ผลของการกระตุ้นด้วยไฟฟ้ากระแสตรงผ่านกะโหลกศีรษะต่อสมรรถภาพทางกายในผู้ป่วยโรคปอดอุดกั้นเรื้อรัง: การศึกษานำร่องแบบสุ่มและมีกลุ่มควบคุม

Chalermkiat  Sawasdee; Paradee  Auvichayapat; Watchara  Boonsawat; Worawat  Champangern; Mattaya  Thasomboon; Napatchanok  Hanwaree; Panita  Thamnithis; Phiangdao  Artchaithorn; Orathai Tunkamnerdthai

doi:10.64960/srimedj.v41i2.270721

Authors

Chalermkiat Sawasdee Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
Paradee Auvichayapat Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
Watchara Boonsawat Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
Worawat Champangern Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
Mattaya Thasomboon Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
Napatchanok Hanwaree Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
Panita Thamnithis Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand
Phiangdao Artchaithorn School of Physical Therapy, Faculty of Associated Medical Science, Khon Kaen University, Khon Kaen, 40002, Thailand
Orathai Tunkamnerdthai Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

DOI:

https://doi.org/10.64960/srimedj.v41i2.270721

Keywords:

obstructive lung disease, transcranial direct current stimulation, physical performance

Abstract

Background and objective: Transcranial direct current stimulation (tDCS) has been shown to increase physical performance in both healthy adults and older individuals. However, research on tDCS in COPD is limited. Therefore, the objective of this study was to investigate the effects of tDCS on functional fitness in patients with COPD.

Methods: A randomized, double-blind, sham-controlled trial was conducted. Participants received either active or sham tDCS applied over the primary motor cortex for 20 minutes daily for five consecutive days. Functional fitness outcomes including Single-Leg Stance (SLS), Time Up and GO test (TUG), Five-Times Sit-to-Stand tests (FTSST), 4-meter gait speed test (4MGS), and hand-grip strength (HGS) were assessed at baseline, post-treatment, and at 1-week follow-up.

Results: Compared with the sham group, the active tDCS group demonstrated significantly greater improvements in the SLS, FTSST, and HGS of right hand at post-treatment (p < 0.05). Improvement in the FTSST was maintained at follow-up. 4MGS also improved in the active tDCS group (p < 0.05). However, the TUG did not demonstrate statistically significant changes following the intervention in either within-group or between-group analyses (p > 0.05).

Conclusion: Multi-session tDCS applied over the primary motor cortex enhanced functional fitness, particularly balance, lower-limb functional strength, and gait speed in patients with COPD.

Author Biographies

Chalermkiat Sawasdee, Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

Paradee Auvichayapat, Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

Orathai Tunkamnerdthai, Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

Noninvasive Brain Stimulation Research Group of Thailand, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

References

Barnes PJ, Burney PGJ, Silverman EK, Celli BR, Vestbo J, Wedzicha JA, et al. Chronic obstructive pulmonary disease. Nat Rev Dis Primer 2015;1:15076. doi:10.1038/nrdp.2015.76.

Bernardo I, Bozinovski S, Vlahos R. Targeting oxidant-dependent mechanisms for the treatment of COPD and its comorbidities. Pharmacol Ther 2015;155:60–79. doi:10.1016/j.pharmthera.2015.08.005.

Barreiro E, Gea J. Respiratory and limb muscle dysfunction in COPD. COPD 2015;12(4):413–26. doi:10.3109/15412555.2014.974737.

Jones SE, Maddocks M, Kon SSC, Canavan JL, Nolan CM, Clark AL, et al. Sarcopenia in COPD: prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax 2015;70(3):213–8. doi:10.1136/thoraxjnl-2014-206440.

Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigaré R, et al. An official American Thoracic Society/European Respiratory Society statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014;189(9):e15-62. doi:10.1164/rccm.201402-0373ST.

Yu T, Frei A, Ter Riet G, Puhan MA. Determinants of physical activity in patients with chronic obstructive pulmonary disease: a 5-year prospective follow-up study. Respiration 2016;92(2):72–9. doi:10.1159/000447975.

