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Peer-reviewedCC BY-NC 4.0BMJ Open

Augmented reality-assisted Tai Chi for adults with diabetes-associated cognitive impairment: study protocol for a randomised controlled trial

  • Haoxuan Li1
  • Xinming Xu2,3
  • Zhouyu Guan3,4
  • Qingqing Zheng3,4
  • Yang Wen5
  • Dian Zeng6
  • Huijie Huang3,4
  • Yiming Qin6,7
  • Mingyue Yin8
  • Guanqiao Li9
  • Hailong Qin10
  • Yiling Zhu11
13 more authors
  • Jinman Kim12
  • Lijuan Mao13
  • Christian Sandor14
  • Nadia Magnenat Thalmann15
  • Josip Car16
  • Chwee Teck Lim17,18,19
  • Felipe Fregni20
  • Francisco B Ortega21
  • Jonathan P Little22,23,24
  • Paddy C Dempsey25,26,27,28
  • Weiping Jia2,3
  • Bin Sheng1,29,30
  • Huating Li3
30 affiliations
  1. 1School of Exercise and Health, Shanghai University of Sport, Shanghai, China
  2. 2Hospital of Chengdu University of Traditional Chinese Medicine, School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
  3. 3Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
  4. 4Shanghai Jiao Tong University School of Medicine, Shanghai, China
  5. 5Guangdong Provincial Key Laboratory of Intelligent Information Processing, College of Electronics and Information Engineering, Shenzhen University, Shenzhen, China
  6. 6School of Clinical Medicine,Tsinghua Medicine, Tsinghua University, Beijing, China
  7. 7Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital Eye Center, Tsinghua Medicine, Tsinghua University, Beijing, China
  8. 8School of Physical Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
  9. 9Vanke School of Public Health, Tsinghua University, Beijing, China
  10. 10Department of Physical Education, Shanghai University of Traditional Chinese Medicine, Shanghai, China
  11. 11School of Wushu, Shanghai University of Sport, Shanghai, China
  12. 12School of Computer Science, The University of Sydney, Sydney, New South Wales, Australia
  13. 13Shanghai University of Sport, Shanghai, China
  14. 14Team ARAl, LISN, Centre National de la Recherche Scientifique (CNRS), Universite Paris-Saclay, Gif-sur-Yvette, Île-de-France, France
  15. 15MIRA Lab, University of Geneva, Geneva, Switzerland
  16. 16School of Life Course and Population Sciences, King’s College London, London, England, UK
  17. 17Department of Biomedical Engineering, National University of Singapore, Singapore
  18. 18Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore
  19. 19Mechanobiology Institute, National University of Singapore, Singapore
  20. 20Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  21. 21Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), CIBEROBN Physiopathology of Obesity and Nutrition, University of Granada, Granada, Spain
  22. 22Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
  23. 23School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
  24. 24Centre for Chronic Disease Prevention and Management, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  25. 25Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  26. 26Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, England, UK
  27. 27Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
  28. 28MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Biomedical Campus, Cambridge, England, UK
  29. 29School of Computer Science, Shanghai Jiao Tong University, Shanghai, China
  30. 30MoE Key Lab of Artificial Intelligence, Artificial Intelligence Institute, Shanghai Jiao Tong University, Shanghai, China
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Abstract

Introduction: Diabetes-associated cognitive impairment (DACI) undermines diabetes self-management and is associated with increased morbidity and mortality. Although mind-body exercise may improve cognition, its benefits are often limited by the lack of timely, precise, individualised instruction and feedback in adults with cognitive impairment. Augmented reality (AR) systems can deliver performance-adaptive, visually anchored cues and auditory prompts in real-world settings, but their cognitive and metabolic benefits in DACI remain unknown. This trial will compare AR-assisted Tai Chi (iTaiChi), instructor-led Tai Chi (TaiChi) and standard care in adults with DACI and explore underlying metabolic and neurobiological mechanisms.

