Effects of Prefrontal tDCS on Cognitive–Motor Performance During Postural Control and Isokinetic Strength Tasks in Women with Fibromyalgia: A Randomized, Sham-Controlled Crossover Study
Source abstract
Abstract
This study investigated the effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (dlPFC) at three intensities (sham, 1 mA, 2 mA) on postural control, isokinetic strength, and cognitive performance in women with fibromyalgia (FM) and healthy controls (HCs). Using a double-blind, sham-controlled, crossover design, 26 participants (13 FM, 13 HC) completed sessions in randomized order, performing tasks under single- and dual-task conditions. Cognitive accuracy improved in both groups following 1 mA and 2 mA stimulation, particularly during single-task scenarios in static balance tasks. Notably, 2 mA tDCS reduced dual-task cost (DTC) in cognitive performance for the FM group, indicating decreased cognitive–motor interference. However, postural and strength outcomes showed no consistent intensity-dependent changes, with only selected nonlinear centers of pressure metrics (e.g., Lyapunov exponent, DFA) indicating possible modulation in FM. Isokinetic strength measures remained largely unaffected by tDCS across all intensities. Overall, the findings suggest that dlPFC-tDCS may selectively enhance cognitive function and reduce cognitive–motor interference in FM, especially under low-demand or higher-intensity stimulation conditions, while offering limited benefits for physical strength and balance.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Transcranial Magnetic Stimulation Studies · Muscle activation and electromyography studies · Stroke Rehabilitation and Recovery
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Grupo de Investigación en Actividad Física Calidad de Vida y Salud (AFYCAV), Departamento Didáctica de la Expresión Musical, Plástica y Corporal, Facultad de Ciencias del Deporte, Universidad de Extremadura, Avenida de la Universidad s/n, 10003 Cáceres, Spain
Grupo Investigación AFYCAV, Instituto Universitario de Investigación e Innovación en Deporte (INIDE), Universidad de Extremadura, Av. de la Universidad s/n, 10003 Cáceres, Spain
Biomedical Research Excellence Networking Center on Frailty and Healthy Aging (CIBERFES), 28029 Madrid, Spain
Neurofisiología Clínica, Hospital San Pedro de Alcántara, 10003 Cáceres, Spain
Funding
Spanish Agency of Research of the Spanish Ministry of Sciences and Innovation · “ERDF A way of making Europe” · Research Grant for Groups · AFYCAV Group · European Union, ERDF/EU and the Junta de Extremadura, “a way of doing Europe” · Biomedical Research Excellence Networking Center on Frailty and Healthy Aging (CIBERFES) and ERDF/EU funds from the European Union · Junta de Extremadura (Regional Government of Extremadura), Extremadura Public Employment Service (SEXPE) and the European Social Fund (ESF/FSE) “a way of doing Europe” · Spanish Ministry of Sciences and Innovation
References (93)
Show source-provided references
1. Fibromyalgia and quality of life: A comparative analysis
2. Prevalence of fibromyalgia: Literature review update10.1016/j.rbr.2016.10.004 ↗
3. Prevalence of fibromyalgia and associated factors in Spain
4. Prevalence of fibromyalgia: A survey in five European countries10.1016/j.semarthrit.2008.12.003 ↗
5. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria10.1016/j.semarthrit.2016.08.012 ↗
6. Review of cognitive dysfunction in fibromyalgia: A convergence on working memory and attentional control impairments10.1016/j.rdc.2009.06.002 ↗
7. Meta-analysis of cognitive performance in fibromyalgia10.1080/13803395.2017.1422699 ↗
8. Sempere-Rubio, N., Aguilar-Rodríguez, M., Inglés, M., Izquierdo-Alventosa, R., and Serra-Añó, P. (2019). Physical Condition Factors that Predict a Better Quality of Life in Women with Fibromyalgia. Int. J. Environ. Res. Public Health, 16.10.3390/ijerph16173173 ↗
