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Abstract: Gonçalves, DS, Moscaleski, LA, da Silva, GM, Morgans, R, Okano, AH, and Moreira, A. The effect of combined transcranial direct current stimulation and pneumatic compression as part of a comprehensive recovery strategy in professional male top-level soccer players. J Strength Cond Res 38(9): 1658-1666, 2024-This retrospective study aimed to examine the effect of transcranial direct current stimulation (tDCS) combined with lower limb pneumatic compression during the postmatch recovery period in top-level professional male soccer players' physiological and perceptual markers of recovery status. During the 2022 season (baseline), pneumatic compression was performed as part of the recovery strategy, applied the day after official match play and psychophysiological measurements (pain, sleep, perceived recovery, and creatine kinase [CK] sampling) were performed on the second day postmatch. During the 2023 season, the tDCS protocol was introduced, with its application being performed simultaneously (in conjunction) with pneumatic compression. Recovery sessions following 10 matches in the 2022 season and following 10 matches in the 2023 season were included in the analyses. Compared with 2022 (baseline; pneumatic compression isolated), the players perceived an increased recovery on the second day postmatch when tDCS was used in conjunction with the pneumatic compression (mean = 12%; p = 0.008) and rated improved sleep quality for the nights after applying tDCS combined with pneumatic compression (mean = 7.5%; p = 0.029). On the second day postmatch, a significant reduction was observed in muscle pain/soreness (mean = 64%; p < 0.0001) and the CK concentration decreased when baseline (pneumatic compression isolated) was compared with tDCS + pneumatic compression (mean = 76%; p = 0.001). In summary, combining pneumatic compression with tDCS may enhance the effects of both interventions, leading to greater overall improvements in recovery. Further research is warranted to confirm these findings and explore the underlying mechanisms in more detail., (Copyright © 2024 National Strength and Conditioning Association.)

Background: Chikungunya virus (CHIKV) is a globally prevalent pathogen, with outbreaks occurring in tropical regions. Chronic pain is the main symptom reported and is associated with decreased mobility and disability. Transcranial direct current stimulation (tDCS) is emerging as a new therapeutic tool for chronic arthralgia., Objective: To evaluate the effectiveness of 10 consecutive sessions of anodal tDCS on pain (primary outcome) in participants with chronic CHIKV arthralgia. Secondary outcomes included functional status, quality of life, and mood., Methods: In this randomized, double-blind, placebo-controlled trial, 30 participants with chronic CHIKV arthralgia were randomly assigned to receive either active (n = 15) or sham (n = 15) tDCS. The active group received 10 consecutive sessions of tDCS over M1 using the C3/Fp2 montage (2 mA for 20 min). Visual analog scale of pain (VAS), health assessment questionnaire (HAQ), short-form 36 health survey (SF-36), pain catastrophizing scale, Hamilton anxiety scale (HAS), timed up and go (TUG) test, lumbar dynamometry, 30-s arm curl and 2-min step test were assessed at baseline, day 10 and at 2 follow-up visits., Results: There was a significant interaction between group and time on pain (p = 0.03; effect size 95 % CI 0.9 (-1.67 to -0.16), with a significant time interaction (p = 0.0001). There was no interaction between time and group for the 2-minute step test (p = 0.18), but the groups differed significantly at day 10 (p = 0.01), first follow-up (p = 0.01) and second follow-up (p = 0.03). HAQ and SF-36 improved but not significantly. There was no significant improvement in mental health, and physical tests., Conclusion: tDCS appears to be a promising intervention for reducing pain in participants with chronic CHIKV arthralgia, although further research is needed to confirm these findings and explore potential long-term benefits., Trial Registration: Brazilian Registry of Clinical Trials (ReBEC): RBR-245rh7., Competing Interests: Declaration of competing interest The City University of New York has a patent on brain stimulation with MB as the inventor. MB has equity in Soterix Medical Inc. No conflict of interest was declared by the other authors., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

We aimed to investigate the influence of interoceptive accuracy on affective valence, arousal, and ratings of perceived exertion (RPE) during 20 minutes of aerobic exercise at both moderate and heavy intensity among physically inactive men. We divided our participant sample into men with poor heartbeat perception (PHP, n = 13) and good heartbeat perception (GHP, n = 15), based on their cardioceptive accuracy. We measured their heart rate reserve (%HR reserve ), perceived affective valence (Feeling Scale; +5/-5), perceived arousal (Felt Arousal Scale, 0-6), and ratings of perceived effort (RPE; Borg scale 6-20) every five minutes during an exercise session on a bicycle ergometer. During moderate-intensity aerobic exercise, the GHP group presented a greater decline in affective valence ( p = 0.010; d = 1.06) and a greater increase in RPE ( p = 0.004; d = 1.20) compared to the PHP group, with no group differences in %HR reserve ( p = 0.590) and arousal ( p = 0.629). Psychophysiological and physiological responses to the heavy-intensity aerobic exercise were not different between groups. We concluded that the influence of interoceptive accuracy on psychophysiological responses during submaximal fixed-intensity aerobic exercise was intensity-dependent in these physically inactive men.

The negative effect of prolonged cognitive demands on psychomotor skills in athletes has been demonstrated. Transcranial direct current stimulation (tDCS) could be used to mitigate this effect. This study examined the effects of tDCS over the left dorsolateral prefrontal cortex (DLPFC) during a 30-min inhibitory Stroop task on cognitive and shooting performances of professional female basketball players. Following a randomised, double-blinded, sham-controlled, cross-over design, players were assigned to receive anodal tDCS (a-tDCS, 2 mA for 20 min) or sham-tDCS in two different sessions. Data from 8 players were retained for analysis. Response Time decreased significantly over time ( p  < 0.001; partial η 2 = 0.44; no effect of condition, or condition vs. time interaction). No difference in mean accuracy and shooting performance was observed between tDCS conditions. The results suggest that a-tDCS exert no additional benefits in reducing the negative effects of prolonged cognitive demands on technical performance compared to sham (placebo). Practitioner summary: Prolonged cognitive demands can negatively affect the athletes' performance. We tested whether transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) could attenuate these effects on cognitive and shooting performance in professional female basketball players. However, tDCS did not exert any additional benefits compared to sham. Abbreviations: tDCS: transcranial direct current stimulation; a-tDCS: anodal transcranial direct current stimulation; PFC: prefrontal cortex; DLPFC: dorsolateral prefrontal cortex; PCT: prolonged cognitive task; TT: time trial; RT: response time; NASA-TLX: National Aeronautics and Space Administration Task Load Index; RPE: ratings of perceived exertion; CR-10 scale: category rating scale; EEG: electroencephalogram; AU: arbitrary units.

Objective: Although relatively costly and non-scalable, non-invasive neuromodulation interventions are treatment alternatives for neuropsychiatric disorders. The recent developments of highly-deployable transcranial electric stimulation (tES) systems, combined with mobile-Health technologies, could be incorporated in digital trials to overcome methodological barriers and increase equity of access. The study aims are to discuss the implementation of tES digital trials by performing a systematic scoping review and strategic process mapping, evaluate methodological aspects of tES digital trial designs, and provide Delphi-based recommendations for implementing digital trials using tES., Methods: We convened 61 highly-productive specialists and contacted 8 tES companies to assess 71 issues related to tES digitalization readiness, and processes, barriers, advantages, and opportunities for implementing tES digital trials. Delphi-based recommendations (>60% agreement) were provided., Results: The main strengths/opportunities of tES were: (i) non-pharmacological nature (92% of agreement), safety of these techniques (80%), affordability (88%), and potential scalability (78%). As for weaknesses/threats, we listed insufficient supervision (76%) and unclear regulatory status (69%). Many issues related to methodological biases did not reach consensus. Device appraisal showed moderate digitalization readiness, with high safety and potential for trial implementation, but low connectivity., Conclusions: Panelists recognized the potential of tES for scalability, generalizability, and leverage of digital trials processes; with no consensus about aspects regarding methodological biases., Significance: We further propose and discuss a conceptual framework for exploiting shared aspects between mobile-Health tES technologies with digital trials methodology to drive future efforts for digitizing tES trials., (Copyright © 2022 International Federation of Clinical Neurophysiology. All rights reserved.)

