The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus

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Ramya Krishna" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Type 2 diabetes mellitus (T2DM) is linked to cognitive dysfunction, and cognitive motor dual-task blindfold training (CMDBT) may enhance cognition by engaging procedural memory centers. This study aimed to evaluate the effectiveness of CMDBT combined with aerobic and resistance exercises on cognitive function in individuals with T2DM. Methods A single-center, parallel-group randomized controlled trial with pre- and post-intervention assessments was conducted. Sixty two adults with T2DM were randomly allocated to an experimental group (CMDBT plus moderate-intensity aerobic and resistance training; n = 31) or a control group (aerobic and resistance training only; n = 31). Both groups trained three times per week for 12 weeks. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) at baseline and after the 12-week intervention. Results Baseline demographic and clinical characteristics were comparable between groups (all p > 0.05). After 12 weeks, the experimental group showed a mean MoCA increase of 3.32 ± 1.74 to 29.13 ± 0.76 (p < 0.0001), exceeding the minimal clinically important difference of 2.3 points, whereas the control group improved by 0.94 points (25.77 ± 1.45 to 26.71 ± 1.37; p = 0.0006). The adjusted between-group difference was 2.38 points (p = 0.0001), demonstrating a significantly greater cognitive benefit with CMDBT. Conclusion CMDBT combined with conventional exercises is more effective than CMDT or conventional therapy alone in enhancing cognition and in T2DM, supporting its integration into rehabilitation programs. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-592/v3", "name": "The Effect Of Visual Deprivation During Cognitive Motor Dual Task..." } } ] } Home Browse The Effect Of Visual Deprivation During Cognitive Motor Dual Task... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Anandh Raj J, Patra RC, S K et al. The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.12688/f1000research.162466.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] J Anandh Raj https://orcid.org/0009-0005-1622-4329 1 , Ramesh Chandra Patra https://orcid.org/0000-0001-5287-8833 2 , Kavitha S 3 , [...] V Subramanyam 4 , K Himabindu 5 , Kilani Kusuma 6 , M.L. Ramya Krishna 7 J Anandh Raj https://orcid.org/0009-0005-1622-4329 1 , Ramesh Chandra Patra https://orcid.org/0000-0001-5287-8833 2 , [...] Kavitha S 3 , V Subramanyam 4 , K Himabindu 5 , Kilani Kusuma 6 , M.L. Ramya Krishna 7 PUBLISHED 17 Oct 2025 Author details Author details 1 Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India 2 Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India 3 School of Health Sciences, The Apollo University, Chittoor, Andhra Pradesh, 517127, India 4 School of Health Sciences, The Apollo University, Chittoor, Andhra Pradesh, 517127, India 5 School of Health Sciences, The Apollo University, Chittoor, Andhra Pradesh, 517127, India 6 Faculty of Physiotherapy, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, 600078, India 7 School of Health Sciences, The Apollo University, Chittoor, Andhra Pradesh, 517127, India J Anandh Raj Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ramesh Chandra Patra Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Kavitha S Roles: Investigation, Visualization V Subramanyam Roles: Conceptualization, Visualization K Himabindu Roles: Investigation, Resources Kilani Kusuma Roles: Conceptualization, Visualization M.L. Ramya Krishna Roles: Conceptualization, Investigation, Methodology, Visualization, Writing – Original Draft Preparation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Global Public Health gateway. Abstract Background Type 2 diabetes mellitus (T2DM) is linked to cognitive dysfunction, and cognitive motor dual-task blindfold training (CMDBT) may enhance cognition by engaging procedural memory centers. This study aimed to evaluate the effectiveness of CMDBT combined with aerobic and resistance exercises on cognitive function in individuals with T2DM. Methods A single-center, parallel-group randomized controlled trial with pre- and post-intervention assessments was conducted. Sixty two adults with T2DM were randomly allocated to an experimental group (CMDBT plus moderate-intensity aerobic and resistance training; n = 31) or a control group (aerobic and resistance training only; n = 31). Both groups trained three times per week for 12 weeks. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) at baseline and after the 12-week intervention. Results Baseline demographic and clinical characteristics were comparable between groups (all p > 0.05). After 12 weeks, the experimental group showed a mean MoCA increase of 3.32 ± 1.74 to 29.13 ± 0.76 (p < 0.0001), exceeding the minimal clinically important difference of 2.3 points, whereas the control group improved by 0.94 points (25.77 ± 1.45 to 26.71 ± 1.37; p = 0.0006). The adjusted between-group difference was 2.38 points (p = 0.0001), demonstrating a significantly greater cognitive benefit with CMDBT. Conclusion CMDBT combined with conventional exercises is more effective than CMDT or conventional therapy alone in enhancing cognition and in T2DM, supporting its integration into rehabilitation programs. READ ALL READ LESS Keywords Type 2 Diabetes mellitus, cognitive function, cognitive motor dual task training, montreal cognitive assessment (MoCA). Corresponding Author(s) Ramesh Chandra Patra ( [email protected] ) Close Corresponding author: Ramesh Chandra Patra Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Anandh Raj J et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Anandh Raj J, Patra RC, S K et al. The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.12688/f1000research.162466.3 ) First published: 17 Jun 2025, 14 :592 ( https://doi.org/10.12688/f1000research.162466.1 ) Latest published: 17 Oct 2025, 14 :592 ( https://doi.org/10.12688/f1000research.162466.3 ) Revised Amendments from Version 2 This revised version provides greater clarity and methodological transparency compared to the earlier version. The introduction now includes a clearly stated research gap, aim, hypothesis, and a stronger rationale for blindfolded cognitive-motor dual-task training in type 2 diabetes. The methods have been expanded with details on sample size