Effects of exercise intervention on cortical excitability and motor performance in healthy populations: a meta-analysis based on transcranial magnetic stimulation measurements

doi:10.12307/2026.442

Abstract

Abstract: OBJECTIVE: Multiple studies have confirmed that exercise interventions can induce changes in cortical excitability detectable by transcranial magnetic stimulation; however, the neural regulatory effects among different training types remain inconsistent, with no unified conclusions. Based on this, this study aims to systematically evaluate the effects of exercise interventions on cortical excitability and motor performance in healthy populations, exploring the underlying mechanisms at neurophysiological and motor functional levels.
METHODS: A systematic search was conducted in PubMed, Web of Science, Embase, Cochrane Library, and Chinese databases including CNKI, VIP, and WanFang. Randomized controlled trials and crossover trials involving healthy adults undergoing exercise interventions were included, where the trial group underwent any form of exercise intervention, while the control group received sham intervention or no exercise intervention. Outcome measures included cortical excitability indexes and motor performance assessed via transcranial magnetic stimulation. Meta-analysis was performed using RevMan 5.4 software, with subgroup and sensitivity analyses conducted to further explore sources of heterogeneity.
RESULTS: A total of 15 studies (380 participants) were included. Meta-analysis results indicated that exercise interventions had significant positive effects on both cortical excitability and motor performance. Exercise interventions significantly enhanced cortical excitability [standard mean difference (SMD)=0.38, 95% confidence interval (CI)=(0.05, 0.72), P=0.03], with a small-to-moderate effect size. Exercise interventions also significantly improved motor performance [SMD=0.42, 95% CI (0.07, 0.76), P=0.02], with a moderate effect size. Subgroup analysis revealed that strength training had the most significant effect on enhancing cortical excitability [SMD=0.53, 95% CI (0.12, 0.94), P=0.01], whereas motor skill training [SMD=-0.29, 95% CI (-1.13, 0.55), P=0.50], high-intensity interval training [SMD=0.04, 95% CI (-0.44, 0.53), P=0.86], and balance training [SMD=0.45, 95% CI (-0.37, 1.26), P=0.28] did not reach statistical significance. Inter-study heterogeneity was relatively high, potentially attributable to differences in intervention types, training duration, or measurement indicators. Sensitivity analysis confirmed the robustness of the results, and funnel plot analysis suggested a low risk of publication bias.
CONCLUSION: Exercise interventions can effectively enhance cortical excitability and motor performance in healthy populations, with strength training demonstrating particularly pronounced effects. Future research should delve deeper into the mechanisms of different training types, optimize training protocol designs to further improve neuroplasticity and motor performance outcomes.

Key words: cortical excitability, motor performance, exercise intervention, transcranial magnetic stimulation, meta-analysis, strength training

CLC Number:

Li Lei, Zhao Qisheng. Effects of exercise intervention on cortical excitability and motor performance in healthy populations: a meta-analysis based on transcranial magnetic stimulation measurements[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(35): 9302-9308.

