Short-term balance consolidation relies on the primary motor cortex: a rTMS study

Structural and functional adaptations occur in the primary motor cortex (M1) after only a few balance learning sessions. Nevertheless, the role of M1 in consolidating balance tasks remains to be discussed, as direct evidence is missing due to the fact that it is unclear whether adaptations in M1 are indeed the driving force for balance improvements or merely the consequence of improved balance. The aim of the present study was to investigate whether the primary motor cortex is involved in the learning and consolidation of balance tasks. Thirty participants were randomly allocated into a repetitive transcranial magnetic stimulation (rTMS) or sham-rTMS group. The experimental design included a single balance acquisition phase, followed by either 15 min of low-frequency rTMS (1 Hz at 115% of resting motor threshold to disrupt the involvement of M1) or sham-rTMS, and finally a retention test 24 h later. During the acquisition phase, no differences in balance improvements were observed between the two groups. However, significant differences between the rTMS and the sham-rTMS group were found from the end of the acquisition phase to the retention test. While the rTMS group had a performance loss, the sham-rTMS group displayed significant off-line gains (p = 0.001). For the first time, this finding may propose a causal relationship between the involvement of M1 and the acquisition and consolidation of a balance task.