, Bernardes AG, Altimari LR, et al. "Effects of transcranial direct current stimulation on psychophysiological responses to maximal incremental exercise test in recreational endurance runners". Frontiers in Psychology. 2018: 1867. doi: 10.3389/fpsyg.2018.01867.
[9] Reardon S. "'Brain doping' may improve athletes' performance". Nature. 2016; 531(7594): 283-4. doi: 10.1038/nature.2016.19534.
[10] Baharlouei H, Saba MA, Shaterzadeh Yazdi MJ, Jaberzadeh S. "The effect of transcranial direct current stimulation on balance in healthy young and older adults: A systematic review of the literature". Neurophysiol Clin. 2020; 50(2): 119-131. doi: 10.1016/j.neucli.2020.01.006.
[11] Kaminski E, Steele CJ, Hoff M, Gundlach C, Rjosk V, Sehm B, et al. "Transcranial direct current stimulation (tDCS) over primary motor cortex leg area promotes dynamic balance task performance". Clinical Neurophysiology. 2016; 127(6): 2455-62. doi: 10.1016/j.clinph.2016.03.018.
[12] Papalia GF, Papalia R, Diaz Balzani LA, Torre G, Zampogna B, Vasta S, et al. "The effects of physical exercise on balance and prevention of falls in older people: A systematic review and meta-analysis". J Clin Med. 2020; 9(8). doi: 10.3390/jcm9082595.
[13] Mokhtari Fard Z, Sabbagh Langeroudi M. "The effects of 8 weeks TRX exercises and core stability in the stable level on the landing pattern, the stability of the core area and balance of girls football players". The Scientific Journal of Rehabilitation Medicine. 2021; 10(3): 546-61. doi: 10.32598/SJRM.10.3.14. [in Persian]
[14] Johnston W, Dolan K, Reid N, Coughlan GF, Caulfield B. "Investigating the effects of maximal anaerobic fatigue on dynamic postural control using the Y-Balance Test". Journal of Science and Medicine in Sport. 2018; 21(1): 103-8. doi: 10.1016/j.jsams.2017.06.007.
[15] Ricotti L. "Static and dynamic balance in young athletes". Journal of Human Sport and Exercise. 2011; 6(4): 616-28. doi: 10.4100/jhse.2011.64.05.
[16] Shouhani M, Jalilian M, Parsaei S, Modara F, Seidkhani H. "The effect of unilateral and bilateral electrical stimulation of the brain on improving the balance of the elderly". Iranian Journal of Ageing. 2020; 15(3): 312-23. doi: 10.32598/sija. [in Persian]
[17] Nikooharf Salehi E, Jaydari Fard S, Jaberzadeh S, Zoghi M. "Transcranial direct current stimulation reduces the negative impact of mental fatigue on swimming performance". Journal of Motor Behavior. 2021: 1-10. doi: 10.1080/00222895.2021.1962238.
[18] de Sousa Fortes L, Faro H, de Lima-Junior D, Albuquerque MR, Ferreira MEC. "Non-invasive brain stimulation over the orbital prefrontal cortex maintains endurance performance in mentally fatigued swimmers". Physiology & Behavior. 2022; 250: 113783. doi: 10.1016/j.physbeh.2022.113783.
[19] Alix-Fages C, Romero-Arenas S, Calderón-Nadal G, Jerez-Martínez A, Pareja-Blanco F, Colomer-Poveda D, et al. "Transcranial direct current stimulation and repeated sprint ability: No effect on sprint performance or ratings of perceived exertion". European Journal of Sport Science. 2022; 22(4): 569-578. doi: 10.1016/j.physbeh.2022.113783.
[20] Lattari E, Campos C, Lamego MK, Legey S, Neto GM, Rocha NB, et al. "Can transcranial direct current stimulation improve muscle power in individuals with advanced weight-training experience?". The Journal of Strength & Conditioning Research. 2020; 34(1): 97-103. doi: 10.1519/JSC.0000000000001956.
