The Effectiveness of Tai Chi Chuan Exercise on Depression, Sleep Quality, and Mental Health

The Effectiveness of Tai Chi Chuan Exercise on Depression, Sleep Quality, and Mental Health | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effectiveness of Tai Chi Chuan Exercise on Depression, Sleep Quality, and Mental Health Ghasim Nabizadehchianeh, Somayeh Morsaljahan, David Ian Walker, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4253409/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The effectiveness of regular physical activity as a therapeutic intervention in modern medicine is widely recognized, making it a potential option for those seeking lifestyle modifications to treat mood disorders. Thus, the goal of this study was to examine the impact of Tai Chi Chuan exercise on depression, sleep quality, and mental well-being. Methods The study used an experimental design, including pre- and post-test assessments, and consisted of both experimental and control groups. The study included male individuals diagnosed with depression who were selected from healthcare centers in Sardasht city during the year 2019. The study involved 30 male individuals with depression symptoms, divided into two groups: the experimental group, which completed 36 Tai Chi Chuan training sessions, and the control group, which did not receive any treatment. The participants completed demographic data collection forms and responded to multiple surveys. The data was analyzed using SPSS-26 software, employing both univariate and multivariate methodologies, and the mean and standard deviations of age were 27.40 (SD = 4.20) and 30.13 (SD = 4.19) respectively. Results The results of the study revealed that both univariate and multivariate analyses of covariance provided evidence supporting the notion that engaging in Tai Chi Chuan exercises led to enhancements in sleep quality and mental health among participants in the experimental group. Furthermore, these enhancements were correlated with a decrease in depressive symptoms. Conclusion In conclusion, participation in Tai Chi activities holds the potential to enhance emotional well-being, sleep patterns, and overall mental health in men experiencing depression. Depression Mental Health Sleep Quality Tai Chi Chuan Figures Figure 1 Glossary Qigong, also known as qi gong, chi kung, or chi gung, refers to the traditional Chinese practice of cultivating life energy, denoted as "qìgōng" in pinyin and "chi gong" in Wade-Giles translation. Traditional Chinese medicine (TCM) incorporates the practice of Qigong, a mind-body technique with a history spanning more than 5000 years, to enhance overall health, well-being and address medical conditions (S. Zhang et al., 2019). Introduction Depression, an increasingly common mental health issue that affects people of all ages, has a significant influence on physical, behavioural, and emotional well-being (Gilbert, 2016 ). Depression is a enduring emotional state marked by persistent symptoms, a melancholic mood, dysthymic features, and a natural inclination towards a lower mood (Nabizadehchianeh et al., 2023 ). According to Hasin et al. ( 2018 ), the occurrence of depression in the United States is consistent with global data from the World Health Organisation, which shows that it affects around 8% of the global population (Hasin et al., 2018 ). Likewise, It is projected to become the leading factor contributing to disability and death by 2030 (Mathers & Loncar, 2006 ); consequently, depression requires thorough comprehension and efficient treatments. Multiple studies showed the convergence of depression and inadequate sleep quality arises as a crucial issue in public health and there is a connection between low sleep quality and a higher probability of experiencing symptoms of depression (Murphy & Peterson, 2015 ; Nutt et al., 2022 ; Rosenberg & Van Hout, 2013 ); Moreover, longitudinal studies highlight a possible cause-and-effect relationship between sleep habits, mental well-being, and the occurrence of anxiety and depression (Matamura et al., 2014 ). The use of non-pharmacological treatments for insomnia is becoming more common due to concerns about persistent side effects and substance dependence associated with traditional medications (Kamel & Gammack, 2006 ; Montgomery & Dennis, 2004 ). Among these therapies, Cognitive-Behavioral Therapy for Insomnia (CBT-I) is popular, despite its specific requirement and demanding therapeutic approach (Black et al., 2014 ; Garland et al., 2014 ). On the other hand, Mind-Body Therapies (MBTs), such as Tai Chi Chuan, show potential in reducing depressive symptoms, psychological distress (Kuang et al., 2024 ; Recchia et al., 2024 ), physical function like blood pressure reduction (Yin et al., 2023 ), improving motor function in patients with Parkinson's disease(Lei et al., 2022 ) improving cognitive function (Chen et al., 2024 ; Sungkarat et al., 2018 ), effects on cognition at the behavioral and neuroelectric levels (Lei et al., 2022 ), improve individuals’ working memory capacity, and then improve their emotion regulation ability (Wang et al., 2023 ) and treating insomnia and offering a diverse range of psychological and physiological benefits (Jimenez et al., 2012 ; Li et al., 2024 ; Liang et al., 2023 ; Takemura et al., 2024 ; Wang et al., 2009 ). Recent research efforts highlight mind-body exercises, specifically Tai Chi Chuan, as activities for improving physical and mental health (Abbott & Lavretsky, 2013 ; Jimenez et al., 2012 ). These studies emphasise the interrelated aspects of the body, mind, and behaviour (Y. Zhang et al., 2019 ; Zou, Zhang, et al., 2019 ). Mind-body treatments, which fall under the umbrella of alternative medicine, seek to enhance the mind's impact on physiological functions. Tai Chi Chuan, a therapeutic intervention, can be compared to aerobic exercise (Ching et al., 2013 ). This mind-body exercise, which has its origins in ancient China, encompasses several practices such as meditation, mental focus, physical traction, and diaphragmatic breathing (Chang et al., 2014 ; Y. Zhang et al., 2019 ). The historical development of Tai Chi Chuan acknowledges the so-called Chen style as its fundamental form, characterised by complicated movements performed through a blend of rapid and slow actions. The philosophical and principled foundations of all types of Tai Chi Chuan are consistent. Nevertheless, it is important to note that each creative approach possesses distinct characteristics and unique forms of expression (Pawlett, 2009 ). While the Yang style is characterized by its quiet and non- pressured nature, it has been commonly used in many studies as adjunctive therapy to enhance the well-being of middle-aged individuals with certain health conditions or illnesses, making it more suitable for this age group compared to the Chen style. However, due to the relatively young age range of the participants in this study, the Chen style, with its emphasis on physical activity and strength, was chosen. The Chen method entails a greater emphasis on physical activity and strength, hence subjecting the participants to heightened levels of pressure compared to the Yang style. The relative simplicity of Tai Chi Chuan in learning and execution, devoid of specialized equipment or dedicated space, informs its selection, particularly within the context of a younger age range (Liu et al., 2018 ; Zou, Han, et al., 2019 ; Zou, Sasaki, et al., 2018 ). Chou et al. ( 2004 ) highlighted advancements in mental well-being attributed to reduced sympathetic activity and increased relaxation in practitioners of Tai Chi Chuan, providing insights into the impact of this aerobic exercise on various aspects of depression in older adults (Chou et al., 2004 ). In a study by Caldwell et al. ( 2009 ), engaging in physical exercise for three months, with two sessions per week lasting 50 minutes each, was associated with improved sleep quality among participants aged 60 to 80 years (Caldwell et al., 2009 ). Studies shwoed, Tai Chi Chuan exhibits the potential to enhance mental well-being and alleviate mental health conditions, including anxiety, depression, and phobias, due to its positive psychological effects (Cai et al., 2022 ; Kuang et al., 2024 ; Posadzki & Jacques, 2009 ; Wu et al., 2024 ). Furthermore, prior research has consistently reported significant enhancements in sleep quality with the practice of Tai Chi Chuan (Si et al., 2020 ; Yang et al., 2023 ). Studies investigating the effects of Tai Chi Chuan training on sleep quality found that participants undergoing such training demonstrated superior sleep quality compared to control groups (Wang et al., 2019 ; Zhu et al., 2018 ). According to Youngstedt et al. ( 2000 ), engaging in activities that serve as distractions from daily concerns and anxieties may contribute to improved emotional stability, reduced depression and anxiety levels, and the promotion of higher-quality sleep (Li et al., 2020 ; Youngstedt et al., 2000 ). Multiple studies confirm the impact of exercise in substantially reducing sleep problems, depression, anxiety, and enhancing well-being. (Bridle et al., 2012 ; Jiang et al., 2017 ; Liu et al., 2020 ; Lyu et al., 2024 ; Zou, Yeung, Li, et al., 2018 ; Zou, Yeung, Quan, et al., 2018 ). The study conducted by Rawtaer et al. ( 2015 ) revealed that a one-year intervention of Tai Chi Chuan resulted in the improvement of epression and anxiety symptoms (Rawtaer et al., 2015 ). Moreover, a meta-analysis conducted by Yang et al. ( 2018 ) demonstrated that the implementation of Tai Chi Chuan intervention resulted in a significant reduction in symptoms related to depression and anxiety among individuals who had experienced a stroke (Yang et al., 2018 ; Yang et al., 2023 ). According to the meta-analysis conducted by Zhang et al. ( 2019 ), Tai Chi has been identified as an effective non-pharmacological intervention for reducing symptoms of depression and anxiety, suggesting its incorporation into public health initiatives (Shu Zhang et al., 2019 ). In another study, engaging in Tai Chi practice for 24 weeks demonstrated positive effects on fatigue, depression, vigor, and sleep quality among older adult women (Cheng et al., 2021 ). This study's goal is to answer these questions: Is Tai Chi Chuan practice decrease depression symptoms in the study sample? Is Tai Chi Chuan improve sleep quality and mental health? In response to the escalating prevalence of depression, there is a strong demand for interventions that are both safe and affordable. Tai Chi Chuan, primarily regarded as a traditional sport, serves as an appropriate focus for examining its influence on depression, sleep quality, and mental health in this cultural context. Therefore, this study aims to assess the efficacy of Tai Chi Chuan exercise as a non-pharmacological intervention for depression. Also investigated in the study is the influence of Tai Chi Chuan on sleep quality and mental well-being. Finally, we examine the nuances associated with different Tai Chi Chuan styles, particularly the Chen style, in influencing depression, sleep quality, and mental health outcomes Moreover, the results of the study could provide valuable insights for public health programmes, presenting a secure and easily available solution that does not require specialised facilities. Method Participants The study targeted male individuals diagnosed with depression who sought