Effects of anodal transcranial direct current stimulation on athletic performance among elite athletes: A systematic review and meta-analysis.

This systematic review examines the influence of resistance training (RT) on the performance outcomes of elite athletes. Adhering to PRISMA guidelines, a comprehensive search across PubMed, Scopus, SPORTDiscus, and Web of Science databases was conducted, considering studies up to November 19, 2023. The inclusion criteria were elite athletes involved in high-level competitions. Studies were categorized by the competitive level among elite athletes, athlete's sex, performance outcomes, and a training modality with subgroup analyses based on these factors. Thirty-five studies involving 777 elite athletes were included. The results of the meta-analysis revealed a large and significant overall effect of RT on sport-specific performance (standardized mean difference, SMD = 1.16, 95% CI: 0.65, 1.66), with substantial heterogeneity (I2 = 84%). Subgroup analyses revealed differential effects based on the competitive level, the type of sport-specific outcomes, and sex. National elite athletes showed more pronounced (large SMD) benefits from RT compared to international elite athletes (small SMD). Global outcomes revealed a medium but non-significant (p > 0.05) SMD, while local outcomes showed a large SMD. Notably, female athletes exhibited a large SMD, though not reaching statistical significance (p > 0.05), probably due to limited study participants. No significant (p > 0.05) differences were found between heavy and light load RT. Resistance training is effective in improving sport-specific performance in elite athletes, with its effectiveness modulated by the competitive level, the type of the performance outcome, and athlete's sex. The findings underscore the need for personalized RT regimens and further research, particularly in female elite athletes, as well as advanced RT methods for international elite athletes.

The paper addresses the degree to which the attainment of the status as an elite athlete in different sports ameliorates the known age-related losses in skeletal muscle structure and function. The retrospective design, based on comparisons of published data on former elite and masters athletes and data on control subjects, assessed the degree to which the attainment of elite and masters athlete status ameliorated the known age-related changes in skeletal muscle structure and function. Institutional. Elite male athletes. Participation in selected individual and team sports. Strength, power, VO2max, and performance. For elite athletes in all sports, as for the general population, age-related muscle atrophy begins at about 50 years of age. Despite the loss of muscle mass, elite athletes who maintain an active lifestyle age gracefully with few health problems. Conversely, those who lapse into inactivity regress toward general population norms for fitness, weight control, and health problems. Elite athletes in the dual and team sports have careers that rarely extend into their 30s. Lifelong physical activity does not appear to have any impact on the loss in fiber number. The loss of fibers can be buffered to some degree by hypertrophy of fibers that remain. It is surprising that the performance of elite athletes in all sports appears to be impaired before the onset of the fiber loss. Even with major losses in physical capacity and muscle mass, the performance of elite and masters athletes is remarkable.

Pre-stimulus alpha rhythms are correlated with post-stimulus sensorimotor performance in athletes and non-athletes: A high-resolution EEG study

Background and Purpose Elite athletes operate under high physiological and competitive demands, where marginal performance improvements are critical for success. Despite advances in training science, conventional training approaches often fail to optimally manage training load, recovery, and performance consistency. Structured performance management-based training programs, which integrate systematic planning, continuous monitoring, and adaptive feedback, have been proposed as a more effective approach; however, experimental evidence in elite athlete populations remains limited. This study aimed to examine the effects of a structured performance management–based training program on physical fitness and competitive performance in elite athletes. Materials and Methods A randomized controlled experimental design with a pretest–posttest control group was employed. Thirty-six elite athletes (aged 18–30 years) were randomly assigned to an experimental group (n = 18) or a control group (n = 18). The experimental group completed a 12-week structured performance management–based training program, while the control group continued conventional training. Physical fitness variables (maximal strength, explosive power, aerobic capacity, and sprint speed) and competitive performance indicators were assessed before and after the intervention. Data were analyzed using paired-sample and independent-samples Student’s t-tests, with effect size calculations, and the level of statistical significance was set at p < 0.05. Results The experimental group demonstrated significantly greater improvements compared with the control group. Maximal strength increased by 13.3 kg, explosive power by 5.5 cm, aerobic capacity by 3.9 ml·kg⁻¹·min⁻¹, and sprint time decreased by 0.15 s. Competitive performance scores improved from 78.4 ± 6.2 to 85.9 ± 6.7. Between-group analyses revealed significant differences for all variables (p = 0.001–0.006) with moderate to large effect sizes (η² = 0.20–0.27). Conclusions Structured performance management–based training is more effective than conventional training in improving physical fitness and competitive performance in elite athletes. Implementing systematic training management may enhance performance outcomes while supporting athlete readiness and consistency.

