Effects of a Blended Indoor and Outdoor Physical Exercise Program on Depressive Symptoms in Hong Kong Older Adults

NCT06190327 | Unknown

• 1 other identifier: 05200098
• Study Type: interventional
• Target: 144
• Locations: 1 country
• Sites: 1

Brief Summary

Depression is a mental health problem often occurring in the elderly. Performing physical exercise is a key element in decreasing depressive symptoms in older adults. Most studies investigating depression and physical exercise have focused on structured exercise comprise of one or two exercise components and based on the clinical patients associated with major depression. There is limited research combining multicomponent (aerobic+resistance+balance) in an exercise program and targeting non-clinical adults with depressive symptoms, with even less available for older adults. More attention has been paid to the role of outdoor exercise on human health. Exercise in a natural environment may provide greater physiological and psychological benefits compared to indoor exercise. Findings demonstrated that green exercise provides double the beneficial effect on improving depression among adults. Although green exercise shows effects on the improvement of depression, recently a review has indicated that structured exercise programs in older adults with depressive symptoms were mainly conducted in the indoor environment. Compared with outdoor exercise which is easily influenced by the weather and with low access of available facilities, indoor exercise is more comfortable, quiet, and convenient to operate especially for older adults. Considering the high relevance between nature and mental health, the combination of indoor and outdoor exercise programs might be able to maximize intervention effectiveness while maintaining the benefits for each type of intervention.Therefore, more rigorous RCT studies in this field are needed, particularly for non-clinical older adults with depressive symptoms.

Conditions

Depressive Symptoms

Keywords

depressive symptoms; older adults; multicomponent structured exercise; blended indoor and outdoor environment; indoor exercise; connectedness to nature

Outcome Measures

Primary Outcomes (2)

• Self-reported depressive symptoms

  The Chinese version of the 15-item Geriatric Depression Scale (GDS-C) will be used to measure the subjective depression level. The GDS are the most widely used scales for the detection of depression symptoms in older adults (Cronbach's α = .81 -.83).

  Outcome evaluations will be performed three times at pre-intervention (T1 baseline), after 16-weeks intervention (T2 post-test), and 3 months after intervention completion (T3 follow-up test).

• Concentration of saliva cortisol

  Objective biomarker of depression will be measured in salivary cortisol. All participants will be provided with three salivette tubes and be asked to collect the saliva samples (2-3 ml) at awakening and 30 mins after awakening, respectively. All saliva samples for all subjects will be collected at the same time of day and samples will not be taken on days in which participants are sick with a fever. The salivette tubes will be stored in the freezer zone until to be tested. ELISA KIT protocol will be used to be followed to collect and analyze the samples in each assessment.

  Evaluations of concentration of saliva cortisol will be performed three times at pre-intervention (T1 baseline), after 16-weeks intervention (T2 post-test), and 3 months after intervention completion (T3 follow-up test).

Secondary Outcomes (4)

• Physical fitness

  Outcome evaluations will be performed three times at pre-intervention (T1 baseline), after 16-weeks intervention (T2 post-test), and 3 months after intervention completion (T3 follow-up test).

• Loneliness

  Evaluations of concentration of saliva cortisol will be performed three times at pre-intervention (T1 baseline), after 16-weeks intervention (T2 post-test), and 3 months after intervention completion (T3 follow-up test).

• Physical activity enjoyment

  Evaluations of concentration of saliva cortisol will be performed three times at pre-intervention (T1 baseline), after 16-weeks intervention (T2 post-test), and 3 months after intervention completion (T3 follow-up test).

• Connectedness to nature

  Evaluations of concentration of saliva cortisol will be performed three times at pre-intervention (T1 baseline), after 16-weeks intervention (T2 post-test), and 3 months after intervention completion (T3 follow-up test).

Other Outcomes (2)

• Self-reported Rate of Perceived Exertion (RPE)

  RPE will be asked at the end of main exercise at each exercise session during the 16-weeks intervention.

