SYSTEMATIC REVIEW article
Front. Physiol.
Sec. Exercise Physiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1681272
This article is part of the Research TopicNeuromodulation Techniques, Mechanisms, and Potential Benefits for Physical Activity Participation and Human PerformanceView all 11 articles
Can exercise therapy combined with transcranial direct current stimulation further improve balance ability in individuals with chronic ankle instability? A systematic review and meta-analysis
Provisionally accepted
- 1Wuhan Sports University, Wuhan, China
- 2Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangdong Province, China, Guangdong, China
- 3Beijing University of Chinese Medicine ShenzhenHospital(Long gang), Guangdong, China, Guangdong, China
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Objectives: To evaluate whether transcranial direct current stimulation (tDCS) combined with exercise therapy enhances balance ability in chronic ankle instability (CAI) individuals. Methods: Systematic searches were conducted in PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases up to July 10, 2025. The Cochrane Risk of Bias tool version 2. was used to assess the methodological quality of studies meeting the inclusion criteria. Meta-analyses were performed using random-effects models, with results expressed as standardized mean differences (SMD) and 95% confidence intervals (95% CI). Evidence quality was evaluated using the GRADE methodology. Results: Eight studies involving 216 participants were included in the meta-analysis. Overall analysis revealed that tDCS combined with exercise therapy did not significantly improve dynamic balance (SMD: 0.08, 95% CI: -0.36 to 0.52, P = 0.72) or static balance (SMD: -0.53, 95% CI: -1.08 to 0.02, P = 0.06) in individuals with CAI. Subgroup analysis by exercise type showed that tDCS combined with non-balance training significantly enhanced dynamic balance ability (SMD: 0.52, 95% CI: 0.07 to 0.97, P = 0.02), while tDCS combined with balance training showed no significant improvements in either composite dynamic balance measures (SMD: -0.26, 95% CI: -0.82 to 0.30, P = 0.36) or Y-balance reach distances in any direction (P > 0.05 for all directions). Conclusions: tDCS provides therapeutic benefits for dynamic balance only when combined with non-balance exercises. Current evidence is insufficient to demonstrate improvements in static balance with tDCS adjunctive therapy.
Keywords: transcranial direct current stimulation, Chronic ankle instability, Sports therapy, Dynamic balance ability, static balance ability
Received: 07 Aug 2025; Accepted: 07 Oct 2025.
Copyright: © 2025 Zheng, Chen, Wang, Chen and Lin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xikai Lin, 1006865638@qq.com
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