ObjectiveSystematically evaluate the acute effects of anodal transcranial direct current stimulation (a-tDCS) on athletes’ sport-specific performance and identify the optimal stimulation parameters and target brain regions for enhancing sport-specific performance.MethodsSearch PubMed, Web of Science, CNKI, Wanfang, and other databases to include randomized controlled trials studying the effects of anodal tDCS on sports performance in healthy athletes. Use a random-effects model to calculate the standardized mean difference (SMD), assess heterogeneity, and evaluate influencing factors. Additionally, conduct three subgroup analyses: (1) based on stimulated brain areas (M1, PFC, TC, CB); (2) based on different sports performance domains (endurance, strength, precision skill tasks, competitive-collaborative skills) for cluster analysis; (3) tDCS protocol parameters (current intensity and stimulation duration).ResultsThis study included 31 articles, covering 473 athletes. The meta-analysis results showed that the acute effect of a-tDCS significantly improved athletes’ specific sports performance, with a moderate effect size (SMD = 0.39, 95% CI = 0.23–0.54, p < 0.001). Subgroup analysis revealed that M1 stimulation had the most consistent effect (SMD = 0.32, 95% CI = 0.15–0.48, p < 0.001), followed by PFC stimulation (SMD = 0.39, 95% CI = 0.03–0.76, p = 0.03). a-tDCS significantly enhanced athletes’ endurance performance (SMD = 0.46, 95% CI = 0.20–0.72, p < 0.001) and competitive-collaborative skill tasks (SMD = 0.45, 95% CI = 0.10–0.80, p = 0.01). Analysis of stimulation parameters indicated that a moderate current intensity of 1.6–2.0 mA (SMD = 0.38, p < 0.001) and a stimulation duration of 16–20 min (SMD = 0.45, p < 0.001) were the optimal protocols for enhancing sports performance.ConclusionThe acute effects of a-tDCS significantly enhance athletes’ endurance and competitive-collaborative skill performance, particularly when targeting the M1 and PFC regions. The optimal stimulation protocol involves a moderate current intensity (1.6–2.0 mA) and duration (16–20 min). Future research should further optimize stimulation parameters and explore long-term effects to enhance the application of a-tDCS in sports training.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=103158, identifier CRD42025103158.

