Modulation of prefrontal functional connectivity by anodal tDCS over left DLPFC predicts performance enhancement in competitive swimmers: A simultaneous tDCS-fNIRS, double-blind, sham-controlled crossover study

While transcranial direct current stimulation (tDCS) has been proposed as a method to enhance physical performance in athletes, the underlying neural mechanisms and the reasons for the widely reported individual variability in its effects remain unclear. This study investigated whether prefrontal hemodynamic responses, measured by functional near-infrared spectroscopy (fNIRS), are associated with the effects of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) on swimming performance. In a double-blind, sham-controlled, crossover design, eight trained male swimmers performed 100 m freestyle trials under both anodal tDCS and sham conditions. We recorded prefrontal cortical activation and functional connectivity using fNIRS during a resting-state period and a subsequent stimulation period. While tDCS led to a numerical improvement in 100 m freestyle time, the overall effect was not statistically significant. The fNIRS analyses revealed that tDCS significantly reduced intra-hemispheric functional connectivity, especially in the stimulated left prefrontal cortex. Crucially, the magnitude of this connectivity reduction correlated with the degree of performance improvement, suggesting a direct brain-behavior link. Exploratory analyses further suggested that baseline functional connectivity could predict an individuals neural response to tDCS, with those having higher baseline connectivity showing a greater reduction. These findings suggest that tDCS over the left DLPFC may enhance physical performance by increasing the neural efficiency of prefrontal networks. Therefore, baseline functional connectivity is a promising physiological biomarker that could be used to personalize neuromodulation protocols in athletes.