Jaitovich A, Barreiro E. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. What we know and can do for our patients. Am J Respir Crit Care Med 2018;198(2):175–86. doi:10.1164/rccm.201710-2140CI.

Zhang H, Wang X, Lin J, Sun Y, Huang Y, Yang T, et al. Grey and white matter abnormalities in chronic obstructive pulmonary disease: a case-control study. BMJ Open 2012;2(2):e000844. doi:10.1136/bmjopen-2012-000844.

Alexandre F, Héraud N, Tremey E, Oliver N, Bourgouin D, Varray A. Specific motor cortex hypoexcitability and hypoactivation in COPD patients with peripheral muscle weakness. BMC Pulm Med 2020;20(1):1. doi:10.1186/s12890-019-1042-0.

Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 2000;527 Pt 3(3):633–9. doi:10.1111/j.1469-7793.2000.t01-1-00633.x.

Sawasdee C, Auvichayapat P, Boonsawat W, Chumpangern W, Thasomboon M, Hanwaree N, et al. Transcranial direct current stimulation’s effect on exercise capacity, respiratory muscle strength, and physical performance in patients with chronic obstructive pulmonary disease: randomized controlled trial. Chron Respir Dis 2025;22:14799731251383504. doi:10.1177/14799731251383504.

Yamada Y, Sumiyoshi T. Neurobiological mechanisms of transcranial direct current stimulation for psychiatric disorders; neurophysiological, chemical, and anatomical considerations. Front Hum Neurosci 2021;15:631838. doi:10.3389/fnhum.2021.631838.

Jeffery DT, Norton JA, Roy FD, Gorassini MA. Effects of transcranial direct current stimulation on the excitability of the leg motor cortex. Exp Brain Res 2007;182(2):281–7. doi:10.1007/s00221-007-1093-y.

Rostami M, Mosallanezhad Z, Ansari S, Ehsani F, Kidgell D, Nourbakhsh MR, et al. Multi-session anodal transcranial direct current stimulation enhances lower extremity functional performance in healthy older adults. Exp Brain Res 2020;238(9):1925–36. doi:10.1007/s00221-020-05827-6.

Marotta N, de Sire A, Marinaro C, Moggio L, Inzitari MT, Russo I, et al. Efficacy of transcranial direct current stimulation (tDCS) on balance and gait in multiple sclerosis patients: a machine learning approach. J Clin Med 2022;11(12):3505. doi:10.3390/jcm11123505.

Yi D, Sung YJ, Yim JE. Effect of transcranial direct current stimulation on walking speed, functional strength, and balance in older adults: a randomized, double- blind controlled trial. Med Sci Monit 2021;27:e932623. doi:10.12659/MSM.932623.

Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2025. [cited Jan 9, 2026]. Available from: https://goldcopd.org

McLay R, Kirkwood RN, Kuspinar A, Richardson J, Wald J, Raghavan N, et al. Validity of balance and mobility screening tests for assessing fall risk in COPD. Chron Respir Dis 2020;17: 1479973120922538. doi:10.1177/1479973120922538.

Vieira ND, Testa D, Ruas PC, Salvini T de F, Catai AM, Melo RC. The effects of 12 weeks Pilates-inspired exercise training on functional performance in older women: a randomized clinical trial. J Bodyw Mov Ther 2017;21(2):251–8. doi:10.1016/j.jbmt.2016.06.010.

Melo TA de, Duarte ACM, Bezerra TS, França F, Soares NS, Brito D. The five times sit-to-stand test: safety and reliability with older intensive care unit patients at discharge. Rev Bras Ter Intensiva 2019;31(1):27–33. doi:10.5935/0103-507X.20190006.

Bisca GW, Fava LR, Morita AA, Machado FVC, Pitta F, Hernandes NA. 4-meter gait speed test in chronic obstructive pulmonary disease: interrater reliability using a stopwatch. J Cardiopulm Rehabil Prev 2018;38(4):E10–3. doi:10.1097/HCR.0000000000000297.