BackgroundThe role of trunk muscle training (TMT) for physical fitness (e.g., muscle power) and sport-specific performance measures (e.g., swimming time) in athletic populations has been extensively examined over the last decades. However, a recent systematic review and meta-analysis on the effects of TMT on measures of physical fitness and sport-specific performance in young and adult athletes is lacking.ObjectiveTo aggregate the effects of TMT on measures of physical fitness and sport-specific performance in young and adult athletes and identify potential subject-related moderator variables (e.g., age, sex, expertise level) and training-related programming parameters (e.g., frequency, study length, session duration, and number of training sessions) for TMT effects.Data SourcesA systematic literature search was conducted with PubMed, Web of Science, and SPORTDiscus, with no date restrictions, up to June 2021.Study Eligibility CriteriaOnly controlled trials with baseline and follow-up measures were included if they examined the effects of TMT on at least one measure of physical fitness (e.g., maximal muscle strength, change-of-direction speed (CODS)/agility, linear sprint speed) and sport-specific performance (e.g., throwing velocity, swimming time) in young or adult competitive athletes at a regional, national, or international level. The expertise level was classified as either elite (competing at national and/or international level) or regional (i.e., recreational and sub-elite).Study Appraisal and Synthesis MethodsThe methodological quality of TMT studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. A random-effects model was used to calculate weighted standardized mean differences (SMDs) between intervention and active control groups. Additionally, univariate sub-group analyses were independently computed for subject-related moderator variables and training-related programming parameters.ResultsOverall, 31 studies with 693 participants aged 11–37 years were eligible for inclusion. The methodological quality of the included studies was 5 on the PEDro scale. In terms of physical fitness, there were significant, small-to-large effects of TMT on maximal muscle strength (SMD = 0.39), local muscular endurance (SMD = 1.29), lower limb muscle power (SMD = 0.30), linear sprint speed (SMD = 0.66), and CODS/agility (SMD = 0.70). Furthermore, a significant and moderate TMT effect was found for sport-specific performance (SMD = 0.64). Univariate sub-group analyses for subject-related moderator variables revealed significant effects of age on CODS/agility (p = 0.04), with significantly large effects for children (SMD = 1.53, p = 0.002). Further, there was a significant effect of number of training sessions on muscle power and linear sprint speed (p ≤ 0.03), with significant, small-to-large effects of TMT for > 18 sessions compared to ≤ 18 sessions (0.45 ≤ SMD ≤ 0.84, p ≤ 0.003). Additionally, session duration significantly modulated TMT effects on linear sprint speed, CODS/agility, and sport-specific performance (p ≤ 0.05). TMT with session durations ≤ 30 min resulted in significant, large effects on linear sprint speed and CODS/agility (1.66 ≤ SMD ≤ 2.42, p ≤ 0.002), whereas session durations > 30 min resulted in significant, large effects on sport-specific performance (SMD = 1.22, p = 0.008).ConclusionsOur findings indicate that TMT is an effective means to improve selected measures of physical fitness and sport-specific performance in young and adult athletes. Independent sub-group analyses suggest that TMT has the potential to improve CODS/agility, but only in children. Additionally, more (> 18) and/or shorter duration (≤ 30 min) TMT sessions appear to be more effective for improving lower limb muscle power, linear sprint speed, and CODS/agility in young or adult competitive athletes.

Anodal transcranial direct current stimulation (a-tDCS) has been used to improve athletic performance in various populations; however, its role in improving performance in elite athletes is unclear. This study aimed to investigate the effects of a-tDCS on athletic performance in elite athletes. We used a single-blind, randomized controlled experimental design and recruited 24 national-level freestyle swimmers from China. All athletes were randomly divided into two groups; the experimental group underwent a-tDCS (current 2mA for 20min) combined with physical training, and the control group underwent a-tDCS sham stimulation combined with physical training. The physical training program was identical in the experimental and control groups. The intervention period was 6weeks, with five weekly sessions of 110min each, consisting of 20min of a-tDCS and 90min of physical training. Base strength, explosive strength, aerobic endurance, and anaerobic endurance were measured in the athletes before and after the intervention. The results were as follows. 1) Basic strength: There was a significant improvement in 5RM pull-ups in the experimental and control groups before and after the intervention (p < 0.05). 2) Explosive strength: There was a significant improvement in vertical jump and swimming start distance into the water in the experimental and control groups before and after the intervention (p < 0.05). 3) Aerobic endurance: There was no significant improvement in the experimental and control groups before and after the intervention. 4) Anaerobic endurance: There was a significant improvement in 400m running performance in the experimental and control groups before and after the intervention (p < 0.05). Compared to physical training alone, a-tDCS combined with physical training can better improve the athletic performance of high-level swimmers, especially in basic strength, explosive strength, and aerobic endurance.