calculation, randomisation, blinding, dropout considerations, and adherence to CONSORT guidelines. Results are more consistent, with normality testing, retention data, and corrected tables included. The discussion has been reorganised, vague statements revised, and a critical comparison with recent literature added. Overall, this version enhances clarity, rigor, and the clinical relevance of the findings. This revised version provides greater clarity and methodological transparency compared to the earlier version. The introduction now includes a clearly stated research gap, aim, hypothesis, and a stronger rationale for blindfolded cognitive-motor dual-task training in type 2 diabetes. The methods have been expanded with details on sample size calculation, randomisation, blinding, dropout considerations, and adherence to CONSORT guidelines. Results are more consistent, with normality testing, retention data, and corrected tables included. The discussion has been reorganised, vague statements revised, and a critical comparison with recent literature added. Overall, this version enhances clarity, rigor, and the clinical relevance of the findings. See the authors' detailed response to the review by Dr Kiruthika Selvakumar READ REVIEWER RESPONSES Introduction Diabetes mellitus comprises a group of chronic metabolic illnesses distinguished as high blood glucose levels resulting from deficiencies in insulin secretion, insulin action, or both. 1 Unlike type 1 diabetes mellitus (T1DM), which is an autoimmune disorder marked by the destruction of insulin-producing beta cells, type 2 diabetes mellitus (T2DM) primarily arises due to insulin resistance along with varying degrees of insulin deficiency. 2 The World Health Organization (WHO) estimated that 422 million people worldwide had diabetes in 2014. Nearly four million fatalities annually are attributed to high blood sugar. 3 By 2045, there will be at least 629 million diabetics worldwide. According to the latest 2025 International Diabetes Federation Diabetes Atlas, approximately 589 million adults aged 20 to 79 worldwide currently live with diabetes, with projections rising to over 850 million by 2050. 4 The India has one of the highest burdens of diabetes worldwide, with approximately 101 million adults aged 20-79 living with diabetes as of 2025. In India, the prevalence of T2DM is rapidly increasing, with significant public health implications. 5 Type 2 diabetes is not only a metabolic disorder but also a significant risk factor for cognitive decline and dementia. 6 – 9 The mechanistic pathways include hyperphosphorylation of tau proteins, which links insulin dysregulation with Alzheimer’s disease pathology. 10 – 13 Chronic accumulation of advanced glycation end products (AGEs) due to sustained hyperglycemia, 7 and endothelial dysfunction causing microvascular damage, neurovascular uncoupling, and reduced cerebral blood flow. 7 – 9 , 14 These pathologies accelerate deterioration in domains such as verbal fluency, executive function, processing speed, memory, and overall cognition. 14 Interventions for cognitive impairment in T2DM commonly employ resistance and aerobic training, which improve insulin sensitivity, cardiorespiratory fitness, and hippocampal integrity, thus benefiting cognitive function. 13 , 15 – 19 Multi-modal programs combining physical and cognitive training have demonstrated superior improvements. 13 , 15 – 18 , 20 Among these, cognitive-motor dual-task training (CMDT)—involving simultaneous performance of cognitive and motor tasks—capitalizes on synergistic neuroplastic mechanisms, yielding greater cognitive benefits compared to single-modality approaches. 21 – 23 In CMDT, performing simultaneous cognitive and motor tasks challenges attentional control and postural stability, contributing to improvements in motor-cognitive interference management during walking and balance. 24 , 25 This aligns with the guided plasticity facilitation framework, which posits that concurrent physical and cognitive stimulation enhances neuroplasticity via factors like increased brain-derived neurotrophic factor (BDNF). 20 However, a critical research gap exists regarding the role of visual deprivation during CMDT for T2DM populations. While cognitive-motor dual-task blindfold training (CMDBT) enhances functional connectivity in motor-cognitive brain regions and improves cerebral cortex activation, 26 – 28 it remains unclear whether removing visual input through blindfolding could further augment neuroplasticity and cognitive outcomes. Visual deprivation via blindfolding functions through sensory substitution, whereby information is rerouted via alternate senses such as tactile and proprioceptive pathways to the visual cortex, promoting cross-modal neuroplasticity. 29 Sensory substitution, first introduced by Paul Bach-y-Rita, 30 has demonstrated efficacy in cortical reorganization and perceptual compensation particularly among visually impaired individuals. 31 , 32 Given that individuals with T2DM experience metabolic and microvascular impairments compromising neural plasticity, 32 – 34 combined cognitive and physical training modalities, including verbal memory tasks paired with treadmill walking and virtual reality dancing. Utilizing standardized cognitive assessments such as the Digit Symbol Substitution Task and Trail Making Test Part B, they found that cognitive-physical dual-task training significantly improved working memory, executive functioning, and attention switching especially with longer intervention durations. 35 , 36 Building on these findings, the blindfold training may uniquely amplify compensatory brain activation and multisensory integration in this population. By forcing dependence on non-visual sensory modalities, blindfold cognitive-motor dual-task training may serve as a stronger neuroplastic stimulus than training allowing visual input. 37 The research question for this study is: Does incorporating visual deprivation into cognitive-motor dual-task training produce superior improvements in cognitive function among adults with T2DM compared to standard conventional therapy involving aerobic and resistance training? The primary aim is to evaluate the effect of cognitive-motor blindfold training on cognitive function in individuals with type 2 diabetes mellitus. The objective is to compare the effects of CMDBT and standard conventional therapy employing aerobic and resistance training on cognition function in type 2 diabetes mellitus. Cognitive-Motor Blindfold Training entails simultaneous motor and cognitive tasks performed under enforced visual deprivation via blindfolding. 