Differentiated brain activation in high-performance athletes supports neuronal mechanisms relevant to sports performance. Preparation for the motor action involves cortical and sub-cortical regions that can be non-invasively modulated by electrical current stimulation. This study aimed to investigate the effect of high-definition transcranial direct current stimulation (HD-tDCS) on electrical brain activity in professional female basketball players during free-throw shooting. Successful free-throw shooting ( n = 2,361) from seven professional female basketball players was analyzed during two experimental conditions (HD-tDCS cathodic and sham) separated by 72 h. Three spectral bio-markers, Power Ratio Index (PRI), Delta Alpha Ratio (DAR), and Theta Beta Ratio (TBR) were measured (electroencephalography [EEG] Brain Products). Multi-channel HD-tDCS was applied for 20 min, considering current location and intensity for cathodic stimulation: FCC1h, AFF5h, AFF1h (-0.5 mA each), and FCC5h (ground). The within EEG analyses (pre and post HD-tDCS) of frontal channels (Fp1, Fp2, F3, F4, FC1, FC3) for 1 second epoch pre-shooting, showed increases in PRI ( p < 0.001) and DAR ( p < 0.001) for HD-tDCS cathodic condition, and in TBR for both conditions (cathodic, p = 0.01; sham, p = 0.002). Sub-group analysis divided the sample into less ( n = 3; LSG) and more ( n = 4; MSG) stable free-throw-shooting performers and revealed that increases in pre to post HD-tDCS in PRI only occurred for the LSG. These results suggest that the effect of HD-tDCS may induce changes in slow frontal frequency brain activities and that this alteration seems to be greater for players demonstrating a less stable free-throw shooting performance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Moscaleski, Fonseca, Brito, Morya, Morgans, Moreira and Okano.)

Background: Due to the quarantine caused by the Coronavirus disease 2019 (COVID-19), professional team-sports adapted their training routine to maintain the athletes' performance and minimize the negative emotional effects. The aim of the present study was to describe a home-based training program and extra-activities applied during the quarantine in elite professional female basketball players, and to compare the internal training load (ITL), session rating of perceived exertion (s-RPE), motivation, and wellbeing responses before and during the quarantine., Methods: Nine female elite players (25.7±7.0 years; 180.0±8.0 cm; 79.0±11.0 kg) belonging to a professional basketball team performed a home-based training program during the quarantine. ITL, s-RPE, training motivation, and wellbeing were examined before (phase 1), at the beginning (phase 2), and during (phase 3) the quarantine., Results: ITL was higher (main effect) in phase 1 (449.5±62.8 a.u.) compared to phase 2 (265.5±39.0 a.u.) and phase 3 (423.1±18.7 a.u.); s-RPE was higher in phase 1 (4.50±0.63 a.u.) compared to phase 2 (3.8±0.6 a.u.), but not to phase 3 (4.37±0.79 a.u.). Motivation was higher in phase 1 (3.6±0.3 a.u.) compared to phase 2 (2.3±0.6 a.u.) and phase 3 (2.4±0.5 a.u.)., Conclusions: The results of the study demonstrated that extra-activities involving online athletes' socialization were implemented to rouse the motivation, but the quarantine period induced a reduction in ITL and influenced the player's training motivation.

Objective: To investigate the effects of transcranial direct current stimulation (tDCS) associated with functional exercise on pain, functional performance, psychological symptoms, and quality of life of patients with fibromyalgia (FM)., Design: Randomized controlled trial. Participants were randomized by blocks into 2 groups: tDCS associated with functional exercise (n=17) and sham-tDCS associated with functional exercise (n=14)., Setting: Laboratory of neuromuscular performance in the department of physical therapy., Participants: Women with FM (N=31) according to American College of Rheumatology-2010 criteria., Interventions: Anodal tDCS or sham-tDCS was applied over the left motor cortex for 5 consecutive days during the first week of intervention (2 mA; 20min). All volunteers also engaged in 8 weeks of functional exercises 3 times per week., Main Outcome Measures: Pain intensity, functional performance, psychological symptoms, and quality of life were assessed pre-exercise and immediately after the first, fourth, and eighth weeks of intervention., Results: Pain intensity, functional performance, psychological symptoms, and quality of life increased significantly in both groups (P<.05); however, no significant differences between groups were found in all outcomes (P>.05)., Conclusion: tDCS associated with functional exercises did not enhance the effects of physical exercise on pain, functional performance, psychological symptoms, and quality of life of patients with FM., (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Clinical impact of transcranial direct current stimulation (tDCS) alone for Parkinson's disease (PD) is still a challenge. Thus, there is a need to synthesize available results, analyze methodologically and statistically, and provide evidence to guide tDCS in PD. Objective: Investigate isolated tDCS effect in different brain areas and number of stimulated targets on PD motor symptoms. Methods: A systematic review was carried out up to February 2021, in databases: Cochrane Library, EMBASE, PubMed/MEDLINE, Scopus, and Web of science. Full text articles evaluating effect of active tDCS (anodic or cathodic) vs. sham or control on motor symptoms of PD were included. Results: Ten studies ( n = 236) were included in meta-analysis and 25 studies ( n = 405) in qualitative synthesis. The most frequently stimulated targets were dorsolateral prefrontal cortex and primary motor cortex. No significant effect was found among single targets on motor outcomes: Unified Parkinson's Disease Rating Scale (UPDRS) III - motor aspects (MD = -0.98%, 95% CI = -10.03 to 8.07, p = 0.83, I 2 = 0%), UPDRS IV - dyskinesias (MD = -0.89%, CI 95% = -3.82 to 2.03, p = 0.55, I 2 = 0%) and motor fluctuations (MD = -0.67%, CI 95% = -2.45 to 1.11, p = 0.46, I 2 = 0%), timed up and go - gait (MD = 0.14%, CI 95% = -0.72 to 0.99, p = 0.75, I 2 = 0%), Berg Balance Scale - balance (MD = 0.73%, CI 95% = -1.01 to 2.47, p = 0.41, I 2 = 0%). There was no significant effect of single vs. multiple targets in: UPDRS III - motor aspects (MD = 2.05%, CI 95% = -1.96 to 6.06, p = 0.32, I 2 = 0%) and gait (SMD = -0.05%, 95% CI = -0.28 to 0.17, p = 0.64, I 2 = 0%). Simple univariate meta-regression analysis between treatment dosage and effect size revealed that number of sessions (estimate = -1.7, SE = 1.51, z-score = -1.18, p = 0.2, IC = -4.75 to 1.17) and cumulative time (estimate = -0.07, SE = 0.07, z-score = -0.99, p = 0.31, IC = -0.21 to 0.07) had no significant association. Conclusion: There was no significant tDCS alone short-term effect on motor function, balance, gait, dyskinesias or motor fluctuations in Parkinson's disease, regardless of brain area or targets stimulated., Competing Interests: The City University of New York holds patents on brain stimulation with MB as inventor. MB has equity in Soterix Medical Inc. MB consults, received grants, assigned inventions, and/or serves on the SAB of SafeToddles, Boston Scientific, GlaxoSmithKline, Biovisics, Mecta, Lumenis, Halo Neuroscience, Google-X, i-Lumen, Humm, Allergan (Abbvie), Apple. HS served as a consultant for Abbott, LivaNova, and Boston Scientific in the previous 5 years. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be a potential conflict of interest., (Copyright © 2022 Oliveira, Araújo, Machado, Rodrigues, Bikson, Andrade, Okano, Simplicio, Pegado and Morya.)