Jeong M, Kang HK, Song P, Park HK, Jung H, Lee SS, et al. Hand grip strength in patients with chronic obstructive pulmonary disease. Int J COPD 2017;12:2385–90. doi:10.2147/COPD.S140915.

Scremim CF, Simões BFPMC, de Barros JA, Valderramas S. Construct validity and reliability of the brazilian version of the falls efficacy scale in patients with COPD. Pulmonology 2020;26(5):268–74. doi:10.1016/j.pulmoe.2020.01.008.

Bernard S, LeBlanc P, Whittom F, Carrier G, Jobin J, Belleau R, et al. Peripheral muscle weakness in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;158(2):629–34. doi:10.1164/ajrccm.158.2.9711023.

Beauchamp MK, Sibley KM, Lakhani B, Romano J, Mathur S, Goldstein RS, et al. Impairments in systems underlying control of balance in COPD. Chest 2012;141(6):1496–503. doi:10.1378/chest.11-1708.

Butcher SJ, Meshke JM, Sheppard MS. Reductions in functional balance, coordination, and mobility measures among patients with stable chronic obstructive pulmonary disease. J Cardpulm Rehabil 2004;24(4):274–80. doi:10.1097/00008483-200407000-00013.

Sheppard JM, Young WB. Agility literature review: classifications, training and testing. J Sports Sci 2006;24(9):919–32. doi:10.1080/02640410500457109.

Cabibel V, Le Toullec B, Oliver N, Héraud N, Varray A. Cortical disorders and muscle weakness in COPD: impact of neuromodulation on intracortical inhibition. In: clinical respiratory physiology, exercise and functional imaging. Eur Respir J 2017;50(suppl61):OA3433. doi:10.1183/1393003.congress-2017.oa3433.

Jones SE, Kon SSC, Canavan JL, Patel MS, Clark AL, Nolan CM, et al. The five-repetition sit-to-stand test as a functional outcome measure in COPD. Thorax 2013;68(11):1015–20. doi:10.1136/thoraxjnl-2013-203576.

Ohlyan A, Chaturvedi R, Bagri M, Rani V, Joshi S, Malik M. Effect of transcranial direct current stimulation on handgrip strength training in amateur badminton players. Rom J Neurol 2024;23(4):376–80. doi:10.37897/RJN.2024.4.4.

Krishnan C, Ranganathan R, Kantak SS, Dhaher YY, Rymer WZ. Anodal transcranial direct current stimulation alters elbow flexor muscle recruitment strategies. Brain Stimulat 2014;7(3):443–50. doi:10.1016/j.brs.2014.01.057.

Wang C, Jiao X, Liang J, Lu A. The impact of muscle mass, strength, and physical functioning on postural balance in older adults with sarcopenia. Clinics (Sao Paulo) 2025;80:100784. doi:10.1016/j.clinsp.2025.100784.

Stotz A, Hamacher D, Zech A. Relationship between muscle strength and gait parameters in healthy older women and men. Int J Environ Res Public Health 2023;20(7):5362. doi:10.3390/ijerph20075362.

Karabin MJ, Sparto PJ, Rosano C, Redfern MS. Impact of strength and balance on functional gait assessment performance in older adults. Gait Posture 2022;91:306–11. doi:10.1016/j.gaitpost.2021.10.045.

Aparicio LVM, Rosa V, Razza LM, Sampaio-Junior B, Borrione L, Valiengo L, et al. Transcranial direct current stimulation (tDCS) for preventing major depressive disorder relapse: results of a 6-month follow-up. Depress Anxiety 2019;36(3):262–8. doi:10.1002/da.22878.

Linnhoff S, Haghikia A, Zaehle T. Effects of repetitive twice-weekly transcranial direct current stimulations on fatigue and fatigability in people with multiple sclerosis. Sci Rep 2023;13(1):5878. doi:10.1038/s41598-023-32779-y.