help from the health clinic in Sardasht City, Iran throughout the year 2019. A total of 30 males participated after meeting specific criteria for experimental and control groups. The experimental group, comprising 15 participants, participated in a specialized Tai Chi Quan exercise intervention, while the control group, also consisting of 15 participants, did not receive this intervention. Randomization and Blindness Random assignment of participants to either the experimental or control group was executed to mitigate selection bias. The double-blind approach provided that both participants and researchers were unaware of group assignments. Statistical analyses, specifically chi-square and independent t-tests, were conducted to affirm the homogeneity of demographic characteristics, including age and education, between the two groups. The results of the Chi-square test and the independent t-test for age and education indicated that there was no statistically significant difference (p > 0.05) between the experimental and control groups. The results are shown in Table 1 . Table 1 Demographic characteristics of experimental (n = 15) and control (n = 15) groups’ members (mean and standard deviation) Variable Experimental Group Control Group p value Education Diploma (7.6) 1 (3.13) 2 314.0 Bachelor (3.53) 8 (66.66) 10 Masters (0.40) 6 (3.13) 2 Ph.D 0 (7.6) 1 Age (years) 4.20 ± 40.27 ± 4.19 13.30 085.0 ------------------------------- Table 1 - Demographic characteristics -------------------------------- Inclusion and Exclusion Criteria Participants meeting the inclusion criteria provided informed consent, scored between 19 and 29 on the Beck Depression Inventory, and fell within the age range of 25 to 35. Exclusion criteria encompassed individuals with physical illnesses, severe neurological disorders, or psychotic symptoms. Additionally, those expressing unwillingness for intervention, exhibiting suicidal thoughts, at risk of suicide, or concurrently engaged in another therapy session were excluded. Intervention The experimental group engaged in a structured 9-step exercise program rooted in Laojia Tai Chi Chuan (Chen style). This intervention was chosen for its recognized therapeutic benefits. Sessions were conducted over a 36-day period under the guidance of an experienced instructor, with a researcher present. Each session comprised a 10-minute warm-up, 10 minutes of meditation, 30 minutes of Tai Chi Chuan exercises, and concluded with a 10-minute rest and meditation period. Procedure Participants were instructed to integrate 30 minutes of daily extracurricular activities into their routine and provide regular reports of their daily experiences to both the instructor and researcher. This additional engagement aimed to assess the impact of the intervention on their overall well-being. Data Collection Prior to the intervention, participants completed assessments using the Beck Depression Inventory, Petersburg Sleep Quality Index, and Mental Health Questionnaire. Subsequent to the intervention, a post-test was conducted for both groups to measure changes in mental health and sleep quality. Beck Depression Inventory-2 The Beck Depression Inventory-2 (BDI-2) first introduced by Beck et al. in 1971 and revised later. It primary goal is assessing the severity of depression in individuals aged 13 to 80. The current questionnaire includes 21 items, each assigned a rating scale from 0 to 3, the questionnaire's total score ranges from 0 to 63. This score formulates four thresholds, with values below 10 indicating an absence of depressive symptoms or a very mild form of depression. Scores within the ranges of 10–18, 19–29, and 30–63 signify mild to moderate, moderate to severe, and severe levels of depression, respectively. Psychometric studies have confirmed the questionnaire's robust reliability and validity. The instrument exhibits internal consistency ranging from 0.73 to 0.92, with an average of 0.86. The alpha coefficient is determined to be 0.86 for clinical groups and 0.81 for non-clinical groups. Iranian studies further revealed alpha coefficients of 0.92 for outpatients and 0.93 for college students. The questionnaire demonstrates a strong association with self-reported ratings of depression and anxiety (Dabson & Mohammad, 2007 ; Storch et al., 2004 ). Pittsburgh Sleep Quality Index The Pittsburgh Sleep Quality Index (PSQI), developed by Buysse (1989), aims to evaluate sleep quality, especially in people experiencing insufficient or substandard sleep. This questionnaire includes seven subscales that evaluate subjective sleep quality, sleep latency, duration, habitual sleep efficiency, sleep disruptions, sleep medication use, and day-to-day dysfunction. The subscales use a rating scale ranging from 0 to 3, with each component assigned a value reflecting normal condition, mild, moderate, or severe conditions. The total score ranges from 0 to 21, and a sleep quality rating of six or higher is indicative of poor sleep quality. Test-retest reliability ranged from 0.93 to 0.98. Also, the instrument showed a high level of internal c nsistency, with a Cronbach's alpha coefficient of 0.83. Its validity is affirmed through multiple investigations, where a coefficient of 0.89 indicates a urate measurement of the intended construct (Buysse et al., 1989 ). General Health Questionnaire (GHQ-28) The General Health Questionnaire-28 (GHQ-28), originally developed by Goldberg and Hiller, has been translated and validated by Nourbala et al. in Iran. Widely acknowledged as a valid tool for assessing an individual's general well-being, this questionnaire comprises four distinct subscales: somatic symptoms, anxiety and insomnia, social dysfunction, and depression. Items are evaluated using a scale ranging from 0 to 3, and the overall score potential spans from 0 to 84. A lower score signifies superior mental health. Cronbach's alpha coefficient, assessing reliability, yielded a value of 0.85. National studies confirmed the questionnaire's validity and reliability at 0.90 and 0.85, respectively, using correlation coefficients and Cronbach's alpha (Goldberg & Hillier, 1979 ). Data analysis method In the data analysis, we used statistical methods such as chi-square and independent t-tests to evaluate group homogeneity and detect significant differences between the experimental and control groups. In order to examine the impact of Tai Chi Chuan on depression, a dependent t-test was used to measure improvements in depressive symptoms, sleep quality, and overall mental health. Covariates were used to calculate the initial differences between groups in pre-test assessments. Afterwards, one-way analysis of covariance (ANCOVA) explored group differences in depressive symptoms, while multivariate analysis of covariance (MANCOVA) evaluated variations in sleep quality and mental health. To evaluate the effectiveness of the Tai Chi Chuan intervention on depression, sleep quality, and mental health, we considered paired T-test results, along with means (M) and standard deviations (SD) of both groups during pre-test to post-test assessments. The statistical software SPSS-26 was used for data analysis. Results The results of the dependent t-test revealed a significant decrease in depressive symptoms following Tai Chi Chuan exercise learning, evident in post-test scores significantly lower than pre-test scores (p < 0.001). Furthermore, the intervention demonstrated significant improvements in overall sleep quality and its constituent factors, including habitual sleep efficiency, sleep interruptions, sleep medication utilization, and daily dysfunction (p 0.05). The post-test phase showed a substantial enhancement in overall mental health and its components due to the intervention (p < 0.01) (refer to Table 2 ). Contrastingly, the control group exhibited no significant change in mean depressive symptom scores between pre-test and post-test evaluations (p < 0.248). However, there was a significant decrease (p = 0.002) in the overall sleep quality score, associated with a substantial increase (p < 0.05) in sleep disturbances and day dysfunction components. No significant changes were observed in any dimensions of sleep quality within the control group during the pre-test and post-test periods (p > 0.05). Additionally, post-test scores for the control group indicated a substantial reduction in mental health and its components, namely physical symptoms, social function, and depression symptoms, with statistical significance below 0.05. There were no statistically significant differences in anxiety symptoms and sleep disturbances levels among participants in the control group between the pre-test and post-test stages (refer to Table 2 ). Table 2 Mean, standard deviation, and dependent t-test results for comparing the pre-test and post-test results of the dependent variables in each group of study. Component Experimental group (n = 15) Control group (n = 15) pre-exam post-test p value pre-exam post-test p value M ± SD M ± SD M ± SD M ± SD 56.2 ± 87.21 44.3 ± 13.14 ** 001.0> 54.3 ± 40.24 16.3 ± 60.25 248.0 Subjective sleep quality 59.0 ± 73.1 59.0 ± 93.0 ** 001.0> 62.0 ± 33.1 59.0 ± 27.1 670.0 Sleep latency 40.1 ± 67.1 83.0 ± 60.1 869.0 30.1 ± 60.1 28.1 ± 73.1 709.0 Sleep duration 06.2 ± 40.6 80.0 ± 07.7 116.0 18.1 ± 33.5 12.1 ± 53.5 271.0 Habitual sleep efficiency 70.0 ± 93.0 62.0 ± 33.0 * 023.0 64.0 ± 47.0 05.1 ± 67.0 384.0 Sleep disturbances 50.3 ± 00.10 25.2 ± 07.5 ** 001.0> 06.3 ± 73.7 13.3 ± 40.10 ** 002.0 Use of sleep medication 88.0 ± 93.0 41.0 ± 20.0 ** 006.0 91.0 ± 53.0 74.0 ± 87.0 136.0 Daily dysfunction 39.1 ± 93.1 91.0 ± 60.0 ** 001.0> 22.1 ± 07.2 53.1 ± 73.2 ** 007.0 Total score of sleep quality 67.4 ± 60.23 81.2 ± 80.15 ** 001.0> 17.4 ± 07.19 42.6 ± 20.23 ** 002.0 Somatic symptoms 00.3 ± 13.8 49.2 ± 73.4 ** 001.0> 73.3 ± 27.7 26.3 ± 93.8 * 050.0 Anxiety symptoms and sleep disorders 86.2 ± 20.7 59.2 ± 13.3 ** 001.0> 87.4 ± 00.7 85.3 ± 60.8 104.0 Social function 02.3 ± 67.7 14.3 ± 87.4 ** 002.0 66.2 ± 73.7 33.3 ± 53.9 * 013.0 Symptoms of depression 70.3 ± 47.4 50.2 ± 67.2 ** 001.0 18.4 ± 20.5 21.4 ± 00.8 ** 002.0 Total mental health score 99.9 ± 47.27 52.8 ± 40.15 ** 001.0> 97.12 ± 20.27 96.11 ± 07.35 ** 005.0 Note. M = Mean, SD = Std. Deviation; * p < 0.05, ** p < 0.01. ------------------------------- Table 2 - Mean, standard deviation, and dependent t-test results for comparing the pre-test and post-test results of the dependent variables in each group of study -------------------------------- The study used a one-way covariance (ANCOVA) analysis to explore differences in depressive symptoms between the experimental and control groups. In addition, multivariate analysis of covariance (MANCOVA) assessed connections between sleep quality, mental health, and experimental conditions. Table 3 shows adjusted mean and standard deviation indexes for dependent variables during the post-test step, considering initial effects observed in the pre-test, and presents ANCOVA findings. Also, the eta coefficient analysis results show that observed groups account for 73% of variability in depression, 72.8% in overall mental health score, and 46.5% in total sleep quality score during the post-test phase. Table 3 shows additional ETA coefficients related to each aspect of sleep quality and its connection with mental health. Table 3 ANCOVA results for comparing the groups in terms of dependent variables Variable Component