BACKGROUND: We explored the potential synergistic effects of combining multisession anodal transcranial direct current stimulation (a-tDCS) with chronic aerobic exercise (AE) on food cravings (FC), impulsivity (IMP), risky decisionmaking (RDM), and cognitive flexibility (CF) in women with overweight or obesity exhibiting food craving symptoms. METHODS: Thirty-six women with overweight or obesity and symptoms of food craving (age 26 +/- 6,4 years) were randomly allocated into three groups using permuted block randomization (n = 12 each): (1) a-tDCS plus AE, (2) Sham plus AE, and (3) Control (no intervention). During Phase 1, the a-tDCS plus AE group received five consecutive sessions of a-tDCS, while the Sham plus AE group received sham tDCS. In Phase 2, both the a-tDCS plus AE and Sham plus AE groups completed three sessions of moderate-intensity continuous aerobic exercise per week for four weeks. Outcome measures, including food cravings (FC) and cognitive flexibility (CF), were assessed at baseline, after five days of tDCS, and after four weeks of AE. Follow-up measurements for FC and CF were also conducted one month post-intervention. RESULTS: FC was lower in the a-tDCS plus AE group compared to Sham plus AE and Control groups in Phase 1 (Cohen's d 1.4 and 1.9, respectively). In Phase 2, a-tDCS plus AE and Sham plus AE groups showed lower FC than the Control group (d 3.8 and d 2.8, respectively), and a-tDCS plus AE also showed a lower FC compared to the Sham plus AE group (d 1.5). FC remained lower in the a-tDCS plus AE group compared to Sham plus AE and Control groups at follow-up (d 1.7 and d 2.4, respectively). CF was higher in the a-tDCS plus AE compared to Sham plus AE and Control groups (d 2.1 and d 1.4, respectively) and in the sham plus AE (d 1.0) compared to control in Phase 2. At follow-up, CF was higher only in the a-tDCS plus AE group compared to the Control (d 1.2). IMP scores were higher in the a-tDCS plus AE group compared to the other groups in Phases 1 (d 1.0 and d 1.4) and 2 (d 5.4 and d 1.9). RDM was higher in the a-tDCS plus AE compared to the Control group in phase 2 (d 1.3). CONCLUSIONS: Multisession a-tDCS combined with four weeks of moderate AE synergistically reduces food cravings and improves related variables to a greater extent than AE alone, with sustained effects, in women with overweight or obesity and symptoms of food craving. TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trials (IRCT id: IRCT20210617051606N7; REGISTRATION DATE: 04.02.2023)

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