This study investigated the effect of transcranial direct current stimulation (tDCS) combined with a recovery training session on the well-being and self-perceived recovery of professional female soccer players after official matches. Data from 13 world-class players were analyzed after participating in four official soccer matches of the first division of the Brazilian Women's Soccer Championship (7-, 10-, and 13-day intervals). We applied anodal tDCS (a-tDCS) over the left dorsolateral prefrontal cortex with 2 mA for 20 minutes (+F3/-F4 montage) the day after each match. Participants underwent two randomly ordered sessions of a-tDCS or sham. Players completed the Well-Being Questionnaire (WBQ) and the Total Quality Recovery (TQR) scale before each experimental condition and again the following morning. A two-way repeated-measures ANOVA showed a significant time x condition interaction on the WBQ (F (1,11) =5.21; p =0.043; η p 2 =0.32), but not on the TQR (F (1,12)  = 0.552; p =  0.47; η p 2  = 0.044). There was a large effect size (ES) for a-tDCS for the WBQ score (ES = 1.02; 95%CI = 0.17;1.88), and there was a moderate WBQ score increase (ES = 0.53; 95%CI = -0.29;1.34) for the sham condition. We found similar increases in the TQR score for a-tDCS (ES = 1.50; 95%CI = 0.63-2.37) and the sham condition (ES = 1.36; 95%CI = 0.51-2.22). These results suggest that a-tDCS (+F3/-F4 montage) combined with a recovery training session may slightly improve perceived well-being beyond the level of improvement after only the recovery training session among world-class female soccer players. Prior to widely adopting this recovery approach, further study is needed with larger and more diverse samples, including for female teams of different performance levels.

Background: Since people with Parkinson disease (PD) rely on limited prefrontal executive resources for the control of gait, interventions targeting the prefrontal cortex (PFC) may help in managing PD-related gait impairments. Transcranial direct current stimulation (tDCS) can be used to modulate PFC excitability and improve prefrontal cognitive functions and gait., Objective: We investigated the effects of adding anodal tDCS applied over the PFC to a session of aerobic exercise on gait, cognition, and PFC activity while walking in people with PD., Methods: A total of 20 people with PD participated in this randomized, double-blinded, sham-controlled crossover study. Participants attended two 30-minute sessions of aerobic exercise (cycling at moderate intensity) combined with different tDCS conditions (active- or sham-tDCS), 1 week apart. The order of sessions was counterbalanced across the sample. Anodal tDCS (2 mA for 20 minutes [active-tDCS] or 10 s [sham-tDCS]) targeted the PFC in the most affected hemisphere. Spatiotemporal gait parameters, cognitive functions, and PFC activity while walking were assessed before and immediately after each session., Results: Compared with the pre-assessment, participants decreased step time variability (effect size: -0.4), shortened simple and choice reaction times (effect sizes: -0.73 and -0.57, respectively), and increased PFC activity in the stimulated hemisphere while walking (effect size: 0.54) only after aerobic exercise + active-tDCS., Conclusion: The addition of anodal tDCS over the PFC to a session of aerobic exercise led to immediate positive effects on gait variability, processing speed, and executive control of walking in people with PD.

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; η 2 p = 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.

Context: Thousands of people worldwide have been infected by the chikungunya virus (CHIKV), and the persistence of joint pain symptoms has been considered the main problem. Neuromodulation techniques such as transcranial direct current stimulation (tDCS) act on brain areas involved in the processing of chronic pain. It was previously demonstrated that tDCS for five consecutive days significantly reduced pain in the chronic phase of chikungunya (CHIK)., Objective: To analyze the effect of alternate tDCS sessions on pain and functional capacity in individuals affected by CHIK., Methods: In a randomized clinical trial, 58 women in the chronic phase of CHIK were divided into two groups: active-tDCS (M1-S0, 2 mA, 20 min) and sham-tDCS. The Visual Analogue Scale (VAS) and the Brief Pain Inventory (BPI) were used to assess pain, while the Health Assessment Questionnaire (HAQ) assessed functional capacity. These scales were used before and after six sessions of tDCS in nonconsecutive days on the primary motor cortex, and at follow-up consultation 7 and 15 days after the last session. A repeated measures mixed-model ANOVA was used for comparison between groups (significant p-values < 0.05)., Results: A significant pain reduction (Z [3, 171] = 14.303; p < 0.0001) was observed in the tDCS group compared to the sham group; no significant difference in functional capacity was observed (Z [1.57] = 2.797; p = 0.1)., Conclusion: Our results suggest that six nonconsecutive sessions of active tDCS on M1 reduce pain in chronic CHIKV arthralgia., Competing Interests: Declaration of competing interest The City University of New York (CUNY) has IP on neuro-stimulation system and methods with author MB as inventor. MB has equity in Soterix Medical. MB serves on Boston Scientific and GlaxoSmithKline Inc. advisory boards., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

This study aimed to examine the effect of transcranial direct current stimulation (tDCS) used as a recovery strategy, on heart rate (HR) measures and perceived well-being in 12 male professional soccer players. tDCS was applied in the days after official matches targeting the left dorsolateral prefrontal cortex (DLPFC) with 2 mA for 20 min (F3-F4 montage). Participants were randomly assigned to anodal tDCS (a-tDCS) or sham tDCS sessions. Players completed the Well-Being Questionnaire (WBQ) and performed the Submaximal Running Test (SRT) before and after tDCS. HR during exercise (HRex) was determined during the last 30 s of SRT. HR recovery (HRR) was recorded at 60 s after SRT. The HRR index was calculated from the absolute difference between HRex and HRR. A significant increase was observed for WBQ (effect of time; p<0.001; η p 2 =0.417) with no effect for condition or interaction. A decrease in HRR (p = 0.014; η p 2 =0.241), and an increase in HRR index were observed (p = 0.045; η p 2 =0.168), with no effect for condition or interaction. No change for HRex was evident (p>0.05). These results suggest that a-tDCS over the DLPFC may have a positive effect on enhancing well-being and parasympathetic autonomic markers, which opens up a possibility for testing tDCS as a promising recovery-enhancing strategy targeting the brain in soccer players. The findings suggest that brain areas related to emotional and autonomic control might be involved in these changes with a possible interaction effect of tDCS by placebo-related effects, but more research is needed to verify this effect., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19., (Copyright © 2020 Baptista, Baltar, Okano, Moreira, Campos, Fernandes, Brunoni, Badran, Tanaka, de Andrade, da Silva Machado, Morya, Trujillo, Swami, Camprodon, Monte-Silva, Sá, Nunes, Goulardins, Bikson, Sudbrack-Oliveira, de Carvalho, Duarte-Moreira, Pagano, Shinjo and Zana.)

