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Depression is a common mental health issue in older adults, often manifesting as insomnia, low mood, vague somatic complaints, cognitive decline, and recurrent thoughts of death or suicide. Even subthreshold depressive symptoms in late life significantly impair quality of life. In Hong Kong, recent data show high prevalence of depressive symptoms among community-dwelling older adults (43.7% in men, 54.8% in women), underscoring the urgent public health and economic need for effective interventions.
Although the previous evidence has shown that BDJ and GT consumption can improve depressive symptoms, gut microbiota, and QoL respectively, the feasibility and effect of the combination of two intervention approaches in older adults remain unclear. Therefore, the proposed study aims to (1) determine the feasibility of a 12-week blended BDJ and GT consumption program among Hong Kong community-dwelling older adults with depressive symptoms in a small-scale sample, and (2) examine the effects of the blended BDJ and GT consumption program on their depressive symptoms, gut-microbiota and QoL compared with that in the active control group.
This study will be a single-blind 2-group RCT to examine the feasibility and the effects (immediate effects and 3-month residual effects) of the 12-week blended BDJ and GT consumption program on depressive symptoms, gut-microbiota and QoL among older adults with depressive symptoms. The target population will be Hong Kong community-dwelling older adults with depressive symptoms. Participants will be randomly assigned into one of two groups: a blended BDJ and GT consumption group and a control group. Evaluation will be conducted at pre-intervention (T1), post-intervention (T2), and 3-month after intervention completion (T3). Outcome assessors will be blinded from the assignment results to the intervention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| blended Baduanjin and Green Tea consumption program | Experimental | Participants, will receive the 12-week blended Baduanjin (60 mins/session) and Green Tea consumption (2 cups per day for 5 weeks) program |
|
| Non-treatment control | Placebo Comparator | Participants will receive biweekly telephone calls within 12 weeks.Each call will last about 5 minutes. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| blended Baduanjin and Green Tea consumption program | Behavioral | The participants will be invited to attend both BDJ exercise and GT consumption interventions for 12 weeks. The exercise instructor will provide group teaching with individual instructions on specific movements. Participants will also adopt a dose of 3g tea with 200ml water, 2 cups daily. The tea consumption will last 12 weeks in this project to keep the same intervention duration as BDJ group. |
| Measure | Description | Time Frame |
|---|---|---|
| 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 12-weeks intervention (T2 post-intervention), and 3 months after intervention completion (T3 follow-up test). |
| Measure | Description | Time Frame |
|---|---|---|
| Gut-microbiota | Total genomic DNA will be extracted from stool samples using NEBnext microbiome DNA enrichment kit (New England Biolabs, Ipswich, MA, US) following the manufacturer's instructions. Gut microbiome will be an be analysed by 16S rRNA gene amplicon sequencing for the V3-V4 region (OmicLab Limited, Hong Kong). The amplified products will be sequenced on the Illumina NovaSeq platform and analysed using QIIME1 software. Several microbiome compositional and functional indicators will be measured, e.g., total gene counts, relative abundance of predominant bacterial groups, alpha and beta diversity, and functional annotations of the gut microbiota (Hu et al., 2023; Wang et al., 2023). DNA extraction, 16S rRNA sequencing and analyses will be performed by OmicLab Limited, Hong Kong. |
| Measure | Description | Time Frame |
|---|---|---|
| Retention rate | Percentage of participants completing assessments at the pre-intervention test, post-intervention test, and follow-up test. Criterion: at least 75% of participants completed data collection. | Data collection will be performed three times at pre-intervention (T1 baseline), after 12-week intervention (T2 post-test), and 3 months after intervention completion (T3 follow-up test). |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yanping Duan | Contact | 34115638 | duanyp@hkbu.edu.hk | |
| Yanping Duan | Contact |
| Name | Affiliation | Role |
|---|---|---|
| Yanping Duan | Hong Kong Baptist University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bliss District Elderly Community Centre | Recruiting | Kwun Tong | Hong Kong |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31295859 | Background | Zhao CN, Tang GY, Cao SY, Xu XY, Gan RY, Liu Q, Mao QQ, Shang A, Li HB. Phenolic Profiles and Antioxidant Activities of 30 Tea Infusions from Green, Black, Oolong, White, Yellow and Dark Teas. Antioxidants (Basel). 2019 Jul 10;8(7):215. doi: 10.3390/antiox8070215. | |
| 37960167 | Background | Wan Z, Qin X, Tian Y, Ouyang F, Wang G, Wan Q. Long-Term Consumption of Green Tea Can Reduce the Degree of Depression in Postmenopausal Women by Increasing Estradiol. Nutrients. 2023 Oct 25;15(21):4514. doi: 10.3390/nu15214514. |
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It's a single-blinded randomized controlled trial study. A total of 48 community-dwelling older adults (aged 65-84 years) with depressive symptoms will be randomly assigned to a blended intervention group or an active control group. The blended intervention group will receive a 12-week program, including Baduanjin exercise (2 sessions/week, 60 min/session) and green tea consumption (3g tea bag with 2cups daily). The active control group will receive biweekly telephone calls in 12 weeks to answer questions about their physical exercise and tea consumption behaviors.
