Comparing different anodic transcranial direct current stimulation montages on whole-body aerobic endurance performance in physically active populations: A systematic review and network meta-analysis

Anodal transcranial direct current stimulation (a-tDCS) shows promise for improving endurance performance, but the optimal montage for this purpose remains unclear. We conducted the first network meta-analysis (NMA) to compare various a-tDCS montages to verify their effects on whole-body endurance performance in physically active people. The search was conducted using four databases until 4 March 2025. A frequentist random-effects NMA was performed to compare different a-tDCS montages. Statistical analysis was conducted using MetaInsight, and confidence in the evidence was assessed with the CINeMA framework. A total of 25 studies involving 648 participants met the inclusion criteria and were included. The NMA provided moderate-certainty evidence indicating that a-tDCS over the dorsolateral prefrontal cortex (DLPFC) yielded the greatest improvement in endurance performance (Standardized Mean Difference - SMD = 0.66) when compared to other electrode placements as the motor (M1) and temporal (TC) cortices. Also, in the NMA, the M1 was ranked second (SMD = 0.38), suggesting another viable option for endurance performance enhancement. In contrast, indirect evidence suggested that a-tDCS over the TC had no significant effect on endurance performance (SMD = 0.15). In conclusion, coaches and athletes may consider applying a-tDCS over the DLPFC or M1 before training or endurance competitions.