BackgroundTranscranial direct current stimulation (tDCS) has emerged as a promising and feasible method to improve motor performance in healthy and clinical populations. However, the potential of tDCS to enhance sport-specific motor performance in athletes remains elusive. ObjectiveWe aimed at analyzing the acute effects of a single anodal tDCS session on sport-specific motor performance changes in athletes compared to sham. MethodsA systematic review and meta-analysis was conducted in the electronic databases PubMed, Web of Science, and SPORTDiscus. The meta-analysis was performed using an inverse variance method and a random-effects model. Additionally, two subgroup analyses were conducted (1) depending on the stimulated brain areas (primary motor cortex (M1), temporal cortex (TC), prefrontal cortex (PFC), cerebellum (CB)), and (2) studies clustered in subgroups according to different sports performance domains (endurance, strength, visuomotor skill). ResultsA total number of 19 studies enrolling a sample size of 258 athletes were deemed eligible for inclusion. Across all included studies, a significant moderate standardized mean difference (SMD) favoring anodal tDCS to enhance sport-specific motor performance could be observed. Subgroup analysis depending on cortical target areas of tDCS indicated a significant moderate SMD in favor of anodal tDCS compared to sham for M1 stimulation. ConclusionA single anodal tDCS session can lead to performance enhancement in athletes in sport-specific motor tasks. Although no definitive conclusions can be drawn regarding the modes of action as a function of performance domain or stimulation site, these results imply intriguing possibilities concerning sports performance enhancement through anodal M1 stimulation.

Study aim: Real-time EEG neurofeedback (NFB) training is gaining popularity as a cognitive-motor enhancement tool in elite sports. However, its protocol-specific effectiveness across disciplines and outcome domains remains unclear. This systematic review and meta-analysis examined the effects of real-time EEG NFB in elite athletes, focusing on protocol characteristics, targeted outcomes, and effect sizes. Material and methods: A search of six databases (2000–2025) identified 24 studies involving national- or international-level athletes. Protocols were categorized by frequency band (e.g., SMR, beta, theta), sport discipline, and performance domain (cognitive, motor, psychological). Risk of bias was assessed using RoB 2 and ROBINS-I; GRADE was applied to evaluate evidence certainty. Eleven studies provided quantitative data for meta-analysis using standardized mean differences (SMD). Results: Most studies involved individual sports, with judo, archery, and shooting most common. SMR and beta protocols dominated in precision sports; theta protocols were prevalent in combat sports. Meta-analysis showed a large pooled effect (SMD = 1.26; 95% CI: 1.05–1.45), with high heterogeneity ( I 2 = 94.1%). GRADE indicated moderate certainty for cognitive and psychological outcomes. Conclusion: EEG NFB appears effective in enhancing attention, motor control, and anxiety regulation in elite athletes. However, methodological variability highlights the need for standardized protocols and further replication.

To determine if transcranial direct-current stimulation (tDCS) could be effective for the enhancement of swimming performance or mood state in elite athletes. Eight male elite triathletes (age = 20 [2]y, maximal oxygen uptake = 71 [4]mL·kg-1·min-1) participated in this crossover, counterbalanced, sham-controlled, double-blind study. Participants received either actual (20min of anodal stimulation of the motor cortex at 2mA) or sham tDCS and performed an 800-m swimming test in which rating of perceived exertion and blood lactate response were measured. Mood state (Brunel Mood Scale) was assessed before and after each tDCS session and after the swimming test. Heart-rate variability and central nervous system readiness were assessed before and after each tDCS session. The chances of finding differences between conditions were determined using magnitude-based inferences. A significant and very likely higher Brunel Mood Scale-determined vigor self-perception was found with actual tDCS after the stimulation session (-0.1 [1.2] and 2.0 [2.3] for sham and actual tDCS, respectively; P = .018, effect size = 1.14) and after exercise (-4.1 [2.9] and -0.9 [3.6] for sham and actual tDCS, respectively; P = .022, effect size = 0.98). However, likely trivial and nonsignificant (P > .05) differences were found between conditions in performance (599 [38]s and 596 [39]s, respectively). Unclear and nonsignificant differences were observed between conditions for the rest of the study end points. tDCS elicited a marked increase in vigor self-perception that was maintained after exercise but failed to improve swimming performance in elite triathletes.