30 – 32 Unlike standard conventional therapy, which involves aerobic and resistance training without integrated cognitive tasks or sensory deprivation, CMDBT promotes reliance on proprioceptive, tactile, and vestibular inputs, thereby enhancing multisensory integration and cross-modal plasticity. Physiologically, CMDBT is hypothesized to strengthen alternative neural pathways, stimulate cortical reorganization especially in prefrontal and parietal networks, and increase demands on compensatory processing mechanisms, resulting in superior cognitive resilience. 32 – 34 This study tested the hypothesis that CMDBT led to significantly greater improvements in cognitive function than standard conventional therapy of aerobic and resistance training in individuals with T2DM by leveraging enhanced neuroplasticity induced through sensory deprivation and multisensory reweighting. Method Study design and ethical approval This single-blinded, randomized controlled trial (RCT) was conducted according to CONSORT guidelines (Clinical Trials Registry of India, CTRI/2024/01/061956). Ethical approval was obtained from the Institutional Ethics Committee of Apollo Institute of Medical Science and Research, Chittoor, Andhra Pradesh, India (Ethics Committee Number: PG/35/IEC/AIMSR/2023) on 30-12-2023. All participants provided written informed consent prior to enrollment. Participant flow A total of 182 participants were assessed for eligibility. Of these, 120 were excluded due to not meeting inclusion criteria or declining to participate. The remaining 62 eligible participants were randomized equally into two groups: Group A (Cognitive-Motor Dual-Task Blindfold Training, CMDBT; n = 31) and Group B (Control: Moderate-Intensity Aerobic and Resistance Training; n = 31). All participants in both groups received their allocated interventions and completed the study protocol. There were no dropouts and follow-up. Data from all 62 participants were analyzed on an intention-to-treat basis. The CONSORT Flow Diagram illustrating participant enrollment, allocation, follow-up, and analysis in Figure 1 . Figure 1. CONSORT flow diagram illustrating the recruitment, randomization, allocation to Cognitive-Motor Dual-Task Blindfold Training (CMDBT) and control (conventional aerobic-resistance therapy) groups, participant follow-up, and inclusion in the analysis of cognitive function outcomes in adults with type 2 diabetes mellitus. Sample size calculation The sample size for this randomized controlled trial was calculated based on detecting a clinically meaningful difference between two independent groups on the primary outcome measure, the Montreal Cognitive Assessment (MoCA) score. Using data from previous studies on cognitive interventions in type 2 diabetes mellitus populations, an expected mean difference of approximately 2.3 points (the minimal clinically important difference for MoCA) with an estimated standard deviation of 2.0 was assumed. 38 , 39 The calculation employed a two-sided independent samples t-test with a significance level (alpha) of 0.05 and desired statistical power of 80% (beta = 0.20) 40 to minimize Type I and Type II errors, respectively. Based on these parameters, the minimum required sample size was estimated at 31 participants per group. This sample size also accounted for ensuring sufficient power to detect meaningful cognitive improvements while considering practical constraints in recruitment. Allocation concealment and randomization were designed accordingly to maintain balance across groups. Randomization: A total of 62 participants were enrolled and randomly assigned equally into two groups (31 per group) using a lottery method. Allocation concealment was maintained through sequentially numbered, sealed, opaque envelopes prepared by an independent investigator uninvolved in assessment. Blinding: Participants were blinded to the group allocation to reduce performance bias. Outcome assessors and data analysts were also blinded to ensure unbiased evaluation of results. Inclusion criteria: Diagnosed with T2DM HbA1c values >6.5 mmol/dL Education level exceeding 5 years (ability to read and write) Diabetes duration between 5 and 10 years Both male and female subjects Willingness to participate and signed informed consent Exclusion criteria: Refusal or inability to cooperate Musculoskeletal anomalies Presence of pressure sores or ulcers Exposure to radiological or X-ray therapy within the past 6 months Microvascular circulation defects Diabetic neuropathy Unstable vital signs Cardiac anomalies Malignant tumors, Participants engaging in high levels of habitual physical activity were excluded to minimize confounding effects on cognitive outcomes and ensure homogeneity between groups. Interventions In this study, participants who fulfilled the selection criteria were asked to provide written informed consent. Baseline measurements were obtained after obtaining consent. A total of 62 subjects were allotted randomly to group A (experimental) and group B (control) in 1:1 parallel with the lottery method. The subjects who fulfilled the eligibility criteria underwent pre interventional assessment MoCA. Experimental group Participants completed a structured, multicomponent program three times per week for 12 weeks (36 sessions). Each session combined progressive cognitive–motor dual-task exercises performed under blindfolded conditions while walking on a treadmill to increase motor-control demands and reduce visual input. Cognitive tasks targeted working memory (digit span, word list recall), visuospatial skills (auditory clock interpretation), executive function (serial arithmetic, verbal sequencing), attention (digit ordering, auditory detection), and language processing (verbal memory and fluency), with task difficulty progressively increased every four weeks. Ten dual-task trials were performed per session. Intensity control: Aerobic training was conducted on a treadmill at 55–70% of age-predicted maximum heart rate (HRmax), verified with Polar ® chest-strap monitors and a Borg Rating of Perceived Exertion (RPE) of 11–13. Resistance exercises were performed at 50–69% of one-repetition maximum (1-RM) using color-coded resistance bands for major upper- and lower-limb joints. 