9. Impact of adding a cognitive task while performing physical fitness tests in women with fibromyalgia: A cross-sectional descriptive study10.1097/MD.0000000000013791 ↗
10. The role of prefrontal cortex in cognitive control and executive function10.1038/s41386-021-01132-0 ↗
11. Fibromyalgia impact in the prefrontal cortex subfields: An assessment with MRI10.1016/j.clineuro.2022.107344 ↗
12. Transcranial direct current stimulation and simultaneous functional magnetic resonance imaging
13. Reduction of Dual-task Costs by Noninvasive Modulation of Prefrontal Activity in Healthy Elders10.1162/jocn_a_00897 ↗
14. Transcranial Direct Current Stimulation May Improve Cognitive-Motor Function in Functionally Limited Older Adults10.1177/1545968318792616 ↗
15. Silva, A.F., Zortea, M., Carvalho, S., Leite, J., Torres, I.L., Fregni, F., and Caumo, W. (2017). Anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex modulates attention and pain in fibromyalgia: Randomized clinical trial. Sci. Rep., 7.10.1038/s41598-017-00185-w ↗
16. Efficacy of Home-Based Transcranial Direct Current Stimulation over the Primary Motor Cortex and Dorsolateral Prefrontal Cortex in the Disability Due to Pain in Fibromyalgia: A Factorial Sham-Randomized Clinical Study10.1016/j.jpain.2023.09.001 ↗
17. Efficacy of anodal transcranial direct current stimulation (tDCS) for the treatment of fibromyalgia: Results of a randomized, sham-controlled longitudinal clinical trial
18. Brain imaging in fibromyalgia syndrome
19. Dysfunctional activation of the dorsolateral prefrontal cortex during pain anticipation is associated with altered subsequent pain experience in fibromyalgia patients10.1016/j.jpain.2023.05.006 ↗
20. Working memory performance is correlated with local brain morphology in the medial frontal and anterior cingulate cortex in fibromyalgia patients: Structural correlates of pain–cognition interaction10.1093/brain/awn229 ↗
21. Decreased gray matter volumes in the cingulo-frontal cortex and the amygdala in patients with fibromyalgia10.1097/PSY.0b013e3181a32da0 ↗
22. What has functional connectivity and chemical neuroimaging in fibromyalgia taught us about the mechanisms and management ofcentralized’pain?10.1186/s13075-014-0425-0 ↗
23. Overlapping structural and functional brain changes in patients with long-term exposure to fibromyalgia pain10.1002/art.38170 ↗
24. Cognitive dysfunction in fibromyalgia and chronic fatigue syndrome: New trends and future directions10.1007/s11926-006-0036-0 ↗
25. Peinado-Rubia, A., Osuna-Pérez, M.C., Rodríguez-Almagro, D., Zagalaz-Anula, N., López-Ruiz, M.C., and Lomas-Vega, R. (2020). Impaired Balance in Patients with Fibromyalgia Syndrome: Predictors of the Impact of This Disorder and Balance Confidence. Int. J. Environ. Res. Public Health, 17.10.3390/ijerph17093160 ↗
26. Sempere-Rubio, N., López-Pascual, J., Aguilar-Rodríguez, M., Cortés-Amador, S., Espí-López, G., Villarrasa-Sapiña, I., and Serra-Añó, P. (2018). Characterization of postural control impairment in women with fibromyalgia. PLoS ONE, 13.10.1371/journal.pone.0196575 ↗
27. Human movement variability, nonlinear dynamics, and pathology: Is there a connection?10.1016/j.humov.2011.06.002 ↗
28. Isokinetic Assessment of the Wrist Muscles in Females with Fibromyalgia10.5606/ArchRheumatol.2016.5908 ↗
29. Isokinetic muscle performance of the hip and ankle muscles in women with fibromyalgia10.1111/1756-185X.12180 ↗
30. Comparison of functional and isokinetic performance between healthy women and women with fibromyalgia10.1016/j.jbmt.2019.05.024 ↗
31. Isokinetic and isometric muscle strength of the knee flexors and extensors in patients with the fibromyalgia syndrome and chronic myofascial pain syndrome10.1300/J094v15n03_07 ↗
32. FRI0472-HPR Assessment of postural control, strenght of lower limbs and pain in individuals with and without fibromyalgia10.1136/annrheumdis-2012-eular.2928 ↗