Modified averages F p- value Eta experimental group control group M ± SD M ± SD Depression 82.0 ± 71.14 82.0 ± 02.25 03.73 001.0> 730.0 Sleep quality Subjective sleep quality 16.0 ± 71.0 16.0 ± 49.1 * 30.7 013.0 258.0 Sleep latency 34.0 ± 57.1 34.0 ± 77.1 11.0 740.0 005.0 Duration of sleep 23.0 ± 82.6 23.0 ± 78.5 * 66.6 017.0 241.0 Habitual sleep efficiency 30.0 ± 32.0 30.0 ± 68.0 49.0 491.0 023.0 Sleep disturbances 70.0 ± 41.4 70.0 ± 06.11 ** 84.31 001.0> 603.0 Use of sleep medication 19.0 ± 28.0 19.0 ± 79.0 30.2 144.0 099.0 Daily dysfunction 25.0 ± 84.0 25.0 ± 49.2 ** 87.13 001.0 398.0 Total score of sleep quality 21.1 ± 94.14 21.1 ± 06.24 ** 24.18 001.0> 465.0 Mental health Somatic symptoms 56.0 ± 39.4 56.0 ± 28.9 ** 36.37 001.0> 609.0 Anxiety symptoms and sleep disorders 60.0 ± 08.3 60.0 ± 65.8 ** 27.42 001.0> 638.0 Social function 57.0 ± 08.5 57.0 ± 32.9 ** 75.26 001.0> 527.0 Symptoms of depression 56.0 ± 98.2 56.0 ± 69.7 ** 58.34 001.0> 590.0 Total mental health score 68.1 ± 53.15 68.1 ± 94.34 ** 31.64 001.0> 728.0 Note. M = Mean, SD = Std. Deviation; * p < 0.05, ** p < 0.01. ------------------------------- Table 3 - ANCOVA results for comparing the groups in terms of dependent variables -------------------------------- Following one-way ANCOVA findings, there was a significant reduction in the mean depression score in the experimental group compared to the control group (p < 0.001), even after considering the influence of depression pre-test results. Multivariate analyses indicated significant results for sleep quality (p = 0.002) and mental health (p = 0.001) in the MANCOVA test, indicating substantial differences between the two groups, particularly in a specific dimension of sleep quality and mental health. According to MANCOVA findings, post-test mean scores of total sleep quality and some components (subjective sleep quality, sleep duration, sleep disturbances, and daily dysfunction) showed significant improvement in the experimental group compared to the control group (p < 0.05), after considering the effects of sleep quality pre-test scores. No statistically significant differences were observed between mean post-test scores of the experimental group and control group for other components of sleep quality (p < 0.05). Furthermore, accounting for the influence of mental health pre-tests, MANCOVA indicated a statistically significant improvement in mean scores of total mental health and its components (post-test) within the experimental group compared to the control group (p < 0.05) (see Fig. 1 ). ------------------------------- Figure 1 : The results the studied groups in two stages of evaluation of symptoms of depression, sleep quality, and mental health. -------------------------------- Discussion The findings of this study highlight the positive impact of Tai Chi Chuan exercise on depression, sleep quality, and overall mental health in male participants experiencing depressive symptoms. Specifically, the results showed that administering Tai Chi Chuan practice to the experimental group resulted in a reduction in reported depression levels. These findings align with Liu et al. ( 2020 ) and Cai et al. ( 2022 ), indicating consistent empirical evidence supporting Tai Chi Chuan's therapeutic effectiveness in alleviating depression-related symptoms (Cheng et al., 2021 ).The results also align with previous research, such as Rawtaer et al. ( 2015 ) and Yang et al. ( 2018 ), emphasising the potential of Tai Chi Chuan as an effective non-pharmacological intervention for enhancing mental health. Also, this result is consistent with the findings demonstrated in the studies conducted by Li et al. ( 2017 ), Deschamps et al. (2007), Zhou et al., 2018, and Abbot et al., 2007. The studies conducted by Abbott et al. (2007), Deschamps et al. (2007), and Zhou et al. (2018) indicate a good correlation between the practice of Tai Chi Chuan and the improvement of mental health. As a result, the observed decline in depressive symptoms, improved sleep quality, and improved mental health in the experimental group indicated that Tai Chi Chuan could be a practical addition to the repertoire of interventions addressing mood disorders. The positive correlation between participating in Tai Chi Chuan exercises and improving sleep quality and mental health matches the literature on mind-body therapies (MBTs). These types of therapies, including Tai Chi Chuan, have demonstrated a positive impact in reducing depressive symptoms and improving cognitive processes (Cai et al., 2022 ; Chou et al., 2004 ; Rawtaer et al., 2015 ; Sungkarat et al., 2018 ; Wang et al., 2019 ; Yang et al., 2018 ; Shu Zhang et al., 2019 ; Y. Zhang et al., 2019 ; Zhu et al., 2018 ; Zou, Zhang, et al., 2019 ). The current study's focus on the Chen style of Tai Chi Chuan for a younger age group was aligned with the rationale that emphasizing physical activity and strength could be more appropriate for individuals within the younger age ranges (Liu et al., 2018 ). In addition, self-worth, self-esteem, and self-confidence are significant factors affected by physical activity, particularly aerobic exercise, correlating with reduced stress and depression levels. Furthermore, Tai Chi Chuan's positive impact on physical strength, flexibility, and overall quality of life for older adults is acknowledged, supported by empirical evidence linking its practice to decreased depression symptoms. In contrast to Brown et al.'s ( 1995 ) study on middle-aged individuals, variations in age among participants may be evidence for differences in results (Brown et al., 1995 ). Yin and Dishman's (2014) study highlights varying effectiveness levels of Tai Chi Chuan and Qigong activities in addressing depression and anxiety symptoms (Yin & Dishman, 2014 ). The results of this specific portion of the study are consistent with prior studies which provide consistent support for Tai Chi Chuan's positive influence on sleep quality (Si et al., 2019 ; Siu et al., 2021 ), emphasising the importance of considering psychological conditions and intervention time. The result suggests that Tai Chi Chuan exercises positively influence mental health, which is consistent with previous studies (Li et al., 2017 ). Its role in improving self-esteem, overall quality of life, motivation, self-efficacy, and mental well-being is emphasised, aligning with Posadzki and Jacques's (2009) findings (Posadzki & Jacques, 2009 ). However, it is necessary to mention some of the particular limitations. The study's relatively small sample size may affect the generalizability of the results. Also, the lack of a long-term follow-up limits our understanding of the sustainability of the observed progress. Future studies could investigate the duration of these effects and potential variations based on different Tai Chi Chuan styles or intervention lengths. The findings of this research emphasize the therapeutic potential of Tai Chi Chuan in the treatment of depression, depression-related sleep disorders, and mental health. Long-term follow-up studies should be the primary focus of future research in order to evaluate the long-term effects of these types of advances. By doing a comparative examination of the many forms of Tai Chi, it may be possible to determine which style is the most successful for certain group, age or situations. The generalizability of the results might be improved by expanding the scope of the study to include a more varied population in terms of age, gender, and cultural backgrounds. This would also provide insights into the wider application of Tai Chi Chuan therapies. In summary, the results of this study provide more evidence that Tai Chi Chuan exercises can be useful in treating depression, improving the quality of sleep, and improving mental health. This study increases the understanding of Tai Chi Chuan's therapeutic potential in different cultural situations and contexts. Future studies by considering different groups and more diverse samples can improve the understanding of how Tai Chi Chuan has the potential to be one of the most effective non-pharmacological therapies for mental disorders with the lowest side effects in comparison to pharmacological therapy. Declarations Funding This research/article has not received financial assistance from any organizations, institutions, or universities. Conflicts of interest/Competing interests The authors have no relevant financial or non-financial interests to disclose. Ethics approval: This study has obtained ethical approval from the Research Ethics Committee of Tabriz University of Medical Sciences with the reference number IR.TBZMED.REC.1398.288. Participants were assured that their data would be treated confidentially. Informed consent was obtained from all participants before their inclusion in the study, and they were given the opportunity to ask questions and seek clarification. The study procedures adhere to ethical standards outlined by the aforementioned committee, ensuring the protection of participants' rights and well-being. Consent to participate: All participants gave consent to participate. Acknowledgments: We extend our sincere appreciation to Loghman Rostami, the instructor of the Tai Chi Chuan Club in Sardasht, the health centers in the surrounding area, and all the participants who participated in this study. References Abbott, R., & Lavretsky, H. (2013, 2013/03/01/). 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A systematic review and meta-analysis of randomized controlled trials. Journal of clinical medicine, 8 (5), 628. https://doi.org/https://doi.org/10.3390/jcm8050628 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4253409","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":293146474,"identity":"ffc3a6b3-0981-4a9a-921b-11dc89202700","order_by":0,"name":"Ghasim Nabizadehchianeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIiWNgGAWjYHACNoYEBgbGBgkIg8GAvQEkykyKFp4DRGhhgGkBAQOJBPxa5KObnz148MdOtl8axKi5I2cu+cbwA0OFdWIDDi2Gd46ZGyTwJBvPnANiHHtmbDk7x1iC4Uw6bi0zEswkEiSYEzfcyGGTSGA7nLjhdo6BBGPbYTxa0r9JJBjUJ+4Ha/l3uH7DzTPGPxj/4dYiL5EDtCUBaLgEUEti2+EEgxs8ZhKMDbi1GEjklBskHDhuPONGmplEYt9hww1n0sosEo6lG+O0ZUb6toc//lTL9s9Ifib549theYPjhzff+FBjLYvTlgNYhRNwKAfbgsusUTAKRsEoGAVwAABNxmCFh9WeqwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Alabama","correspondingAuthor":true,"prefix":"","firstName":"Ghasim","middleName":"","lastName":"Nabizadehchianeh","suffix":""},{"id":293146475,"identity":"f656c1d8-c50a-4bf4-be05-8825fe090355","order_by":1,"name":"Somayeh Morsaljahan","email":"","orcid":"","institution":"University of Tabriz","correspondingAuthor":false,"prefix":"","firstName":"Somayeh","middleName":"","lastName":"Morsaljahan","suffix":""},{"id":293146476,"identity":"22b6532b-6683-4d69-a7e1-0130983cb54b","order_by":2,"name":"David Ian Walker","email":"","orcid":"","institution":"University of Alabama","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"Ian","lastName":"Walker","suffix":""},{"id":293146477,"identity":"af48a041-0677-468a-afdf-82895ed46555","order_by":3,"name":"Touraj Hashemi Nosratabad","email":"","orcid":"","institution":"University of Tabriz","correspondingAuthor":false,"prefix":"","firstName":"Touraj","middleName":"Hashemi","lastName":"Nosratabad","suffix":""}],"badges":[],"createdAt":"2024-04-11 15:45:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4253409/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4253409/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55512187,"identity":"ad67884f-006d-475c-9d1d-389c08d07dfd","added_by":"auto","created_at":"2024-04-29 12:42:37","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32066,"visible":true,"origin":"","legend":"\u003cp\u003eThe results the studied groups in two stages of evaluation of symptoms of depression, sleep quality, and mental health.