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Zero-time Exercise for Depression

Study Description
Brief Summary:
This study will examine the feasibility and effectiveness of a new lifestyle-integrated exercise, viz. Zero-time Exercise (ZTEx), for the management of depressive symptoms in Chinese adults in Hong Kong. ZTEx refers to the integration of simple strength- and stamina-enhancing physical activity into daily life, which can be done anytime, anywhere and by anyone. Depression is often accompanied by a tendency to sedentary behaviours and sleep disturbances, and sedentary lifestyles is associated with depression. The conventional psychological treatment approach for depression, viz. Cognitive Behavioural Therapy (CBT), emphasises the relationship between activity and mood. One of the treatment components in CBT for depression, viz. Behavioural Activation (BA), aims to promote activity engagement that are reinforcing and consistent with the long-term goals in reducing sedentary behaviour and increasing physical activity. The simple and brief ZTEx uses a foot-in-the-door approach to initiate simple behaviour change as an entry-level step for facilitating BA for participants with depression. A pilot randomized controlled trial (RCT) has shown some evidence on the effectiveness of ZTEx on improving insomnia. However, investigators have found no RCT on the effectiveness of ZTEx for the management of depressive symptoms.

Condition or disease Intervention/treatment Phase
Depression Behavioral: Zero-time Exercise Not Applicable

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 14 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Zero-time Exercise for Depression: A Pilot Randomised Controlled Trial
Actual Study Start Date : May 1, 2019
Actual Primary Completion Date : July 31, 2019
Actual Study Completion Date : August 31, 2019
Arms and Interventions
Arm Intervention/treatment
Experimental: Treatment group
Zero-time Exercise group
Behavioral: Zero-time Exercise
A 2-hour group ZTEx training once per week for 2 consecutive weeks (totally 4 hours)

No Intervention: Waitlist group
Outcome Measures
Primary Outcome Measures :
  1. Change in the Patient Health Questionnaire (PHQ-9) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    The PHQ-9, a 20-item questionnaire used for screening, diagnosing, monitoring and measuring the severity of depression, which scores each of the nine DSM-IV criteria as "0" (not at all) to "3" (nearly every day). PHQ-9 scores of 5, 10, 15, and 20 represents mild, moderate, moderately severe and severe depression


Secondary Outcome Measures :
  1. Change in Hospital Anxiety and Depression Scale (HADS) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A 14-item self-rating scale that measures anxiety and depression in both hospital and community settings. It is divided into an Anxiety subscale (HADS-A) and a Depression subscale (HADS-D) both containing seven intermingled items. It is for screening purpose and not meant to be a diagnostic tool. HADS scores of 8-10, 11-14, and 15-21 represent mild, moderate, and severe anxiety and depression separately

  2. Change in Insomnia Severity Index (ISI) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A 7-item scale designed to evaluate perceived insomnia severity. Ratings on the 5-point Likert scale are obtained on the perceived severity of sleep-onset, sleep-maintenance, early morning awakening problems, satisfaction with current sleep pattern, interference with daily functioning, noticeably of impairment attributed to the sleep problem, and level of distress caused by the sleep problem. Total score categories: 0-7 is no clinically significant insomnia, 8-14 is subthreshold insomnia,15-21 is clinical insomnia (moderate severity), and 22-28 is clinical insomnia (severe)

  3. Change in Multidimensional Fatigue Inventory (MFI) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A 20-item self-report instrument designed to measure fatigue. Ratings on a 5-point Likert scale are obtained on the dimensions of general fatigue, physical fatigue, mental fatigue, reduced motivation and reduced activity. Scores on each subscale range from 4 to 20, with higher scores indicating greater fatigue