33. Effect of transcranial direct current stimulation on postural stability and lower extremity strength in hemiplegic stroke patients10.5535/arm.2013.37.6.759 ↗
34. Azarkolah, A., Noorbala, A.A., Ansari, S., Hallajian, A.H., and Salehinejad, M.A. (2023). Efficacy of Transcranial Direct Current Stimulation on Pain Level and Disability of Patients with Fibromyalgia: A Systematic Review of Randomized Controlled Trials with Parallel-Group Design. Brain Sci., 14.10.3390/brainsci14010026 ↗
35. World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191–2194.10.1001/jama.2013.281053 ↗
36. Gomez-Alvaro, M.C., Villafaina, S., Leon-Llamas, J.L., Murillo-Garcia, A., Melo-Alonso, M., Sánchez-Gómez, J., Molero, P., Cano-Plasencia, R., and Gusi, N. (2022). Effects of Transcranial Direct Current Stimulation on Brain Electrical Activity, Heart Rate Variability, and Dual-Task Performance in Healthy and Fibromyalgia Women: A Study Protocol. Behav. Sci., 12.10.3390/bs12020037 ↗
37. CONSORT 2010 statement: Extension to randomised crossover trials10.1136/bmj.l4378 ↗
38. Gomez-Alvaro, M.C., Gusi, N., Cano-Plasencia, R., Leon-Llamas, J.L., Murillo-Garcia, A., Melo-Alonso, M., and Villafaina, S. (2024). Effects of Different Transcranial Direct Current Stimulation Intensities over Dorsolateral Prefrontal Cortex on Brain Electrical Activity and Heart Rate Variability in Healthy and Fibromyalgia Women: A Randomized Crossover Trial. J. Clin. Med., 13.10.3390/jcm13247526 ↗
39. Effects of Transcranial Direct Current Stimulation over the Dorsolateral Prefrontal Cortex (PFC) on Cognitive-Motor Dual Control Skills10.1177/0031512520935695 ↗
40. The effect of transcranial direct current stimulation on task processing and prioritisation during dual-task gait10.1007/s00221-015-4232-x ↗
41. Modulation of prefrontal cortex with anodal tDCS prevents post-exercise facilitation interference during dual task10.1080/08990220.2017.1292238 ↗
42. Transcranial direct current stimulation reduces the cost of performing a cognitive task on gait and postural control10.1111/ejn.12492 ↗
43. Effects of transcranial direct current stimulation (tDCS) on multiscale complexity of dual-task postural control in older adults10.1007/s00221-015-4310-0 ↗
44. Does the transcranial direct current stimulation improve dual-task postural control in young healthy adults?10.1007/s10339-020-01000-7 ↗
45. Jor’dan, A.J., Bernad-Elazari, H., Mirelman, A., Gouskova, N.A., Lo, O.Y., Hausdorff, J.M., and Manor, B. (2022). Transcranial Direct Current Stimulation May Reduce Prefrontal Recruitment During Dual Task Walking in Functionally Limited Older Adults—A Pilot Study. Front. Aging Neurosci., 14.10.3389/fnagi.2022.843122 ↗
46. Brain polarization in humans: A reappraisal of an old tool for prolonged non-invasive modulation of brain excitability10.1016/S1388-2457(02)00437-6 ↗
47. Modulation of cortical excitability by weak direct current stimulation—Technical, safety and functional aspects10.1016/S1567-424X(09)70230-2 ↗
48. Transcranial direct current stimulation (tDCS)10.1016/S1567-424X(09)70229-6 ↗
49. Relationships between the fibromyalgia impact questionnaire, tender point count, and muscle strength in female patients with fibromyalgia: A cohort study10.1002/art.24512 ↗
50. Determining the number of repetitions to establish isokinetic knee evaluation protocols specific to angular velocities of 60°/second and 180°/second10.1016/j.jbmt.2020.12.043 ↗
51. Revision of posturography based on force plate for balance evaluation10.1590/S1413-35552010000300003 ↗
52. Stergiou, N. (2018). Nonlinear Analysis for Human Movement Variability, CRC Press.10.1201/9781315370651 ↗
53. Determining Lyapunov exponents from a time series10.1016/0167-2789(85)90011-9 ↗
54. Wurdeman, S.R. (2018). Lyapunov exponent. Nonlinear Analysis for Human Movement Variability, CRC Press.10.1201/9781315370651-4 ↗
