Different Exercising Intensities and Frequencies of Exercise on Depressive Mood and Insomnia

Effects of Different Exercising Intensities and Frequencies of Walking Exercise on Depressive Mood and Insomnia in Older Adults

Aerobic exercise intervention for depression was conventionally recommended three times weekly with moderate intensity in previous studies, but little is known about the training effect of aerobic exercise at low frequency and vigorous intensity. The purpose of this study is to compare the training effect of aerobic exercise at different exercising frequencies and intensities on older adults with comorbid insomnia and depressive symptoms. In this study, the investigators will investigate two types of aerobic exercise (i.e., vigorous-intensity exercise and moderate-intensity exercise) under different exercising frequencies (i.e., regular exercising pattern and weekend warrior). Individuals with chronic insomnia and depressive symptoms will be recruited and randomly allocated into 5 groups: 1) attention control group (stretching exercise), 2) moderate intensity exercise performed thrice weekly (MIE×3/wk), 3) moderate intensity exercise performed once weekly (MIE×1/wk), 4) vigorous intensity exercise performed thrice weekly (VIE×3/wk), and 5) vigorous intensity exercise performed once weekly (VIE×1/wk). Intervention will be maintained for 12 weeks. Outcome assessments will be conducted at baseline, 6 weeks and 12 weeks after the intervention. Outcomes including depressive status, chronic insomnia, objective sleep quality and pattern (measured by Actigraphy), subjective sleep quality (measured by Epworth sleepiness scale, insomnia severity index, PSQI), anxiety status (measured by HADS and GAD-7), quality of life (measured by SF-12), attention level (measured by computer attention test), exercise enjoyment (measured by physical activity enjoyment scale), habitual physical activity level (measured by IPAQ), aerobic fitness (measured by metabolic cart), body adiposity (measured by DXA), blood chemistry, adherence, medication usage, and adverse events will be measure in this study. This proposed study will provide pilot evidence for the benefits, effectiveness, safety, adherence, and sustainability of low-frequency vigorous aerobic exercise. the investigators expect the low-frequency exercise modality will enhance the practical suitability of aerobic exercise and will provide evidence for weekend warrior aerobic training strategy as a new exercise option in the management of elderly insomnia and depression.

Study Overview

• Status: Completed
• Conditions: Sleep Disorder; Depressive Symptoms
• Intervention / Treatment: Behavioral: Exercise intervention

• Study Type: Interventional
• Enrollment (Actual): 75
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong
    • LKS Faculty of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. borderline abnormal depression with score above 8 out of 21 on Hospital Anxiety and Depression Scale (HADS),
2. chronic insomnia according to the fifth edition of the diagnostic and statistical manual of mental disorder (DSM-5),
3. Cantonese, Mandarin or English speaking, and 4) age 50 or above. To enhance generalizability, males and females will be recruited.

Exclusion Criteria:

