Comparison of the efficacy of neuromodulation techniques based on corticospinal excitability in improving exercise-induced fatigue in athletes: a systematic review and network meta-analysis
- 1Guangdong Ersha Sports Training Center, Guangzhou, China
- 2Department of Social Work, Guangzhou Resettlement Center for Assisted Persons, Guangzhou, China
- 3Affiliated Hospital of Xiangnan University, Chenzhou, China
Abstract
Background: Exercise-induced fatigue (EIF) is a core problem in competitive sports, significantly affecting the training quality and performance of athletes. Neuromodulation techniques based on corticospinal excitability regulation—including both central and peripheral stimulation—offer a novel approach to EIF intervention; however, the comparative efficacy of different techniques remains unclear.
Objective: To compare the effects of various neuromodulation techniques on EIF in athletes using a systematic review and network meta-analysis.
Methods: PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP databases were systematically searched for randomized controlled trials comparing neuromodulation techniques with placebo/sham stimulation/blank control from database inception to June 2026. The Cochrane ROB-2 tool was used to assess risk of bias, and the CINeMA framework was applied to evaluate evidence quality. A Bayesian model was employed for network meta-analysis, with SUCRA values calculated to rank efficacy, and meta-regression was used to explore sources of heterogeneity.
Results: A total of 14 RCTs involving 756 athletes were included. The paired meta-analysis showed that neuromodulation techniques significantly reduced BLA levels and alleviated fatigue (MD = −0.47, 95% CI: −0.57, −0.38). Network meta-analysis indicated that TEAS combined with acupuncture ranked first in improving RPE (SUCRA = 99.3%), blood lactate (SUCRA = 96.3%), and BUN (SUCRA = 72.6%). CINeMA evaluation showed that most evidence was of low quality. Meta-regression revealed that the total number of stimulations negatively moderated the effect on blood lactate (P = 0.001), and intervention type, risk of bias, and study design significantly influenced BUN outcomes (all P < 0.05).
Conclusion: TEAS combined with acupuncture may be associated with the most favorable SUCRA ranking, but this should be interpreted as exploratory for improving EIF in athletes. However, the overall quality of current evidence is low, and SUCRA rankings should be interpreted as exploratory. Future high-quality RCTs are needed to validate these findings and determine the optimal stimulation parameter ranges.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261446854.
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BibTeX
@article{qiurong2026comparison,
title = {{Comparison of the efficacy of neuromodulation techniques based on corticospinal excitability in improving exercise-induced fatigue in athletes: a systematic review and network meta-analysis}},
author = {Peng Qiurong and Wu Libing and Li Qing},
journal = {Frontiers in Psychology},
year = {2026},
month = oct,
doi = {10.3389/fpsyg.2026.1948789},
url = {https://doi.org/10.3389/fpsyg.2026.1948789},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparison of the efficacy of neuromodulation techniques based on corticospinal excitability in improving exercise-induced fatigue in athletes: a systematic review and network meta-analysis
AU - Peng Qiurong
AU - Wu Libing
AU - Li Qing
PY - 2026
DA - 2026/10/13
JO - Frontiers in Psychology
DO - 10.3389/fpsyg.2026.1948789
UR - https://doi.org/10.3389/fpsyg.2026.1948789
AB - Background: Exercise-induced fatigue (EIF) is a core problem in competitive sports, significantly affecting the training quality and performance of athletes. Neuromodulation techniques based on corticospinal excitability regulation—including both central and peripheral stimulation—offer a novel approach to EIF intervention; however, the comparative efficacy of different techniques remains unclear. Objective: To compare the effects of various neuromodulation techniques on EIF in athletes using a systematic review and network meta-analysis. Methods: PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP databases were systematically searched for randomized controlled trials comparing neuromodulation techniques with placebo/sham stimulation/blank control from database inception to June 2026. The Cochrane ROB-2 tool was used to assess risk of bias, and the CINeMA framework was applied to evaluate evidence quality. A Bayesian model was employed for network meta-analysis, with SUCRA values calculated to rank efficacy, and meta-regression was used to explore sources of heterogeneity. Results: A total of 14 RCTs involving 756 athletes were included. The paired meta-analysis showed that neuromodulation techniques significantly reduced BLA levels and alleviated fatigue (MD = −0.47, 95% CI: −0.57, −0.38). Network meta-analysis indicated that TEAS combined with acupuncture ranked first in improving RPE (SUCRA = 99.3%), blood lactate (SUCRA = 96.3%), and BUN (SUCRA = 72.6%). CINeMA evaluation showed that most evidence was of low quality. Meta-regression revealed that the total number of stimulations negatively moderated the effect on blood lactate (P = 0.001), and intervention type, risk of bias, and study design significantly influenced BUN outcomes (all P < 0.05). Conclusion: TEAS combined with acupuncture may be associated with the most favorable SUCRA ranking, but this should be interpreted as exploratory for improving EIF in athletes. However, the overall quality of current evidence is low, and SUCRA rankings should be interpreted as exploratory. Future high-quality RCTs are needed to validate these findings and determine the optimal stimulation parameter ranges. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261446854.
SN - 1664-1078
ER -