Could transcranial direct-current stimulation in the insular cortex increase exercise tolerance in patients with heart failure?

Abstract

Although studies have shown that transcranial direct-current stimulation (tDCS) can improve physical performance, reduce fatigue, modulate the cardiac autonomic nervous system and increase tolerance to exercise by decreasing the rating of perceived exertion in healthy subjects, athletes, and non-athletes, it has not been examined in patients that have suffered from heart failure (HF). Despite the established benefits of physical exercise, our study investigates whether anodal electrode (a-tDCS) stimulation in the insular cortex, combined with aerobic exercise, enhances physical performance. We aim to assess its impact on inflammatory cytokines, subclinical parameters in cardiopulmonary tests, and quality of life in HFrEF patients compared to sham stimulations. To our knowledge, there are no reports in the literature of studies that have analyzed the effects of a-tDCS applied to the insular area on aerobic performance in patients with HFrEF; thus, our objective is unique and can have a great impact on cardiac rehabilitation. On the other hand, the hypothesis presented here should be approached with caution since there is a lack of clinical trials on this topic.