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Transcranial direct current stimulation (tDCS) seems to be a potential tool to optimize the long-term effects of multimodal physical training (MPT) on fitness components in post-stroke patients. We investigated the effects of cortical tDCS combined with MPT on motor function reflected by strength, motor performance, and cardiorespiratory capacity in chronic stroke patients. This double-blind randomized controlled trial included 18 volunteers (55 ± 10 y, 72 ± 13 kg), who underwent MPT preceded by either sham stimulation (SHAM) or 2 mA bi-hemispheric tDCS. MPT consisted of 24 sessions of 60–70 min performed 2 d/wk within 12–16 weeks, with individualized intensity. Outcomes were Fugl-Meyer scores for lower limbs (FM-LL), and total (FM-Total); speed in the 10-m walk test (10MWT); oxygen uptake and work output at maximal effort (VO 2max  and W max ), and gas exchange threshold (VO 2 -GET and W-GET); peak torque of isokinetic knee extension (PT-EXT) and flexion (PT-FLEX) of paretic and non-paretic limbs; bilateral strength deficit during knee extension (DS-EXT) and flexion (DS-FLEX). Pre-  vs . post-intervention improvements were detected in tDCS  vs . SHAM ( p  &lt; 0.05) for FM-total (29.6%  vs . 15.9%; effect size [ES] = 0.78), FM-LL (35.9%  vs . 9.0%; ES = 1.23), 10MWT (10.6%  vs . 3.8%; ES = 0.67), W max  (75.0%  vs . 4.3%; ES = 1.68), W-GET (91.6%  vs . 12.4%; ES = 1.62), PT-EXT (25.6%  vs . −6.5%; ES = 1.94) and PT-FLEX (26.3%  vs . 9.8%; ES = 0.65) of the paretic limb, and DS-EXT (−13.7%  vs . 2.5; ES = 1.43). Bi-hemispheric cortical tDCS optimized the effects of MPT performed with moderate volume and intensity upon muscle strength, motor function, and cardiorespiratory performance in stroke hemiparetic survivors. (Registration number RBR-22rh3p).

topics in stroke rehabilitation

Multimodal physical training combined with tDCS improves physical fitness components in people after stroke: a double-blind randomized controlled trial