The coronavirus disease 19 (COVID-19) pandemic has resulted in the urgent need to develop and deploy treatment approaches that can minimize mortality and morbidity. As infection, resulting illness, and the often prolonged recovery period continue to be characterized, therapeutic roles for transcranial electrical stimulation (tES) have emerged as promising non-pharmacological interventions. tES techniques have established therapeutic potential for managing a range of conditions relevant to COVID-19 illness and recovery, and may further be relevant for the general management of increased mental health problems during this time. Furthermore, these tES techniques can be inexpensive, portable, and allow for trained self-administration. Here, we summarize the rationale for using tES techniques, specifically transcranial Direct Current Stimulation (tDCS), across the COVID-19 clinical course, and index ongoing efforts to evaluate the inclusion of tES optimal clinical care., (Copyright © 2020 Pilloni, Bikson, Badran, George, Kautz, Okano, Baptista and Charvet.)

Purpose: Some evidence suggests that sedentary women may be more vulnerable to cognitive task-induced mental fatigue. Mental fatigue, in turn, may worse aerobic exercise performance, presumably via increased perceived effort. However, it remains unclear whether acute mental fatigue induction increases perceived effort and worsens endurance performance in high-level professional athletes and whether such effects are influenced by sex., Methods: We studied 30 athletes (15 women and 16 men) in a single-blinded, randomized, controlled and crossover protocol. In separate visits, athletes either performed a 45-min cognitive task (Stroop's color-word conflict test) to induce mental fatigue or watched a 45-min documentary as control. Then athletes performed a time-to-exhaustion test on a treadmill., Results: Perceptual measures and cognitive performance indicated that the prolonged cognitive task induced a similar mental fatigue state in women and men. Cardiorespiratory and metabolic responses to the TEE did not change with mental fatigue in both sexes. Mental fatigue increased perceived effort during the time-to-exhaustion test, anticipated attainment of maximal effort, and shortened time to exhaustion similarly in women and men (mean ± SE, -27.3 ± 20.9 s for women vs -26.7 ± 15.1 s for men; P = 0.98)., Conclusions: The prolonged cognitive task provoked mental fatigue, anticipated attainment of maximal perceived effort, and worsened aerobic performance in professional runners with no sex differences. Although we did not contrasted athletes with nonathletes, our results suggest that being an athlete may somehow prevent women from developing greater mental fatigue and suffering more from its underlying effects compared with men.

Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.

Arboviral diseases have been considered a global public health problem due to their growing territorial dispersion and impact on the population around the world. Individuals affected by the chikungunya virus go through an acute febrile illness associated with severe pain and long-lasting polyarthralgia. After the initial stage, infected individuals may progress to the chronic stage, which has an epidemic character and a high rate of disability and reduced mobility, impacting negatively on their quality of life. The aim of this study was to evaluate the relationship between pain, functional capacity, and kinesiophobia in individuals in the chronic stage of chikungunya virus infection. A cross-sectional study was conducted in the city of Natal, in Rio Grande do Norte, Brazil, between July and September 2018. The participants were 59 women in the chronic stage of chikungunya virus infection. Data were collected in at physical therapy outpatient clinic of the Federal University of Rio Grande do Norte (UFRN), using a socio-demographic questionnaire, the Visual Analogue Scale (VAS), the Nordic Musculoskeletal Questionnaire (NMQ), the Brief Pain Inventory (BPI), the Health Assessment Questionnaire (HAQ), and the Tampa Scale for Kinesiophobia (TSK). Descriptive statistics and bivariate analysis of the time data were conducted by simple regression. The participants' mean age was just over 50 years and average duration of virus infection was 21.54 months. Most participants had moderate to severe pain intensity that more frequent in the ankle and wrist joints. Functional capacity was low, and there was moderate fear of performing exercises and activities of daily living. Duration of infection was associated with increased pain intensity and loss of functional capacity. We can conclude that women in the chronic stage of chikungunya infection have significant pain, reduced functional capacity, and fear of performing common movements of daily living., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Interoception has been shown to influence self-regulation of effort and perceived exertion during exercise. However, whether interoceptive accuracy influences submaximal and maximal exercise performance, as well as psychophysiological responses to it, remains elusive. We assessed poor (n = 15) and good (n = 17) heartbeat perceivers young men accordingly with their interoceptive accuracy. Heart rate variability (HRV) and blood pressure were measured at rest, and peak power, ratings of perceived exertion (RPE), and HR during a maximal incremental test in a bicycle ergometer. Results: At rest, HR, diastolic and mean blood pressure was lower, and inter-beat intervals were longer for good heartbeat perceivers, with no difference in HRV. During exercise, good and poor heartbeat perceivers exhibited the same submaximal and maximal power, HR, RPE at submaximal intensity, and physical fitness. Interoceptive accuracy does not influence cardiac autonomic modulation perceptual responses and performance at submaximal and maximal intensities during maximal incremental exercise., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Transcranial direct current stimulation (tDCS) has been used to improve exercise performance, though the protocols used, and results found are mixed., Objective: We aimed to analyze the effect of tDCS on improving exercise performance., Methods: A systematic search was performed on the following databases, until December 2017: PubMed/MEDLINE, Embase, Web of Science, SCOPUS, and SportDiscus. Full-text articles that used tDCS for exercise performance improvement in adults were included. We compared the effect of anodal (anode near nominal target) and cathodal (cathode near nominal target) tDCS to a sham/control condition on the outcome measure (performance in isometric, isokinetic or dynamic strength exercise and whole-body exercise)., Results: 22 studies (393 participants) were included in the qualitative synthesis and 11 studies (236 participants) in the meta-analysis. The primary motor cortex (M1) was the main nominal tDCS target (n = 16; 72.5%). A significant effect favoring anodal tDCS (a-tDCS) applied before exercise over M1 was found on cycling time to exhaustion (mean difference = 93.41 s; 95%CI = 27.39 s-159.43 s) but this result was strongly influenced by one study (weight = 84%), no effect was found for cathodal tDCS (c-tDCS). No significant effect was found for a-tDCS applied on M1 before or during exercise on isometric muscle strength of the upper or lower limbs. Studies regarding a-tDCS over M1 on isokinetic muscle strength presented mixed results. Individual results of studies using a-tDCS applied over the prefrontal and motor cortices either before or during dynamic muscle strength testing showed positive results, but performing meta-analysis was not possible., Conclusion: For the protocols tested, a-tDCS but not c-tDCS vs. sham over M1 improved exercise performance in cycling only. However, this result was driven by a single study, which when removed was no longer significant. Further well-controlled studies with larger sample sizes and broader exploration of the tDCS montages and doses are warranted., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Transcranial direct current stimulation (tDCS) is an appropriate treatment for Parkinson's disease (PD). It offers promising results and is known to improve symptoms. Nevertheless, consistent parameters need to be established for research purposes., Objective: To verify the effectiveness of acute tDCS on non-motor and motor symptoms in PD., Methods: A double-blind, randomized and sham-controlled study, in which twenty individuals randomly underwent two (one real, one sham) stimulation sessions. The current was applied to the dorsolateral prefrontal cortex (DLPFC) for 20 min at 2 mA. Participants were assessed before and after the stimulation using the Trail Making Test (TMT), Verbal Fluency test, Stroop test, Timed Up and Go test and video gait analysis. In the statistical analysis, a two-way variance analysis of repeated measures was applied to the variables time, group and time vs. group interaction, using Sidak's post-hoc test., Results: Statistically significant differences were found for TMT part B in both groups. For the Verbal Fluency test differences were found only within the group that received real stimulation. Additionally, both groups revealed improved reaction time in the congruent, incongruent and total phases of the Stroop test, but a significant difference in the Stroop effect was found only within the group that received real stimulation., Conclusion: The results confirm that improvements on cognitive tests are possible after a single session of DLPFC stimulation., (Copyright © 2018. Published by Elsevier B.V.)