  4. Change in International Physical Activities Questionnaire - Chinese version (IPAQ-C) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    IPAQ-C is a short form questionnaire assessing walking, moderate-intensity activities and vigorous-intensity activities undertaken across 4 domains - leisure time physical activity, domestic and gardening (yard) activities, work-related physical activity and transport-related physical activity. Both continuous and categorical scores can be represented. For continuous scoring, the items provide separate scores on the three specific types of activities. Computation of the total score requires summation of the duration (in minutes) and frequency (days) of the three specific type of activities. Median minutes/week or median MET-minutes/week is derived for each type of activity - Walking = 3.3 METs, Moderate PA = 4.0 METs and Vigorous PA = 8.0 METs. For categorical scoring, category 1 represents the lowest level of physical activity, category 2 represents moderate level of physical activity, and category 3 represents the highest level of physical activity.

  5. Change in Short Form (Six-Dimension) Health Survey - The Chinese (Hong Kong) Version (SF-6D) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A preference-based single index measure of health. A six-digit number represents each SF-6D health state, each digit denotes the level of one of six SF-6D dimensions: physical functioning, role limitation, social functioning, bodily pain, mental health, and vitality. The SF-6D index, scored from 0.0 (worst health state) to 1.0 (best health state)

  6. Change in Sheehan Disability Scale (SDS) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A 5-item self-report tool for assessing functional impairment in work/school, social life, and family life. Representation of scores in terms of functional impairment: 0: not at all, 1-3: mildly, 4-6: moderately, 7-9: markedly, 10: extremely

  7. Change in Ecological momentary assessment (EMA) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A smartphone application will be developed and installed in the participant's smartphones for recording the participants' momentary mood, daytime insomnia symptoms as well as activities.


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Hong Kong residents aged 18-65 years
  • Cantonese language fluency
  • Patient Health Questionnaire (PHQ-9) score ≥ 10 and ≤ 14; and
  • Willingness to provide informed consent and comply with the trial protocol.

Exclusion Criteria:

  • Pregnancy;
  • Have high levels of suicidal ideation (referral information to professional services will be provided);
  • Unstable psychotropic drugs within 2 weeks before study entry and throughout the treatment phase;
  • Current involvement in psychotherapy for depression;
  • Having unsafe conditions and are not recommended for exercising by physicians; and
  • Major psychiatric, medical or neurocognitive disorders that would make participation infeasible or interfere with the adherence to physical exercising.
Contacts and Locations

