A 12-week Intensive Aerobic and Resistance Exercise Program (IAREP) intervention was implemented on high-risk and low-risk subjects with cognitive impairment in type 2 Diabetes Mellitus. The study aims to evaluate the effectiveness of IAREP on cognition, metabolic and inflammatory health, physical function, vascular health, and health practice behaviour in the Type 2 Diabetes Mellitus population (T2DM).
Background and Significance: T2DM is a leading cause of morbidity and mortality among adults worldwide, with approximately 5 million diabetes-related deaths accounting for 12.8% of all-cause mortality in 2015. The prevalence of T2DM in Asia is on the rise, with an anticipated increase from 78 million in 2015 to 140 million by 2040. Asia, therefore, is emerging as the "diabetes epicentre" due to rapid economic development, urbanisation, and nutrition transition. T2DM is a complex disease with environmental and genetic contributions that cause many severe complications in middle-aged and older adults, including a higher susceptibility to mild cognitive impairment (MCI) and dementia. The prevalence of cognitive impairment in T2DM ranges from 21.8% to 67.5% worldwide in all adults. Our previous study developed a risk stratification score (RSS) to quickly screen the T2DM population for high-risk or low-risk cognitive impairment. Exercise intervention plays a crucial role inof T2DM the management . Aerobic exercise has multiple benefits to metabolic functions, including increasing cardiovascular fitness, improving skeletal muscle capillary density, and reducing body fat. Resistance training is considered a promising intervention for reversing the loss of muscle function and deterioration of muscle structure associated with ageing. Intervention strategies, such as the proposed combined aerobic and resistance training program, will provide a guideline to prescribe exercise dosage for individuals with T2DM who are at risk of cognitive impairment. Methods: A mixed-methods study was conducted, comprising a quasi-experimental control trial followed by a process evaluation through focus group discussions. The study screened 150 subjects, and 58 were recruited. Participants were assigned to either the exercise intervention group or the non-exercise control group according to their availability. The intervention group received a 12-week Intensive Aerobic and Resistance Exercise Program (IAREP), while the control group received usual care from Jurong National University Polyclinics without participating in the IAREP exercise.
Study Type
INTERVENTIONAL
Allocation
IAREP is a combined aerobic exercise and resistance training program that developed by qualified exercise professionals. It encompasses a 12-week exercise intervention, conducted in a blended mode which consists of face-to-face exercise, Zoom exercise, and pre-recorded video exercise. Frequency: 3 times exercise per week. Intensity: moderate to vigorous exercise. Time of the exercise: 45-60 mins. Type of exercise: combined aerobic and resistance training. Warm-up: aerobic workout with dynamic stretch (for targeted muscles). Aerobic exercise: each session encompasses 5 exercise. Resistance training: each session encompasses 4 exercise, 2 upper body exercise and 2 lower body exercise. Cool-down: relax targeted muscles.
National University Polyclinic (Jurong Polyclinics)
Singapore, Singapore, Singapore
Change in Cognitive Function Based on Risk Stratification Score (RSS)
Pre- and post-intervention measurements were conducted to assess the Risk Stratification Score (RSS). RSS scores range from -3.4 to 6.8; higher scores represent worse outcomes.
Time frame: Baseline and 12 weeks
Number of Participants With Change in Cognitive Function (Cognitive Impairment) Based on Vascular Dementia Battery (VDB)
Pre- and post-intervention measurements were conducted to assess the number of participants with change in cognitive function (Cognitive Impairment). This outcome reports the count of participants with Cognitive Impairment (CI) in each group at both assessments. A decrease in this count from Pre to Post indicates improved group cognitive function; an increase indicates worsened function. CI was diagnosed per Vascular Dementia Battery (VDB) criteria as a score below the clinical cutoff in any of its seven domains: executive function (score range 0-18), attention (score range 0-60), language (score range 0-15), verbal memory (score range 0-110), visual memory (score range 0-117), visuoconstruction (score range 0-97), and visuomotor speed (score range 0-150), where a higher score means a better outcome.
Time frame: Baseline and 12 weeks
Change in Cognitive Function Based on the Montreal Cognitive Assessment (MoCA)
Pre- and post-intervention measurements were conducted to assess the Montreal Cognitive Assessment (MoCA). MoCA scores range from 0 to 30, with higher scores indicating better outcomes.
Time frame: Baseline and 12 weeks
Change in Metabolic Health
Pre- and post-intervention measurements were conducted. Measure the change in blood test of HbA1c for metabolic conditions.
Time frame: Baseline and 12 weeks
Change in Inflammatory Condition
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NON_RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
58
Pre- and post-intervention measurements were conducted. Measure the change in blood tests of IL6, CRP, and TNFa for inflammatory conditions.
Time frame: Baseline and 12 weeks
Change in Short Physical Performance Battery (SPPB)
Pre- and post-intervention measurements were conducted. Measure the change in Short Physical Performance Battery (SPPB). The scores range from 0 to 12; a higher score means a better outcome.
Time frame: Baseline and 12 weeks
Change in Sarcopenia Risk
Pre- and post-intervention measurements were conducted. Measure the change in sarcopenia condition from a rapid sarcopenia screening of Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F). The scores range from 0 to 10; a higher score means a worse outcome.
Time frame: Baseline and 12 weeks
Change in Blood Pressure
Pre- and post-intervention measurements were conducted. Measure the change in systolic blood pressure (SBP) and diastolic blood pressure.
Time frame: Baseline and 12 weeks
Change in Physical Activity: International Physical Activity Questionnaire - Short Form
The IPAQ-SF questionnaire assesses daily physical activities by asking individuals about their engagement in vigorous activities (e.g., heavy lifting), moderate activities (e.g., carrying light loads), and walking over the past 7 days. The IPAQ-SF provides valuable insights into physical activity levels, aiding in health risk assessments and lifestyle improvements.
Time frame: Baseline and 12 weeks
Change in Self-care of Diabetes Index (SCODI)
Pre- and post-intervention measurements were conducted. Measure the change in the Self-care of Diabetes Inventory. There are 40 items (5-point Likert type) and 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence.
Time frame: Baseline and 12 weeks
Change in Self-related and Health Practice (SRAHP)
Pre- and post-intervention measurements were conducted. Measure the change in self-perceived ability to implement health-promoting behaviours, which include subscales of Exercise, Nutrition, Responsible Health Practice, and Psychological Well-being. The scores range from 0 to 112; a higher score means a better outcome.
Time frame: Baseline and 12 weeks