• Process evaluation of intervention program

  Outcome evaluations will be conducted at the completion of 16-weeks intervention.

Study Arms (3)

blended indoor and outdoor multicomponent structured exercise group

EXPERIMENTAL

Participants will receive a 16-week blended indoor and outdoor multicomponent structured exercise program, with 2 sessions per week (90 mins/session).

Behavioral: Blended indoor and outdoor multicomponent structured exercise

indoor-only multicomponent structured exercise group

ACTIVE COMPARATOR

Participants will receive a 16-week indoor-only multicomponent structured exercise program, with 2 sessions per week (90 mins/session).

Behavioral: Indoor-only multicomponent structured exercise

control group

NO INTERVENTION

The control group will not receive any intervention during the whole project.

Interventions

Blended indoor and outdoor multicomponent structured exercise BEHAVIORAL

Participants will receive a 16-week blended indoor and outdoor multicomponent structured exercise program, with 2 sessions per week (90 mins/session). Session 1/week will conduct in indoor setting, while session 2/week will conducted in outdoor setting (park). Each session will comprise 10-min warm-up, 30-min aerobic training, 20-min muscle strength, 20-min postural balance training, and 10-min cool-down.

blended indoor and outdoor multicomponent structured exercise group

Indoor-only multicomponent structured exercise BEHAVIORAL

Participants will receive a 16-week indoor-only multicomponent structured exercise program, with 2 sessions per week (90 mins/session). Both two sessions will conducted in indoor setting. Each session will comprise 10-min warm-up, 30-min aerobic training, 20-min muscle strength, 20-min postural balance training, and 10-min cool-down.

indoor-only multicomponent structured exercise group

Eligibility Criteria

• Age: 60 Years - 74 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• to 74 years at the start date of the project.
• Chinese version of Geriatric Depression Scale (GDS-C) scoring 5-15 (i.e., mild to serve level of depressive symptoms).
• Passing the PAR-Q plus screening or with the physician's approval for readiness to participate in high-intensity exercise.

You may not qualify if:

• Having cognition impairment regarded by specialists.
• are attending other health projects related to physical exercise.

Sponsors & Collaborators

• Hong Kong Baptist University: lead

Study Sites (1)

Bliss District Elderly Community Centre

Kowloon Bay, Hong Kong

RECRUITING

Related Publications (14)

• Wei J, Hou R, Zhang X, Xu H, Xie L, Chandrasekar EK, Ying M, Goodman M. The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis. Br J Psychiatry. 2019 Aug;215(2):449-455. doi: 10.1192/bjp.2019.74. Epub 2019 Apr 10.

  PMID: 30968781 BACKGROUND

• Cheung KCK, Chou KL. Poverty, deprivation, and depressive symptoms among older adults in Hong Kong. Aging Ment Health. 2019 Jan;23(1):22-29. doi: 10.1080/13607863.2017.1394438. Epub 2017 Oct 31.

  PMID: 29086588 BACKGROUND

• Zhao SZ, Wong JYH, Luk TT, Wai AKC, Lam TH, Wang MP. Mental health crisis under COVID-19 pandemic in Hong Kong, China. Int J Infect Dis. 2020 Nov;100:431-433. doi: 10.1016/j.ijid.2020.09.030. Epub 2020 Sep 16.

  PMID: 32947051 BACKGROUND

• Teychenne M, Ball K, Salmon J. Sedentary behavior and depression among adults: a review. Int J Behav Med. 2010 Dec;17(4):246-54. doi: 10.1007/s12529-010-9075-z.

  PMID: 20174982 BACKGROUND

• Catalan-Matamoros D, Gomez-Conesa A, Stubbs B, Vancampfort D. Exercise improves depressive symptoms in older adults: An umbrella review of systematic reviews and meta-analyses. Psychiatry Res. 2016 Oct 30;244:202-9. doi: 10.1016/j.psychres.2016.07.028. Epub 2016 Jul 22.