We compared in-task affect to HIIE and MICE, and its relationship with time spent at different metabolic domains, perceived exertion (RPE), self-efficacy, enjoyment, and future intention of exercise in overweight inactive men. Muscle damage and soreness, and inflammation were assessed post-exercise. Fifteen participants (28.9 ± 5.0 yr; 29.2 ± 3.8 kg/m 2 ) completed a HIIE (10 × 1 min at 100% V max , 1 min recovery) and MICE (20 min at 55-59% VO 2reserve ) session. Affect, alertness, RPE, and self-efficacy were assessed in-task, and enjoyment and future intention post-task. At baseline, 24 and 48 h, creatine kinase, lactate dehydrogenase, interleukin-6 and -10, tumor necrosis factor alpha, and muscle soreness were assessed. Affect (-3.1 ± 1.8 vs. 0.8 ± 1.8, P < .001) and self-efficacy (70 ± 15 vs. 90 ± 15%, P < .001) were lower, while RPE and alertness were higher in HIIE compared to MICE (Ps ≤ .02). Affect was negatively correlated with RPE in HIIE (r = -0.90) and MICE (r = -0.72), and time spent above respiratory compensation point in HIIE (r = -0.59). Affect was positively correlated with self-efficacy in MICE (r = 0.74). Enjoyment, future intention, muscle damage and soreness, and inflammation were similar between HIIE and MICE post-exercise. Therefore, in-task HIIE was experienced as unpleasant compared to MICE, but the psychological and physiological responses post-task were similar in overweight inactive men., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP., Objective: To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice., Methods: Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study., Results: The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain., Conclusion: Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making., Competing Interests: Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Salivary cortisol increases in response to stressors, including physical exertion and psychological stress associated with sports competition. In addition, stress may induce change in brain-derived neurotrophic factor (BDNF). However, there are still no data available to compare the salivary BDNF level in sedentary male individuals and elite team-sport male athletes, regularly involved in activities that require elevated attention and concentration. This information could contribute to the advance of understanding of the effect of regular exercise on the salivary level of BDNF, the pre-to-post change in salivary BDNF during exercise, and the association between salivary cortisol and salivary BDNF responses to physical exercise. Therefore, this study aimed to compare the concentration of salivary cortisol and BDNF, before and after exercise, in sedentary individuals and elite male basketball players. The sedentary group (23.0 ± 4.2 yrs) performed a high-intensity exercise protocol and the basketball players (18.6 ± 0.5 yrs) participated in three official basketball matches. Saliva samples were tested for cortisol and BDNF using ELISA. A significant increase in salivary cortisol from pre- to post-match was observed only for the basketball players (p < 0.05). Basketball players also presented a higher salivary BDNF concentration for both resting (pre) and post-physical exercise (p < 0.05); however, no change in pre- to post-exercise salivary BDNF was observed for either group (p > 0.05). Elevated BDNF in athletes may be associated to their repeated exposure to stressful competition situations. The current findings also suggest that different mechanisms might be involved in salivary cortisol and BDNF responses during physical exercise.

This study investigated the effects of mental exertion on Small-Sided-Games (SSG) technical performance, salivary testosterone (T), cortisol (C), and alpha-amylase (sAA) responses in 32 basketball players (15.2 ± 1.2 years; 180 ± 11 cm; 72 ± 15 kg). Technical performance and heart rate (HR) were assessed on two occasions, preceded by a 30-min incongruent Stroop task (mentally exertion treatment) or a 30-min control treatment. Saliva samples were collected before and after the treatment and after the SSG, and ratings of perceived exertion (session-RPE) was assessed. Large increase was observed from pre-control treatment to post-SSG for T (ES = 0.98) and sAA (ES = 0.82), but there was a small difference from pre-Stroop-task to post-SSG in T (ES = 0.33) and a moderate difference for sAA (ES = 0.55). Small changes in C for both conditions were observed (ES = 0.00 and 0.15, respectively). There were small differences between treatments for session-RPE (ES = 0.07), maximum (ES = -0.35) and average HR (ES = -0.16). Increased turnovers during the SSG (ES = 0.71) was seen following the Stroop task. The data suggest that mental fatigue state is a key regulator of technical performance of basketball players and that mental fatigue seems to modulate endocrine and autonomic responses., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The Chikungunya (CHIK) virus is epidemic in Brazil, with 170,000 cases in the first half of 2016. More than 60% of patients present relapsing and remitting chronic arthralgia with debilitating pain lasting years. There are no specific therapeutic agents to treat and rehabilitee infected persons with CHIK. Persistent pain can lead to incapacitation, requiring long-term pharmacological treatment. Advances in non-pharmacological treatments are necessary to promote pain relief without side effects and to restore functionality. Clinical trials indicate transcranial direct current stimulation (tDCS) can treat a broad range of chronic pain disorders, including diffuse neuromuscular pain and arthralgia. Here, we demonstrate that the tDCS across the primary motor cortex significantly reduces pain in the chronic phase of CHIK. High-resolution computational model was created to analyze the cortical electric field generated during tDCS and a diffuse and clustered brain current flow including M1 ipsilateral and contralateral, left DLPFC, nucleus accumbens, and cingulate was found. Our findings suggest tDCS could be an effective, inexpensive and deployable therapy to areas lacking resources with a significant number of patients with chronic CHIK persistent pain.

The aim of this study was to investigate whether carbohydrate mouth rinse (CMR) improves physical performance of cyclists during a 30-km time trial test and its influence on water balance compared to other strategies of fluid intake. Eleven recreationally trained male cyclists completed a 30 km time trial cycle ergometer under three experimental interventions: (a) CMR, (b) drinking to replace all weight loss (DWL), and (c) drinking "ad libitum" (DAL). Time to complete the 30 km time trial, heart rate, average power, velocity, weight loss, urine color, urine density and pH were evaluated. Statistical analysis was performed using repeated measures analysis of variance (RM-ANOVA) and generalized estimating equations (GEE) with Bonferroni adjustment (p < 0.05). Time to complete the 30 km time trial was similar among CMR 54.5 ± 2.9 min, DWL 53.6 ± 3.9 min and DAL 54.5 ± 2.5 min (p = 0.13). CMR (1.7 ± 0.4%) elicited similar water loss compared to the DAL (1.4 ± 0.6%) intervention, but it was higher than the DWL intervention (0.6 ± 0.6%) (p < 0.01). CMR did not improve the performance of recreationally trained cyclists in a 30 km time trial test compared to other fluid intake strategies. Furthermore, CMR causes higher water loss compared to DWL intervention.

