Exercise training for executive function in type 2 diabetes: A systematic review and practice implications

Abstract

Type 2 diabetes (T2DM) is associated with cognitive decline, particularly impairing executive function. Although exercise is recognized as a potential strategy to mitigate cognitive deficits, the most effective exercise characteristics for improving executive function in individuals with T2DM remain unclear. This systematic review evaluated the effects of exercise interventions lasting at least four weeks on executive function. A comprehensive search of five English-language databases identified 7,641 records, of which 16 studies met the inclusion criteria, including 11 randomized controlled trials (RCTs). Aerobic training was the most commonly investigated modality, followed by combined aerobic and resistance training. Overall, 63% of studies and 82% of RCTs reported directional findings favoring exercise on executive-function outcomes. Combined training showed the most consistent directional findings; certainty remains limited. Higher exercise intensity and the inclusion of cognitively engaging motor tasks were more frequently associated with directional findings favoring exercise on executive-function outcomes. Evidence suggests that structured, multi-component exercise programs incorporating aerobic, resistance, balance, and flexibility training at moderate-to-high intensity may represent promising approaches for improving executive function and may be reasonable candidates for future trials and cautious clinical consideration. Regular participation and the integration of cognitive challenges during exercise may further enhance benefits. These findings suggest that tailored exercise interventions may contribute to cognitive health management in individuals with T2DM, although confidence in these findings remains limited by methodological heterogeneity and the absence of pooled effect estimates.