Methods and analysis: In this randomised controlled trial, 246 community-dwelling adults aged 45–75 years with DACI will be enrolled and randomly allocated in a 1:1:1 ratio to a TaiChi group, an iTaiChi group or a standard care group. All participants will receive standard care. In addition, participants assigned to the two exercise groups will undertake a standardised Yang-style 24-form Tai Chi programme three times weekly for 12 weeks. The primary outcome is the change in Montreal Cognitive Assessment Score. Secondary outcomes include physical health related parameters and brain health related parameters.

Ethics and dissemination: This study was approved by the Ethics Committee of Shanghai Sixth People’s Hospital (Approval No. 2025–017). Dissemination of the findings will include peer-reviewed publications, conference presentations and media releases.

Trial registration number: ChiCTR2500111614.

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Cite

BibTeXRIS
BibTeX
@article{li2026augmented,
  title = {{Augmented reality-assisted Tai Chi for adults with diabetes-associated cognitive impairment: study protocol for a randomised controlled trial}},
  author = {Haoxuan Li and Xinming Xu and Zhouyu Guan and Qingqing Zheng and Yang Wen and Dian Zeng and Huijie Huang and Yiming Qin and Mingyue Yin and Guanqiao Li and Hailong Qin and Yiling Zhu and Jinman Kim and Lijuan Mao and Christian Sandor and Nadia Magnenat Thalmann and Josip Car and Chwee Teck Lim and Felipe Fregni and Francisco B Ortega and Jonathan P Little and Paddy C Dempsey and Weiping Jia and Bin Sheng and Huating Li},
  journal = {BMJ Open},
  year = {2026},
  month = sep,
  doi = {10.1136/bmjopen-2026-120433},
  url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120433},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Augmented reality-assisted Tai Chi for adults with diabetes-associated cognitive impairment: study protocol for a randomised controlled trial
AU  - Haoxuan Li
AU  - Xinming Xu
AU  - Zhouyu Guan
AU  - Qingqing Zheng
AU  - Yang Wen
AU  - Dian Zeng
AU  - Huijie Huang
AU  - Yiming Qin
AU  - Mingyue Yin
AU  - Guanqiao Li
AU  - Hailong Qin
AU  - Yiling Zhu
AU  - Jinman Kim
AU  - Lijuan Mao
AU  - Christian Sandor
AU  - Nadia Magnenat Thalmann
AU  - Josip Car
AU  - Chwee Teck Lim
AU  - Felipe Fregni
AU  - Francisco B Ortega
AU  - Jonathan P Little
AU  - Paddy C Dempsey
AU  - Weiping Jia
AU  - Bin Sheng
AU  - Huating Li
PY  - 2026
DA  - 2026/09/30
JO  - BMJ Open
DO  - 10.1136/bmjopen-2026-120433
UR  - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-120433
AB  - Introduction: Diabetes-associated cognitive impairment (DACI) undermines diabetes self-management and is associated with increased morbidity and mortality. Although mind-body exercise may improve cognition, its benefits are often limited by the lack of timely, precise, individualised instruction and feedback in adults with cognitive impairment. Augmented reality (AR) systems can deliver performance-adaptive, visually anchored cues and auditory prompts in real-world settings, but their cognitive and metabolic benefits in DACI remain unknown. This trial will compare AR-assisted Tai Chi (iTaiChi), instructor-led Tai Chi (TaiChi) and standard care in adults with DACI and explore underlying metabolic and neurobiological mechanisms.  Methods and analysis: In this randomised controlled trial, 246 community-dwelling adults aged 45–75 years with DACI will be enrolled and randomly allocated in a 1:1:1 ratio to a TaiChi group, an iTaiChi group or a standard care group. All participants will receive standard care. In addition, participants assigned to the two exercise groups will undertake a standardised Yang-style 24-form Tai Chi programme three times weekly for 12 weeks. The primary outcome is the change in Montreal Cognitive Assessment Score. Secondary outcomes include physical health related parameters and brain health related parameters.  Ethics and dissemination: This study was approved by the Ethics Committee of Shanghai Sixth People’s Hospital (Approval No. 2025–017). Dissemination of the findings will include peer-reviewed publications, conference presentations and media releases.  Trial registration number: ChiCTR2500111614.
SN  - 2044-6055
SN  - 2044-6055
ER  -