Background: The hypothesis of the central effect of carbohydrate mouth rinse (CMR) on performance improvement in a fed state has not been established, and its psychophysiological responses have not yet been described. The aim of this study was to evaluate the effect of CMR in athletes fed state on performance, biochemical and psychophysiological responses compared to ad libitum water intake., Methods: Eleven trained male cyclists completed a randomized, crossover trial, which consisted of a 30 km cycle ergometer at self-selected intensity and in a fed state. Subjects were under random influence of the following interventions: CMR with a 6% unflavored maltodextrin solution; mouth rinsing with a placebo solution (PMR); drinking "ad libitum" (DAL). The time for completion of the test (min), heart rate (bpm) and power (watts), rating of perceived exertion (RPE), affective response, blood glucose (mg/dL) and lactate (mmol/DL), were evaluated before, during and immediately after the test, while insulin (uIL/mL), cortisol (μg/dL) and creatine kinase (U/L) levels were measured before, immediately after the test and 30 min after the test., Results: Time for completion of the 30 km trial did not differ significantly among CMR, PMR and DAL interventions (means = 54.5 ± 2.9, 54.7 ± 2.9 and 54.5 ± 2.5 min, respectively; p  = 0.82). RPE and affective response were higher in DAL intervention ( p  < 0.01). Glucose, insulin, cortisol and creatine kinase responses showed no significant difference among interventions., Conclusions: In a fed state, CMR has not caused metabolic changes, and it has not improved physical performance compared to ad libitum water intake, but demonstrated a possible central effect. ReBec registration number: RBR-4vpwkg. Available in http://www.ensaiosclinicos.gov.br/rg/?q=RBR-4vpwkg., Competing Interests: This study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte under protocol number 31747714.7.0000.5568. The study was conducted in accordance with the requirements of the declarations of Helsinki. All participants were informed about the procedures and signed an informed consent form prior to enrollment in the study.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The aim of the present study was to investigate the effect of a short period of supplementation with glutamine dipeptide (GDP) on the acute responses to resistance training on the executive functions of people with HIV/AIDS. The sample consisted of 10 HIV+ women (45.00 ± 12.77 years old; 65.71 ± 12.04 kg; 1.54 ± 0.05 m) who were submitted to a randomized double-blind crossover procedure according to two experimental conditions: orally supplemented with 20 g/day of GDP or with maltodextrin for seven days. On the seventh day of supplementation all participants did cognitive function tests before and immediately after a resistance training session. Seven days of washout were adopted between conditions. Stroop and N -back tests were used to evaluate the executive functions. The training reduced the response time of each card in isolation and the latency time among them. GDP supplementation increased the magnitude of this effect, thus, reducing the latency time from the first to the last card in the Stroop test by almost 50% ( P < 0.01). Considering the N -back test, there were no significant differences. It is suggested that GDP supplementation may increase the magnitude of the effect of an acute resistance training session in cognitive functions, particularly in the inhibitory control of people with HIV/AIDS. This trial is registered with NCT03236532.

Background: Pleasure is a key factor for physical activity behavior in sedentary individuals. Inhibitory cognitive control may play an important role in pleasure perception while exercising, especially at high intensities. In addition, separate work suggests that autonomic regulation and cerebral hemodynamics influence the affective and cognitive responses during exercise., Purpose: We investigated the effects of exercise intensity on affect, inhibitory control, cardiac autonomic function, and prefrontal cortex (PFC) oxygenation., Methods: Thirty-seven sedentary young adults performed two experimental conditions (exercise and control) in separate sessions in a repeated-measures design. In the exercise condition, participants performed a maximum graded exercise test on a cycle ergometer as we continuously measured oxygen consumption, heart rate variability (HRV), and PFC oxygenation. At each of 8 intensity levels we also measured inhibitory control (Stroop test), associative and dissociative thoughts (ADT), and affective/pleasure ratings. In the control condition, participants sat motionless on a cycle ergometer without active pedaling, and we collected the same measures at the same points in time as the exercise condition. We evaluated the main effects and interactions of exercise condition and intensity level for each measure using two-way repeated measures ANOVAs. Additionally, we evaluated the relationship between affect and inhibitory control, ADT, HRV, and PFC oxygenation using Pearson's correlation coefficients., Results: For exercise intensities below and at the ventilatory threshold (VT), participants reported feeling neutral, with preservation of inhibitory control, while intensities above the VT were associated with displeasure (p<0.001), decreased inhibitory control and HRV (p<0.001), and increased PFC oxygenation (p<0.001). At the highest exercise intensity, pleasure was correlated with the low-frequency index of HRV (r = -0.34; p<0.05) and the low-frequency/high-frequency HRV ratio (r = -0.33; p<0.05). PFC deoxyhemoglobin was correlated with pleasure two stages above the VT (r = -0.37; p<0.05)., Conclusion: Our results support the notion that exercise at high intensities influences inhibitory control and one's perception of pleasure, which are linked to changes in cardiac autonomic control and cerebral hemodynamics. These findings strengthen the existence of an integrated brain-heart-body system and highlight the importance of exercise intensity in exercise-related behavior in sedentary individuals.

This study evaluated whether transcranial direct current stimulation (tDCS) could change physiological and psychological responses during vigorous exercise with a constant load. 13 sedentary males (23.0±4.2 years; 25.6±4.2 kg/m²) took part in this randomized, crossed-over, sham-controlled, and double-blinded study. Participants underwent 2 sessions with anodal or sham tDCS (2 mA, 20 min) applied before exercise over the left temporal cortex targeting the left insular cortex. The exercise was performed at vigorous intensity (%HR max 81.68±6.37) for 30 min. Heart rate (HR), rating of perceived exertion (RPE) and affective responses (pleasure/displeasure) were recorded at every 5 min. Additionally, heart rate variability (HRV) was measured before, immediately after and 60 min after the end of exercise. A 2-way repeated measure ANOVA showed that tDCS improved HRV neither at rest nor after exercise (p>0.15). Similarly, HR, RPE, and affective responses were not enhanced by tDCS during vigorous exercise (p>0.23). The findings of this study suggest that tCDS does not modulate either HRV at rest nor HR, RPE and affective responses during exercise. Transcranial direct current stimulation's efficiency might depend on the participants' levels of physical fitness and parameters of stimulation (e. g., duration, intensity, and arrangement of electrodes)., Competing Interests: Conflict of Interest: The authors have no conflict of interest to declare., (© Georg Thieme Verlag KG Stuttgart · New York.)

Pleasure plays a key role in exercise behavior. However, the influence of cycling cadence needs to be elucidated. Here, we verified the effects of cycling cadence on affect, perceived exertion (ratings of perceived exertion), and physiological responses. In three sessions, 15 men performed a maximal cycling incremental test followed by two 30-min constant workload (50% of peak power) bouts at 60 and 100 r/min. The pleasure was higher when participants cycled at 60 r/min, whereas ratings of perceived exertion, heart rate, and oxygen uptake were lower ( p < .05). Additionally, the rate of decrease in pleasure and increase in ratings of perceived exertion was less steep at 60 r/min ( p < .01). Cycling at 60 r/min is more pleasant, and the perceived effort and physiological demand are lower than at 100 r/min.

Post-stroke patients usually exhibit reduced peak muscular torque (PT) and/or force steadiness during submaximal exercise. Brain stimulation techniques have been proposed to improve neural plasticity and help to restore motor performance in post-stroke patients. The present study compared the effects of bihemispheric motor cortex transcranial direct current stimulation (tDCS) on PT and force steadiness during maximal and submaximal resistance exercise performed by post-stroke patients vs. healthy controls. A double-blind randomized crossover controlled trial (identification number: TCTR20151112001; URL: http://www.clinicaltrials.in.th/) was conducted involving nine healthy and 10 post-stroke hemiparetic individuals who received either tDCS (2 mA) or sham stimulus upon the motor cortex for 20 min. PT and force steadiness (reflected by the coefficient of variation (CV) of muscular torque) were assessed during unilateral knee extension and flexion at maximal and submaximal workloads (1 set of 3 repetitions at 100% PT and 2 sets of 10 repetitions at 50% PT, respectively). No significant change in PT was observed in post-stroke and healthy subjects. Force steadiness during knee extension (~25-35%, P < 0.001) and flexion (~22-33%, P < 0.001) improved after tDCS compared to the sham condition in post-stroke patients, but improved only during knee extension (~13-27%, P < 0.001) in healthy controls. These results suggest that tDCS may improve force steadiness, but not PT in post-stroke hemiparetic patients, which might be relevant in the context of motor rehabilitation programs.