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4253409/v1/46c2b1408c8cc485a4b0ec72.png"},{"id":69339412,"identity":"33e75f6a-d74b-4212-bcb2-972547db93ce","added_by":"auto","created_at":"2024-11-19 10:47:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":716393,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4253409/v1/d255ecab-8331-4228-9604-e23d6226e76a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effectiveness of Tai Chi Chuan Exercise on Depression, Sleep Quality, and Mental Health","fulltext":[{"header":"Glossary","content":"\u003cp\u003eQigong, also known as qi gong, chi kung, or chi gung, refers to the traditional Chinese practice of cultivating life energy, denoted as \u0026quot;q\u0026igrave;gōng\u0026quot; in pinyin and \u0026quot;chi gong\u0026quot; in Wade-Giles translation. Traditional Chinese medicine (TCM) incorporates the practice of Qigong, a mind-body technique with a history spanning more than 5000 years, to enhance overall health, well-being and address medical conditions (S. Zhang et al., 2019).\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eDepression, an increasingly common mental health issue that affects people of all ages, has a significant influence on physical, behavioural, and emotional well-being (Gilbert, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Depression is a enduring emotional state marked by persistent symptoms, a melancholic mood, dysthymic features, and a natural inclination towards a lower mood (Nabizadehchianeh et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). According to Hasin et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), the occurrence of depression in the United States is consistent with global data from the World Health Organisation, which shows that it affects around 8% of the global population (Hasin et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Likewise, It is projected to become the leading factor contributing to disability and death by 2030 (Mathers \u0026amp; Loncar, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2006\u003c/span\u003e); consequently, depression requires thorough comprehension and efficient treatments.\u003c/p\u003e \u003cp\u003eMultiple studies showed the convergence of depression and inadequate sleep quality arises as a crucial issue in public health and there is a connection between low sleep quality and a higher probability of experiencing symptoms of depression (Murphy \u0026amp; Peterson, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Nutt et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Rosenberg \u0026amp; Van Hout, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2013\u003c/span\u003e); Moreover, longitudinal studies highlight a possible cause-and-effect relationship between sleep habits, mental well-being, and the occurrence of anxiety and depression (Matamura et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe use of non-pharmacological treatments for insomnia is becoming more common due to concerns about persistent side effects and substance dependence associated with traditional medications (Kamel \u0026amp; Gammack, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Montgomery \u0026amp; Dennis, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Among these therapies, Cognitive-Behavioral Therapy for Insomnia (CBT-I) is popular, despite its specific requirement and demanding therapeutic approach (Black et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Garland et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, Mind-Body Therapies (MBTs), such as Tai Chi Chuan, show potential in reducing depressive symptoms, psychological distress (Kuang et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Recchia et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), physical function like blood pressure reduction (Yin et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), improving motor function in patients with Parkinson's disease(Lei et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) improving cognitive function (Chen et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sungkarat et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), effects on cognition at the behavioral and neuroelectric levels (Lei et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), improve individuals\u0026rsquo; working memory capacity, and then improve their emotion regulation ability (Wang et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and treating insomnia and offering a diverse range of psychological and physiological benefits (Jimenez et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Liang et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Takemura et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Recent research efforts highlight mind-body exercises, specifically Tai Chi Chuan, as activities for improving physical and mental health (Abbott \u0026amp; Lavretsky, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Jimenez et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). These studies emphasise the interrelated aspects of the body, mind, and behaviour (Y. Zhang et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Zou, Zhang, et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Mind-body treatments, which fall under the umbrella of alternative medicine, seek to enhance the mind's impact on physiological functions. Tai Chi Chuan, a therapeutic intervention, can be compared to aerobic exercise (Ching et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). This mind-body exercise, which has its origins in ancient China, encompasses several practices such as meditation, mental focus, physical traction, and diaphragmatic breathing (Chang et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Y. Zhang et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe historical development of Tai Chi Chuan acknowledges the so-called Chen style as its fundamental form, characterised by complicated movements performed through a blend of rapid and slow actions. The philosophical and principled foundations of all types of Tai Chi Chuan are consistent. Nevertheless, it is important to note that each creative approach possesses distinct characteristics and unique forms of expression (Pawlett, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile the Yang style is characterized by its quiet and non- pressured nature, it has been commonly used in many studies as adjunctive therapy to enhance the well-being of middle-aged individuals with certain health conditions or illnesses, making it more suitable for this age group compared to the Chen style. However, due to the relatively young age range of the participants in this study, the Chen style, with its emphasis on physical activity and strength, was chosen. The Chen method entails a greater emphasis on physical activity and strength, hence subjecting the participants to heightened levels of pressure compared to the Yang style. The relative simplicity of Tai Chi Chuan in learning and execution, devoid of specialized equipment or dedicated space, informs its selection, particularly within the context of a younger age range (Liu et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Zou, Han, et al., \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Zou, Sasaki, et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChou et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) highlighted advancements in mental well-being attributed to reduced sympathetic activity and increased relaxation in practitioners of Tai Chi Chuan, providing insights into the impact of this aerobic exercise on various aspects of depression in older adults (Chou et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). In a study by Caldwell et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), engaging in physical exercise for three months, with two sessions per week lasting 50 minutes each, was associated with improved sleep quality among participants aged 60 to 80 years (Caldwell et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Studies shwoed, Tai Chi Chuan exhibits the potential to enhance mental well-being and alleviate mental health conditions, including anxiety, depression, and phobias, due to its positive psychological effects (Cai et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Kuang et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Posadzki \u0026amp; Jacques, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Wu et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, prior research has consistently reported significant enhancements in sleep quality with the practice of Tai Chi Chuan (Si et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Yang et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Studies investigating the effects of Tai Chi Chuan training on sleep quality found that participants undergoing such training demonstrated superior sleep quality compared to control groups (Wang et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Zhu et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). According to Youngstedt et al. (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), engaging in activities that serve as distractions from daily concerns and anxieties may contribute to improved emotional stability, reduced depression and anxiety levels, and the promotion of higher-quality sleep (Li et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Youngstedt et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMultiple studies confirm the impact of exercise in substantially reducing sleep problems, depression, anxiety, and enhancing well-being. (Bridle et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Jiang et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Liu et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lyu et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Zou, Yeung, Li, et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Zou, Yeung, Quan, et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The study conducted by Rawtaer et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) revealed that a one-year intervention of Tai Chi Chuan resulted in the improvement of epression and anxiety symptoms (Rawtaer et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Moreover, a meta-analysis conducted by Yang et al. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) demonstrated that the implementation of Tai Chi Chuan intervention resulted in a significant reduction in symptoms related to depression and anxiety among individuals who had experienced a stroke (Yang et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Yang et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). According to the meta-analysis conducted by Zhang et al. (\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), Tai Chi has been identified as an effective non-pharmacological intervention for reducing symptoms of depression and anxiety, suggesting its incorporation into public health initiatives (Shu Zhang et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In another study, engaging in Tai Chi practice for 24 weeks demonstrated positive effects on fatigue, depression, vigor, and sleep quality among older adult women (Cheng et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study's goal is to answer these questions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIs Tai Chi Chuan practice decrease depression symptoms in the study sample?