| Author: | He, Jiali |
| Title: | An integration of Tai Chi and repetitive transcranial magnetic stimulation for sleep disturbance in older adults |
| Advisors: | Tsang, Hector (RS) Chan, Sunny (RS) |
| Degree: | Ph.D. |
| Year: | 2025 |
| Department: | Department of Rehabilitation Sciences |
| Pages: | xix, 221 pages : color illustrations |
| Language: | English |
| Abstract: | Background: Poor sleep quality and sleep problems are prevalent health issues worldwide among older adults. Tai Chi (TC), a mind–body exercise, has benefits to regulate sleep and arousal via a bottom–up process. Repetitive transcranial magnetic stimulation (rTMS), as an external neuromodulation technique, opens up intervention possibilities through a top–down approach to regulating sleep and arousal. Thus, we assume that combining the two processes would yield synergistic and long-lasting benefits for sleep disturbance. Methods: This research project consisted of Study 1: A literature review to elaborate the underlying mechanism of sleep and arousal, and propose a combined treatment of TC and rTMS that modulate sleep and arousal via a bottom–up pathway and a top–down pathway separately; Study 2: A systematic review and meta-analysis investigating the effect of the combination of non-invasive brain stimulation (NIBS) with psychosocial intervention for individuals with depressive symptoms to provide insights into the potential of such combination for managing sleep disturbance; Study 3: A pilot study to explore feasibility, effect size, and adverse event of applying TC combined with rTMS on improving sleep disturbance in older adults; and Study 4: A randomized controlled study to test the efficacy and safety of TC combined with rTMS in alleviating sleep disturbance in the elderly and to unravel its underlying mechanisms. Results: The research project started with defining sleep disturbance and provided an overview of this health issue in older adults, and then followed by Study 1 to develop a combined treatment to regulate sleep and arousal. In Study 2, seventeen qualified studies were included in the systematic review and meta-analysis. The results showed that NIBS plus psychosocial intervention induced a significantly greater effect in alleviating depressive symptoms relative to NIBS alone. In Study 3, thirty-eight older adults were randomly allocated into either: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The results demonstrated that integrating TC with rTMS synergistically improves insomnia severity and sleep–wake patterns when compared with TAU, with benefits lasting up to three months. No serious adverse events observed throughout the study and treatment adherence was high. In Study 4, a total of 152 participants were randomized to one of four groups: (1) TC plus active rTMS (n = 38), (2) TC plus sham rTMS (n = 38), (3) TC-alone (n = 38), and (4) low-intensity physical exercise (PE) control group (n = 38). Within sub-study 1, the behavioral outcomes revealed that TC plus active rTMS yielded a significantly more improvement in sleep – wake pattern relative to its sham comparator after intervention and the benefits lasted three months. In the subsample without depressive symptoms, the TC plus active rTMS, TC plus sham rTMS, and the TC alone group exhibited a greater benefit in actigraphy-assessed sleep efficiency and wake time after sleep onset compared to both variables in the PE group at both T1 and T2, respectively. As to the other subsample with depressive symptoms, the TC plus active rTMS had greater improvements in sleep efficiency compared to both the TC plus sham rTMS and the PE at T1. In sub-study 2, however, none of the potential mediators explained how combining TC and rTMS reduced insomnia severity in our study. Conclusions: The findings of this research project demonstrated that an innovative treatment approach to combine TC with rTMS can produce synergistic and more long-lasting effects in relieving sleep disturbance among older adults. |
| Rights: | All rights reserved |
| Access: | open access |
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