Aerobic Exercise Combined With Repetitive Transcranial Magnetic Stimulation in College Students at Suicide Risk: Protocol for a Single‐Centre Non‐Randomised Controlled Pilot Study

BACKGROUND: College students are vulnerable to depressive symptoms, suicidal ideation, sleep disturbance, and stress-related psychological problems. Aerobic exercise and repetitive transcranial magnetic stimulation (rTMS) have each shown therapeutic potential in affective disorders, but evidence on their combined application in college students at suicide risk remains limited, particularly when neurophysiological outcomes are considered. OBJECTIVES: To evaluate the feasibility, safety, and preliminary effects of aerobic exercise combined with rTMS on suicidal ideation, depressive symptoms, sleep, and prefrontal functional activation in college students at suicide risk. METHODS: This prospective single-centre non-randomised controlled pilot study will enrol students aged 18-21 years who are identified as being at suicide risk by the Xinhai University Crisis Intervention System. At-risk participants will enter one of three groups: active rTMS plus aerobic exercise, sham rTMS plus aerobic exercise, or standardised group psychological intervention/usual support. A separately recruited healthy reference cohort will complete the same assessment schedule without active treatment. Active rTMS will be delivered over the left dorsolateral prefrontal cortex at 10 Hz and 120% of the individual motor threshold once daily for 2 weeks. Aerobic exercise will be prescribed at a target heart-rate zone of 135-164 beats/min for 30-60 min per session every 2 days for 2 weeks, with heart rate and adherence objectively monitored. OUTCOME MEASURES: The primary outcomes are changes in the Self-rating Idea of Suicide Scale (SIOSS) total score and Self-rating Depression Scale (SDS) standard score from baseline to week 4. Secondary outcomes include SIOSS and SDS dimensions, total sleep time, task-related and resting-state functional near-infrared spectroscopy (fNIRS) measures, adherence, concomitant care, and adverse events. ETHICS AND DISSEMINATION: The study was approved by the Ethical Review Committee of Yancheng First People's Hospital (Approval No. 2023-K-230) and the Ethics Committee of INTI International University (Approval No. INTI-IU/FHLS-RC/BTCMI/AUGUST2022/003). Findings will be disseminated through peer-reviewed publications and academic conferences. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2400079723.