Journal of Cognitive Enhancement

, Volume 2, Issue 4, pp 377–387 | Cite as

Would the Use of Safe, Cost-Effective tDCS Tackle Rather than Cause Unfairness in Sports?

  • Laura Sophie ImperatoriEmail author
  • Luke Milbourn
  • Mirko Daniel Garasic
Original Article


Neuromodulation technologies like transcranial direct current stimulation (tDCS) might enable professional and amateur athletes to reach their respective levels of physical excellence in a safe, cost-effective, and fair manner. Key factors that may assist an athlete in achieving their potential usually include training for many years, often since childhood, and access to a high level of funding. If cost-effective neuromodulation based on tDCS lives up to its promises (regarding safety and efficacy), tDCS can help athletes to learn relevant skills more effectively and thus reach their respective levels of physical excellence more quickly, especially athletes with limited time and resources. Whilst dangerous, illegal drugs such as EPO and steroids can increase performance without training, current evidence suggests that tDCS assists an athlete in improving their performance in combination with training. Given that the World Anti-Doping Association has not made any statement regarding the permissibility of tDCS, whilst access to and popularity of tDCS are constantly increasing, it is important to consider more in-depth if the use of tDCS can be justified. Here, we will outline three key criteria that any performance-enhancing measure must meet if its use can be considered ethical and permissible according to WADA requirements. tDCS must meet our requirements of safety, hard work from the athlete and accessibility. The preliminary evidence regarding its safety, its relatively low cost and the reasonable expectation, that long-term improvements can only be made if its application is paralleled by intense training, justifies its further research in the context of athletic performance enhancement. Moreover, we also consider its potential wider impact, especially how tDCS could help to level the playing field between amateur and elite athletes.


tDCS Sports Athletic performance Enhancement Ergogenic aid Doping 


Compliance with Ethical Standards

Conflict of Interest

The first author obtained a reduced tDCS device ($200 discount) in June 2017 based on disclosing her scientific and athletic background with Halo Neuroscience. The other authors declare that there is no conflict of interest.