1. contraindications to participating in physical exercise;
2. regular exercise habit in the past three months (i.e.,>75 minutes of vigorous-intensity exercise weekly or >150 minutes of moderate-intensity exercise weekly);
3. any pre-existing medical or physical issues that affect the experimental test and exercise intervention;
4. diagnosis with psychosis, schizophrenia or bipolar disorder;
5. currently receiving non-medication treatment for depression or insomnia, such as mindfulness training or cognitive behavior therapy;
6. shift worker or other commitment that interferes with the regular sleep pattern at night; and
7. abnormal heart's electrical activity according to the exercise electrocardiography (ECG) test, such as irregular heartbeat, arrhythmia, and myocardial infarction.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Attention control; Subjects in this group will receive one session of 75 minutes stretching exercise per week throughout the 12 weeks experimental period	Behavioral: Exercise intervention; Subjects in attention control group will receive one session of 75 minutes of stretching exercise weekly. All walking exercise session will be performed on motor-driven treadmill. Subjects in moderate-intensity walking groups will walk at an intensity of 3.25 metabolic equivalents (METs). Subjects in vigorous-intensity walking groups will brisk walk at an intensity of 6.5 metabolic equivalents (METs). Warm-up and cool-down will be provided before and after the training. Participants who failed to achieve 80% attendance will be excluded from the study. All exercise sessions were supervised by qualified athletic coach.
Active Comparator: Moderate-intensity walking exercise ×3/wk; Subjects in this group will receive three sessions of 50 minutes vigorous walking exercise per week throughout the 12 weeks experimental period	Behavioral: Exercise intervention; Subjects in attention control group will receive one session of 75 minutes of stretching exercise weekly. All walking exercise session will be performed on motor-driven treadmill. Subjects in moderate-intensity walking groups will walk at an intensity of 3.25 metabolic equivalents (METs). Subjects in vigorous-intensity walking groups will brisk walk at an intensity of 6.5 metabolic equivalents (METs). Warm-up and cool-down will be provided before and after the training. Participants who failed to achieve 80% attendance will be excluded from the study. All exercise sessions were supervised by qualified athletic coach.
Active Comparator: Moderate-intensity walking exercise ×1/wk; Subjects in this group will receive one session of 150 minutes vigorous walking exercise per week throughout the 12 weeks experimental period	Behavioral: Exercise intervention; Subjects in attention control group will receive one session of 75 minutes of stretching exercise weekly. All walking exercise session will be performed on motor-driven treadmill. Subjects in moderate-intensity walking groups will walk at an intensity of 3.25 metabolic equivalents (METs). Subjects in vigorous-intensity walking groups will brisk walk at an intensity of 6.5 metabolic equivalents (METs). Warm-up and cool-down will be provided before and after the training. Participants who failed to achieve 80% attendance will be excluded from the study. All exercise sessions were supervised by qualified athletic coach.
Active Comparator: Vigorous-intensity walking exercise ×3/wk; Subjects in this group will receive three sessions of 25 minutes vigorous walking exercise per week throughout the 12 weeks experimental period	Behavioral: Exercise intervention; Subjects in attention control group will receive one session of 75 minutes of stretching exercise weekly. All walking exercise session will be performed on motor-driven treadmill. Subjects in moderate-intensity walking groups will walk at an intensity of 3.25 metabolic equivalents (METs). Subjects in vigorous-intensity walking groups will brisk walk at an intensity of 6.5 metabolic equivalents (METs). Warm-up and cool-down will be provided before and after the training. Participants who failed to achieve 80% attendance will be excluded from the study. All exercise sessions were supervised by qualified athletic coach.
Active Comparator: Vigorous-intensity walking exercise ×1/wk; Subjects in this group will receive one session of 75 minutes vigorous walking exercise per week throughout the 12 weeks experimental period	Behavioral: Exercise intervention; Subjects in attention control group will receive one session of 75 minutes of stretching exercise weekly. All walking exercise session will be performed on motor-driven treadmill. Subjects in moderate-intensity walking groups will walk at an intensity of 3.25 metabolic equivalents (METs). Subjects in vigorous-intensity walking groups will brisk walk at an intensity of 6.5 metabolic equivalents (METs). Warm-up and cool-down will be provided before and after the training. Participants who failed to achieve 80% attendance will be excluded from the study. All exercise sessions were supervised by qualified athletic coach.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Level of depression	Hospital Anxiety and Depression Scale (HADS) will be used to measure the level of depression	After completion of the 12 weeks intervention
Remission rate of insomnia	Brief insomnia questionnaire (BIQ) will be employed to diagnose the chronic insomnia based on the DSM-5 criteria.	After completion of the 12 weeks intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Subjective sleep data	The Epworth sleepiness scale, insomnia severity index, and Pittsburgh sleep quality index (PSQI) will be used to measure the sleep quality.	After completion of the 12 weeks intervention
Objective sleep data	Actigraphy will be used to measure the sleep quality and pattern.	After completion of the 12 weeks intervention
Change in dose of Sleep Medication	The dose of sleep medication used by the subjects changes after intervention.	After completion of the 12 weeks intervention
7-day Sleep Diary	Self-recorded sleep parameters (sleep onset latency, sleep efficiency, total sleep time, wake time after sleep onset, number of awakening and average awaken time)	After completion of the 12 weeks intervention
Treatment response rate	The percentage of participants that have their Score of Pittsburgh Sleep Quality Index reduced by at least 5 points	After completion of the 12 weeks intervention
Body composition	Body lean mass, fat mass, and bone density will be measured by dual-energy X-ray absorptiometry	After completion of the 12 weeks intervention
Maximal oxygen consumption	Metabolic cart will measure the maximal oxygen consumption during the maximal exercise test	After completion of the 12 weeks intervention
Anxiety level	Anxiety level will be measured by HASD and General Anxiety Disorder-7.	After completion of the 12 weeks intervention
Severity of depression	PHQ-9 will be used to examine the severity of depression.	After completion of the 12 weeks intervention
Blood chemistry tests	biological markers related to depression and sleep will be measured by enzyme-linked immunosorbent assa	After completion of the 12 weeks intervention
Subjectively measured quality of life	Measured by the 12-item Short Form Survey, scores range from 0 to 100, higher scores indicating better physical and mental health functioning	After completion of the 12 weeks intervention
Enjoyment of exercise intervention	Physical activity enjoyment scale will be used to test the subject's perception of the exercise, higher scores reflect greater levels of enjoyment	After completion of the 12 weeks intervention
Attention level	Computer attention test in PsychoPy v2 software will be employed to measure the attention.	After completion of the 12 weeks intervention
Habitual physical activity	Habitual physical activity will be measured by IPAQ	After completion of the 12 weeks intervention

Collaborators and Investigators

• Sponsor: The University of Hong Kong

Publications and helpful links

General Publications

• Chin EC, Yu AP, Leung CK, Bernal JD, Au WW, Fong DY, Cheng CP, Siu PM. Effects of Exercise Frequency and Intensity on Reducing Depressive Symptoms in Older Adults With Insomnia: A Pilot Randomized Controlled Trial. Front Physiol. 2022 Apr 5;13:863457. doi: 10.3389/fphys.2022.863457. eCollection 2022.

Study record dates

Study Major Dates

• Study Start (Actual): January 31, 2019
• Primary Completion (Actual): September 30, 2021
• Study Completion (Actual): October 31, 2021

Study Registration Dates

• First Submitted: April 17, 2020
• First Submitted That Met QC Criteria: April 17, 2020
• First Posted (Actual): April 21, 2020

Study Record Updates

• Last Update Posted (Actual): February 1, 2022
• Last Update Submitted That Met QC Criteria: January 17, 2022
• Last Verified: July 1, 2021

More Information

Terms related to this study

• Keywords: Exercise; Insomnia; Mood
• Additional Relevant MeSH Terms: Behavioral Symptoms; Mental Disorders; Nervous System Diseases; Sleep Disorders, Intrinsic; Dyssomnias; Neurologic Manifestations; Depression; Sleep Wake Disorders; Sleep Initiation and Maintenance Disorders
• Other Study ID Numbers: DI

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No