[Purpose] This study examined the exercise intensity and psychophysiological responses to a self-selected resistance training session in sedentary male subjects. [Subjects and Methods] Twelve sedentary male subjects (35.8 ± 5.8 years; 25.5 ± 2.6 kg·m(2)) underwent four sessions at 48-h intervals: familiarization; two sessions of one repetition maximum test and a resistance training session in which they were told to self-select a load to complete 3 sets of 10 repetitions of chest press, leg press, seated rows, knee extension, overhead press, biceps curl, and triceps pushdown exercises. During the latter, the percentage of one repetition maximum, affective responses (feeling scale), and rating of perceived exertion (OMNI-RES scale) were measured. [Results] The percentage of one repetition maximum for all exercises was >51% (14-31% variability), the rating of perceived exertion was 5-6 (7-11% variability), and the affective responses was 0-1 point with large variability. [Conclusion] Sedentary male subjects self-selected approximately 55% of one maximum repetition, which was above the intensity suggested to increase strength in sedentary individuals, but below the recommended intensity to improve strength in novice to intermediate exercisers. The rating of perceived exertion was indicative of moderate intensity and slightly positive affective responses.

Background: The temporal and insular cortex (TC, IC) have been associated with autonomic nervous system (ANS) control and the awareness of emotional feelings from the body. Evidence shows that the ANS and rating of perceived exertion (RPE) regulate exercise performance. Non-invasive brain stimulation can modulate the cortical area directly beneath the electrode related to ANS and RPE, but it could also affect subcortical areas by connection within the cortico-cortical neural networks. This study evaluated the effects of transcranial direct current stimulation (tDCS) over the TC on the ANS, RPE and performance during a maximal dynamic exercise., Methods: Ten trained cyclists participated in this study (33±9 years; 171.5±5.8 cm; 72.8±9.5 kg; 10-11 training years). After 20-min of receiving either anodal tDCS applied over the left TC (T3) or sham stimulation, subjects completed a maximal incremental cycling exercise test. RPE, heart rate (HR) and R-R intervals (as a measure of ANS function) were recorded continuously throughout the tests. Peak power output (PPO) was recorded at the end of the tests., Results: With anodal tDCS, PPO improved by ~4% (anodal tDCS: 313.2±29.9 vs 301.0±19.8 watts: sham tDCS; p=0.043), parasympathetic vagal withdrawal was delayed (anodal tDCS: 147.5±53.3 vs 125.0±35.4 watts: sham tDCS; p=0.041) and HR was reduced at submaximal workloads. RPE also increased more slowly during exercise following anodal tDCS application, but maximal RPE and HR values were not affected by cortical stimulation., Conclusions: The findings suggest that non-invasive brain stimulation over the TC modulates the ANS activity and the sensory perception of effort and exercise performance, indicating that the brain plays a crucial role in the exercise performance regulation., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background/aim: Currently, the equipment and techniques available to assess brain function during dynamic exercise are limited, which has restricted our knowledge of how the brain regulates exercise. This study assessed the brain areas activated during cycling by making use of a novel cycle ergometer, constructed to measure functional MRI (fMRI) brain images during dynamic exercise. Furthermore, we compared brain activation at different levels of ratings of perceived exertion (RPE) generated during the exercise., Methods: Seven healthy adults performed cycling exercise in a novel MRI compatible cycle ergometer while undergoing brain  fMRI. Participants completed a cycling block protocol comprising six trials of 2 min cycling with 16-s intervals between trials. Participants reported their RPE every minute through an audio link. The MRI cycling ergometer transferred the torque generated on the ergometer through a cardan system to a cycling ergometer positioned outside the MRI room. For data analysis, the effects of cycling as opposed to rest periods were examined after motion correction., Results: The multiparticipant analysis revealed in particular the activation of the cerebellar vermis and precentral and postcentral gyrus when periods of cycling versus rest were compared. Single participant analysis in four participants revealed that activation of the posterior cingulate gyrus and precuneus occurred in cycling blocks perceived as 'hard' compared with exercise blocks that were less demanding., Conclusions: The present study offers a new approach to assess brain activation during dynamic cycling exercise, and suggests that specific brain areas could be involved in the sensations generating the rating of perceived exertion., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

The study evaluated the effect of transcranial direct current stimulation (tDCS) applied over prefrontal cortex on the oxygen uptake (V˙ O2) at rest and during post-exercise recovery. The V˙ O2 was assessed in eleven healthy subjects before, during tDCS (sham or anodal tDCS, 2 mA, 20 min), and 30-min following isocaloric aerobic exercise (~200 kcal). During tDCS, no changes were observed on V˙ O2 compared to baseline (P=0.95) and sham condition (P=0.85). The association between isocaloric exercise and anodal tDCS increased the V˙ O2 throughout 30-min recovery compared to sham condition (P<0.001). Therefore, the energy expenditure within the excess post-exercise oxygen consumption (EPOC) period, after anodal tDCS was approximately 19% higher compared to the sham condition (P<0.05). In conclusion, anodal tDCS applied on the prefrontal cortex combined with submaximal aerobic exercise increased the EPOC, enhancing the V˙ O2 and energy expenditure at least for 30-min of recovery., (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Ratings of perceived exertion (RPE) and affective responses were assessed during Tai Chi Chuan. A total of 16 women (M age = 61.2 yr., SD = 8.8) participated in this study. Individuals practiced Tai Chi Chuan three times/week during seven weeks, and were assessed session-by-session (21 Wu Tai Chi Chuan sessions) in three moments (15, 30, and 45 min.) using Borg's scale (CR 0-10) and the Feeling Scale (+5/-5). With regard to RPE, there was a difference between 15 and 30 min. and between 15 and 45 min. The same pattern of differences was observed for the affective response. The RPE during the seven weeks ranged from "fairly light" to "moderate" and the affective response from "good" to "very good." Thus, Tai Chi Chuan was perceived as a low-moderate intensity and pleasurable (positive affect) exercise by middle-aged and elderly women.

This study investigated whether transcranial direct current stimulation (tDCS) on dorsolateral prefrontal cortex (DLPFC) isolated or combined with aerobic exercise influenced the desire to eat, hunger, and satiety in overweight subjects. Nine volunteers underwent anodal or sham tDCS (2 mA; 20 min) over DLPFC and isocaloric exercise bouts (70%VO(2)R; ~200 kcal). The appetite sensations were evaluated by visual analogue scales at four moments: I - Baseline; II - After tDCS; III - Post-Exercise and IV - 30-min Post-Exercise. The tDCS on left DLPFC decreased the desire to eat at baseline (tDCS -26% vs. -14% Sham). The tDCS associated with exercise had greater suppressing effect in desire to eat compared to either tDCS or exercise alone (tDCS -39% vs. -27% Sham). Moreover, the tDCS associated with exercise decreased hunger (tDCS -48% vs. 36% Sham) and increased satiety (tDCS 28% vs. 7% Sham) immediately after exercise. The post-exercise 30-min recovery elicited an overall increase in appetite. However the increase in desire to eat and hunger after recovery was lower after tDCS (29% and 13%, respectively) compared to sham stimulation (77% and 113%, respectively). These findings in overweight subjects indicate that the combination of tDCS over DLPFC and aerobic exercise induced greater decrease in appetite sensations compared to anodal tDCS or exercise alone., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study compared the activation pattern and the fatigue rate among the superficial muscles of the quadriceps femoris (QF) during severe cycling exercise. Peak oxygen consumption (VO(2)peak) and maximal accumulated oxygen Deficit (MAOD) were established by 10 well-trained male cyclists (27.5 ± 4.1 years, 71.0 ± 10.3 kg, 173.4 ± 6.6 cm, mean VO(2)peak 56.7 ± 4.4 ml·kg·min(-1), mean MAOD 5.7 ± 1.1 L). Muscle activity (electromyographic [EMG] signals) was obtained during the supramaximal constant workload test (MAOD) and expressed by root mean square (RMS) and median frequency (MF slope). The RMS of the QF, vastus lateralis (VL) and vastus medialis (VM) muscles were significantly higher than at the beginning after 75% of exercise duration, whereas for the rectus femoris (RF), this was observed after 50% of exercise duration (p ≤ 0.05). The slope of the MF was significantly higher in the RF, followed by the VL and VM (-3.13 ± 0.52 vs. -2.61 ± 0.62 vs. -1.81 ±0.56, respectively; p < 0.05). We conclude that RF may play an important role in limiting performance during severe cycling exercise.