Locations
Layout table for location information
Hong Kong
The Chinese University of Hong Kong
Sha Tin, Hong Kong
Sponsors and Collaborators
Chinese University of Hong Kong
Tracking Information
First Submitted Date  ICMJE January 18, 2019
First Posted Date  ICMJE January 22, 2019
Last Update Posted Date March 11, 2020
Actual Study Start Date  ICMJE May 1, 2019
Actual Primary Completion Date July 31, 2019   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: January 19, 2019)
Change in the Patient Health Questionnaire (PHQ-9) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
The PHQ-9, a 20-item questionnaire used for screening, diagnosing, monitoring and measuring the severity of depression, which scores each of the nine DSM-IV criteria as "0" (not at all) to "3" (nearly every day). PHQ-9 scores of 5, 10, 15, and 20 represents mild, moderate, moderately severe and severe depression
Original Primary Outcome Measures  ICMJE
 (submitted: January 18, 2019)
Change in the Patient Health Questionnaire (PHQ-9) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
The PHQ-9, a 20-item questionnaire used for screening, diagnosing, monitoring and measuring the severity of depression, which scores each of the nine DSM-IV criteria as "0" (not at all) to "3" (nearly every day).
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: January 19, 2019)
  • Change in Hospital Anxiety and Depression Scale (HADS) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A 14-item self-rating scale that measures anxiety and depression in both hospital and community settings. It is divided into an Anxiety subscale (HADS-A) and a Depression subscale (HADS-D) both containing seven intermingled items. It is for screening purpose and not meant to be a diagnostic tool. HADS scores of 8-10, 11-14, and 15-21 represent mild, moderate, and severe anxiety and depression separately
  • Change in Insomnia Severity Index (ISI) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A 7-item scale designed to evaluate perceived insomnia severity. Ratings on the 5-point Likert scale are obtained on the perceived severity of sleep-onset, sleep-maintenance, early morning awakening problems, satisfaction with current sleep pattern, interference with daily functioning, noticeably of impairment attributed to the sleep problem, and level of distress caused by the sleep problem. Total score categories: 0-7 is no clinically significant insomnia, 8-14 is subthreshold insomnia,15-21 is clinical insomnia (moderate severity), and 22-28 is clinical insomnia (severe)
  • Change in Multidimensional Fatigue Inventory (MFI) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A 20-item self-report instrument designed to measure fatigue. Ratings on a 5-point Likert scale are obtained on the dimensions of general fatigue, physical fatigue, mental fatigue, reduced motivation and reduced activity. Scores on each subscale range from 4 to 20, with higher scores indicating greater fatigue
  • Change in International Physical Activities Questionnaire - Chinese version (IPAQ-C) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    IPAQ-C is a short form questionnaire assessing walking, moderate-intensity activities and vigorous-intensity activities undertaken across 4 domains - leisure time physical activity, domestic and gardening (yard) activities, work-related physical activity and transport-related physical activity. Both continuous and categorical scores can be represented. For continuous scoring, the items provide separate scores on the three specific types of activities. Computation of the total score requires summation of the duration (in minutes) and frequency (days) of the three specific type of activities. Median minutes/week or median MET-minutes/week is derived for each type of activity - Walking = 3.3 METs, Moderate PA = 4.0 METs and Vigorous PA = 8.0 METs. For categorical scoring, category 1 represents the lowest level of physical activity, category 2 represents moderate level of physical activity, and category 3 represents the highest level of physical activity.
  • Change in Short Form (Six-Dimension) Health Survey - The Chinese (Hong Kong) Version (SF-6D) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A preference-based single index measure of health. A six-digit number represents each SF-6D health state, each digit denotes the level of one of six SF-6D dimensions: physical functioning, role limitation, social functioning, bodily pain, mental health, and vitality. The SF-6D index, scored from 0.0 (worst health state) to 1.0 (best health state)
  • Change in Sheehan Disability Scale (SDS) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A 5-item self-report tool for assessing functional impairment in work/school, social life, and family life. Representation of scores in terms of functional impairment: 0: not at all, 1-3: mildly, 4-6: moderately, 7-9: markedly, 10: extremely
  • Change in Ecological momentary assessment (EMA) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A smartphone application will be developed and installed in the participant's smartphones for recording the participants' momentary mood, daytime insomnia symptoms as well as activities.
Original Secondary Outcome Measures  ICMJE
 (submitted: January 18, 2019)
  • Change in Hospital Anxiety and Depression Scale (HADS) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    HADS is a 14-item self-rating scale that measures anxiety and depression in both hospital and community settings. It is divided into an Anxiety subscale (HADS-A) and a Depression subscale (HADS-D) both containing seven intermingled items. It is for screening purpose and not meant to be a diagnostic tool.