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|
| Non-treatment control | Behavioral | Participants will receive biweekly telephone calls within 12 weeks.Each call will last about 5 minutes.The participants will be asked several questions about their physical exercise and tea consumption behaviors. |
|
| Evaluations of stool test will be performed three times at pre-intervention (T1), the 12-week (3-month) post-intervention (T2), and the 3-month follow-up (T3) occasions. |
| Perceived quality of life | The quality of life will be assessed using the brief version of the Hong Kong Chinese WHO Quality of Life Scale (WHOQOL-BREF) (Cronbach's α = .73 - .84). The scale includes 28 items, covering four dimensions of how older adults perceive their quality of life. The total score of the questionnaire ranges from 28 to 140, and a higher score indicates that the individual feels they have a high quality of life. | Outcome evaluations will be performed three times at pre-intervention (T1 baseline), after 12-week intervention (T2 post-test), and 3 months after intervention completion (T3 follow-up test) |
| Session attendance rate | Participants completed at least 83% of intervention sessions for BDJ (20 out of 24 sessions) and GT consumption (140 out of 168 cups) | Session attendance will be recorded during the 12-week intervention |
| 38069198 | Background | Souza PB, de Araujo Borba L, Castro de Jesus L, Valverde AP, Gil-Mohapel J, Rodrigues ALS. Major Depressive Disorder and Gut Microbiota: Role of Physical Exercise. Int J Mol Sci. 2023 Nov 28;24(23):16870. doi: 10.3390/ijms242316870. |
| 28448076 | Background | Pan CW, Ma Q, Sun HP, Xu Y, Luo N, Wang P. Tea Consumption and Health-Related Quality of Life in Older Adults. J Nutr Health Aging. 2017;21(5):480-486. doi: 10.1007/s12603-016-0784-0. |
| 36423358 | Background | Luo X, Zhao M, Zhang Y, Zhang Y. Effects of baduanjin exercise on blood glucose, depression and anxiety among patients with type II diabetes and emotional disorders: A meta-analysis. Complement Ther Clin Pract. 2023 Feb;50:101702. doi: 10.1016/j.ctcp.2022.101702. Epub 2022 Nov 8. |
| Background | Leung, K., Tay, M., Cheng, S., & Lin, F. (1997). Hong Kong Chinese version World Health Organization Quality of Life Measure-Abbreviated Version WHOQoL-BREF (HK). Hong Kong: Hong Kong Hospital Authority. |
| 27491067 | Background | Kelly JR, Borre Y, O' Brien C, Patterson E, El Aidy S, Deane J, Kennedy PJ, Beers S, Scott K, Moloney G, Hoban AE, Scott L, Fitzgerald P, Ross P, Stanton C, Clarke G, Cryan JF, Dinan TG. Transferring the blues: Depression-associated gut microbiota induces neurobehavioural changes in the rat. J Psychiatr Res. 2016 Nov;82:109-18. doi: 10.1016/j.jpsychires.2016.07.019. Epub 2016 Jul 25. |
| 35844786 | Background | Jin Y, Sun HL, Lam SC, Su Z, Hall BJ, Cheung T, Qin MZ, Ng CH, Xiang YT; International Research Collaboration on COVID-19. Depressive symptoms and gender differences in older adults in Hong Kong during the COVID-19 pandemic: a network analysis approach. Int J Biol Sci. 2022 Jun 6;18(10):3934-3941. doi: 10.7150/ijbs.69460. eCollection 2022. |
