IMPORTANCE Previous studies that have shown tai chi to improve sleep were mainly based on subjective assessments, which might have produced results confounded by self-reporting bias. OBJECTIVE To compare the effectiveness of tai chi for improving sleep in older adults with insomnia with conventional exercise and a passive control group using actigraphy-based objective measurements. DESIGN, SETTING, AND PARTICIPANTS This randomized, 3-arm, parallel group, assessor-masked clinical trial was conducted at a single research unit in Hong Kong between August 2014 and August 2018. Eligible participants, aged 60 years or older and with chronic insomnia, were randomly allocated into tai chi training, exercise, and control groups. INTERVENTIONS 12-week tai chi training, 12-week conventional exercise, and no intervention control. MAIN OUTCOMES AND MEASURES Primary outcomes were measures taken from actigraphy sleep assessment. Secondary outcomes included remission of insomnia, insomnia treatment response, Pittsburgh Sleep Quality Index score, Insomnia Severity Index score, and self-reported sleep using a 7-day sleep diary. Assessments were performed at baseline, end of the intervention (postintervention), and 24 months after the intervention (follow-up). Data analysis was performed from September 2018 to August 2020. RESULTS A total of 320 participants (mean [SD] age, 67.3 [6.8] years; mean [SD] insomnia duration, 124.4 [134.5] months; 256 [80.0%] women) were randomly allocated into control (110 participants), exercise (105 participants), and tai chi (105 participants) groups and included in the data analysis. Compared with the control group, the exercise and tai chi groups showed improved sleep efficiency

Background The relationship between the frequency of high-intensity interval training (HIIT) and the resultant adaptations is largely unclear. Purpose This study compared the effects of different frequencies of HIIT with those of moderate-intensity continuous training (MICT) on body composition in overweight or obese adults. Methods Fifty-six overweight or obese (body mass index = 26.4 ± 2.9) men between 18 and 30 yr old (age = 22.8 ± 3.1 yr) were randomly assigned to the following groups: no-intervention control (CON; n = 14), MICT performed thrice weekly (MICT×3/wk; n = 9), HIIT performed thrice weekly (HIIT×3/wk; n = 14), HIIT performed twice weekly (HIIT×2/wk; n = 10), and HIIT performed once weekly (HIIT×1/wk; n = 9). Each HIIT session consisted of 12 × 1-min bouts at 90% heart rate reserve, interspersed with 11 × 1-min bouts at 70% heart rate reserve. Aerobic capacity, body composition, resting heart rate, vascular function, insulin resistance, and biomarkers of metabolic syndrome risk factor were examined at baseline, after 4 wk, and after 8 wk of intervention. Results Aerobic capacity and percent fat-free mass significantly increased in all exercise groups compared with those in the CON group (CON vs all exercise groups, P < 0.05), whereas body fat mass and systolic blood pressure significantly decreased after 8 wk of intervention in all exercise groups compared with those in the CON group (CON vs all exercise groups, P < 0.05). Body fat mass significantly decreased after 4 wk in all HIIT groups compared with those in the CON group (CON vs all HIIT groups, P < 0.05) but not in the MICT×3/wk group. Conclusion These novel results demonstrated that performing HIIT once weekly, even with a lower weekly volume of exercise, improved cardiorespiratory fitness, body composition, and blood pressure in overweight/obese adults. Low-frequency HIIT might be a feasible and effective strategy for the prescription of an initial exercise program for inactive, overweight, or obese young men.

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ObjectiveTo assess the comparative effectiveness of exercise, antidepressants and their combination for alleviating depressive symptoms in adults with non-severe depression.DesignSystematic review and network meta-analysis.Data sourcesEmbase, MEDLINE, PsycINFO, Cochrane Library, Web of Science, Scopus and SportDiscus.Eligibility criteriaRandomised controlled trials (1990–present) that examined the effectiveness of an exercise, antidepressant or combination intervention against either treatment alone or a control/placebo condition in adults with non-severe depression.Study selection and analysisRisk of bias, indirectness and the overall confidence in the network were assessed by two independent investigators. A frequentist network meta-analysis was performed to examine postintervention differences in depressive symptom severity between groups. Intervention drop-out was assessed as a measure of treatment acceptability.ResultsTwenty-one randomised controlled trials (n=2551) with 25 comparisons were included in the network. There were no differences in treatment effectiveness among the three main interventions (exercise vs antidepressants: standardised mean differences, SMD, −0.12; 95% CI −0.33 to 0.10, combination versus exercise: SMD, 0.00; 95% CI −0.33 to 0.33, combination vs antidepressants: SMD, −0.12; 95% CI −0.40 to 0.16), although all treatments were more beneficial than controls. Exercise interventions had higher drop-out rates than antidepressant interventions (risk ratio 1.31; 95% CI 1.09 to 1.57). Heterogeneity in the network was moderate (τ2=0.03; I2=46%).ConclusionsThe results suggest no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with non-severe depression. These findings support the adoption of exercise as an alternative or adjuvant treatment for non-severe depression in adults.Systematic review registrationPROSPERO CRD4202122656.

