A Technology-Blended Exercise Intervention for Cognitive Risk Reduction and Brain Health in Middle-Aged and Older Adults with Type 2 Diabetes in Singapore
Jinghua Zhang, Wilson Wai San Tam, Jinhua Lu, Junjie Chen, Jed Montayre, Joji Kusuyama, Yanhong Dong, Xin Yi Yap, Wentao Zhou, Na Wang, Hui Nan Yeo, Frena Jia Sy Lee, Vivien Xi WuAbstract
Background
Type 2 diabetes mellitus (T2DM) is a major modifiable risk factor for accelerated brain ageing, cognitive decline, and dementia. However, sustainable lifestyle interventions targeting cognitive health in at-risk older adult populations remain limited. This mixed-methods study evaluated the effects of a 12-week technology-blended Intensive Aerobic and Resistance Exercise Program (IAREP) on cognitive risk and related health outcomes among middle-aged and older adults with T2DM in a primary care setting in Singapore.
Methods
Participants were recruited from a community polyclinic and allocated to either the intervention or usual care group. The intervention integrated face-to-face, Zoom-based, and video-recorded home exercise sessions to support accessibility and adherence. Quantitative outcomes included cognitive impairment risk, physical function, metabolic and inflammatory markers, physical activity, and self-care maintenance. Qualitative focus group discussions explored participant experiences following programme completion.
Results
Fifty-three participants completed the study (mean age 66.7 years). Compared with usual care, the intervention group demonstrated significant reductions in predicted risk of cognitive impairment (F(1,51)=4.9, p = 0.031, η²ₚ=0.088), improvements in physical function (F(1,51)=10.6, p = 0.002, η²ₚ=0.172), and higher physical activity levels (F(1,51)=8.3, p = 0.006, η²ₚ=0.140). Self-care maintenance also improved significantly (F(1,51)=4.5, p = 0.040, η²ₚ=0.081). Adherence was high (88.9%). Qualitative findings highlighted enhanced motivation, social connectedness, and perceived cognitive and physical well-being.
Conclusion
These findings support technology-blended exercise might be a feasible and scalable strategy for cognitive risk reduction and brain health promotion among middle-aged and older adults with T2DM, with potential translational relevance for dementia prevention in primary care and community settings.