1-RM testing was repeated biweekly, and heart rate and RPE were monitored every 10 minutes to ensure adherence to prescribed intensity. Control group Participants received standard conventional physiotherapy of equal frequency, duration, and intensity but without cognitive or blindfold components. Aerobic training was performed on a treadmill at 55–70% HRmax, continuously monitored with heart-rate telemetry and maintained at an RPE of 11–13. Resistance exercises targeted the same muscle groups at 50–69% 1-RM, with biweekly 1-RM reassessments and progressive load adjustments using resistance bands. Heart rate and RPE were monitored every 10 minutes to maintain the target intensity. Outcome measures The primary outcome was cognitive function measured by the Montreal Cognitive Assessment (MoCA) at baseline of 0 th week and post-intervention at 12 th week. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), a widely used 30-point screening tool designed to detect mild cognitive impairment across multiple cognitive domains. The MoCA evaluates the following subdomains: executive functions (e.g., alternating trail making, verbal abstraction, clock drawing), memory (immediate and delayed recall of a word list), language (naming, sentence repetition, verbal fluency), attention (digit span, vigilance, serial subtraction), visuospatial abilities (cube and clock copying), abstraction, and orientation to time and place. Administration typically takes 10–15 minutes. Scores below 26 indicate potential cognitive impairment. The MoCA is more sensitive than the Mini-Mental State Examination (MMSE) for detecting subtle cognitive deficits, making it suitable for assessing cognitive function in clinical populations, including individuals with type 2 diabetes mellitus. 41 Interim analysis and safety monitoring Participant adherence, safety, and adverse events were monitored continuously, with interim analyses conducted monthly to evaluate compliance, efficacy signals, and participant well-being. Statistical analysis Statistical analysis was performed using IBM SPSS Statistics 30 version 19 under subscription version. with a two-tailed alpha level of 0.05 defining significance. Normality of data distribution was confirmed via Shapiro-Wilk tests ( W > 0.90 for all groups). Within-group changes in MoCA scores were analyzed using paired t -tests, while between-group differences at post-intervention were assessed via independent t -tests. Effect sizes were calculated using Cohen’s d , interpreted as small ( d = 0.20), medium ( d = 0.50), and large ( d ≥ 0.80). 42 Homogeneity of variance was verified with Levene’s test ( p > 0.10 for all comparisons), supporting the use of equal variances assumed in t -tests. Clinical significance was evaluated against the established minimal clinically important difference (MCID) of 2.3 points for MoCA in diabetic populations. All data are reported as mean ± standard deviation (SD), with 95% confidence intervals (CI) calculated for mean differences. Results A total of 62 participants diagnosed with type 2 diabetes mellitus were randomly allocated into two groups: Group A (Cognitive-Motor Dual-Task Blindfold Training, CMDBT; n = 31) and Group B (Control: Moderate-Intensity Aerobic and Resistance Training; n = 31). Baseline demographic and clinical characteristics were comparable between groups, with no statistically significant differences observed in age, gender distribution, duration of diabetes, educational level, HbA1c, body mass index (BMI), or Mini-Mental State Examination (MMSE) scores (all p > 0.05), confirming homogeneity. 43 The normality of Montreal Cognitive Assessment (MoCA) scores was verified using the Shapiro-Wilk test (p > 0.05), allowing the use of parametric statistical analyses. There were no dropouts during the intervention period, and all participants completed baseline and post-intervention assessments. Data were analyzed on an intention-to-treat basis. Within-group analyses showed significant improvements in cognitive function for both groups. In Group A (CMDBT), mean MoCA scores increased by 3.32 points, from 25.81 ± 1.74 pre-intervention to 29.13 ± 0.76 post-intervention (t = 6.32, df = 30, p < 0.0001). This increase exceeded the minimal clinically important difference (MCID) of 2.3 points and was accompanied by a 56% reduction in score variability (SD reduced from 1.74 to 0.76), indicating a consistent and robust treatment effect ( Table 1 , Figure 2 ). In contrast, Group B (control) exhibited a statistically significant but smaller mean increase of 0.94 points in MoCA scores, from 25.77 ± 1.45 to 26.71 ± 1.37 (t = 6.02, df = 30, p = 0.0006). However, this gain did not surpass the MCID threshold. The standard deviation decreased marginally by about 5.5% (from 1.45 to 1.37), suggesting more variability in response to aerobic and resistance training alone ( Table 2 , Figure 3 ). Table 1. Pre & post Mean score values of MoCA scale within experimental group A. Test N Mean score Standard deviation DF t-value p-value Std. Error Pre 31 25.81 1.14 30 15.87 0.0001 0.28 Post 31 29.13 0.76 Figure 2. Graphical representation of Means of pre and post values of MoCA within experimental Group A. Table 2. Pre & post Mean score values of MoCA scale within CONTROL group B. Test N Mean score Standard deviation DF t-value p-value Std. Error Pre 31 25.77 1.45 30 6.10 0.0001 0.15 Post 31 26.71 1.37 Figure 3. Graphical representation of Means of pre and post values of MoCA within CONTROL Group B. Between-group comparison demonstrated that post-intervention MoCA scores in Group A (29.13 ± 0.76) were significantly higher than in Group B (26.71 ± 1.37) , with a mean difference of 2.42 points (p < 0.0001) (see Table 3 ). Effect size analysis showed a large effect for Group A (Cohen’s d = 1.89) versus a moderate effect for Group B (d = 0.65) ( Figure 3 ), further supporting the superior cognitive benefits of the blindfolded cognitive-motor dual-task training ( Table 3 , Figure 4 ). Table 3. Mean score of post-interventional values of MONTREAL COGNITIVE ASSESSMENT (MoCA) between experimental groups A, and control group B. Test N Mean score Standard deviation DF t-value p-value Std. Error Post 31 29.13 0.76 30 8.58 0.0001 0.28 Post 31 26.71 1.37 Figure 4. Graphical representation of Means of post values of MoCA between Group A & Group B. Discussion The primary research question of this study was whether incorporating