Studies have shown that Tai Chi and conventional exercise can modify the brain through distinct mechanisms, resulting in different brain adaptations. Therefore, it is conceivable to speculate that these two exercise modalities may have different effects on improving cognitive function. This study was a parallel group, assessor-blinded, pilot randomized controlled trial comparing the effects of Tai Chi and conventional exercise on improving cognitive function in older persons with mild cognitive impairment (MCI). A total of 34 adults aged ≥ 50 years with MCI were randomized (1:1:1) to the Tai Chi group (TC, n = 10, 3 sessions of 60-min Yang-style Tai Chi training per week for 24 weeks), conventional exercise group (EX: n = 12, 3 sessions of 60-min fitness training per week for 24 weeks), or control group (CON: n = 12, no intervention). Global cognitive function assessed by the Hong Kong version of the Montreal Cognitive Assessment (MoCA-HK) and performance in various cognitive domains were examined at baseline, and 12 and 24 weeks of the intervention. Both exercise groups showed improved global cognitive function as measured by MoCA-HK compared with the control group after 12 and 24 weeks of the intervention, (all P < 0.001). Only TC achieved clinically relevant improvement on global cognitive function at week 12. Both exercise groups achieved clinically relevant improvements at the end of the interventions at week 24. Compared with EX, TC exhibited greater improvements on global cognitive function indicated by MoCA-HK after 12 weeks of the intervention (P < 0.001) and cognitive flexibility indicated by part B/A ratio score of the Trail Making Test throughout the study (all P < 0.05). Both interventions were equally effective in improving the other examined cognitive domains. Further studies are needed to substantiate the superior long-term benefits of Tai Chi on global cognitive function compared with conventional exercise, and dissect the underlying mechanisms of the two exercises on improving cognitive domains and the corresponding brain adaptations. Trial registration: This study was registered at clinicaltrials.gov (Trial registration number: NCT04248400; first registration date: 30/01/2020).

The optimal intensity of physical activity for alleviating depression in middle-aged and older adults remains unclear. The World Health Organization (WHO) physical activity guidelines recommend adults and older adults to accumulate at least 150-300 minutes of moderate or 75-150 minutes of vigorous aerobic-type physical activity weekly or an equivalent combination of both for health benefits including reduced risk of depression. This parallel, assessor-blinded, pilot randomized controlled trial preliminarily compared the effectiveness of the minimal volume of aerobic-type physical activity at different intensities as recommended by WHO (150 minutes of moderate walking exercise and 75 minutes of vigorous walking exercise weekly) on alleviating depression in middle-aged and older adults. Thirty-five participants were randomized to the control group (CON), moderate walking exercise group (MOD), or vigorous walking exercise group (VIG). The exercise frequency was three times a week and the intervention duration was 12 weeks. The primary outcome was the severity of depression assessed by Beck Depression Inventory. Secondary outcomes included severity of anxiety, sleep quality, quality of life, and cardiorespiratory fitness. Thirty participants completed the study (CON: n = 10, MOD: n = 10, VIG: n = 10). Participants in both MOD and VIG had significantly decreased depression severity after the intervention compared to CON (both p < 0.001). There was no significant difference between MOD and VIG (p = 0.92). Both MOD and VIG interventions also mitigated anxiety severity, improved quality of life and cardiorespiratory fitness. The minimum volume of walking exercise at either moderate or vigorous intensity was found to alleviate depression in middleaged and older adults.Trial registration: ClinicalTrials.gov identifier: NCT04403373. Highlights. The 12-week 150-minute moderate walking exercise and 75-minute vigorous walking exercise (the minimal weekly volumes of aerobic-type physical activity recommended by WHO guidelines) similarly reduced the severity of depression in middle-aged and older adults. . The 12-week walking exercise interventions significantly reduced anxiety severity concomitant with improved quality of life and cardiorespiratory fitness in middle-aged and older adults with depression.

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BackgroundThe effects of exercise frequency and intensity on alleviating depressive symptoms in older adults with insomnia are unclear.PurposeThe purpose of this study was to investigate the influence of different exercise frequencies and intensities on prescribed aerobic-type physical activity (i.e., 75 min of vigorous-intensity exercise or 150 min of moderate-intensity exercise weekly) for reducing depressive symptoms in older adults living with insomnia, as recommended by the WHO.DesignThis study is a randomized, controlled, assessor-blinded trial.SettingThis study is conducted at a single research site in Hong Kong.ParticipantsThis study includes older adults aged 50 years or above with depressive symptoms and insomnia.InterventionParticipants were randomly assigned in a 1:1:1:1:1 ratio to the following groups: attention control (CON), moderate walking once weekly (MOD × 1/week), moderate walking thrice weekly (MOD × 3/week), vigorous walking once weekly (VIG × 1/week), and vigorous walking thrice weekly (VIG × 3/week). The total weekly exercise volumes among the walking groups were matched to the minimum recommended physical activity volume.MeasurementsDepression, anxiety, self-perceived sleep quality, insomnia severity, actigraphy-assessed 7-day sleep data, 7-day sleep diary, cardiorespiratory fitness, adherence, and habitual physical activity were examined at baseline and after 12 weeks of intervention.ResultsBoth MOD × 3/week and VIG × 3/week groups demonstrated reduced depression (Hospital Anxiety and Depression Scale [HADS] – Depression: MOD × 3/wk: −68.6%; VIG × 3/week: −67.4%) and anxiety levels (HADS – Anxiety: MOD × 3/week: −54.3%; VIG × 3/week: −59.8%) compared with CON (both p &lt; 0.01). Self-perceived sleep quality was improved in MOD × 3/week (−31.4% of the Pittsburgh Sleep Quality Index [PSQI]), VIG × 1/week (−34.1% of PSQI), and VIG × 3/week (−38.3% of PSQI), but not in MOD × 1/week, when compared with CON (p &lt; 0.05). No serious adverse events were observed in this study.ConclusionThe effects of walking training on reducing depressive symptoms appeared to be dependent on exercise frequency. Our findings suggest that three sessions of walking per week at either moderate or vigorous-intensity effectively alleviate depressive symptoms in older adults with insomnia. Additional research is needed to further verify the effects of exercise frequency on depression.Clinical Trial Registration[ClinicalTrials.gov], identifier [NCT04354922].