  1. Angius, L., Hopker, J., & Mauger, A. R. (2017). The ergogenic effects of transcranial direct current stimulation on exercise performance. Frontiers in Physiology, 8, 90.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Antal, A., Keeser, D., Priori, A., Padberg, F., & Nitsche, M. A. (2015). Conceptual and procedural shortcomings of the systematic review “evidence that transcranial direct current stimulation (tDCS) generates little-to-no reliable neurophysiologic effect beyond MEP amplitude modulation in healthy human subjects: a systematic review” by Horvath and co-workers. Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation, 8(4), 846–849.CrossRefGoogle Scholar
  3. Berthelot, G., Tafflet, M., El Helou, N., Len, S., Escolano, S., Guillaume, M., et al. (2010). Athlete atypicity on the edge of human achievement: performances stagnate after the last peak, in 1988. PloS One, 5(1), e8800.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Bhasin, S., Storer, T. W., Berman, N., Callegari, C., Clevenger, B., Phillips, J., et al. (1996). The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. New England Journal of Medicine, 335(1), 1–7.CrossRefPubMedGoogle Scholar
  5. Bikson, M., Grossman, P., Thomas, C., Zannou, A. L., Jiang, J., Adnan, T., et al. (2016). Safety of transcranial direct current stimulation: evidence based update 2016. Brain Stimulation, 9(5), 641–661.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Boggio, P. S., Castro, L. O., Savagim, E. A., Braite, R., Cruz, V. C., Rocha, R. R., et al. (2006). Enhancement of non-dominant hand motor function by anodal transcranial direct current stimulation. Neuroscience Letters, 404(1-2), 232–236.CrossRefPubMedGoogle Scholar
  7. Borghesi, R. (2008). Allocation of scarce resources: Insight from the NFL salary cap. Journal of Economics and Business, 60(6), 536–550.CrossRefGoogle Scholar
  8. Bouchard, C., Sarzynski, M. A., Rice, T. K., Kraus, W. E., Church, T. S., Sung, Y. J., et al. (2010). Genomic predictors of the maximal O2 uptake response to standardized exercise training programs. Journal of Applied Physiology, 110(5), 1160–1170.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Bullard, L. M., Browning, E. S., Clark, V. P., Coffman, B. A., Garcia, C. M., Jung, R. E., et al. (2011). Transcranial direct current stimulation’s effect on novice versus experienced learning. Experimental Brain Research, 213(1), 9–14.CrossRefPubMedGoogle Scholar
  10. Chatzopoulos, I. (2009). The legal framework of doping: doping sanctions and their critique. International Quarterly of Sport Science, l. Google Scholar
  11. Cogiamanian, F., Marceglia, S. A. R. A., Ardolino, G., Barbieri, S., & Priori, A. (2007). Improved isometric force endurance after transcranial direct current stimulation over the human motor cortical areas. European Journal of Neuroscience, 26(1), 242–249.CrossRefPubMedGoogle Scholar
  12. Colzato, L. S., Nitsche, M. A., & Kibele, A. (2017). Noninvasive brain stimulation and neural entrainment enhance athletic performance—a review. Journal of Cognitive Enhancement, 1(1), 73–79.CrossRefGoogle Scholar
  13. Consolvo, S., Everitt, K., Smith, I., & Landay, J. A. (2006). Design requirements for technologies that encourage physical activity. In Proceedings of the SIGCHI conference on Human Factors in computing systems (pp. 457–466). New York: ACM.Google Scholar
  14. David, P., (2005) Human rights in youth sport: a critical review of children’s rights in competitive sportsGoogle Scholar
  15. Davis, N. J. (2013). Neurodoping: brain stimulation as a performance-enhancing measure. Sports Medicine, 43(8), 649–653.CrossRefPubMedGoogle Scholar
  16. Edwards, D. J., Cortes, M., Wortman-Jutt, S., Putrino, D., Bikson, M., Thickbroom, G., & Pascual-Leone, A. (2017). Transcranial direct current stimulation and sports performance. Frontiers in Human Neuroscience, 11, 243.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Epstein, D. (2014). The sports gene: Inside the science of extraordinary athletic performance. New York: Penguin.Google Scholar
  18. Garasic, M. D., & Lavazza, A. (2015). Performance enhancement in the workplace: why and when healthy individuals should disclose their reliance on pharmaceutical cognitive enhancers. Frontiers in Systems Neuroscience, 9, 13.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Geeraets, V. (2018). Ideology, doping and the spirit of sport. Sport, Ethics and Philosophy, 12(3), 255–271.CrossRefGoogle Scholar
  20. Hackney, A. C. (2017). Doping, performance-enhancing drugs, and hormones in sport: mechanisms of action and methods of detection. New York: Elsevier.Google Scholar
