• Núbia Ribeiro Conceição, Lilian Teresa Bucken Gobbi, Priscila Nóbrega-Sousa, Diego Orcioli-Silva, Victor Spiandor Beretta, Ellen Lirani-Silva, Alexandre Hideki Okano, and Rodrigo Vitório.
• São Paulo State University (UNESP), Institute of Biosciences, Graduate Program in Movement Sciences, Rio Claro, SP, Brazil.
• Neurorehabil Neural Repair. 2021 Aug 1; 35 (8): 717-728.

BackgroundSince people with Parkinson disease (PD) rely on limited prefrontal executive resources for the control of gait, interventions targeting the prefrontal cortex (PFC) may help in managing PD-related gait impairments. Transcranial direct current stimulation (tDCS) can be used to modulate PFC excitability and improve prefrontal cognitive functions and gait.ObjectiveWe investigated the effects of adding anodal tDCS applied over the PFC to a session of aerobic exercise on gait, cognition, and PFC activity while walking in people with PD.MethodsA total of 20 people with PD participated in this randomized, double-blinded, sham-controlled crossover study. Participants attended two 30-minute sessions of aerobic exercise (cycling at moderate intensity) combined with different tDCS conditions (active- or sham-tDCS), 1 week apart. The order of sessions was counterbalanced across the sample. Anodal tDCS (2 mA for 20 minutes [active-tDCS] or 10 s [sham-tDCS]) targeted the PFC in the most affected hemisphere. Spatiotemporal gait parameters, cognitive functions, and PFC activity while walking were assessed before and immediately after each session.ResultsCompared with the pre-assessment, participants decreased step time variability (effect size: -0.4), shortened simple and choice reaction times (effect sizes: -0.73 and -0.57, respectively), and increased PFC activity in the stimulated hemisphere while walking (effect size: 0.54) only after aerobic exercise + active-tDCS.ConclusionThe addition of anodal tDCS over the PFC to a session of aerobic exercise led to immediate positive effects on gait variability, processing speed, and executive control of walking in people with PD.

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