55. International physical activity questionnaire: Reliability and validity in a Spanish population10.1080/17461390903426667 ↗
56. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment10.1111/j.1532-5415.2005.53221.x ↗
57. Murillo-Garcia, A., Leon-Llamas, J.L., Villafaina, S., Rohlfs-Dominguez, P., and Gusi, N. (2021). MoCA vs. MMSE of fibromyalgia patients: The possible role of dual-task tests in detecting cognitive impairment. J. Clin. Med., 10.10.3390/jcm10010125 ↗
58. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)10.1007/s11136-011-9903-x ↗
59. Chen, B., Liu, P., Xiao, F., Liu, Z., and Wang, Y. (2021). Review of the upright balance assessment based on the force plate. Int. J. Environ. Res. Public Health, 18.10.3390/ijerph18052696 ↗
60. Clinical stabilometry standardization: Basic definitions–acquisition interval–sampling frequency10.1016/j.gaitpost.2012.07.009 ↗
61. Gomez-Alvaro, M.C., Leon-Llamas, J.L., Melo-Alonso, M., Villafaina, S., Domínguez-Muñoz, F.J., and Gusi, N. (2024). Test-Retest Reliability of Isokinetic Strength in Lower Limbs under Single and Dual Task Conditions in Women with Fibromyalgia. J. Clin. Med., 13.10.3390/jcm13051288 ↗
62. Controlling the false discovery rate: A practical and powerful approach to multiple testing10.1111/j.2517-6161.1995.tb02031.x ↗
63. Effect size estimates: Current use, calculations, and interpretation10.1037/a0024338 ↗
64. Machado, S., Jansen, P., Almeida, V., and Veldema, J. (2019). Is tDCS an adjunct ergogenic resource for improving muscular strength and endurance performance? A systematic review. Front. Psychol., 10.10.3389/fpsyg.2019.01127 ↗
65. Different montages of transcranial direct current stimulation on postural stability in chronic low back pain patients: A randomized sham-controlled study10.3233/BMR-230229 ↗
66. Cha, S., Choi, J., Moon, C., and Cho, K. (2025). Non-invasive brain stimulation contributing to postural control with and without stroke: A systematic review and meta-analysis. Sci. Rep., 15.10.1038/s41598-025-07840-7 ↗
67. Fibromyalgia is associated with impaired balance and falls
68. Collado-Mateo, D., Gallego-Diaz, J.M., Adsuar, J.C., Domínguez-Muñoz, F.J., Olivares, P.R., and Gusi, N. (2015). Fear of Falling in Women with Fibromyalgia and Its Relation with Number of Falls and Balance Performance. BioMed Res. Int., 2015.10.1155/2015/589014 ↗
69. Transcranial Direct Current Stimulation (tDCS) Improves Back-Squat Performance in Intermediate Resistance-Training Men10.1080/02701367.2020.1815638 ↗
70. Etemadi, M., Amiri, E., Tadibi, V., Grospretre, S., Valipour Dehnou, V., and Machado, D. (2023). Anodal tDCS over the left DLPFC but not M1 increases muscle activity and improves psychophysiological responses, cognitive function, and endurance performance in normobaric hypoxia: A randomized controlled trial. BMC Neurosci., 24.10.1186/s12868-023-00794-4 ↗
71. Effect of tDCS targeting the M1 or left DLPFC on physical performance, psychophysiological responses, and cognitive function in repeated all-out cycling: A randomized controlled trial10.1186/s12984-023-01221-9 ↗
72. Brain stimulation over dorsomedial prefrontal cortex modulates effort-based decision making10.3758/s13415-022-01021-z ↗
73. Causal role of lateral prefrontal cortex in mental effort and fatigue10.1002/hbm.25146 ↗
74. The influence of balance, physical disability, strength, mechanosensitivity and spinal mobility on physical activity at home, work and leisure time in women with fibromyalgia10.1016/j.clinbiomech.2018.10.009 ↗
75. Beyond pain in fibromyalgia: Insights into the symptom of fatigue10.1186/ar4395 ↗
76. The Effect of Combining Transcranial Direct Current Stimulation and Pain Neuroscience Education in Patients with Chronic Low Back Pain and High Pain Catastrophizing: An Exploratory Clinical, Cognitive, and fMRI Study10.1002/brb3.70543 ↗