  • Change in Insomnia Severity Index (ISI) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    ISI is a 7-item scale designed to evaluate perceived insomnia severity. Ratings on the 5-point Likert scale are obtained on the perceived severity of sleep-onset, sleep-maintenance, early morning awakening problems, satisfaction with current sleep pattern, interference with daily functioning, noticeably of impairment attributed to the sleep problem, and level of distress caused by the sleep problem.
  • Change in Multidimensional Fatigue Inventory (MFI) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    MFI is a 20-item self-report instrument designed to measure fatigue. Ratings on a 5-point Likert scale are obtained on the dimensions of general fatigue, physical fatigue, mental fatigue, reduced motivation and reduced activity.
  • Change in International Physical Activities Questionnaire - Chinese version (IPAQ-C) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    Participants' sitting time, walking time and moderate and vigorous physical activity are assessed by 5 questions from a short form of the International Physical Activity Questionnaire - Chinese version a short form of the IPAQ-C.
  • Change in Short Form (Six-Dimension) Health Survey - The Chinese (Hong Kong) Version (SF-6D) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    The SF-6D is a preference-based single index measure of health. A six-digit number represents each SF-6D health state, each digit denotes the level of one of six SF-6D dimensions: physical functioning, role limitation, social functioning, bodily pain, mental health, and vitality.
  • Change in Sheehan Disability Scale (SDS) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    SDS is a brief, 5-item self-report tool that assesses functional impairment in work/school, social life, and family life.
  • Change in Ecological momentary assessment (EMA) [ Time Frame: Baseline, 1-week post-treatment and 4-week post treatment ]
    A smartphone application will be developed and installed in the participant's smartphones for recording the participants' momentary mood, daytime insomnia symptoms as well as activities.
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Zero-time Exercise for Depression
Official Title  ICMJE Zero-time Exercise for Depression: A Pilot Randomised Controlled Trial
Brief Summary This study will examine the feasibility and effectiveness of a new lifestyle-integrated exercise, viz. Zero-time Exercise (ZTEx), for the management of depressive symptoms in Chinese adults in Hong Kong. ZTEx refers to the integration of simple strength- and stamina-enhancing physical activity into daily life, which can be done anytime, anywhere and by anyone. Depression is often accompanied by a tendency to sedentary behaviours and sleep disturbances, and sedentary lifestyles is associated with depression. The conventional psychological treatment approach for depression, viz. Cognitive Behavioural Therapy (CBT), emphasises the relationship between activity and mood. One of the treatment components in CBT for depression, viz. Behavioural Activation (BA), aims to promote activity engagement that are reinforcing and consistent with the long-term goals in reducing sedentary behaviour and increasing physical activity. The simple and brief ZTEx uses a foot-in-the-door approach to initiate simple behaviour change as an entry-level step for facilitating BA for participants with depression. A pilot randomized controlled trial (RCT) has shown some evidence on the effectiveness of ZTEx on improving insomnia. However, investigators have found no RCT on the effectiveness of ZTEx for the management of depressive symptoms.
Detailed Description Not Provided
Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Condition  ICMJE Depression
Intervention  ICMJE Behavioral: Zero-time Exercise
A 2-hour group ZTEx training once per week for 2 consecutive weeks (totally 4 hours)
Study Arms  ICMJE
  • Experimental: Treatment group
    Zero-time Exercise group
    Intervention: Behavioral: Zero-time Exercise
  • No Intervention: Waitlist group
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: March 9, 2020)
14
Original Estimated Enrollment  ICMJE
 (submitted: January 18, 2019)
40
Actual Study Completion Date  ICMJE August 31, 2019
Actual Primary Completion Date July 31, 2019   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Hong Kong residents aged 18-65 years
  • Cantonese language fluency
  • Patient Health Questionnaire (PHQ-9) score ≥ 10 and ≤ 14; and
  • Willingness to provide informed consent and comply with the trial protocol.

Exclusion Criteria:

  • Pregnancy;
  • Have high levels of suicidal ideation (referral information to professional services will be provided);
  • Unstable psychotropic drugs within 2 weeks before study entry and throughout the treatment phase;
  • Current involvement in psychotherapy for depression;
  • Having unsafe conditions and are not recommended for exercising by physicians; and
  • Major psychiatric, medical or neurocognitive disorders that would make participation infeasible or interfere with the adherence to physical exercising.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 65 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Hong Kong
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03811327
Other Study ID Numbers  ICMJE PSY005
Has Data Monitoring Committee Not Provided
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE Not Provided
Responsible Party Fiona YY Ho, Chinese University of Hong Kong
Study Sponsor  ICMJE Chinese University of Hong Kong
Collaborators  ICMJE Not Provided
Investigators  ICMJE Not Provided
PRS Account Chinese University of Hong Kong
Verification Date March 2020

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP