College students represent the future of families, communities, and countries. The college age is also a critical time in which individuals begin to take definitive steps towards independence, and is considered to be the first major transition an individual faces . However, due to the intense pressure of competition among students, their physical activity decline is evident during the first transition period into adulthood, especially in the first college year [2–4]. It is estimated that only 44% of college age students in America meet physical activity recommendations, as opposed to 68% of high school students . Similarly, the percentage of physically inactive college students is 13.5% for Taiwan, 16.8% for Hong Kong, and 28.5% for Korea . It is well know that physical activity can enhance the functioning of cardiovascular systems and have substantial benefits in reducing the risk of cardiovascular diseases [7, 8]. College students may therefore be a population at risk and susceptible to chronic diseases [9–11].
The psychological and/or mental wellbeing of college students might be ‘worse off’ than that of the general population. As a result of risky behaviors and multiple stressors, such as academic challenge, competition and achievements , various forms of mental health problems are more frequently present among college students than same-aged non student populations [13–15]. Convincing evidence has shown a marked increase in psychological distress including depression, paranoia, and hypomania among American college students over the past 50 years . Longitudinal studies of psychological distress in college students showed that, although distress levels peaked during the first year and then declined for most students, some of them manifested with severe distress levels which did not decrease over time [17, 18]. If left ignored and untreated, mental health problems may lead to students dropping out of college, attempting or committing suicide, or engaging in other risky, dangerous behaviors . However, it is estimated that only a minority of college students with mental health problems seek and receive adequate help .
The growing research continues to strengthen the idea that regular exercise or physical activities are positively associated with physical and psychological health outcomes [21, 22]. As a traditional Chinese mind-body exercise, TCC has been practiced for many centuries in China and is increasing in popularity in the West. Through deeply diaphragmatic breathing, basic slow and gentle mind-body moments, practitioners can achieve an efficiency of ‘body relaxation and mind calm’ and Tian Ren He Yi (the theory that mankind is an integral part of nature) . TCC, or meditative movement types of exercise in general may provide attractive and effective exercise alternatives for the large amount of people at a risk of preventable diseases, who live a sedentary lifestyle, and who lack the motivation to engage in more conventional exercise . Several systematic reviews have suggested that TCC may have significant improvement in balance capability, flexibility, cardiovascular and respiratory function, hypertension, osteoporosis, depression, anxiety and stress of the general population [25–33]. However, it was difficult to draw firm conclusions due to the fact that limitations or biases exist in the majority of the studies, such as small sample size or lacking rigorously randomized design . Furthermore, for young adults, (particularly the college student population) the evidence is unclear as to whether TCC can be recommended as an effective exercise for improving emotional state, psychological wellbeing and physical fitness. Therefore high quality, rigorous, prospective, well-controlled randomized trials with appropriate comparison groups and validated outcome measures are needed to further understand the effects of TCC serving as an intervention for specific psychological outcomes in college student populations. The purpose of this trial is to systematically evaluate the effects of TCC on physical and psychological outcomes of college students including mood, anxiety, psychological wellbeing, self-efficacy, and quality of life.
We designed a strict randomized controlled trial to systematically evaluate the effectiveness of TCC exercise on the physical and mental health of college students.