To investigate whether the manipulation of brain excitability by transcranial direct current stimulation (tDCS) modulates the heart rate variability (HRV), the effect of tDCS applied at rest on the left temporal lobe in athletes (AG) and non-athletes (NAG) was evaluated. The HRV parameters (natural logarithms of LF, HF, and LF/HF) was assessed in 20 healthy men before, and immediately after tDCS and sham stimulation. After anodal tDCS in AG the parasympathetic activity (HF(log)) increased (P<0.01) and the sympathetic activity (LF(log)) and sympatho-vagal balance (LF/HF(log)) decreased (P<0.01), whereas no significant effects were detected in NAG (P>0.05). No significant changes in HRV indexes were provoked by sham stimulation in both AG and NAG (P>0.05). In conclusion, tDCS applied on the left temporal lobe significantly increased the overall HRV in AG, enhancing the parasympathetic and decreasing the sympathetic modulation of heart rate. Consequently the sympatho-vagal balance decreased at rest in AG but not in NAG. Releasing a weak electric current to stimulate selected brain areas may induce favorable effects on the autonomic control to the heart in highly fit subjects., (Published by Elsevier Ireland Ltd.)

The aims of this study were to verify the relationship between rating of perceived exertion (RPE) and electromyography (EMG) increases during exhaustive constant-load cycling bouts and, to compare and to correlate the power outputs corresponding to perceived exertion threshold (PET) and neuromuscular fatigue threshold (NFT). 11 men completed 3-4 different exhaustive constant-load cycling bouts on a cycle ergometer, being RPE and EMG measured throughout the bouts. The linear regression of the RPEslope and EMGslope against the power output identified the PET and NFT intensity, respectively. There was a significant relationship between RPEslope and EMGslope (R(2)=0.69; P<0.01). However, the linearity of RPEslope (R(2)=0.93±0.07) was significantly higher (P<0.001) than EMGslope (R(2)=0.63±0.25). In addition, the RPEslope and EMGslope were related to time to exhaustion (r=-0.59 and r=-0.60; P<0.001). There was no significant difference (P=0.42) between PET (201.5±27.9W) and NFT (210.3±22.6W) and they were significantly correlated (r=0.78; P=0.005). Therefore, the RPE and EMG increases during exhaustive constant-load cycling bouts are related and, PET and NFT intensities are similar and closely associated., (© Georg Thieme Verlag KG Stuttgart · New York.)

The purpose of this study was to identify and compare the Electromyographic Fatigue Threshold (EMG(FT)) determined in the Vastus Lateralis (VL), Rectus Femoris (RF), Biceps Femoris (BF), Semitendinosus (ST) and Tibialis Anterior (TA) during stationary cycling in trained cyclists and non-cyclists. Using a cycle ergometer, 13 cyclists (28.4 +/- 6.9 years; 70.3 +/- 13 kg; 176.1 +/- 8.5 cm) and 11 non-cyclists (25.8 +/- 4 years; 73 +/- 9.1 kg; 175 +/- 6.4 cm), performed a maximum incremental test (ITmax) (90 rpm) to determine the (EMG(FT)). Maximal power output (W(PEAK)) reached by cyclists was higher than for non-cyclists (372.6 W and 248.9 W respectively) (P < 0.01). For the five muscles analyzed in cyclists, EMG(FT) occurred at 85.7% of cases in the VL, 92.9% in RE 78.6% in BE 78.6% in ST and 50% in TA, while in the non-cyclists group, this occurrence was 100% to muscle VL, 100% to RF, 92.6% to BF, 78.6% to ST, and 78.6% to TA. Analyzing the percentage corresponding to the power at EMG(FT) in relation to W(PEAK) reached, no differences between groups were observed for RF, BF and ST, however VL and TA, as well as the mean from all muscles were lower for cyclists than non-cyclists (P < 0.05). The present results showed that EMG(FT) is more easily identified in RF and VL muscles for both groups, and it may be an interesting method to evaluate the adaptive responses from aerobic and anaerobic metabolisms during cycling training programs.

The objective of this study was to compare the efficiency of pedaling (EP) and the electromyographic activity (EMG) between cyclists and non-cyclists during cycling in different cadences. Using a cyclosimulator, 12 cyclists (26.5 +/- 4.5 years; 68.2 +/- 10.5 kg; 175.6 +/- 8.2 cm) and 9 non-cyclists (25.1 +/- 4.3 years; 72.6 +/- 9.8 kg; 174.6 +/- 6.2 cm), performed a maximum incremental test (ITmax), and subsequently, two constant load tests (Tconst) in different cadences (60 and 90 rpm) at the intensity of the electromyographic fatigue threshold (EMGth) determined in ITmax. Before the Tconst, the subjects performed a maximum isometric voluntary contraction (MIVC) for the normalization of the EMG data of Tconst. During Tconst, the EMG of the studied muscles was recorded, as well as the EP Although there was a trend of higher values in all occasions for the cyclists, there were no statistical differences in EP and the EMG when compared in a same cadence between groups. However, when the EMG is compared in different cadences in the same group, there was a significant increase (p < 0.05) in the muscles that work during the recovery phase with the increase in cadence, in both groups, being more evident in the cyclists. In conclusion, the hypothesis that cyclists had better technique than non-cyclists was not confirmed statistically. However, it was found that the increase in cadence improves the EP and the recruitment in both groups.

Objective: The aim of this study was to describe by means of surface electromyography the activation of the rectus abdominis, obliquus externus and rectus femoris muscles during the "crunch" abdominal exercise performed with loads., Methods: Thirteen subjects performed crunch exercises with loads representing 80, 60, 40 and 20% of the 1-RM (100%) in a random order with the subjects drawing lots, and with a 5 min rest between sets. Surface bipolar EMG electrodes were used. The root mean square of the EMG was calculated for the first repetition of each load. Differences between conditions were tested using a one way ANOVA for repeated measures. Post-hoc Bonferroni tests was used to detect significant differences between specific loads (p<0.05)., Results: An average of the percentage values of all studied abdominal muscles was used as a representative value of abdominal synergy (Ab Syn). In general it can be concluded that the abdominal muscles were significantly more recruited in the 100% load condition. Abdominal activation significantly differed between the various loads; however, in general adjacent loads (20 vs. 40% - 1-RM) did not differ., Conclusions: These results suggest that for young, healthy and physically active adults when the objective is progression in the training process of abdominal force, the option ought to be for changes of load superior to 20% of the 1-RM.