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIs Tai Chi Chuan improve sleep quality and mental health?\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eIn response to the escalating prevalence of depression, there is a strong demand for interventions that are both safe and affordable. Tai Chi Chuan, primarily regarded as a traditional sport, serves as an appropriate focus for examining its influence on depression, sleep quality, and mental health in this cultural context. Therefore, this study aims to assess the efficacy of Tai Chi Chuan exercise as a non-pharmacological intervention for depression. Also investigated in the study is the influence of Tai Chi Chuan on sleep quality and mental well-being. Finally, we examine the nuances associated with different Tai Chi Chuan styles, particularly the Chen style, in influencing depression, sleep quality, and mental health outcomes Moreover, the results of the study could provide valuable insights for public health programmes, presenting a secure and easily available solution that does not require specialised facilities.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eThe study targeted male individuals diagnosed with depression who sought help from the health clinic in Sardasht City, Iran throughout the year 2019. A total of 30 males participated after meeting specific criteria for experimental and control groups. The experimental group, comprising 15 participants, participated in a specialized Tai Chi Quan exercise intervention, while the control group, also consisting of 15 participants, did not receive this intervention.\u003c/p\u003e \u003cp\u003eRandomization and Blindness\u003c/p\u003e \u003cp\u003eRandom assignment of participants to either the experimental or control group was executed to mitigate selection bias. The double-blind approach provided that both participants and researchers were unaware of group assignments. Statistical analyses, specifically chi-square and independent t-tests, were conducted to affirm the homogeneity of demographic characteristics, including age and education, between the two groups. The results of the Chi-square test and the independent t-test for age and education indicated that there was no statistically significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) between the experimental and control groups. The results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003ctable id=\"Tab1\" border=\"1\" style=\"margin-right: calc(54%); width: 46%;\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic characteristics of experimental (n\u0026thinsp;=\u0026thinsp;15) and control (n\u0026thinsp;=\u0026thinsp;15) groups\u0026rsquo; members (mean and standard deviation)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" style=\"width: 32.0896%;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 23.8806%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 20.6468%;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 12.6866%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\" style=\"width: 16.9154%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 15.1741%;\"\u003e\n \u003cp\u003eDiploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 23.8806%;\"\u003e\n \u003cp\u003e(7.6) 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6468%;\"\u003e\n \u003cp\u003e(3.13) 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"4\" style=\"width: 12.6866%;\"\u003e\n \u003cp\u003e314.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.1741%;\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 23.8806%;\"\u003e\n \u003cp\u003e(3.53) 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6468%;\"\u003e\n \u003cp\u003e(66.66) 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.1741%;\"\u003e\n \u003cp\u003eMasters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 23.8806%;\"\u003e\n \u003cp\u003e(0.40) 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6468%;\"\u003e\n \u003cp\u003e(3.13) 2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 15.1741%;\"\u003e\n \u003cp\u003ePh.D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 23.8806%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6468%;\"\u003e\n \u003cp\u003e(7.6) 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" style=\"width: 32.0896%;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 23.8806%;\"\u003e\n \u003cp\u003e4.20\u0026thinsp;\u0026plusmn;\u0026thinsp;40.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 20.6468%;\"\u003e\n \u003cp\u003e\u0026plusmn;\u0026thinsp;4.19 13.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 12.6866%;\"\u003e\n \u003cp\u003e085.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e \u003cp\u003e-------------------------------\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e- Demographic characteristics\u003c/p\u003e \u003cp\u003e--------------------------------\u003c/p\u003e \u003cp\u003eInclusion and Exclusion Criteria\u003c/p\u003e \u003cp\u003eParticipants meeting the inclusion criteria provided informed consent, scored between 19 and 29 on the Beck Depression Inventory, and fell within the age range of 25 to 35. Exclusion criteria encompassed individuals with physical illnesses, severe neurological disorders, or psychotic symptoms. Additionally, those expressing unwillingness for intervention, exhibiting suicidal thoughts, at risk of suicide, or concurrently engaged in another therapy session were excluded.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cp\u003eThe experimental group engaged in a structured 9-step exercise program rooted in Laojia Tai Chi Chuan (Chen style). This intervention was chosen for its recognized therapeutic benefits. Sessions were conducted over a 36-day period under the guidance of an experienced instructor, with a researcher present. Each session comprised a 10-minute warm-up, 10 minutes of meditation, 30 minutes of Tai Chi Chuan exercises, and concluded with a 10-minute rest and meditation period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eParticipants were instructed to integrate 30 minutes of daily extracurricular activities into their routine and provide regular reports of their daily experiences to both the instructor and researcher. This additional engagement aimed to assess the impact of the intervention on their overall well-being.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003ePrior to the intervention, participants completed assessments using the Beck Depression Inventory, Petersburg Sleep Quality Index, and Mental Health Questionnaire. Subsequent to the intervention, a post-test was conducted for both groups to measure changes in mental health and sleep quality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eBeck Depression Inventory-2\u003c/h2\u003e \u003cp\u003eThe Beck Depression Inventory-2 (BDI-2) first introduced by Beck et al. in 1971 and revised later. It primary goal is assessing the severity of depression in individuals aged 13 to 80. The current questionnaire includes 21 items, each assigned a rating scale from 0 to 3, the questionnaire's total score ranges from 0 to 63. This score formulates four thresholds, with values below 10 indicating an absence of depressive symptoms or a very mild form of depression. Scores within the ranges of 10\u0026ndash;18, 19\u0026ndash;29, and 30\u0026ndash;63 signify mild to moderate, moderate to severe, and severe levels of depression, respectively. Psychometric studies have confirmed the questionnaire's robust reliability and validity. The instrument exhibits internal consistency ranging from 0.73 to 0.92, with an average of 0.86. The alpha coefficient is determined to be 0.86 for clinical groups and 0.81 for non-clinical groups. Iranian studies further revealed alpha coefficients of 0.92 for outpatients and 0.93 for college students. The questionnaire demonstrates a strong association with self-reported ratings of depression and anxiety (Dabson \u0026amp; Mohammad, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Storch et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePittsburgh Sleep Quality Index\u003c/h2\u003e \u003cp\u003eThe Pittsburgh Sleep Quality Index (PSQI), developed by Buysse (1989), aims to evaluate sleep quality, especially in people experiencing insufficient or substandard sleep. This questionnaire includes seven subscales that evaluate subjective sleep quality, sleep latency, duration, habitual sleep efficiency, sleep disruptions, sleep medication use, and day-to-day dysfunction. The subscales use a rating scale ranging from 0 to 3, with each component assigned a value reflecting normal condition, mild, moderate, or severe conditions. The total score ranges from 0 to 21, and a sleep quality rating of six or higher is indicative of poor sleep quality. Test-retest reliability ranged from 0.93 to 0.98. Also, the instrument showed a high level of internal c nsistency, with a Cronbach's alpha coefficient of 0.83. Its validity is affirmed through multiple investigations, where a coefficient of 0.89 indicates a urate measurement of the intended construct (Buysse et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e1989\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Health Questionnaire (GHQ-28)\u003c/h2\u003e \u003cp\u003eThe General Health Questionnaire-28 (GHQ-28), originally developed by Goldberg and Hiller, has been translated and validated by Nourbala et al. in Iran. Widely acknowledged as a valid tool for assessing an individual's general well-being, this questionnaire comprises four distinct subscales: somatic symptoms, anxiety and insomnia, social dysfunction, and depression. Items are evaluated using a scale ranging from 0 to 3, and the overall score potential spans from 0 to 84. A lower score signifies superior mental health. Cronbach's alpha coefficient, assessing reliability, yielded a value of 0.85. National studies confirmed the questionnaire's validity and reliability at 0.90 and 0.85, respectively, using correlation coefficients and Cronbach's alpha (Goldberg \u0026amp; Hillier, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1979\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis method\u003c/h2\u003e \u003cp\u003eIn the data analysis, we used statistical methods such as chi-square and independent t-tests to evaluate group homogeneity and detect significant differences between the experimental and control groups. In order to examine the impact of Tai Chi Chuan on depression, a dependent t-test was used to measure improvements in depressive symptoms, sleep quality, and overall mental health. Covariates were used to calculate the initial differences between groups in pre-test assessments. Afterwards, one-way analysis of covariance (ANCOVA) explored group differences in depressive symptoms, while multivariate analysis of covariance (MANCOVA) evaluated variations in sleep quality and mental health. To evaluate the effectiveness of the Tai Chi Chuan intervention on depression, sleep quality, and mental health, we considered paired T-test results, along with means (M) and standard