Brain pathways intertwined with exercise equipment, symbolizing mental and physical activity in diabetes management.

Can Exercise Slow Cognitive Decline? A New Look at Diabetes and Brain Health

Lena Kashyap in Health & Wellness July 2025 • 5 min read.

"A pilot study explores how a multi-modal exercise program could boost cognitive function in older adults with Type 2 diabetes, offering hope for preventing dementia."

The global rise in dementia cases is a growing concern, with projections estimating nearly 115 million affected individuals by 2050. As the search for effective disease-modifying medications continues, identifying preventive strategies, particularly for high-risk individuals, has become crucial. Type 2 diabetes (T2D) has emerged as a significant modifiable risk factor, increasing the risk of dementia nearly twofold.

Individuals with T2D often experience accelerated cognitive decline, predominantly affecting executive function and processing speed. This decline is attributed to a mix of neurodegeneration and cerebrovascular disease. Given the complex interplay of risk factors associated with T2D-related dementia, therapeutic approaches addressing multiple factors simultaneously are likely to yield the best outcomes. Structured exercise training has shown promise, improving glycemic, metabolic, and vascular profiles in individuals with T2D.

While observational studies suggest exercise benefits cognitive health, randomized controlled trials (RCTs) in older adults have produced inconsistent results. People with T2D represent a unique high-risk group with clustered biological risk factors for cognitive decline, making them potentially responsive to risk factor optimization through multi-modal exercise programs. A pilot RCT was conducted to assess the feasibility and potential cognitive benefits of a multi-modal exercise program.

The CDOT-X Study: Design and Multi-Modal Exercise

Brain pathways intertwined with exercise equipment, symbolizing mental and physical activity in diabetes management.

The Cognition and Diabetes in Older Tasmanians A pilot RCT of exercise (CDOT-X) study was a 6-month single-blind parallel RCT. It compared a progressive multi-modal exercise program with a stretching and gentle movement control group. The study included individuals with previously diagnosed T2D, and outcome assessments were blinded. The exercise program included aerobic and resistance training (ART).

Participants were randomized into either an ART program or a stretching/gentle movement control group. Randomization used a central, automated allocation procedure stratified by age. Assessment staff remained blinded to group allocation, while participants were informed that the study examined the difference between two types of exercise, without revealing the nature of the alternative program. All assessments and exercise classes occurred at the Menzies Institute for Medical Research, University of Tasmania.

Aerobic and Resistance Training (ART): This program involved two supervised one-hour sessions per week, supplemented by one unsupervised session at home. It consisted of approximately 30 minutes of moderate- to high-intensity progressive resistance training (PRT) and 30 minutes of aerobic activity like cycling or treadmill walking. The intensity was individually tailored and progressed based on the Borg Scale of perceived exertion.
Control Intervention: Participants in this group received a 6-month light intensity stretching and gentle movement program, also implemented by accredited exercise physiologists. This included two supervised one-hour sessions per week and one unsupervised session at home. The activities were designed to match the participative involvement and socialization of the intervention group.

Feasibility measures included the ability to coordinate recruitment, screening, and clinic tasks, class coordination, and participant attendance. Adherence was assessed by attendance at supervised sessions and a participant exercise diary. Safety was monitored through the tracking and description of serious and other adverse events. Retention was measured by the number of participants who withdrew.

The Path Forward

This pilot study provides encouraging evidence for the feasibility and potential benefits of a multi-modal exercise program in preserving cognitive function among individuals with T2D. Further research is needed to confirm these findings and determine the long-term impact of exercise on cognitive health.

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This article is based on research published under:

DOI-LINK: 10.1186/s12877-017-0635-9, Alternate LINK

Title: Feasibility Of A Multi-Modal Exercise Program On Cognition In Older Adults With Type 2 Diabetes – A Pilot Randomised Controlled Trial

Subject: Geriatrics and Gerontology

Journal: BMC Geriatrics

Publisher: Springer Science and Business Media LLC

Authors: M. L. Callisaya, R. M. Daly, J. E. Sharman, D. Bruce, T. M. E. Davis, T. Greenaway, M. Nolan, R. Beare, M. G. Schultz, T. Phan, L. C. Blizzard, V. K. Srikanth

Published: 2017-10-16

Everything You Need To Know

Why is Type 2 diabetes considered a significant risk factor for dementia?

Type 2 diabetes (T2D) is considered a significant modifiable risk factor for dementia because it nearly doubles an individual's risk. People with T2D often experience accelerated cognitive decline, particularly affecting executive function and processing speed. This decline is linked to a combination of neurodegeneration and cerebrovascular disease. Therapeutic approaches addressing these multiple factors simultaneously, such as structured exercise training, are seen as beneficial for individuals with T2D.

What is a multi-modal exercise program, and why is it potentially beneficial for individuals with Type 2 diabetes at risk of cognitive decline?

A multi-modal exercise program typically combines different types of exercise, such as aerobic and resistance training (ART). It is potentially beneficial for individuals with Type 2 diabetes (T2D) at risk of cognitive decline because it addresses multiple risk factors simultaneously. For instance, Aerobic and Resistance Training (ART) improves glycemic, metabolic, and vascular profiles, potentially slowing down cognitive decline associated with T2D. Programs like the one used in the Cognition and Diabetes in Older Tasmanians A pilot RCT of exercise (CDOT-X) study are tailored to individual intensity levels and progress based on perceived exertion.

Can you describe the Aerobic and Resistance Training (ART) program used in the CDOT-X study, and how did it differ from the control intervention?

In the Cognition and Diabetes in Older Tasmanians A pilot RCT of exercise (CDOT-X) study, the Aerobic and Resistance Training (ART) program involved two supervised one-hour sessions per week, supplemented by one unsupervised session at home. Each session consisted of approximately 30 minutes of moderate- to high-intensity progressive resistance training (PRT) and 30 minutes of aerobic activity like cycling or treadmill walking. The intensity was individually tailored and progressed based on the Borg Scale of perceived exertion. In contrast, the control intervention consisted of a 6-month light intensity stretching and gentle movement program, also with two supervised one-hour sessions per week and one unsupervised session at home. This was designed to match the participative involvement and socialization of the ART intervention group, but without the high-intensity elements.

What were the main feasibility measures assessed in the CDOT-X study, and why are these measures important?

The main feasibility measures assessed in the Cognition and Diabetes in Older Tasmanians A pilot RCT of exercise (CDOT-X) study included the ability to coordinate recruitment, screening, and clinic tasks, class coordination, and participant attendance. Adherence was assessed by attendance at supervised sessions and a participant exercise diary. Safety was monitored through the tracking and description of serious and other adverse events. Retention was measured by the number of participants who withdrew. These measures are crucial because they provide insight into whether a larger, more comprehensive study would be viable. High adherence, retention, and safety indicate that the intervention is acceptable and sustainable for the target population.

What is the significance of the CDOT-X study's findings, and what further research is recommended based on the study's outcomes?

The Cognition and Diabetes in Older Tasmanians A pilot RCT of exercise (CDOT-X) study provides encouraging evidence for the feasibility and potential benefits of a multi-modal exercise program, specifically Aerobic and Resistance Training (ART), in preserving cognitive function among individuals with Type 2 diabetes (T2D). This is significant because it suggests a non-pharmacological intervention could help mitigate cognitive decline in a high-risk group. Further research is needed to confirm these findings, determine the long-term impact of exercise on cognitive health, and explore the specific mechanisms through which multi-modal exercise programs like ART may exert their cognitive benefits. Future studies should also investigate optimal exercise parameters and individualization strategies.