| 36388277 | Background | Jin X, Yang S, Lu J, Li Y, Zhao Y, Li D, Wang X, Liu L, Wu M. Exploring the therapeutic mechanism of Baduanjin in the treatment of elderly stable angina pectoris based on the gut microbiota-lipid metabolism spectrum: Study protocol for a randomized controlled trial. Front Public Health. 2022 Oct 31;10:1027839. doi: 10.3389/fpubh.2022.1027839. eCollection 2022. |
| 37692389 | Background | Jia W, Tang Q, Zou Y, Yang Y, Wu W, Xu W. Investigating the antidepressant effect of Ziyan green tea on chronic unpredictable mild stress mice through fecal metabolomics. Front Microbiol. 2023 Aug 24;14:1256142. doi: 10.3389/fmicb.2023.1256142. eCollection 2023. |
| 32066686 | Background | Huang Y, Li L, Gan Y, Wang C, Jiang H, Cao S, Lu Z. Sedentary behaviors and risk of depression: a meta-analysis of prospective studies. Transl Psychiatry. 2020 Jan 22;10(1):26. doi: 10.1038/s41398-020-0715-z. |
| 37577447 | Background | Hu L, Ni Z, Zhao K, Li X, Gao X, Kang Y, Yu Z, Qin Y, Zhao J, Peng W, Lu L, Sun H. The association between oral and gut microbiota in male patients with alcohol dependence. Front Microbiol. 2023 Jul 28;14:1203678. doi: 10.3389/fmicb.2023.1203678. eCollection 2023. |
| 30642326 | Background | Lopez-Torres Hidalgo J; DEP-EXERCISE Group. Effectiveness of physical exercise in the treatment of depression in older adults as an alternative to antidepressant drugs in primary care. BMC Psychiatry. 2019 Jan 14;19(1):21. doi: 10.1186/s12888-018-1982-6. |
| Background | Dou, W., Su, S., Zhao, Y., Guo, X., Zhang, Z., Yao, J., & Wang, S. (2020). Effect of Baduanjin on the balancing ability and intestinal flora for older adults. China Preventive Medicine Journal, 32(4), 425-428. |
| 35272982 | Background | Cheung DST, Chau PH, Lam TC, Ng AYM, Kwok TWH, Takemura N, Woo J, Yu DS, Lin CC. A pilot randomized controlled trial using Baduanjin qigong to reverse frailty status among post-treatment older cancer survivors. J Geriatr Oncol. 2022 Jun;13(5):682-690. doi: 10.1016/j.jgo.2022.02.014. Epub 2022 Mar 7. |
| 34328049 | Background | Bigarella LG, Ballotin VR, Mazurkiewicz LF, Ballardin AC, Rech DL, Bigarella RL, Selistre LDS. Exercise for depression and depressive symptoms in older adults: an umbrella review of systematic reviews and Meta-analyses. Aging Ment Health. 2022 Aug;26(8):1503-1513. doi: 10.1080/13607863.2021.1951660. Epub 2021 Jul 30. |
| 36117757 | Background | Manshadi Seyed Ali D, Seyed Alireza M, Mohammad Reza S, Jayran Z, SeyedAhmad S, Shams Ali R, Seyed Saeid M, Ali AA. Effect of green tea consumption in treatment of mild to moderate depression in Iranian patients living with HIV: A double-blind randomized clinical trial. Chin Herb Med. 2020 Nov 26;13(1):136-141. doi: 10.1016/j.chmed.2020.08.002. eCollection 2021 Jan. |
| ID | Term |
|---|---|
| D003863 | Depression |
| ID | Term |
|---|---|
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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