visual deprivation into cognitive-motor dual-task training (CMDBT) would produce superior cognitive improvements in adults with type 2 diabetes mellitus (T2DM) compared to standard conventional therapy comprising moderate-intensity aerobic and resistance exercises. The present study demonstrated that CMDBT significantly improved overall cognitive function, with participants in the experimental group showing greater gains than those undergoing conventional therapy alone. Both interventions yielded statistically significant pre-to-post improvements (p < 0.0001), but the magnitude of change in the CMDBT group exceeded the minimal clinically important difference (MCID) for the Montreal Cognitive Assessment (MoCA), highlighting the additive benefits of integrating cognitive-motor tasks with visual deprivation. Cognitive decline in T2DM is multifactorial, with vascular dysfunction and metabolic dysregulation playing critical roles. Chronic hyperglycemia induces glycation of vascular proteins, endothelial dysfunction, and oxidative stress, which impair cerebral perfusion and neurovascular coupling, ultimately leading to neuronal injury and cognitive deterioration. 44 , 45 These pathophysiological processes predominantly affect executive function, memory, processing speed, verbal fluency, and global cognition, consistent with deficits observed in diabetic populations. 46 , 47 By situating the study’s findings within this mechanistic framework, the superior cognitive gains observed in the CMDBT group can be understood as counteracting diabetes-related neurovascular and metabolic insults through targeted neuroplastic stimulation. The cognitive improvements in the CMDBT group are likely mediated by enhanced functional connectivity between motor and cognitive brain networks elicited by dual-task training. Walking on a treadmill while performing cognitive tasks engages multiple neural circuits—including the prefrontal cortex, basal ganglia, cerebellum, and brainstem—promoting neuroplasticity through task-specific integration of sensory, motor, and cognitive inputs. 48 , 49 The addition of blindfolding enforces sensory substitution, rerouting non-visual information via tactile and proprioceptive pathways to the visual cortex, thereby enhancing cross-modal plasticity and interhemispheric communication. 50 , 51 This mechanism aligns with evidence from sensory substitution research demonstrating cortical reorganization and improved functional outcomes in visually impaired and neurologically rehabilitated individuals. 52 , 53 Previous studies support the efficacy of multimodal cognitive-motor interventions in older adults. Eggenberger et al. 48 investigated combined cognitive and physical training in adults ≥70 years and reported significant improvements in working memory, executive function, and attention, particularly with longer-duration interventions. Similarly, Hewston and Deshpande 49 found that dual-task balance training improved gait performance and reduced cognitive-motor interference in adults with T2DM, indirectly supporting neurological benefits from dual-task approaches. Our findings extend this literature by demonstrating that adding visual deprivation to cognitive-motor training further amplifies cognitive gains, likely through enhanced multisensory integration and compensatory neural activation. This study advances current knowledge by incorporating blindfold-induced sensory deprivation into structured CMDBT sessions, combined with moderate-intensity aerobic and resistance training. The intervention was feasible, time-efficient, and cost-effective, making it suitable for clinical and rehabilitation settings. Clinically, the magnitude of cognitive improvement in the CMDBT group aligns with thresholds associated with reduced dementia risk in diabetic populations, emphasizing the potential utility of sensory-enhanced cognitive-motor interventions to mitigate diabetes-associated cognitive decline. In conclusion, integrating CMDBT with visual deprivation appears to offer significant advantages over conventional therapy for improving cognitive outcomes in adults with T2DM. These results advocate for incorporating sensory-enhanced dual-task training into rehabilitation protocols. Future research should investigate long-term cognitive and functional outcomes, optimal dosing, and underlying neurophysiological mechanisms using neuroimaging and biomarker analyses. Conclusion This study demonstrated that a 12-week cognitive-motor dual-task training (CMDBT) program, combined with aerobic and resistance exercises, produced significant and clinically meaningful improvements in cognitive function among individuals with type 2 diabetes mellitus (T2DM). While both CMDBT and moderate-intensity aerobic exercise interventions yielded significant within-group cognitive gains, CMDBT resulted in significantly greater enhancements compared to aerobic training alone. These findings highlight CMDBT’s potential as an effective, feasible, and time-efficient intervention to mitigate cognitive decline associated with T2DM. The robust improvements observed provide a strong rationale for integrating CMDBT into clinical rehabilitation protocols and warrant further research to explore its long-term benefits and underlying neurophysiological mechanisms. Ultimately, such interventions may contribute to improving cognitive health and overall quality of life in patients living with T2DM. Limitations of the study • The study includes small sample size, the study did not include long term follow up. • This study sample size was relatively small to detect the effects of cognitive motor dual-task training (CMDTT) on cognitive function in patients with type 2 diabetes mellitus. Recommendations of the study • Follow-up programs can be included to assess the short- and long-term effects of the treatment. • Further studies should be conducted to evaluate the effects of cognitive motor dual-task training in other conditions. • The effects of cognitive motor dual-task training on other types of diabetes and its complications should be studied. • Further study should include more measurement tools like fMRI. Ethics and consent statement This study was conducted in accordance with the Declaration of Helsinki and was approved by an institutional ethics committee on 30-12-2023 at the Apollo Institute of Medical Science and Research, Chittoor, Andhra Pradesh, India. Ethics Committee Number: