Effects of Tai Chi Chuan on Cognitive Function in Adults 60 Years or Older With Type 2 Diabetes and Mild Cognitive Impairment in China

Abstract

ImportanceType 2 diabetes (T2D) is associated with the progression of cognitive dysfunction. Physical activity benefits cognition, but no evidence from randomized clinical trials has shown whether tai chi chuan has better long-term benefits than fitness walking in cognitive function for patients with T2D and mild cognitive impairment (MCI).ObjectiveTo compare the effectiveness of tai chi chuan, a mind-body exercise, for improving cognitive function in older adults with T2D and MCI, with fitness walking.Design, Setting, and ParticipantsThis randomized clinical trial was conducted between June 1, 2020, and February 28, 2022, at 4 sites in China. Participants included 328 adults (aged ≥60 years) with a clinical diagnosis of T2D and MCI.InterventionsParticipants were randomized in a 1:1:1 ratio to a tai chi chuan group, a fitness walking group, or a control group. The tai chi chuan group received 24-form simplified tai chi chuan. The fitness walking group received fitness walking training. Both exercise groups took the training for 60 min/session, 3 times/wk, for 24 weeks in a supervised setting. All 3 groups were provided with a 30-minute diabetes self-management education session, once every 4 weeks for 24 weeks. The participants were followed up for 36 weeks.Main Outcomes and MeasuresThe primary outcome was the global cognitive function measured at 36 weeks by the Montreal Cognitive Assessment (MoCA). Secondary outcomes included MoCA at 24 weeks and other cognitive subdomain measures and blood metabolic indices at 24 and 36 weeks.ResultsA total of 328 participants (mean [SD] age, 67.55 [5.02] years; mean [SD] T2D duration, 10.48 [6.81] years; 167 [50.9%] women) were randomized to the tai chi chuan group (n = 107), fitness walking group (n = 110), or control group (n = 111) and included in the intention-to-treat analysis. At 36 weeks, the tai chi chuan group showed improved MoCA scores compared with the fitness walking group (mean [SD], 24.67 [2.72] vs 23.84 [3.17]; between-group mean difference, 0.84 [95% CI, 0.02-1.66]; P = .046) in the intention-to-treat analysis. The per-protocol analysis data set and subgroup analysis at 36 weeks showed similar results. Based on the generalized linear models, the treatment effects were similar in each group after adjusting for self-reported dietary calories and physical activity. There were 37 nonserious adverse events (tai chi chuan group, 8; fitness walking group, 13; control group, 16) unrelated to the study with no statistically significant difference among the 3 groups (P = .26).Conclusions and RelevanceIn this randomized clinical trial including older adults with T2D and MCI, tai chi chuan was more effective than fitness walking in improving global cognitive function. The findings support a long-term benefit, suggesting the potential clinical use of tai chi chuan as an exercise intervention to improve cognitive function for older adults with T2D and MCI.Trial RegistrationClinicalTrials.gov Identifier: NCT04416841

Lifestyle intervention Tai Chi for adult patients with type 2 diabetes mellitus: a PRIO-harms based overview of 17 systematic reviews

“…While Tai Chi may not exhibit unparalleled performance compared to other forms of exercise, it presents distinct advantages in certain aspects. Recent research underscores Tai Chi’s potential as a viable cognitive treatment for older adults grappling with T2DM and mild cognitive impairment ( 4 ). Despite sharing aerobic traits with other exercises, Tai Chi’s efficacy cannot be solely attributed to its moderate intensity and energy expenditure.…”

“…( 4 ) Outcome measures (O) : Primary outcomes were HbA1c and FBG. Secondary outcomes included postprandial blood glucose (PBG), fasting serum insulin (FINS), index of homeostasis model assessment of insulin resistance (HOMA-IR), body mass index (BMI), the Short-Form Health Survey (SF-36), BMI, lipids-related indices (total cholesterol (TCh), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL)), cognition, balance, and emotion.…”

“…Tai Chi, a holistic mind-body practice blending mindfulness and physical movement, has emerged as a noteworthy clinical intervention. Recent research has suggested its potential as a cognitive treatment for older adults dealing with both T2DM and mild cognitive impairment ( 4 ). Moreover, Tai Chi’s efficacy extends to conditions like metabolic syndrome ( 5 ), fibromyalgia ( 6 ), knee osteoarthritis ( 7 ), Parkinson’s disease ( 8 ), and insomnia after breast cancer ( 9 ), as substantiated by clinical validation.…”

Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition)

“… 266 Exercise also helps to improve cognitive function, and a randomized clinical trial found that tai chi was more effective than fitness walking in improving cognitive function in Chinese older patients with T2DM. 267 …”

Non-drug interventions of traditional Chinese medicine in preventing type 2 diabetes: a review

“…Besides, Yijinjing combined with elastic band exercise, reducing the body weight, body mass index and fat content and improving muscle function and growth hormone secretion in patients with prediabetes, can delay muscle mass loss and diabetes development [80]. Furthermore, in a randomized clinical trial including 328 patients aged 60 and above with type 2 diabetes and mild cognitive impairment, the Tai Chi Chuan group had higher Montreal cognitive assessment scores compared with the control group and the fitness walking group at 36 weeks, suggesting its potential to prevent cognitive impairment and exacerbation in senile patients with type 2 diabetes [81]. These three recent clinical trials all manifested that adverse events unrelated to the studies did not have statistically significant differences between the TCM exercises group and the other group [79][80][81].…”