SummaryElectrophysiological studies in humans and animals suggest that noninvasive neurostimulation methods such as transcranial direct current stimulation (tDCS) can elicit long-lasting [1], polarity-dependent [2] changes in neocortical excitability. Application of tDCS can have significant and selective behavioral consequences that are associated with the cortical location of the stimulation electrodes and the task engaged during stimulation [3–8]. However, the mechanism by which tDCS affects human behavior is unclear. Recently, functional magnetic resonance imaging (fMRI) has been used to determine the spatial topography of tDCS effects [9–13], but no behavioral data were collected during stimulation. The present study is unique in this regard, in that both neural and behavioral responses were recorded using a novel combination of left frontal anodal tDCS during an overt picture-naming fMRI study. We found that tDCS had significant behavioral and regionally specific neural facilitation effects. Furthermore, faster naming responses correlated with decreased blood oxygen level-dependent (BOLD) signal in Broca's area. Our data support the importance of Broca's area within the normal naming network and as such indicate that Broca's area may be a suitable candidate site for tDCS in neurorehabilitation of anomic patients, whose brain damage spares this region.

IntroductionIn recent years, non-invasive brain stimulation (NIBS) interventions for attention-deficit/hyperactivity disorder (ADHD) have received increasing attention. However, which of the various NIBS methods is more effective in improving cognitive functions and core symptoms in patients with ADHD remains unclear.MethodsRandomized controlled trials (RCTs) on NIBS in patients with ADHD were searched. Standardized mean differences (SMDs) for cognitive functions and core symptoms changes were pooled in Bayesian network meta-analyses.ResultAfter reviewing 3,976 retrieved citations, a total of 37 RCTs (N = 1,615 participants) were included. This NMA provides evidence that none of the NIBS interventions significantly improved inhibitory control compared to sham controls. However, a statistically significant difference was observed between anodal transcranial direct current stimulation (tDCS) over the left DLPFC plus cathodal tDCS over the right supraorbital area 1.5 mA (SMD = −0.87, 95% CI: −1.80 to −0.07) and High-definition anodal transcranial direct current stimulation over the vertex 0.25 mA (SMD = −1.04, 95% CI: −2.09 to 0.00). In terms of working memory, anodal tDCS over the left DLPFC plus cathodal tDCS over the right DLPFC (SMD = 0.95, 95% CI: 0.05–1.84) and anodal tDCS over the right inferior frontal cortex (rIFC) plus cathodal tDCS over the right supraorbital area (SMD = 0.86, 95% CI: 0.28–1.45) were associated with significant improvements compared to sham stimulation. For cognitive flexibility, only anodal tDCS over the left DLPFC plus cathodal tDCS over the right supraorbital area (SMD = −0.76, 95% CI: −1.31 to −0.21) demonstrated a statistically significant benefit relative to sham. Regarding inattention, both transcranial pulse stimulation (SMD = −2.62, 95% CI: −6.35 to 1.12) and transcranial alternating current stimulation 10 Hz (SMD = −2.35, 95% CI: −5.00 to 0.30) showed favorable trends in comparison with sham; however, these differences did not reach statistical significance, though they approached the threshold. Finally, no NIBS intervention was found to significantly improve hypersensitivity or impulsivity when compared to sham stimulation.ConclusionThe dual-tDCS and a-tDCS may be considered among the preferred NIBS interventions for improving cognitive function in ADHD. Specifically, anodal tDCS over the left DLPFC plus cathodal tDCS over the right supraorbital area improved cognitive flexibility; while anodal tDCS over the left DLPFC plus cathodal tDCS over the right DLPFC enhanced working memory; both dual-tDCS and a-tDCS demonstrated superior efficacy relative to repetitive transcranial magnetic stimulation (rTMS) for inhibitory control; further research is needed to investigate TPS for improving attention and impulsivity.

