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
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
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 .
Source: Frontiers in Psychology
Authors: Peng Qiurong, Wu Libing, Li Qing
Institution: Xiangnan University
Language: English
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7221617281