PG/35/IEC/AIMSR/2023. Written informed consent was obtained from all participants. The study conducted as per guideline of Declaration of Helsinki. DATA COLLECTION SHEET: the study participants are De identified with the serial number EXPERIMENTAL GROUP A - CMDBT CONTROL GROUP B - Conventional Therapy S.no MoCA Score S.no MoCA Score Pre-Test Post-Test Pre-Test Post-Test 1 24 28 1 25 26 2 25 29 2 27 28 3 24 29 3 25 26 4 27 30 4 24 25 5 27 30 5 27 25 6 23 28 6 25 27 7 24 29 7 24 24 8 24 28 8 26 27 9 26 30 9 27 28 10 24 29 10 24 25 11 27 29 11 28 29 12 29 30 12 26 28 13 26 29 13 28 28 14 28 30 14 26 27 15 27 30 15 24 27 16 24 28 16 26 27 17 25 29 17 27 28 18 24 28 18 24 26 19 28 30 19 26 26 20 26 29 20 28 28 21 28 30 21 24 25 22 28 30 22 27 28 23 25 29 23 26 26 24 23 28 24 26 27 25 27 30 25 28 29 26 25 29 26 24 25 27 26 29 27 26 27 28 24 28 28 24 26 29 26 29 29 24 25 30 28 29 30 28 29 31 28 30 31 25 26 Data availability The datasets generated analyzed during the current study are available in the Anandh Raj, J (2025). Pretest and post test values of MoCA in Group A and B in Type 2 Diabetes Mellitus subjects. figshare. Dataset. ( https://figshare.com/s/014afef5a58e663a3b96 ). 54 DOI: 10.6084/m9.figshare.28513433.V2 Extended data The extended data for this study include the demographic dataset of participants have been deposited in the Anandh Raj, J (2025). Baseline characteristics of 12-week & 18th-week follow-up of cognitive motor dual-task training in type 2 diabetes mellitus subjects. figshare. Dataset. https://doi.org/10.6084/m9.figshare.29134604.v1 . 43 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0) Acknowledgement I sincerely thank my supervisor Ramesh Chandra Patra, Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Punjab, India, for their invaluable guidance and support. I am Grateful to Apollo Institute of Medical Science and Research and the ethical review board for their approval. Heartfelt appreciation to all participants, research assistants, and healthcare professionals for their contribution. References 1. 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Publisher Full Text Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 17 Jun 2025 ADD YOUR COMMENT Comment Author details Author details 1 Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India 2 Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India 3 School of Health Sciences, The Apollo University, Chittoor, Andhra Pradesh, 517127, India 4 School of Health Sciences, The Apollo University, Chittoor, Andhra Pradesh, 517127, India 5 School of Health Sciences, The Apollo University, Chittoor, Andhra Pradesh, 517127, India 6 Faculty of Physiotherapy, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, 600078, India 7 School of Health Sciences, The Apollo University, Chittoor, Andhra Pradesh, 517127, India J Anandh Raj Roles: Conceptualization, Data Curation, Investigation, Methodology, Project Administration, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ramesh Chandra Patra Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Kavitha S Roles: Investigation, Visualization V Subramanyam Roles: Conceptualization, Visualization K Himabindu Roles: Investigation, Resources Kilani Kusuma Roles: Conceptualization, Visualization M.L. Ramya Krishna Roles: Conceptualization, Investigation, Methodology, Visualization, Writing – Original Draft Preparation Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (3) version 3 Revised Published: 17 Oct 2025, 14:592 https://doi.org/10.12688/f1000research.162466.3 version 2 Revised Published: 19 Aug 2025, 14:592 https://doi.org/10.12688/f1000research.162466.2 version 1 Published: 17 Jun 2025, 14:592 https://doi.org/10.12688/f1000research.162466.1 Copyright © 2025 Anandh Raj J et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Anandh Raj J, Patra RC, S K et al. The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.12688/f1000research.162466.3 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 3 VERSION 3 PUBLISHED 17 Oct 2025 Revised Views 0 Cite How to cite this report: Rodrigues JGdS. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425726 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425726 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Nov 2025 João Gabriel da Silveira Rodrigues , Universidade Federal de Minas Gerais, Belo Horizonte, State of Minas Gerais, Brazil Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.189242.r425726 The manuscript entitled “The effect of visual deprivation during cognitive motor dual-task training on cognitive function in type 2 diabetes mellitus” evaluated the effectiveness of cognitive motor dual-task training (CMDBT) combined with aerobic and resistance exercises on cognitive function ... Continue reading READ ALL The manuscript entitled “The effect of visual deprivation during cognitive motor dual-task training on cognitive function in type 2 diabetes mellitus” evaluated the effectiveness of cognitive motor dual-task training (CMDBT) combined with aerobic and resistance exercises on cognitive function in individuals with type 2 diabetes mellitus (T2DM). The topic is relevant and adds valuable information regarding a novel intervention. However, although the manuscript addresses an interesting subject for the scientific community, several major issues need to be addressed before the study can be considered for publication. Major Comments The MoCA was originally conceptualized and validated as a cognitive screening tool, not as an instrument to assess the effectiveness or efficacy of an intervention. Please justify why this screening tool was selected for evaluating intervention outcomes. A previous study (DOI: 10.1016/j.diabres.2021.108700) investigated the effects of exercise training on specific cognitive domains in individuals with T2DM. The authors reported that exercise efficacy appears to be domain-specific, with improvements in attentional and executive processes, whereas processing speed and memory remained unchanged. In light of this evidence, the present manuscript should engage in a discussion with the aforementioned study to address the limitations of using the MoCA—which is a screening instrument and not designed to evaluate specific cognitive domains or intervention effects. Methods 3. From a physiological perspective, the repetition of acute exercise sessions can lead to chronic adaptations. Therefore, reporting adherence (i.e., the percentage of total sessions completed) for the intervention group is mandatory. 