deviations (SD) of both groups during pre-test to post-test assessments. The statistical software SPSS-26 was used for data analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe results of the dependent t-test revealed a significant decrease in depressive symptoms following Tai Chi Chuan exercise learning, evident in post-test scores significantly lower than pre-test scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, the intervention demonstrated significant improvements in overall sleep quality and its constituent factors, including habitual sleep efficiency, sleep interruptions, sleep medication utilization, and daily dysfunction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No statistically significant differences were noted in pre-test and post-test ratings of sleep quality across all aspects within the experimental group (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The post-test phase showed a substantial enhancement in overall mental health and its components due to the intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eContrastingly, the control group exhibited no significant change in mean depressive symptom scores between pre-test and post-test evaluations (p\u0026thinsp;\u0026lt;\u0026thinsp;0.248). However, there was a significant decrease (p\u0026thinsp;=\u0026thinsp;0.002) in the overall sleep quality score, associated with a substantial increase (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in sleep disturbances and day dysfunction components. No significant changes were observed in any dimensions of sleep quality within the control group during the pre-test and post-test periods (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Additionally, post-test scores for the control group indicated a substantial reduction in mental health and its components, namely physical symptoms, social function, and depression symptoms, with statistical significance below 0.05. There were no statistically significant differences in anxiety symptoms and sleep disturbances levels among participants in the control group between the pre-test and post-test stages (refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMean, standard deviation, and dependent t-test results for comparing the pre-test and post-test results of the dependent variables in each group of study.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"3\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eComponent\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\" style=\"width: 24.1043%;\"\u003e\n \u003cp\u003eExperimental group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\" style=\"width: 29.2846%;\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003epre-exam\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003epost-test\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003epre-exam\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003epost-test\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e56.2\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;87.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e44.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e001.0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e54.3\u0026thinsp;\u0026plusmn;\u0026thinsp;40.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;60.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e248.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eSubjective sleep quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e59.0\u0026thinsp;\u0026plusmn;\u0026thinsp;73.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e59.0\u0026thinsp;\u0026plusmn;\u0026thinsp;93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e001.0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e62.0\u0026thinsp;\u0026plusmn;\u0026thinsp;33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e59.0\u0026thinsp;\u0026plusmn;\u0026thinsp;27.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e670.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eSleep latency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;67.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e83.0\u0026thinsp;\u0026plusmn;\u0026thinsp;60.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e869.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e30.1\u0026thinsp;\u0026plusmn;\u0026thinsp;60.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;73.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e709.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eSleep duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e06.2\u0026thinsp;\u0026plusmn;\u0026thinsp;40.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e80.0\u0026thinsp;\u0026plusmn;\u0026thinsp;07.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e116.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e18.1\u0026thinsp;\u0026plusmn;\u0026thinsp;33.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;53.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e271.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eHabitual sleep efficiency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e70.0\u0026thinsp;\u0026plusmn;\u0026thinsp;93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e62.0\u0026thinsp;\u0026plusmn;\u0026thinsp;33.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e023.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e64.0\u0026thinsp;\u0026plusmn;\u0026thinsp;47.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e05.1\u0026thinsp;\u0026plusmn;\u0026thinsp;67.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e384.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eSleep disturbances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e50.3\u0026thinsp;\u0026plusmn;\u0026thinsp;00.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e25.2\u0026thinsp;\u0026plusmn;\u0026thinsp;07.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e001.0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e06.3\u0026thinsp;\u0026plusmn;\u0026thinsp;73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e13.3\u0026thinsp;\u0026plusmn;\u0026thinsp;40.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e002.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eUse of sleep medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e88.0\u0026thinsp;\u0026plusmn;\u0026thinsp;93.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e41.0\u0026thinsp;\u0026plusmn;\u0026thinsp;20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e006.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e91.0\u0026thinsp;\u0026plusmn;\u0026thinsp;53.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e74.0\u0026thinsp;\u0026plusmn;\u0026thinsp;87.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e136.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eDaily dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e39.1\u0026thinsp;\u0026plusmn;\u0026thinsp;93.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e91.0\u0026thinsp;\u0026plusmn;\u0026thinsp;60.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e001.0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e22.1\u0026thinsp;\u0026plusmn;\u0026thinsp;07.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e53.1\u0026thinsp;\u0026plusmn;\u0026thinsp;73.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003e**\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e007.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eTotal score of sleep quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e67.4\u0026thinsp;\u0026plusmn;\u0026thinsp;60.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e81.2\u0026thinsp;\u0026plusmn;\u0026thinsp;80.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e001.0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e17.4\u0026thinsp;\u0026plusmn;\u0026thinsp;07.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;20.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003e**\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e002.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eSomatic symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e00.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e49.2\u0026thinsp;\u0026plusmn;\u0026thinsp;73.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e001.0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e73.3\u0026thinsp;\u0026plusmn;\u0026thinsp;27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;93.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e050.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eAnxiety symptoms and sleep disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e86.2\u0026thinsp;\u0026plusmn;\u0026thinsp;20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e59.2\u0026thinsp;\u0026plusmn;\u0026thinsp;13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e001.0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e87.4\u0026thinsp;\u0026plusmn;\u0026thinsp;00.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e85.3\u0026thinsp;\u0026plusmn;\u0026thinsp;60.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e104.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eSocial function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e02.3\u0026thinsp;\u0026plusmn;\u0026thinsp;67.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e14.3\u0026thinsp;\u0026plusmn;\u0026thinsp;87.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e002.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e33.3\u0026thinsp;\u0026plusmn;\u0026thinsp;53.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e013.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eSymptoms of depression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e70.3\u0026thinsp;\u0026plusmn;\u0026thinsp;47.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e50.2\u0026thinsp;\u0026plusmn;\u0026thinsp;67.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e001.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e18.4\u0026thinsp;\u0026plusmn;\u0026thinsp;20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e21.4\u0026thinsp;\u0026plusmn;\u0026thinsp;00.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e\u003csup\u003e\u003cstrong\u003e**\u003c/strong\u003e\u003c/sup\u003e\u003cstrong\u003e002.0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 16.1351%;\"\u003e\n \u003cp\u003eTotal mental health score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e99.9\u0026thinsp;\u0026plusmn;\u0026thinsp;47.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 6.6604%;\"\u003e\n \u003cp\u003e52.8\u0026thinsp;\u0026plusmn;\u0026thinsp;40.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 10.6778%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e001.0\u0026gt;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e97.12\u0026thinsp;\u0026plusmn;\u0026thinsp;20.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 7.2947%;\"\u003e\n \u003cp\u003e96.11\u0026thinsp;\u0026plusmn;\u0026thinsp;07.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 14.6952%;\"\u003e\n \u003cp\u003e\u003csup\u003e**\u003c/sup\u003e005.