77. Functional brain changes in sarcopenia: Evidence for differential central neural mechanisms in dynapenic older women10.1007/s40520-023-02391-1 ↗
78. The longitudinal bidirectional association between sarcopenia and cognitive function in community-dwelling older adults: Findings from the China Health and Retirement Longitudinal Study10.7189/jogh.13.04182 ↗
79. Sarcopenia is associated with cognitive impairment in older adults: A systematic review and meta-analysis10.1007/s12603-019-1188-8 ↗
80. Du, J., Tao, X., Zhu, L., Wang, H., Qi, W., Min, X., Wei, S., Zhang, X., and Liu, Q. (2025). Development of a visualized risk prediction system for sarcopenia in older adults using machine learning: A cohort study based on CHARLS. Front. Public Health, 13.10.3389/fpubh.2025.1544894 ↗
81. Effects of transcranial direct current stimulation on dual-task performance in older and young adults: A systematic review and meta-analysis10.1016/j.aggp.2024.100047 ↗
82. Investigation of the dual-task performance and affecting factors in female patients with fibromyalgia syndrome10.1080/03630242.2023.2185748 ↗
83. Muñoz-Perete, J.M., Cano-Sánchez, J., Castellote-Caballero, Y., Vico-Rodríguez, P., Cano-Orihuela, M., Sánchez-Alcalá, M., and Carcelén-Fraile, M.d.C. (2025). Effectiveness of Transcranial Stimulation on Cognitive Abilities of Older Adults with Mild Cognitive Impairment. J. Clin. Med., 14.10.3390/jcm14072472 ↗
84. Santos, V., Zortea, M., Alves, R.L., Naziazeno, C., Saldanha, J.S., Carvalho, S., Leite, A., Torres, I., Souza, A., and Calvetti, P. (2018). Cognitive effects of transcranial direct current stimulation combined with working memory training in fibromyalgia: A randomized clinical trial. Sci. Rep., 8.10.1038/s41598-018-30127-z ↗
85. Serrano, P.V., Zortea, M., Alves, R.L., Beltrán, G., Bavaresco, C., Ramalho, L., Alves, C.F.d.S., Medeiros, L., Sanches, P.R.S., and Silva, D.P. (2022). The effect of home-based transcranial direct current stimulation in cognitive performance in fibromyalgia: A randomized, double-blind sham-controlled trial. Front. Hum. Neurosci., 16.10.3389/fnhum.2022.992742 ↗
86. Partially non-linear stimulation intensity-dependent effects of direct current stimulation on motor cortex excitability in humans10.1113/jphysiol.2012.249730 ↗
87. Incomplete evidence that increasing current intensity of tDCS boosts outcomes10.1016/j.brs.2017.12.002 ↗
88. Mobility Assessment under Dual Task Conditions in Women with Fibromyalgia: A Test-Retest Reliability Study10.1002/pmrj.12375 ↗
89. Khan, M.J., Kannan, P., Wong, T.W.-L., Fong, K.N.K., and Winser, S.J. (2022). A systematic review exploring the theories underlying the improvement of balance and reduction in falls following dual-task training among older adults. Int. J. Environ. Res. Public Health, 19.10.3390/ijerph192416890 ↗
90. Ljubisavljevic, M.R., Oommen, J., Filipovic, S., Bjekic, J., Szolics, M., and Nagelkerke, N. (2019). Effects of tDCS of dorsolateral prefrontal cortex on dual-task performance involving manual dexterity and cognitive task in healthy older adults. Front. Aging Neurosci., 11.10.3389/fnagi.2019.00144 ↗
91. Home-Based Transcranial Direct Current Stimulation vs Placebo for Fibromyalgia: A Randomized Clinical Trial10.1001/jamanetworkopen.2025.14262 ↗
92. Ben Izhak, S., Jacoby, N., Diedrich, L., Antal, A., and Lavidor, M. (2025). Enhanced cognitive performance in older adults through combined cognitive training and transcranial direct current stimulation. Sci. Rep., 15.10.1038/s41598-025-08322-6 ↗
93. Luo, N., Zhao, B., Wang, H., Wu, J., Luo, Y., Yuan, M., and Xu, C. (2025). Effect of transcranial direct current stimulation combined with cognitive rehabilitation on cognitive function and activities of daily living in patients with post-stroke cognitive impairment: A systematic review and meta-analysis. Front. Neurol., 16.10.3389/fneur.2025.1523001 ↗