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Acute effect of high-definition and conventional tDCS on exercise performance and psychophysiological responses in endurance athletes: a randomized controlled trial.
da Silva Machado, DG, Bikson, M, Datta, A, Caparelli-Dáquer, E, Unal, G, Baptista, AF, Cyrino, ES, Li, LM, Morya, E, Moreira, A, et al
Scientific reports. 2021;11(1):13911
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Exercise-induced fatigue can be associated with a limited descending command from the central nervous system to the muscle which may affect muscle contraction and its ability to generate force. Transcranial direct current stimulation (tDCS) is the application of weak electrical current to stimulate different areas of the brain to influence exercise performance and perception. High-definition transcranial direct current stimulation (HD-tDCS) is a modification of conventional tDCS to increase the focality, precision, long-lasting effects and greater neuronal excitability change. This single-centre, randomised, crossover, single-blinded, sham-controlled trial compared the effects of HD-tDCS and conventional tDCS on exercise performance and psychophysiological responses in healthy young male endurance athletes. The study found no effect of HD-tDCS or conventional tDCS on exercise performance and psychophysiological responses to exhaustive exercise. Further robust studies are required to evaluate the effects of both forms of tDCS in athletes compared to non-athletes and its effects when tDCS is applied to other areas of the central nervous system. Healthcare professionals can use the results of this study to understand that there is no evidence currently to support the utilisation of tDCS in improving exercise performance in athletes.
Abstract
Transcranial direct current stimulation (tDCS) has been used aiming to boost exercise performance and inconsistent findings have been reported. One possible explanation is related to the limitations of the so-called "conventional" tDCS, which uses large rectangular electrodes, resulting in a diffuse electric field. A new tDCS technique called high-definition tDCS (HD-tDCS) has been recently developed. HD-tDCS uses small ring electrodes and produces improved focality and greater magnitude of its aftereffects. This study tested whether HD-tDCS would improve exercise performance to a greater extent than conventional tDCS. Twelve endurance athletes (29.4 ± 7.3 years; 60.15 ± 5.09 ml kg-1 min-1) were enrolled in this single-center, randomized, crossover, and sham-controlled trial. To test reliability, participants performed two time to exhaustion (TTE) tests (control conditions) on a cycle simulator with 80% of peak power until volitional exhaustion. Next, they randomly received HD-tDCS (2.4 mA), conventional (2.0 mA), or active sham tDCS (2.0 mA) over the motor cortex for 20-min before performing the TTE test. TTE, heart rate (HR), associative thoughts, peripheral (lower limbs), and whole-body ratings of perceived exertion (RPE) were recorded every minute. Outcome measures were reliable. There was no difference in TTE between HD-tDCS (853.1 ± 288.6 s), simulated conventional (827.8 ± 278.7 s), sham (794.3 ± 271.2 s), or control conditions (TTE1 = 751.1 ± 261.6 s or TTE2 = 770.8 ± 250.6 s) [F(1.95; 21.4) = 1.537; P = 0.24; η2p = 0.123]. There was no effect on peripheral or whole-body RPE and associative thoughts (P > 0.05). No serious adverse effect was reported. A single session of neither HD-tDCS nor conventional tDCS changed exercise performance and psychophysiological responses in athletes, suggesting that a ceiling effect may exist.
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Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial.
Wang, C, Schmid, CH, Fielding, RA, Harvey, WF, Reid, KF, Price, LL, Driban, JB, Kalish, R, Rones, R, McAlindon, T
BMJ (Clinical research ed.). 2018;360:k851
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Fibromyalgia is a complex disorder, characterised by chronic widespread musculoskeletal pain, fatigue, sleep problems and depression. Conventional treatment is multidisciplinary, including medication, exercise and CBT. This randomised, single-blinded trial aimed to determine the effectiveness of regular Tai Chi practice when compared to the standard recommended exercise, aerobic training. 226 adults diagnosed with fibromyalgia were randomly assigned to either 24 weeks of supervised aerobic exercise or 12 or 24 weeks of Tai Chi classes. A standard fibromyalgia impact questionnaire was used to assess changes in pain and quality of life measures, along with patient perception of various aspects of their condition. The study found that Fibromyalgia Impact Questionnaire scores improved across all treatment groups, however the 24-week Tai Chi group saw a statistically significant greater improvement than the aerobic group. In addition, those patients on the 24-week Tai Chi programme experienced greater improvement than those on the 12-week Tai Chi programme. There was also higher attendance and fewer drop-outs in the Tai Chi groups in comparison to the aerobic exercise group. Tai Chi could therefore be considered as an alternative to aerobic exercise in a multi-disciplinary approach to fibromyalgia treatment.
Abstract
OBJECTIVES To determine the effectiveness of tai chi interventions compared with aerobic exercise, a current core standard treatment in patients with fibromyalgia, and to test whether the effectiveness of tai chi depends on its dosage or duration. DESIGN Prospective, randomized, 52 week, single blind comparative effectiveness trial. SETTING Urban tertiary care academic hospital in the United States between March 2012 and September 2016. PARTICIPANTS 226 adults with fibromyalgia (as defined by the American College of Rheumatology 1990 and 2010 criteria) were included in the intention to treat analyses: 151 were assigned to one of four tai chi groups and 75 to an aerobic exercise group. INTERVENTIONS Participants were randomly assigned to either supervised aerobic exercise (24 weeks, twice weekly) or one of four classic Yang style supervised tai chi interventions (12 or 24 weeks, once or twice weekly). Participants were followed for 52 weeks. Adherence was rigorously encouraged in person and by telephone. MAIN OUTCOME MEASURES The primary outcome was change in the revised fibromyalgia impact questionnaire (FIQR) scores at 24 weeks compared with baseline. Secondary outcomes included changes of scores in patient's global assessment, anxiety, depression, self efficacy, coping strategies, physical functional performance, functional limitation, sleep, and health related quality of life. RESULTS FIQR scores improved in all five treatment groups, but the combined tai chi groups improved statistically significantly more than the aerobic exercise group in FIQR scores at 24 weeks (difference between groups=5.5 points, 95% confidence interval 0.6 to 10.4, P=0.03) and several secondary outcomes (patient's global assessment=0.9 points, 0.3 to 1.4, P=0.005; anxiety=1.2 points, 0.3 to 2.1, P=0.006; self efficacy=1.0 points, 0.5 to 1.6, P=0.0004; and coping strategies, 2.6 points, 0.8 to 4.3, P=0.005). Tai chi treatment compared with aerobic exercise administered with the same intensity and duration (24 weeks, twice weekly) had greater benefit (between group difference in FIQR scores=16.2 points, 8.7 to 23.6, P<0.001). The groups who received tai chi for 24 weeks showed greater improvements than those who received it for 12 weeks (difference in FIQR scores=9.6 points, 2.6 to 16.6, P=0.007). There was no significant increase in benefit for groups who received tai chi twice weekly compared with once weekly. Participants attended the tai chi training sessions more often than participants attended aerobic exercise. The effects of tai chi were consistent across all instructors. No serious adverse events related to the interventions were reported. CONCLUSION Tai chi mind-body treatment results in similar or greater improvement in symptoms than aerobic exercise, the current most commonly prescribed non-drug treatment, for a variety of outcomes for patients with fibromyalgia. Longer duration of tai chi showed greater improvement. This mind-body approach may be considered a therapeutic option in the multidisciplinary management of fibromyalgia. TRIAL REGISTRATION ClinicalTrials.gov NCT01420640.