Figures/Tables 7

2.1 文献筛选结果依据检索策略，初步共检索文献1 281篇(Web of Science数据库271 篇，PubMed数据库667篇，Embase数据库203篇，Cochrane Library数据库43篇，中国知网31篇，维普数据库48篇，万方数据库18篇)，中文数据库检索的97篇文献，经严格筛选后未发现符合PICOS标准的合格研究(需同时报告经颅磁刺激皮质兴奋性指标和运动表现定量数据)，故未纳入Meta分析。将所有文献导入EndNote 21软件，去除重复文献258篇后剩余1 023篇；随后，研究人员通过阅读标题初筛，剔除与研究主题无关及综述类文献510篇；经摘要筛选后，进一步排除文献327篇，剩余186篇；对剩余文献进一步阅读全文筛选，剔除非随机对照试验、无相关结局指标、非运动干预、非健康人群文献171篇，最终共纳入15篇文献用于Meta分析。具体文献筛选流程如图1 (PRISMA声明流程图)。 2.2 纳入文献的基本特征所纳入文献的基本特征如表1所示。15篇文献包括13篇随机对照试验和2篇交叉随机对照试验，研究对象为健康成人，无神经或肌肉骨骼疾病；研究发表时间跨度为2005-2022年；总样本量为380，因部分文献存在受试者退出或随机交叉实验重复计入，表1中为实际纳入Meta分析的有效样本数，男性约占62%；试验组干预措施包括力量训练、运动技能训练、高强度间歇训练、平衡训练等，对照组通常为无训练、静坐、观看纪录片或维持日常活动；主要结局指标包括皮质兴奋性指标，如运动诱发电位幅度、短间隔皮质内抑制、运动阈值和最大复合肌肉动作电位，次要结局指标包括运动表现，如单次最大力量、最大自主等长收缩、最大力量、运动表现评分、平衡时间和肌肉厚度。 2.3 纳入文献的质量评价采用Cochrane工具7项评估(总分7分)，低偏倚风险用“+”表示(得1分)，高偏倚风险用“-”表示(不得分)，不清楚用“?”表示(不得分)。此次研究所纳入的15篇文献中，平均分数为6.4分，有9篇达到7分、3篇达到6分，见表2。图2所示，每个条目代表一个偏倚类型，颜色表示不同的风险等级：绿色(低风险)、黄色(不明确风险)、红色(高风险)，从图中可以看出大多数研究在各个偏倚类别中均表现出低风险，但在研究结局盲法评价等方面仍然存在一定比例的高风险或不明确风险。图3所示，所纳入文献在各个偏倚类别下的具体评估情况。总体而言，纳入文献的质量较高。 2.4 Meta分析结果 2.4.1 大脑皮质兴奋性分析在纳入的所有文献中，森林图(图4)呈现了运动干预对皮质兴奋性的总体效应分析，共纳入20项研究数据，其中标有a、b、c的研究来源于同一篇文章，但因试验设计将试验组分为3个亚组(分别接受不同类型的运动干预干预，如动态力量训练、速度渐进式训练和等长训练)，在Meta分析中被视为独立研究处理。异质性检验显示研究间异质性较高(I2=66%，P < 0.000 1)，选用随机效应模型进行分析，结果显示运动干预对"

皮质兴奋性具有显著的正向效应[SMD=0.38，95%CI(0.05，0.72)，P=0.03]，效应量为小到中等。 2.4.2 运动表现分析根据森林图(图5)的分析，纳入21项研究数据，系统评价了运动干预对运动表现的总体效应。异质性检验显示研究间异质性较高(I2=70%，P < 0.000 01)，选用随机效应模型进行分析，结果显示试验组受试者的运动表现强于对照组[SMD=0.42，95%CI(0.07，0.76)，P=0.02]，效应量为中等。 2.4.3 亚组分析如图所示(图6)展示了不同训练类型对皮质兴奋性影响的亚组分析结果，包括力量训练、运动技能训练、高强度间歇训练和平衡训练。总体而言，异质性检验显示研究间异质性较高(I2= 64%，P < 0.000 1)，选用随机效应模型进行分析，结果显示运动干预显著提升了皮质兴奋性[SMD=0.42，95%CI(0.10，0.75)，P=0.01]。其中，力量训练可显著提升皮质兴奋性[SMD=0.53，95%CI(0.12，0.94)，P = 0.01]，运动技能训练、高强度间歇训练和平衡训练未能显著提升皮质兴奋性[SMD=-0.29，95%CI(-1.13，0.55)，P=0.50；SMD=0.04，95%CI(-0.44，0.53)，P=0.86；SMD=0.45，95%CI(-0.37，1.26)，P=0.28]，表明力量训练可能是提升皮质兴奋性的最有效干预方式，而其他训练类型的效果尚需进一步验证。 2.5 发表偏倚风险分析如图7所示，圆形代表力量训练亚组，红色菱形代表运动技能训练亚组，绿色方形代表高强度间歇训练亚组，蓝色三角形代表平衡训练亚组。从图形分布来看，各亚组数据点散布于图中不同区域，部分点靠近中心虚线，尽管数据点分布具有一定离散性，但未显示明显的集中趋势，表明各亚组数据分布较为均衡，未因亚组差异导致显著的分布异常。虽然少数数据点位于漏斗图边缘，可能存在小样本效应，但整体形态较为对称，提示此次Meta分析的发表偏倚风险较低。"

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