A 12-week exercise intervention delivered via a blended modality of face-to-face, Zoom-based, and video-recorded sessions to promote adherence to physical activity among middle-aged and older adults with type 2 diabetes (T2D) in Singapore is feasible and may help improve outcomes, including cognitive performance, as shown in a mixed-methods study.
Compared with usual care, the exercise intervention was associated with reduced predicted risk of cognitive impairment (p=0.031), improved physical function (p=0.002), increased physical activity levels (p=0.006), and improved self-care maintenance (p=0.040). No significant between-group difference was observed for other outcomes. [J Gerontol A Biol Sci Med Sci 2026;doi:10.1093/gerona/glag192]
Adherence to the exercise intervention was high at 88.9 percent. Participants attended a median of 10 sessions out of the 12 planned face-to-face sessions and a median of 12 virtual live sessions. Moreover, participants self-reportedly performed the video-recorded exercise sessions a median of 11 times.
Semi-structured interviews with participants who completed the exercise intervention indicated that the intervention enhanced motivation, fostered social connectedness, and improved perceived cognitive and physical well-being.
Participants reported that the structured support, professional guidance, and personalized routines provided by the exercise intervention helped facilitate sustained engagement. Discipline emerged as both a motivator and a challenge that factored in building consistent exercise habits and maintaining adherence.
Additionally, participants described how group sessions transformed physical activity into a shared experience with meaning and significance. “I enjoy [the programme] because [the participants] come together and do the exercises, and it feels like we are friends. If I exercise alone, it’s very boring… I feel happier in a group,” according to one participant. The social connection achieved through exercising in a group made even challenging routines feel achievable through laughter and support.
When exercise stopped becoming a chore, participants found satisfaction and reaped benefits. Generally, participants observed increased flexibility and mobility that enhanced their daily functioning. The participants also reported improved mental health by stabilizing mood and reducing stress. These benefits reinforced the participants’ commitment to exercising.
A transformative intervention
Called the Intensive Aerobic and Resistance Exercise Program (IAREP), the exercise intervention was designed to address the challenges that prevent middle-aged and older adults with T2DM from sustaining regular physical activity.
Low physical activity compliance rates in this population are often attributed to busy schedules, low motivation, physical limitations, and racial disparities, according to the investigators. “Traditional exercise programmes often lack flexibility, personalized guidance, or innovative delivery methods tailored to the[se] unique needs.”
IAREP was developed based on the American College of Sports Medicine (ACSM) and Singapore Physical Activity Guidelines. The programme included three components: (1) an exercise prescription based on the FITT principles (ie, frequency, intensity, time, and type of exercise), consisting of moderate-to-vigorous, low-impact combined aerobic and resistance exercise performed three times per week for 45–60 min per session; (2) a tailored design with progression guided by rating of perceived exertion, individual adjustment, and exercise options of varying difficulty; and (3) a blended delivery model combining face-to-face group exercise in the polyclinic, live group exercise via Zoom at home, and individual video-recorded exercise sessions at home.
Overall, the findings suggest that “structured exercise interventions in IAREP offer a promising, transformative strategy for changing exercise behaviour,” the investigators said.
“The qualitative data indicate that the high adherence to IAREP was facilitated by structured programme commitment, professional guidance, flexible exercise delivery, increased confidence, and social support, providing context for the observed improvements in physical function, physical activity, and self-care maintenance,” they added.
The study included 53 participants with T2D ages 40 to 85 years (median age 67 years, 49.1 percent female), of which 25 were randomly allocated to the exercise intervention group and 28 in the usual care group.
The primary outcome was cognition, measured using the Vascular Dementia Battery and Risk Stratification Scores. Secondary outcomes included metabolic glycaemic profile, inflammatory markers (IL-6, CRP, and TNF-α), Short Physical Performance Battery, rapid sarcopenia screening, blood pressure, physical activity status (International Physical Activity Questionnaire Short Form), Self-Care of Diabetes Inventory, and Self-Rated Abilities for Health Practice scale.