A technology-blended exercise intervention for cognitive risk reduction and brain health in middle-aged and older adults with type 2 diabetes in Singapore: a mixed-methods study

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 (CI) risk, physical function, metabolic and inflammatory markers, physical activity, and self-care maintenance. Qualitative focus group discussions (FGDs) explored participant experiences following program 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 CI (F(1,51) = 4.9, p = .031, η²_p = 0.088), improvements in physical function (F(1,51) = 10.6, p = .002, η²_p = 0.172), and higher physical activity levels (F(1,51) = 8.3, p = .006, η²_p = 0.140). Self-care maintenance also improved significantly (F(1,51) = 4.5, p = .040, η²_p = 0.081). Adherence was high (88.9%). Qualitative findings highlighted enhanced motivation, social connectedness, and perceived cognitive and physical well-being. Conclusions: 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.