4. Intervention studies should account for potential dropouts when determining sample size to ensure sufficient statistical power. Please clarify why this adjustment was not performed in the present study. 5. In Figure 1, the authors should indicate how many participants were excluded during the initial recruitment phase due to the exclusion criteria. 6. Participants in the control group received standard conventional physiotherapy. However, previous studies have highlighted that physiotherapy interventions may also enhance neurotrophic factors (DOI: 10.1016/j.archger.2011.05.014). Please clarify how this potential confounding factor was addressed or controlled for in the current study. 7. The authors did not report the participants’ characteristics. Sociodemographic, metabolic, and cognitive characteristics of the participants were not reported. These data are essential for interpreting the findings and determining their generalizability. Please include this information. 8. Age and educational level are well known to influence MoCA performance. Therefore, it is crucial to include these parameters, along with other relevant variables, in the proposed Table 1 describing participant characteristics. 9. Some medications used to control blood glucose may affect cognitive function and MoCA scores. Considering the longitudinal design of this study, please include a description of the drug therapy prescribed to participants (pre- and post-intervention) to better contextualize this potential limitation. 10. The limitation session of this study is too small. IMO, several points raised in this letter should be added as study limitations. 11. Details of the exercise session, specially regarding the resistance exercise (exercise volume, rest, exercise number, sequence, etc) should be provided. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Physical exercise, exercise physiology, cognition, type 2 diabetes, older adults I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rodrigues JGdS. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425726 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425726 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Rizzo M. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425730 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425730 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Nov 2025 Maria Rizzo , Messina University, Messina, Italy Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.189242.r425730 The manuscript "The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus" presents a methodologically rigorous and innovative RCT exploring the effects of visual deprivation during cognitive-motor training in individuals with Type ... Continue reading READ ALL The manuscript "The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus" presents a methodologically rigorous and innovative RCT exploring the effects of visual deprivation during cognitive-motor training in individuals with Type 2 diabetes mellitus. It contributes novel insights into the role of sensory deprivation in enhancing cognitive outcomes through cross-modal plasticity mechanisms. The study is scientifically sound, well-documented, and clinically relevant, with appropriate methodology and transparent data sharing. Only minor editorial and structural improvements are recommended for clarity. 1. Minor editorial improvements could further enhance readability, particularly by simplifying long sentences in the Introduction and Discussion. 2. Although technically sound, the manuscript could benefit from a brief justification of why the 12-week intervention period was chosen, referencing similar cognitive-motor training durations from prior literature. 3. It would be helpful to include a short paragraph in Data Availability summarizing how to access the dataset from figshare to guide readers unfamiliar with the platform. 4. Statistical analyses are appropriate and correctly interpreted. Use of both p -values and effect sizes (Cohen’s d ) is commendable. The authors verified assumptions of normality and variance homogeneity before applying parametric tests. Results are reported with adequate precision, including mean ± SD and confidence intervals. The discussion accurately reflects the magnitude and clinical relevance of findings (MCID of 2.3 points for MoCA). The Authors can add in disccussion section "Future studies could incorporate multivariate analyses (e.g., ANCOVA) to control for potential covariates such as age, baseline cognitive status, or education level." 5. To strengthen the impact, the authors could include a short paragraph discussing potential neurophysiological mechanisms (e.g., BDNF modulation) to bridge behavioral outcomes and neural plasticity. 6. Ensure consistency in abbreviation usage (e.g., CMDBT, CMDT). Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Physiology and Behavior I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Rizzo M. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425730 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425730 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Ramachandran, A. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425729 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425729 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Nov 2025 Arunachalam Ramachandran, , Madhav University, Abu Road, Rajasthan, India Approved VIEWS 0 https://doi.org/10.5256/f1000research.189242.r425729 The research is well drafted and the research question dealt with is of good clinical significance, given the fact that T2DM is on the high and that too India is becoming the capital of Diabetes. I would suggest that the ... Continue reading READ ALL The research is well drafted and the research question dealt with is of good clinical significance, given the fact that T2DM is on the high and that too India is becoming the capital of Diabetes. I would suggest that the author include the content on how the cognitive factors affect the socio-psychological components of the patients in the introduction to emphasise the need for the study. also, I would suggest the author incorporate the impact of "Visual Deprivation" in the treatment process. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Neuro rehabilitation, Physiotherapy, Yoga and Virtual rehabilitation I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ramachandran, A. