Journal of Exercise & Organ Cross Talk
Journal of Eexercise & Organ Cross Talk

Lactate threshold–based functional training for neurocognitive and physical outcomes in elderly with type 3 diabetes: Study protocol for a long-term RCT

Document Type : Hypothesis

Authors

Zahra Reisi Filabadi 1
Ebrahim Banitalebi 1
Mostafa Rahimi 1
Mohammad Rabiei 1
Majid Mardaniyan Ghahfarrokhi 2

1 Department of Sport Science, Shahrekord University, Shahrekord, Iran.

2 Department of Exercise Physiology, Faculty of Sport Sciences, Arak University, Arak, Iran.

10.22122/jeoct.2026.573709.1191
Abstract
Type 3 diabetes (T3D), defined by the concurrence of type 2 diabetes and age-related cognitive impairment, is linked to progressive deterioration in both cognitive and physical function. Emerging evidence suggests that functional exercise training prescribed in relation to individualized lactate thresholds may enhance neurocognitive and physical adaptations by matching exercise intensity to individual metabolic capacity and systemic organ cross-talk. Randomized controlled trial will examine the effects of long-term, lactate-threshold–based functional training on cognitive and physical function in older adults with T3D, highlighting the role of exercise intensity in optimizing outcomes. Sixty-six adults aged 60–80 years with Type 3 diabetes and cognitive impairment, assessed by the Mini-Mental State Examination, will be recruited from the Chaharmahal and Bakhtiari Diabetes Association and randomly assigned to three groups. The intervention group will undertake a six-month, individualized high-intensity functional training program combining supervised and home-based sessions. Primary outcomes include changes in cognitive performance and physical function assessed using validated and standardized measures. It is hypothesized that lactate-threshold–guided functional exercise at tailored intensities will lead to significant improvements in both cognitive and physical function, emphasizing the critical role of exercise intensity in modulating neurocognitive and functional adaptations in elderly individuals with type 3 diabetes. This study aims to provide robust evidence for intensity-specific, lactate-threshold–based exercise prescriptions in this population.

What is already known on this subject?

Exercise can benefit cognition in older adults and those with T2D. The lactate threshold is a key metabolic marker, and lactate may act as a signaling molecule for brain health. However, the efficacy of functional training prescribed specifically relative to the lactate threshold in T3D is unknown.

 

What this study adds?

This protocol describes the first long-term RCT to compare the effects of high-intensity (above LT) vs. low-intensity (below LT) neuro-functional training on cognitive and physical outcomes in elderly with T3D. It will provide novel evidence on whether tailoring exercise intensity to individual metabolic capacity optimizes outcomes.

Keywords

Type 3 diabetes
Elderly
Cognitive impairment
Lactate-threshold
Neuro-functional training

Subjects

Acknowledgements

It is truly fitting to express gratitude and appreciation to the esteemed and wise professors, Dr. Ebrahim Bani Talebi and Dr. Mostafa Rahimi, who, with a grace as radiant as the sun, illuminated the land of the heart and enriched the garden of knowledge and learning through their effective and constructive guidance.

Funding

This research has no financial support and is not supported by any organization, and all financial costs of the research are borne by the author and the authors declare no conflict of interest.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Compliance with ethical standards

Conflict of interest The authors declare that they have no conflict of interest.

Ethical approval The trial has received approval from the Research Ethics Committee of Shahrekord University (IR.SKU.REC.1402.032).

Informed consent Performed. 

Author contributions 

Conceptualization: Z.R.F; Methodology: M.M.G,; Software: E.B,;  Validation: M.R,; Formal analysis: Z.R.F,; Investigation: E.B,; Resources: M.M.G,; Data curation: M.M.G,; Writing - original draft: Z.R.F,; Writing - review & editing: M.M.G,; Visualization: E.B,;  Supervision: E.B,; Project administration: M.M.G,;  Funding acquisition: Z.R.F,

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Journal of Exercise & Organ Cross Talk
Volume 6, Issue 1
Winter 2026
Pages 49-61

  • Receive Date 05 December 2025
  • Revise Date 11 February 2026
  • Accept Date 12 February 2026

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