ObjectivesProximal hamstring tendon avulsion injuries are severe and potentially career-threatening for elite athletes. Until now, no data have been published on the non-operative treatment of this injury in elite athletes....

Introduction Eccentric strength training is a promising approach to improving upper body strength in athletes, as this type of training has several advantages over training that involves concentric or isometric muscle action (Hoppeler, 2016). Eccentric training shows greater gains in muscle strength and mass with lower cardiovascular and metabolic demands (Douglas et al., 2017; Roig et al., 2009). This, combined with the time-efficient components, makes eccentric training particularly attractive for use in athletes with spinal cord injury (SCI). Despite an increasing number of studies focusing on eccentric training in the lower extremities, little is known about the effects in upper body extremities. Therefore, the main objective of this study was to investigate the feasibility of an eccentric arm-crank training protocol and its effects on upper body performance in elite athletes with SCI. Methods Nine strength training experienced elite athletes (median (Q1-Q3) age 29 (25–35) years) 6 men, 6 (3-10) years active as elite athlete, 12 (10-13) hours of weekly training) with SCI were recruited. The athletes were active in various wheelchair sports including basketball, cycling and athletics. The athletes performed twenty eccentric arm-crank training sessions (2-3 sessions/week for 10-12 weeks), during which intensity (74-182% of predetermined maximal aerobic power) and duration (8-14 min) were progressively increased. The following parameters were assessed before and after the intervention: maximal strength (one repetition maximum (1RM) bench press, grip strength), anaerobic performance (Wingate test), aerobic performance (V̇O2peak-ramp test), arm circumferences. The normal training routine was continued during the study. Results Nine athletes with paraplegia successfully completed the eccentric arm-cranking protocol. The cardiometabolic demands of the training sessions were relatively low at an intensity of 69% (66-76) of maximum heart rate. The athletes improved their maximal aerobic power (+3%, p = 0.047) and increased their arm circumferences (+1-3%, p ≤ 0.027). The further parameters showed no significant improvements, nevertheless most athletes showed individual improvements in all parameters. Discussion/Conclusion Twenty sessions of progressive eccentric arm-cranking, added on top of the normal training routine, improved performance in elite athletes with SCI. The individual improvements found in the athletes are clinically relevant as in this well-trained population, any further gains in upper body performance can be difficult to reach. Nevertheless, such progress can make a critical difference in competition. These preliminary data suggest that our protocol is a feasible method for improving upper body performance in elite athletes using eccentric strength training. A future study will assess the effects of eccentric training during primary SCI rehabilitation.

Transcranial direct current stimulation (tDCS) has been shown to improve motor learning in numerous studies. However, only a few of these studies have been conducted on elite-level performers or in complex motor tasks that have been practiced extensively. The purpose was to determine the influence of tDCS applied to the dorsolateral prefrontal cortex (DLPFC) on motor learning over multiple days on 10-m air rifle shooting performance in elite Deaflympic athletes. Two male and two female elite Deaflympic athletes (World, European, and National medalists) participated in this case series. The study utilized a randomized, double-blind, SHAM-controlled, cross-over design. Anodal tDCS or SHAM stimulation was applied to the left DLPFC for 25 min with a current strength of 2 mA concurrent with three days of standard shooting practice sessions. Shooting performance was quantified as the points and the endpoint error. Separate 2 Condition (DLPFC-tDCS, SHAM) × 3 Day (1,2,3) within-subjects ANOVAs revealed no significant main effects or interactions for either points or endpoint error. These results indicate that DLPFC-tDCS applied over multiple days does not improve shooting performance in elite athletes. Different stimulation parameters or very long-term (weeks/months) application of tDCS may be needed to improve motor learning in elite athletes.