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\" style=\"width: 63.4324%;\"\u003e\n \u003cp\u003eNote. M\u0026thinsp;=\u0026thinsp;Mean, SD\u0026thinsp;=\u0026thinsp;Std. Deviation; *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e \u003cp\u003e-------------------------------\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e- Mean, standard deviation, and dependent t-test results for comparing the pre-test and post-test results of the dependent variables in each group of study\u003c/p\u003e \u003cp\u003e--------------------------------\u003c/p\u003e \u003cp\u003eThe study used a one-way covariance (ANCOVA) analysis to explore differences in depressive symptoms between the experimental and control groups. In addition, multivariate analysis of covariance (MANCOVA) assessed connections between sleep quality, mental health, and experimental conditions. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows adjusted mean and standard deviation indexes for dependent variables during the post-test step, considering initial effects observed in the pre-test, and presents ANCOVA findings.\u003c/p\u003e\u003cp\u003eAlso, the eta coefficient analysis results show that observed groups account for 73% of variability in depression, 72.8% in overall mental health score, and 46.5% in total sleep quality score during the post-test phase. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows additional ETA coefficients related to each aspect of sleep quality and its connection with mental health.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eANCOVA results for comparing the groups in terms of dependent variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eComponent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eModified averages\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003eEta\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eexperimental group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003econtrol group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.0\u0026thinsp;\u0026plusmn;\u0026thinsp;71.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82.0\u0026thinsp;\u0026plusmn;\u0026thinsp;02.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e03.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e001.0\u0026gt;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e730.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eSleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubjective sleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;71.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u0026thinsp;\u0026plusmn;\u0026thinsp;49.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e*\u003c/sup\u003e30.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e013.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e258.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSleep latency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.0\u0026thinsp;\u0026plusmn;\u0026thinsp;57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.0\u0026thinsp;\u0026plusmn;\u0026thinsp;77.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e740.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e005.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration of sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;82.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e66.6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e017.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e241.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHabitual sleep efficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.0\u0026thinsp;\u0026plusmn;\u0026thinsp;32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.0\u0026thinsp;\u0026plusmn;\u0026thinsp;68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e491.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e023.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSleep disturbances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.0\u0026thinsp;\u0026plusmn;\u0026thinsp;41.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70.0\u0026thinsp;\u0026plusmn;\u0026thinsp;06.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e84.31\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e001.0\u0026gt;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e603.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUse of sleep medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u0026thinsp;\u0026plusmn;\u0026thinsp;28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.0\u0026thinsp;\u0026plusmn;\u0026thinsp;79.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e144.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e099.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDaily dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;84.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;49.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e87.13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e001.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e398.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal score of sleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.1\u0026thinsp;\u0026plusmn;\u0026thinsp;94.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.1\u0026thinsp;\u0026plusmn;\u0026thinsp;06.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e24.18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e001.0\u0026gt;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e465.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSomatic symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.0\u0026thinsp;\u0026plusmn;\u0026thinsp;39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.0\u0026thinsp;\u0026plusmn;\u0026thinsp;28.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e36.37\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e001.0\u0026gt;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e609.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnxiety symptoms and sleep disorders\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0\u0026thinsp;\u0026plusmn;\u0026thinsp;08.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.0\u0026thinsp;\u0026plusmn;\u0026thinsp;65.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e27.42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e001.0\u0026gt;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e638.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.0\u0026thinsp;\u0026plusmn;\u0026thinsp;08.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.0\u0026thinsp;\u0026plusmn;\u0026thinsp;32.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e75.26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e001.0\u0026gt;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e527.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSymptoms of depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.0\u0026thinsp;\u0026plusmn;\u0026thinsp;98.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.0\u0026thinsp;\u0026plusmn;\u0026thinsp;69.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e58.34\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e001.0\u0026gt;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e590.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal mental health score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.1\u0026thinsp;\u0026plusmn;\u0026thinsp;53.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.1\u0026thinsp;\u0026plusmn;\u0026thinsp;94.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e31.64\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e001.0\u0026gt;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e728.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eNote. M\u0026thinsp;=\u0026thinsp;Mean, SD\u0026thinsp;=\u0026thinsp;Std. Deviation; *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e-------------------------------\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e- ANCOVA results for comparing the groups in terms of dependent variables\u003c/p\u003e \u003cp\u003e--------------------------------\u003c/p\u003e \u003cp\u003eFollowing one-way ANCOVA findings, there was a significant reduction in the mean depression score in the experimental group compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), even after considering the influence of depression pre-test results.\u003c/p\u003e \u003cp\u003eMultivariate analyses indicated significant results for sleep quality (p\u0026thinsp;=\u0026thinsp;0.002) and mental health (p\u0026thinsp;=\u0026thinsp;0.001) in the MANCOVA test, indicating substantial differences between the two groups, particularly in a specific dimension of sleep quality and mental health.\u003c/p\u003e \u003cp\u003eAccording to MANCOVA findings, post-test mean scores of total sleep quality and some components (subjective sleep quality, sleep duration, sleep disturbances, and daily dysfunction) showed significant improvement in the experimental group compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), after considering the effects of sleep quality pre-test scores. No statistically significant differences were observed between mean post-test scores of the experimental group and control group for other components of sleep quality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Furthermore, accounting for the influence of mental health pre-tests, MANCOVA indicated a statistically significant improvement in mean scores of total mental health and its components (post-test) within the experimental group compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e-------------------------------\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: The results the studied groups in two stages of evaluation of symptoms of depression, sleep quality, and mental health.\u003c/p\u003e \u003cp\u003e--------------------------------\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study highlight the positive impact of Tai Chi Chuan exercise on depression, sleep quality, and overall mental health in male participants experiencing depressive symptoms. Specifically, the results showed that administering Tai Chi Chuan practice to the experimental group resulted in a reduction in reported depression levels. These findings align with Liu et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and Cai et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), indicating consistent empirical evidence supporting Tai Chi Chuan's therapeutic effectiveness in alleviating depression-related symptoms (Cheng et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).The results also align with previous research, such as Rawtaer et al. (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) and Yang et al. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), emphasising the potential of Tai Chi Chuan as an effective non-pharmacological intervention for enhancing mental health. Also, this result is consistent with the findings demonstrated in the studies conducted by Li et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), Deschamps et al. (2007), Zhou et al., 2018, and Abbot et al., 2007. The studies conducted by Abbott et al. (2007), Deschamps et al. (2007), and Zhou et al. (2018) indicate a good correlation between the practice of Tai Chi Chuan and the improvement of mental health. As a result, the observed decline in depressive symptoms, improved sleep quality, and improved mental health in the experimental group indicated that Tai Chi Chuan could be a practical addition to the repertoire of interventions addressing mood disorders.