# Effect of a digital-based integrated exercise and sleep intervention for older adults with depression: study protocol for a stepped-wedge cluster randomized controlled trial

## TL;DR

This study tests a combined exercise and sleep program to reduce depression in older adults and assess its health and cost benefits.

## Contribution

The study introduces a novel integrated exercise and sleep intervention for geriatric depression with a focus on clinical and cost-effectiveness.

## Key findings

- The intervention will assess depressive symptom reduction in older adults through exercise and sleep optimization.
- The study will explore potential biological mechanisms like BDNF and brain connectivity changes.
- Economic evaluation will determine the cost-effectiveness of the integrated approach.

## Abstract

Geriatric depression affects 12.95-28.4% of adults aged ≥ 60, yet treatment rates remain critically low globally. Lifestyle factors, particularly exercise and sleep demonstrate therapeutic potential, integrated interventions may exert synergistic effects on geriatric depression, though such interventions remain scarce. The Geriatric Exercise-Sleep Optimization (GESO) project aims to evaluate the clinical efficacy and cost-effectiveness of a combined exercise and sleep health intervention in alleviating depressive symptoms among community-dwelling older adults with depression, and exploring the potential underlying mechanisms. This is a stepped-wedge cluster-randomized trial (SW-CRT). A 12-week integrated exercise and sleep intervention will be implemented to all eligible participants during the study period. The primary aim is to evaluate the clinical efficacy in alleviating depressive symptoms. Secondary aims are to evaluate the additional health outcomes (i.e., quality of life, physical activity level, daily step count, sleep quality, and anxiety symptom), cost-effectiveness, and potential mechanisms. Costs will be aggregated and analyzed for economic evaluation. Costs will be aggregated and analyzed for economic evaluation. Salivary measured BDNF and irisin levels, and EEG-based brain function connectivity will be collected to assess potential intervention mechanisms. Mixed-effect linear regression models will be used to evaluate the effects of the integrated exercise-sleep intervention on primary and secondary outcomes. This study is expected to provide an effective and practical mode for an integrated exercise and sleep intervention among community-dwelling older adults with depression. Intended outcomes of the trial will facilitate changes in best practice to improve outcomes for this population.

Trial registration

Chinese Clinical Trail Registry ChiCTR2500107641, Registration date: 15 August 2025.

The online version contains supplementary material available at 10.1186/s12877-026-07071-z.