  PMID: 27494042 BACKGROUND

• Eigenschenk B, Thomann A, McClure M, Davies L, Gregory M, Dettweiler U, Ingles E. Benefits of Outdoor Sports for Society. A Systematic Literature Review and Reflections on Evidence. Int J Environ Res Public Health. 2019 Mar 15;16(6):937. doi: 10.3390/ijerph16060937.

  PMID: 30875938 BACKGROUND

• Askari J, Saberi-Kakhki A, Yassini SM. The Effect of Aerobic Indoor Exercise Compared with Green Exercise on Different Symptoms of Depression: An Investigation of Psychological Mediators of Stress and Coping. Open Journal of Medical Psychology. 2017 Jul 3;6(03):197.

  BACKGROUND

• Li N, Wu J. Revise of the Connectedness to Nature Scale and its Reliability and Validity. China Journal of Health Psychology. 2016 Mar 22;24(9):1347-50.

  BACKGROUND

• Loureiro A, Veloso TJ. Outdoor exercise, well-being and connectedness to nature. Psico. 2014 Mar;45(3):299-304.

  BACKGROUND

• Cheng ST, Chan AC. A brief version of the geriatric depression scale for the chinese. Psychol Assess. 2004 Jun;16(2):182-6. doi: 10.1037/1040-3590.16.2.182.

  PMID: 15222814 BACKGROUND

• Chiu HF, Lee H, Chung W, Kwong P. Reliability and validity of the Cantonese version of mini-mental state examination-a preliminary study. Hong Kong Journal of Psychiatry. 1994;4(2):25.

  BACKGROUND

• Chung PK, Zhao YN, Quach, B, Liu JD. The Use of the Cantonese Rating of Perceived Exertion Scale in Older People. Proceedings of the 12th SCSEPF Annual Conference. 2013.

  BACKGROUND

• Chung PK, Leung KM. Psychometric Properties of Eight-Item Physical Activity Enjoyment Scale in a Chinese Population. J Aging Phys Act. 2018 Oct 12:1-6. doi: 10.1123/japa.2017-0212. Online ahead of print.

  PMID: 29722637 BACKGROUND

• Cheng S, Duan Y, Lau WB, Liang W, Chan NJ, Young KD, Baker JS, Lau TJ. Effect of a blended indoor and outdoor multicomponent structured exercise on depressive symptoms in Hong Kong older adults: study protocol of a randomized controlled trial. BMC Public Health. 2025 Nov 14;25(1):3949. doi: 10.1186/s12889-025-25244-0.

  PMID: 41239372 DERIVED

MeSH Terms

Conditions

Depression

Condition Hierarchy (Ancestors)

Behavioral Symptoms; Behavior

Study Officials

• Yanping Duan, P.hD

  Hong Kong Baptist Univeristy; Department of Sport, Physical Education and Health

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Yanping Duan, P.hD

CONTACT

34115638; duanyp@hkbu.edu.hk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This study follows a randomized controlled experimental design (RCT), parallel type with three groups and being assessed in a pretest, posttest, and after three months of the completion of the intervention. The participants will be randomly allocated to two experimental group, and one non-exercise control group. The non-exercise control group continue to maintain their daily routine and keep diaries to record . To monitor the control condition, participants will need to keep diaries to record their daily physical exercise, medicines used, illness and participation in other health-related activities. The research assistant will give telephone calls to the participants biweekly to check their diaries and identify if they change their lifestyles or experience adverse events. Two exercise groups, one group will perform multicomponent structured exercise in blended indoor and outdoor setting, the other group will conduct the same exercise only in indoor setting.

Study Record Dates

• First Submitted: December 19, 2023
• First Posted: January 5, 2024
• Study Start: April 1, 2023
• Primary Completion: July 1, 2024
• Study Completion: November 3, 2024
• Last Updated: January 5, 2024

Record last verified: 2023-12

Data Sharing

• IPD Sharing: Will not share

Locations

HK (1)