[21] Brahms M, Heinzel S, Rapp M, Mückstein M, Hortobágyi T, Stelzel C, et al. "The acute effects of mental fatigue on balance performance in healthy young and older adults- A systematic review and meta-analysis". Acta Psychologica. 2022; 225: 103540. doi: 10.1016/j.actpsy.2022.103540.
[22] Pitts J, Bhatt T. "Effects of mentally induced fatigue on balance control: A systematic review". Experimental Brain Research. 2023; 241(1): 13-30. doi: 10.1007/s00221-022-06464-x.
[23] Durlak JA. "How to select, calculate, and interpret effect sizes". Journal of Pediatric Psychology. 2009; 34(9): 917-28. doi: 10.1093/jpepsy/jsp004.
[24] Okumura Y, Sakamoto S. "Statistical power and effect sizes of depression research in Japan". Psychiatry and Clinical Neurosciences. 2011; 65(4): 356-64. doi: 10.1111/j.1440-1819.2011.02208.x.
[25] Machado FA, Kravchychyn ACP, Peserico CS, da Silva DF, Mezzaroba PV. "Incremental test design, peak ‘aerobic’running speed and endurance performance in runners". Journal of Science and Medicine in Sport. 2013; 16(6): 577-82. doi: 10.1016/j.jsams.2012.12.009.
[26] Filipas L, Gallo G, Pollastri L, La Torre A. "Mental fatigue impairs time trial performance in sub-elite under 23 cyclists". PLoS One. 2019; 14(6): e0218405. doi: 10.1371/journal.pone.0218405. 
[27] Martin K, Staiano W, Menaspà P, Hennessey T, Marcora S, Keegan R, et al. "Superior inhibitory control and resistance to mental fatigue in professional road cyclists". PLoS One. 2016; 11(7): e0159907. doi: 10.1371/journal.pone.0159907.
[28] Grosprêtre S, Grandperrin Y, Nicolier M, Gimenez P, Vidal C, Tio G, et al. "Effect of transcranial direct current stimulation on the psychomotor, cognitive, and motor performances of power athletes". Scientific Reports. 2021; 11(1): 1-13. doi: 10.1038/s41598-021-89159-7.
[29] Etemadi M, Amiri E, Tadibi V, Grospretre S, Valipour Dehnou V, Da Silva Machado DG. “Effect of transcranial direct current stimulation on dynamic balance after endurance exhausting activity in normobaric hypoxia”. J Appl Exer Physiol. 2022; 18(35): 5-6. doi: 10.22080/JAEP.2023.24721.2122. [in Persian]
[30] Wittenberg E, Thompson J, Nam CS, Franz JR. "Neuroimaging of human balance control: a systematic review". Front Hum Neurosci. 2017; 11: 170. doi:10.3389/fnhum.2017.00170.
[31] Robertson CV, Marino FE. "A role for the prefrontal cortex in exercise tolerance and termination". J Appl Physiol. 2016; 120(4): 464-6. doi: 10.1152/japplphysiol.00363.2015.
[32] Manor B, Zhou J, Jor'dan A, Zhang J, Fang J, Pascual-Leone A. "Reduction of dual-task costs by noninvasive modulation of prefrontal activity in healthy elders". J Cogn Neurosci. 2016; 28(2): 275-281. doi: 10.1162/jocn_a_00897.
[33] Zhou D, Zhou J, Chen H, Manor B, Lin J, Zhang J. "Effects of transcranial direct current stimulation (tDCS) on multiscale complexity of dual-task postural control in older adults". Exp Brain Res. 2015; 233(8): 2401-9. doi: 10.1007/s00221-015-4310-0.
[34] Marotta N, de Sire A, Marinaro C, et al. "Efficacy of transcranial direct current stimulation (tDCS) on balance and gait in multiple sclerosis patients: A machine learning approach". J Clin Med. 2022; 11(12): 3505. doi: 10.3390/jcm11123505.
[35] Kaminski E, Hoff M, Rjosk V, et al. "Anodal transcranial direct current stimulation does not facilitate dynamic balance task learning in healthy old adults". Front Hum Neurosci. 2017; 11: 16. doi: 10.3389/fnhum.2017.00016.