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

Author: Yannan Chen1, Jiawei Qin1,2, Liyuan Tao3, Zhizhen Liu1,4, Jia Huang1,4, Weilin Liu1,4, Ying Xu1,4, Qiang Tang5, Yongguo Liu6, Zhuhong Chen7, Shangjie Chen8, Shengxiang Liang1,4, Cong Chen1,4, Jinjin Xie1,4, Jue Liu9, Lidian Chen1,4, Jing Tao1,4
1 College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
2 Department of Rehabilitation Medicine, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China.
3 Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.
4 National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.
5 Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Haerbin, China.
6 Knowledge and Data Engineering Laboratory of Chinese Medicine, School of Information and Software Engineering, University of Electronic Science and Technology of China, Chengdu, China.
7 Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
8 The Second Affiliated Hospital of Shenzhen University, Shenzhen, China.
9 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Conference/Journal: JAMA Netw Open
Date published: 2023 Apr 3
Other: Volume ID: 6 , Issue ID: 4 , Pages: e237004 , Special Notes: doi: 10.1001/jamanetworkopen.2023.7004. , Word Count: 432

Type 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).

To 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 participants:
This 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.

Participants 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 measures:
The 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.

A 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 relevance:
In 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 registration:
ClinicalTrials.gov Identifier: NCT04416841.

PMID: 37022680 PMCID: PMC10080376 DOI: 10.1001/jamanetworkopen.2023.7004