\u003c/p\u003e \u003cp\u003eThe positive correlation between participating in Tai Chi Chuan exercises and improving sleep quality and mental health matches the literature on mind-body therapies (MBTs). These types of therapies, including Tai Chi Chuan, have demonstrated a positive impact in reducing depressive symptoms and improving cognitive processes (Cai et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Chou et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Rawtaer et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Sungkarat et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Wang et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Yang et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Shu Zhang et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Y. Zhang et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Zhu et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Zou, Zhang, et al., \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe current study's focus on the Chen style of Tai Chi Chuan for a younger age group was aligned with the rationale that emphasizing physical activity and strength could be more appropriate for individuals within the younger age ranges (Liu et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In addition, self-worth, self-esteem, and self-confidence are significant factors affected by physical activity, particularly aerobic exercise, correlating with reduced stress and depression levels. Furthermore, Tai Chi Chuan's positive impact on physical strength, flexibility, and overall quality of life for older adults is acknowledged, supported by empirical evidence linking its practice to decreased depression symptoms.\u003c/p\u003e \u003cp\u003eIn contrast to Brown et al.'s (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1995\u003c/span\u003e) study on middle-aged individuals, variations in age among participants may be evidence for differences in results (Brown et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1995\u003c/span\u003e). Yin and Dishman's (2014) study highlights varying effectiveness levels of Tai Chi Chuan and Qigong activities in addressing depression and anxiety symptoms (Yin \u0026amp; Dishman, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe results of this specific portion of the study are consistent with prior studies which provide consistent support for Tai Chi Chuan's positive influence on sleep quality (Si et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Siu et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), emphasising the importance of considering psychological conditions and intervention time.\u003c/p\u003e \u003cp\u003eThe result suggests that Tai Chi Chuan exercises positively influence mental health, which is consistent with previous studies (Li et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Its role in improving self-esteem, overall quality of life, motivation, self-efficacy, and mental well-being is emphasised, aligning with Posadzki and Jacques's (2009) findings (Posadzki \u0026amp; Jacques, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, it is necessary to mention some of the particular limitations. The study's relatively small sample size may affect the generalizability of the results. Also, the lack of a long-term follow-up limits our understanding of the sustainability of the observed progress. Future studies could investigate the duration of these effects and potential variations based on different Tai Chi Chuan styles or intervention lengths.\u003c/p\u003e \u003cp\u003eThe findings of this research emphasize the therapeutic potential of Tai Chi Chuan in the treatment of depression, depression-related sleep disorders, and mental health. Long-term follow-up studies should be the primary focus of future research in order to evaluate the long-term effects of these types of advances. By doing a comparative examination of the many forms of Tai Chi, it may be possible to determine which style is the most successful for certain group, age or situations. The generalizability of the results might be improved by expanding the scope of the study to include a more varied population in terms of age, gender, and cultural backgrounds. This would also provide insights into the wider application of Tai Chi Chuan therapies.\u003c/p\u003e \u003cp\u003eIn summary, the results of this study provide more evidence that Tai Chi Chuan exercises can be useful in treating depression, improving the quality of sleep, and improving mental health. This study increases the understanding of Tai Chi Chuan's therapeutic potential in different cultural situations and contexts. Future studies by considering different groups and more diverse samples can improve the understanding of how Tai Chi Chuan has the potential to be one of the most effective non-pharmacological therapies for mental disorders with the lowest side effects in comparison to pharmacological therapy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research/article has not received financial assistance from any organizations, institutions, or universities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eThis study has obtained ethical approval from the Research Ethics Committee of Tabriz University of Medical Sciences with the reference number IR.TBZMED.REC.1398.288. Participants were assured that their data would be treated confidentially. Informed consent was obtained from all participants before their inclusion in the study, and they were given the opportunity to ask questions and seek clarification. The study procedures adhere to ethical standards outlined by the aforementioned committee, ensuring the protection of participants\u0026apos; rights and well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eAll participants gave consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eWe extend our sincere appreciation to Loghman Rostami, the instructor of the Tai Chi Chuan Club in Sardasht, the health centers in the surrounding area, and all the participants who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbbott, R., \u0026amp; Lavretsky, H. (2013, 2013/03/01/). 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The Beneficial Effects of Traditional Chinese Exercises for Adults with Low Back Pain: A Meta-Analysis of Randomized Controlled Trials. \u003cem\u003eMedicina, 55\u003c/em\u003e(5), 118. https://doi.org/https://doi.org/10.3390/medicina55050118\u003c/li\u003e\n\u003cli\u003eZhu, D., Dai, G., Xu, D., Xu, X., Geng, J., Zhu, W., Jiang, X., \u0026amp; Theeboom, M. (2018). Long-Term Effects of Tai Chi Intervention on Sleep and Mental Health of Female Individuals With Dependence on Amphetamine-Type Stimulants. \u003cem\u003eFront Psychol, 9\u003c/em\u003e, 1476. https://doi.org/10.3389/fpsyg.2018.01476\u003c/li\u003e\n\u003cli\u003eZou, L., Han, J., Li, C., Yeung, A. S., Hui, S. S.-c., Tsang, W. W., Ren, Z., \u0026amp; Wang, L. (2019). Effects of Tai Chi on lower limb proprioception in adults aged over 55: A systematic review and meta-analysis. \u003cem\u003eArchives of physical medicine and rehabilitation, 100\u003c/em\u003e(6), 1102-1113. https://doi.org/https://doi.org/10.1016/j.apmr.2018.07.425\u003c/li\u003e\n\u003cli\u003eZou, L., Sasaki, J. E., Wei, G.-X., Huang, T., Yeung, A. S., Neto, O. B., Chen, K. W., \u0026amp; Hui, S. S.-c. (2018). Effects of mind\u0026ndash;body exercises (Tai Chi/Yoga) on heart rate variability parameters and perceived stress: A systematic review with meta-analysis of randomized controlled trials. \u003cem\u003eJournal of clinical medicine, 7\u003c/em\u003e(11), 404. https://doi.org/https://doi.org/10.3390/jcm7110404\u003c/li\u003e\n\u003cli\u003eZou, L., Yeung, A., Li, C., Wei, G.-X., Chen, K. W., Kinser, P. A., Chan, J. S., \u0026amp; Ren, Z. (2018). Effects of meditative movements on major depressive disorder: a systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eJournal of clinical medicine, 7\u003c/em\u003e(8), 195. https://doi.org/https://doi.org/10.3390/jcm7080195\u003c/li\u003e\n\u003cli\u003eZou, L., Yeung, A., Quan, X., Boyden, S. D., \u0026amp; Wang, H. (2018). A systematic review and meta-analysis of mindfulness-based (Baduanjin) exercise for alleviating musculoskeletal pain and improving sleep quality in people with chronic diseases. \u003cem\u003eInternational Journal of Environmental Research and Public Health, 15\u003c/em\u003e(2), 206. https://doi.org/https://doi.org/10.3390/ijerph15020206\u003c/li\u003e\n\u003cli\u003eZou, L., Zhang, Y., Yang, L., Loprinzi, P. D., Yeung, A. S., Kong, J., Chen, K. W., Song, W., Xiao, T., \u0026amp; Li, H. (2019). Are mindful exercises safe and beneficial for treating chronic lower back pain? A systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eJournal of clinical medicine, 8\u003c/em\u003e(5), 628. https://doi.org/https://doi.org/10.3390/jcm8050628\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Depression, Mental Health, Sleep Quality, Tai Chi Chuan","lastPublishedDoi":"10.21203/rs.3.rs-4253409/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4253409/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe effectiveness of regular physical activity as a therapeutic intervention in modern medicine is widely recognized, making it a potential option for those seeking lifestyle modifications to treat mood disorders. Thus, the goal of this study was to examine the impact of Tai Chi Chuan exercise on depression, sleep quality, and mental well-being.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study used an experimental design, including pre- and post-test assessments, and consisted of both experimental and control groups. The study included male individuals diagnosed with depression who were selected from healthcare centers in Sardasht city during the year 2019. The study involved 30 male individuals with depression symptoms, divided into two groups: the experimental group, which completed 36 Tai Chi Chuan training sessions, and the control group, which did not receive any treatment. The participants completed demographic data collection forms and responded to multiple surveys. The data was analyzed using SPSS-26 software, employing both univariate and multivariate methodologies, and the mean and standard deviations of age were 27.40 (SD\u0026thinsp;=\u0026thinsp;4.20) and 30.13 (SD\u0026thinsp;=\u0026thinsp;4.19) respectively.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results of the study revealed that both univariate and multivariate analyses of covariance provided evidence supporting the notion that engaging in Tai Chi Chuan exercises led to enhancements in sleep quality and mental health among participants in the experimental group. Furthermore, these enhancements were correlated with a decrease in depressive symptoms.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIn conclusion, participation in Tai Chi activities holds the potential to enhance emotional well-being, sleep patterns, and overall mental health in men experiencing depression.\u003c/p\u003e","manuscriptTitle":"The Effectiveness of Tai Chi Chuan Exercise on Depression, Sleep Quality, and Mental Health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-29 12:42:32","doi":"10.21203/rs.3.rs-4253409/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c2ca716e-d9fa-4768-a8e5-ec414cdca6dd","owner":[],"postedDate":"April 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-19T10:39:02+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-29 12:42:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4253409","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4253409","identity":"rs-4253409","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}