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This study could contribute to the advancements in healthcare by exploring the innovative intervention, which is Transcranial Direct Current Stimulation (tDCS). Investigating its impact on cardiovascular and locomotor outcomes could give rise to new non-pharmacological interventions for health promotion, disease prevention, and rehabilitation.
Age-related functional decline occurs in various organs like the cardiovascular system, brain, muscles, lungs, kidneys, and immune system in the body, contributing significantly to the onset of frailty in elderly individuals. Due to routine degeneration of aging, physical impairments related to movement take place, which include strength, balance, gait, and performance issues (5).
Cardiovascular autonomic regulation is considered an important factor in health, while the autonomic nervous system is important for adapting therapy for prolonged cardiovascular outcomes.
The process of aging can produce pathological changes in the cardiovascular system, whose results may lead to CVD. One of the main changes of aging is the augmented stiffness of central arteries, known as vascular aging. It occurs due to loss of elastic fibers and accumulation of collagen in the major elastic arteries, which leads to an increase in systolic and pulse pressures of healthy elderly individuals. These hemodynamic changes in vessels lead to clinical illness and increase the risk of developing hypertension, atherosclerosis, and stroke. While some other studies have shown that aging is also related to continuous decline in exercise capacity, walking ability, and physical function, impacting the performance of daily activity and maintaining personal independence. Walking limitation is very frequent in the elderly population, estimated at 58.1% to 93.2%, which can be a functional dependence risk factor among community dwellers. While increasing walking ability impacts several aspects of health-related quality of life, including physical, social, and emotional well-being.
tDCS has a considerable impact on neuroplasticity and hypotension by delivering new interventional strategies to control blood pressure.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 | Experimental |
| |
| Group 2 | Sham Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| tDCS | Other | The focal electrodes of 25-35 cm² will be placed on M1, identifying via the 10/20 EEG system. |
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| Measure | Description | Time Frame |
|---|---|---|
| 10-Meter Walk Test (10MWT) | The 10MWT is broadly used in preventive care and rehabilitation centers; it is evaluated by measuring participant speed and counting the number of steps taken within a given time period. This measurement method includes walking a certain section set on a smooth floor at the normal or maximum speed. After this, walking time and number of steps taken are to be measured | baseline, week 1, and week 5 |
| Blood Pressure Monitor | A sphygmomanometer is used to measure systolic and diastolic blood pressure before and after intervention sessions. The modified sphygmomanometer showed excellent test-retest reliability with an intraclass correlation coefficient (ICC) of 0.996. | baseline, week 1, and week 5 |
| 6-Minute Walk Test (6MWT) | It is a sub-maximal exercise test used to assess aerobic capacity and endurance. Any change in performance capacity are determined based on the distance covered in six minutes. The 6MWT is a practically performed simple test that requires a 100-ft hallway but no exercise equipment needed. It helps to evaluates the global and integrated responses of all the systems involved during exercise, including the cardiovascular and pulmonary systems, systemic and peripheral circulation, blood, neuromuscular units, and muscle metabolism | baseline, week 1, and 5 |
| Short Physical performance battery | It consists of 3 timed components: 1) a 4-m usual pace walk, 2) a 5-repetition chair stand without using one's arms, and 3) a progressive test of standing balance. It is an objective measurement instrument of balance, lower extremity strength, and functional capacity in older adults. The final total SPPB scores ranged between 4 and 12, with 4 to 6 representing the low, 7 to 9 the middle, and 10 to 12 the best performance. | baseline, week 1, and 5 |
| Heart rate variability (HRV) |
| Measure | Description | Time Frame |
|---|---|---|
| tDCS Safety Screening Questionnaire | Used to assess the safety and suitability of participants for tDCS intervention by assessing different potential risks. It includes medical history, medication, skin sensitivities, neurological conditions, and mental health. | baseline, week 1, and 5 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Nimra Irshad, DPT | Contact | 00923157338975 | nimrairshad225@gmail.com | |
| Mirza Obaid Baig, MSPT | Contact | 00923332238706 | obaid.baig@riphah.edu.pk |
| Name | Affiliation | Role |
|---|---|---|
| Mirza Obaid Baig, MSPT | Riphah International University | Principal Investigator |
| Sumaiyah Obaid, MSPT | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Pakistan Railway Hospital | Rawalpindi | Punjab Province | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33423544 | Background | Rodrigues B, Barboza CA, Moura EG, Ministro G, Ferreira-Melo SE, Castano JB, Ruberti OM, De Amorim RFB, Moreno H Junior. Transcranial direct current stimulation modulates autonomic nervous system and reduces ambulatory blood pressure in hypertensives. Clin Exp Hypertens. 2021 May 19;43(4):320-327. doi: 10.1080/10641963.2021.1871916. Epub 2021 Jan 11. | |
| 37974293 |
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| ID | Term |
|---|---|
| D065908 | Transcranial Direct Current Stimulation |
| ID | Term |
|---|---|
| D004599 | Electric Stimulation Therapy |
| D013812 | Therapeutics |
| D003295 | Convulsive Therapy |
| D013000 | Psychiatric Somatic Therapies |
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| Sham stimulation | Other | Sham stimulation of the M1 area by using the 25-35 square centimeter electrodes. |
|
Heart Rate Variability (HRV) in community-dwellers is a critical, non-invasive marker of autonomic nervous system function, with lower HRV values consistently predicting higher cardiovascular risk, mortality, and functional decline. Among community-dwelling older adults, reduced HRV is strongly associated with adverse health outcomes such as frailty, cognitive impairment, and depression. |
| baseline, week 1, and 5 |
| da Silva VCC, da Silva Areas FZ, Lopes ALRB, de Almeida E Val FF, da Costa AG, Dos Santos JCC, Ferreira JMBB, Peixoto Tinoco Areas G. Anodal transcranial direct current stimulation associated with aerobic exercise on the functional and physical capacity of patients with heart failure with reduced ejection fraction: ELETRIC study protocol. Trials. 2023 Nov 17;24(1):738. doi: 10.1186/s13063-023-07694-2. |
| 40613366 | Background | Choi BJ, Lee H, Kang N. Does Transcranial Direct Current Stimulation Improve Gait Performances in Healthy Older Adults? A Meta-Analysis. J Integr Neurosci. 2025 Jun 19;24(6):36636. doi: 10.31083/JIN36636. |
| 33337767 | Background | Keller-Ross ML, Chantigian DP, Nemanich S, Gillick BT. Cardiovascular Effects of Transcranial Direct Current Stimulation and Bimanual Training in Children With Cerebral Palsy. Pediatr Phys Ther. 2021 Jan 1;33(1):11-16. doi: 10.1097/PEP.0000000000000762. |
| 32394750 | Background | Bornheim S, Thibaut A, Beaudart C, Maquet P, Croisier JL, Kaux JF. Evaluating the effects of tDCS in stroke patients using functional outcomes: a systematic review. Disabil Rehabil. 2022 Jan;44(1):13-23. doi: 10.1080/09638288.2020.1759703. Epub 2020 May 12. |
| D004191 | Behavioral Disciplines and Activities |
| D004597 | Electroshock |
| D011580 | Psychological Techniques |