  21. Haugen, K. K. (2004). The performance-enhancing drug game. Journal of Sports Economics, 5(1), 67–86.CrossRefGoogle Scholar
  22. Heuberger, J. A., Rotmans, J. I., Gal, P., Stuurman, F. E., van’t Westende, J., Post, T. E., et al. (2017). Effects of erythropoietin on cycling performance of well trained cyclists: a double-blind, randomised, placebo-controlled trial. The Lancet Haematology, 4(8), e374–e386.CrossRefPubMedGoogle Scholar
  23. Hill, J. O., & Peters, J. C. (1998). Environmental contributions to the obesity epidemic. Science(80), 280(5368), 1371–1374.CrossRefGoogle Scholar
  24. Horvath, J. C., Forte, J. D., & Carter, O. (2015). Evidence that transcranial direct current stimulation (tDCS) generates little-to-no reliable neurophysiologic effect beyond MEP amplitude modulation in healthy human subjects: a systematic review. Neuropsychologia, 66, 213–236.CrossRefPubMedGoogle Scholar
  25. Lattari, E., Campos, C., Lamego, M. K., de Souza Passos, S. L., Neto, G. M., Rocha, N. B., et al. (2017). Can transcranial direct current stimulation improve muscle power in individuals with advanced resistance training experience?. Journal of Strength and Conditioning Research.
  26. Ljubisavljevic, M., Maxood, K., Bjekic, J., Oommen, J., & Nagelkerke, N. (2016). Long-term effects of repeated prefrontal cortex transcranial direct current stimulation (tDCS) on food craving in normal and overweight young adults. Brain Stimulation, 9(6), 826–833.CrossRefPubMedGoogle Scholar
  27. McMahon, D. (2018). UCI bans Sky’s motorhome RV from cycling and Tour de France - Business Insider. [Online]. Available: Accessed 18 Jun 2018.
  28. McNamee, M. J. (2012). The spirit of sport and the medicalisation of anti-doping: empirical and normative ethics. Asian Bioethics Review, 4(4), 374–392.Google Scholar
  29. McNamee, M. J., & Tarasti, L. (2010). Juridical and ethical peculiarities in doping policy. Journal of Medical Ethics, 36(3), 165–169.CrossRefPubMedGoogle Scholar
  30. Montenegro, R., Okano, A., Gurgel, J., Porto, F., Cunha, F., Massaferri, R., & Farinatti, P. (2015). Motor cortex tDCS does not improve strength performance in healthy subjects. Motriz: Revista de Educação Física, 21(2), 185–193.Google Scholar
  31. Monte-Silva, K., Kuo, M. F., Hessenthaler, S., Fresnoza, S., Liebetanz, D., Paulus, W., & Nitsche, M. A. (2013). Induction of late LTP-like plasticity in the human motor cortex by repeated non-invasive brain stimulation. Brain Stimulation, 6(3), 424–432.CrossRefPubMedGoogle Scholar
  32. Moreau, D., Wang, C.-H., Tseng, P., & Juan, C.-H. (2015). Blending transcranial direct current stimulations and physical exercise to maximize cognitive improvement. Frontiers in Psychology, 6, 678.PubMedPubMedCentralGoogle Scholar
  33. Mulhere, K. (2018). Olympic figure skating: how much it costs to compete | Money. [Online]. Available: Accessed 22 Aug 2018.
  34. Nitsche, M. A., & Paulus, W. (2001). Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans sustained excitability elevations induced by transcranial DC motor cortex stimulation in. Neurology, 57(10), 1899–1901.CrossRefPubMedGoogle Scholar
  35. Nitsche, M. A., Seeber, A., Frommann, K., Klein, C. C., Rochford, C., Nitsche, M. S., et al. (2005). Modulating parameters of excitability during and after transcranial direct current stimulation of the human motor cortex. The Journal of Physiology, 568(1), 291–303.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Nitsche, M. A., Cohen, L. G., Wassermann, E. M., Priori, A., Lang, N., Antal, A., et al. (2008). Transcranial direct current stimulation: state of the art 2008. Brain Stimulation, 1(3), 206–223.CrossRefPubMedGoogle Scholar
  37. Norton, K., & Olds, T. (2001). Morphological evolution of athletes over the 20th century: causes and consequences. Sports Medicine, 31(11), 763–783.CrossRefPubMedGoogle Scholar
  38. Parry, J. (2018). E-sports are Not Sports. Sport, Ethics and Philosophy, 1–16.
  39. Poreisz, C., Boros, K., Antal, A., & Paulus, W. (2007). Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients. Brain Research Bulletin, 72(4–6), 208–214.CrossRefPubMedGoogle Scholar
  40. Pritchard, D. (2010). Achievements, luck and value. Think, 9(25), 19–30.CrossRefGoogle Scholar
  41. Pummell, B., Harwood, C., & Lavallee, D. (2008). Jumping to the next level: a qualitative examination of within-career transition in adolescent event riders. Psychology of Sport and Exercise, 9(4), 427–447.CrossRefGoogle Scholar
