Practicing the traditional Chinese martial art of tai chi chuan, commonly known as tai chi, was found to be beneficial for cognitive function in older adults with type 2 diabetes (T2D) and mild cognitive impairment (MCI), according to recent findings.¹

Tai chi, a popular mind-body exercise using physical, cognitive, social, and meditative elements, previously found to be effective in helping to control levels of blood glucose for T2D patients.² This large scale was conducted to expand upon this knowledge and test tai chi against the benefits of fitness walking.

The study was based out of China and was authored by Yannan Chen, PhD, from the College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine in China.

“However, no large-scale randomized clinical trials have been reported on whether tai chi chuan is more beneficial than fitness walking for patients with T2D and MCI,” Chen and colleagues wrote. “Therefore, we designed a randomized clinical trial to explore the effectiveness of tai chi chuan in improving cognitive function of older adults with T2D and MCI compared with a fitness walking group and a control group.”

Background and Findings

Between June 1, 2020, and February 28, 2022, the investigators conducted a randomized clinical trial at 4 different locations in China. The team recruited 328 adults, all of whom were aged 60 years or older and had a clinical diagnosis of T2D as well as MCI. The study participants were divided into 3 groups in a 1:1:1 ratio, namely tai chi group, fitness walking group, and control.

All study groups were given education seminars on managing type 2 diabetes, with seminars covering such topics as maintaining healthy dietary habits, monitoring blood glucose levels, and preventing related complications. The requisite seminars were done by clinical endocrinologists and lasted for a half hour each, with a single seminar conducted every 4 weeks for a 24 week span.

While the control arm did not receive any exercise intervention and continued with their usual lifestyle, the fitness walking arm had a supervised walking program for 24 weeks, and the tai chi arm had supervised training on ‘24-form’ tai chi for the same duration. Both groups trained for 60 minutes per session, three times per week, for 24 weeks, under the supervision of the research team.

All three groups received a 30-minute diabetes self-management education session once every four weeks for 24 weeks. The participants were monitored for 36 weeks, and were given a recommendation to maintain their exercise routine even after 24 weeks of supervised training ended, leading up to the groups’ 36-week follow-up evaluations.

The primary measure used to assess cognitive function was the Montreal Cognitive Assessment (MoCA), given at 36 weeks following the intervention. MoCA was also used at the 24 week mark, along with other cognitive subdomain measures and blood metabolic indices.

Overall, the investigators reported that the tai chi group (107) had improved MoCA scores at 36 weeks compared to the fitness walking group (110) in the intention-to-treat analysis, and the team’s per-protocol analysis and their subgroup analysis at 36 weeks had similar data.

The effects were found to be similar in each study arm after adjusting for self-reported dietary calories and physical activity. The team added that non-serious adverse events that were determined to be unrelated to the study were found in 37 study participants, with no statistically significant difference among all 3 groups.

The investigators’ study results indicate long-term benefits for tai chi practice, suggesting this exercise intervention may help improve cognitive function in older adults with MCI and T2D.

“The findings on duration of T2D, BMI, and comorbidity suggest that interventions may be more effective in the early or mild stages of the disease,” they wrote. “Therefore, this also suggests that in the future, early tai chi chuan training would be more effective for people with T2D and MCI, especially women with low levels of education."

References

1. ^{Chen Y, Qin J, Tao L, et al. Effects of Tai Chi Chuan on Cognitive Function in Adults 60 Years or Older With Type 2 Diabetes and Mild Cognitive Impairment in China: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(4):e237004. doi:10.1001/jamanetworkopen.2023.7004.}
2. ^{Song G, Chen C, Zhang J, Chang L, Zhu D, Wang X. Association of traditional Chinese exercises with glycemic responses in people with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. J Sport Health Sci. 2018;7(4):442-452. doi:10.1016/j.jshs.2018.08.004.}