  42. Rattray, B., Argus, C., Martin, K., Northey, J., & Driller, M. (2015). Is it time to turn our attention toward central mechanisms for post-exertional recovery strategies and performance?. Frontiers in Physiology, 6, 79.CrossRefPubMedPubMedCentralGoogle Scholar
  43. von Rein, E., Hoff, M., Kaminski, E., Sehm, B., Steele, C. J., Villringer, A., & Ragert, P. (2015). Improving motor performance without training: the effect of combining mirror visual feedback with transcranial direct current stimulation. Journal of Neurophysiology, 113(7), 2383–2389.CrossRefGoogle Scholar
  44. Reis, J., Schambra, H. M., Cohen, L. G., Buch, E. R., Fritsch, B., Zarahn, E., et al. (2009). Noninvasive cortical stimulation enhances motor skill acquisition over multiple days through an effect on consolidation. Proceedings of the National Academy of Sciences, 106(5), 1590–1595.CrossRefGoogle Scholar
  45. Robertson, J. (2018). The 2018 Winter Olympics are already tainted - The New York Times. [Online]. Available: Accessed 18 Jun 2018.
  46. Savulescu, J., Foddy, B., & Clayton, M. (2004). Why we should allow performance enhancing drugs in sport. British Journal of Sports Medicine, 38(6), 666–670.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Schumacher, Y. O., Mroz, R., Mueller, P., Schmid, A., & Ruecker, G. (2006). Success in elite cycling: A prospective and retrospective analysis of race results. Journal of Sports Sciences, 24(11), 1149–1156.CrossRefPubMedGoogle Scholar
  48. Scott, M. (2018). Olympics: North Korea’s Kim Jong-su loses medals after positive drugs test | Sport | The Guardian. [Online]. Available: Accessed 25 Jun 2018.
  49. Sieljacks, P., Thams, L., Nellemann, B., Larsen, M. S., Vissing, K., & Christensen, B. (2016). Comparative effects of aerobic training and erythropoietin on oxygen uptake in untrained humans. Journal of Strength and Conditioning Research, 30(8), 2307–2317.CrossRefPubMedGoogle Scholar
  50. Starkey, N. (2018). Tyson Gay ban: what is oxilofrine? | Sport | The Guardian. [Online]. Available: Accessed 18 Jun 2018.
  51. Tanaka, S., Hanakawa, T., Honda, M., & Watanabe, K. (2009). Enhancement of pinch force in the lower leg by anodal transcranial direct current stimulation. Experimental Brain Research, 196(3), 459–465.CrossRefPubMedPubMedCentralGoogle Scholar
  52. Thevis, M., Kuuranne, T., & Geyer, H. (2018). Annual banned-substance review: analytical approaches in human sports drug testing. Drug Testing and Analysis, 10(1), 9–27.CrossRefPubMedGoogle Scholar
  53. Timmons, J. A. (2011). Variability in training-induced skeletal muscle adaptation. Journal of Applied Physiology, 110(3), 846–853.CrossRefPubMedGoogle Scholar
  54. Union Cycliste Internationale (UCI) (2018). Regulations. [Online]. Available: Accessed 30 Sep 2018.
  55. Vargas, V. Z., Baptista, A. F., Pereira, G. O., Pochini, A. C., Ejnisman, B., Santos, M. B., et al. (2018). Modulation of isometric quadriceps strength in soccer players with transcranial direct current stimulation: a crossover study. The Journal of Strength & Conditioning Research, 32(5), 1336–1341.CrossRefGoogle Scholar
  56. Vitor-Costa, M., Okuno, N. M., Bortolotti, H., Bertollo, M., Boggio, P. S., Fregni, F., & Altimari, L. R. (2015). Improving cycling performance: transcranial direct current stimulation increases time to exhaustion in cycling. PloS One, 10(12), e0144916.CrossRefPubMedPubMedCentralGoogle Scholar
  57. Waddington, I., Christiansen, A. V., Gleaves, J., Hoberman, J., & Møller, V. (2013). Recreational drug use and sport: Time for a WADA rethink?. Performance Enhancement & Health, 2(2), 41–47.CrossRefGoogle Scholar
  58. Waters-Metenier, S., Husain, M., Wiestler, T., & Diedrichsen, J. (2014). Bihemispheric transcranial direct current stimulation enhances effector-independent representations of motor synergy and sequence learning. The Journal of Neuroscience, 34(3), 1037–1050.CrossRefPubMedPubMedCentralGoogle Scholar
  59. Williams, P. S., Hoffman, R. L., and Clark, B. C., (2013) “Preliminary evidence that anodal transcranial direct current stimulation enhances time to task failure of a sustained submaximal contraction”. PLoS One, vol. 8, no. 12Google Scholar
  60. World Anti-Doping Agency (WADA) (2015). World Anti-Doping Code. Montreal.
  61. World Anti-Doping Agency (WADA) (2016). The World Anti-Doping Code: International Standard. Prohibited List January 2017.Google Scholar
  62. Worldometers (2017). World population clock. Worldometers. [Online]. Available:

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.IMT School for Advanced Studies LuccaLuccaItaly
  2. 2.Independent ResearcherLuccaItaly
  3. 3.UNESCO Chair in Bioethics and Human RightsRomeItaly

Personalised recommendations