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425729 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425729 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Selvakumar DK. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425022 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425022 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 27 Oct 2025 Dr Kiruthika Selvakumar , Universiti Tunku Abdul Rahman, Sungai Long, Selangor, Malaysia Approved VIEWS 0 https://doi.org/10.5256/f1000research.189242.r425022 No ... Continue reading READ ALL No further remarks.Approved Competing Interests: No competing interests were disclosed. Reviewer Expertise: Physiotherapy, Headache, Migraine, Stroke Rehabilitation, Paediatric Rehabilitation, Geriatric Rehabilitation, Scoliosis and Low pain pain I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Selvakumar DK. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425022 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425022 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 2 VERSION 2 PUBLISHED 19 Aug 2025 Revised Views 0 Cite How to cite this report: Leite NJC. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.184769.r407289 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v2#referee-response-407289 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 16 Sep 2025 Nilton João Chantre Leite , University of Évora, Évora, Portugal Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.184769.r407289 Thank you for the opportunity to review this interesting manuscript. I have some recommendations to strengthen the presentation and impact of this work. ABSTRACT: 1. Background: The connection you make between dual-task training and cognitive function ... Continue reading READ ALL Thank you for the opportunity to review this interesting manuscript. I have some recommendations to strengthen the presentation and impact of this work. ABSTRACT: 1. Background: The connection you make between dual-task training and cognitive function is very persuasive. To further focus the reader, please consider adding the objective of the study. 2. Methods: The methodology description is clear, but it might benefit from a slight reorganization to improve flow. It could be more straightforward to begin with the study design and randomization, then describe the interventions assigned to each group, and finally the assessment time points. 3. Results: Can the main message be condensed into a single sentence, integrating the " p" value and the average difference observed between the groups? INTRODUCTION: 1. I recommend reviewing the use of abbreviations throughout the manuscript. For clarity and consistency, ensure that each term is written in full upon its first appearance and then used consistently in all subsequent sections. 2. In the first paragraph, I recommend updating the epidemiological data on diabetes (e.g., prevalence, mortality, economic impact) using the latest figures from the International Diabetes Federation's Diabetes Atlas ." 3. Please add a supporting citation for the claim that “… blindfold training may uniquely amplify compensatory brain activation and multisensory integration in this population. By forcing dependence on non-visual sensory modalities, blindfold cognitive-motor dual-task training may serve as a stronger neuroplastic stimulus than training allowing visual input. METHODS: 1. Please consider relocating the first paragraph to the Introduction section and the paragraph on ethical approval to the Study Design section. 2. The sample size calculation is clearly presented. To further strengthen this section, could you please add a citation for the software/statistical method used or reference of the study from which the parameters were derived? 3. Please consider describing how the intensity of the interventions was controlled, and monitored across all participants and training sessions. 4. Please clarify whether participants' baseline physical activity levels were assessed and if activity was and controlled for during the trial. The interpretation of the results would be significantly strengthened by ruling out physical activity as a confounding variable. If this data is available, please present it. If not, this should be acknowledged as a study limitation, as differences in activity levels could offer an alternative explanation for the differential cognitive outcomes observed between the groups. 5. Please provide a description of the MoCA instrument and its specific subdomains (e.g., executive functions, memory, language, orientation, visuospatial abilities) that were assessed. This is essential for the reader to understand what cognitive functions are being analyzed. STATISTICAL ANALYSIS: 1. Please consider adding a citation for the Cohen's effect size cut-off values used. RESULTS: 1. I could not locate the baseline demographic and clinical characteristics in the cited source, [Anandh Raj J: Pretest and post test values of MoCA in Group A and B in Type 2 Diabetes Mellitus subjects. Dataset. figshare. 2025]. Please review this citation for accuracy. 2. A stated aim of this study, introduced in paragraph 7 of the Introduction, was to explore effects on MoCA subdomains. To fully address this aim, please present the analysis of these subdomains (e.g., executive functions, memory, language, orientation) in the Results section. This data is essential to provide a nuanced interpretation of the intervention's specific cognitive effects. 3. Please consider relocating the following paragraphs to the Discussion Section: "Clinically, the magnitude of improvement in Group A aligns with thresholds associated with reduced dementia risk in diabetic populations, highlighting the potential of integrating sensory deprivation to augment cognitive rehabilitation in type 2 diabetes mellitus." "These findings advocate for incorporating sensory-enhanced cognitive-motor dual-task training into rehabilitation protocols to optimize cognitive outcomes and potentially mitigate diabetes-associated cognitive decline." DISCUSSION: 1. To improve the focus of the Discussion, I recommend opening the section with the study's main research question. This will provide essential context for the interpretation of the findings that follow. 2. The arguments presented in the second and third paragraphs require supporting references. Please integrate citations from the relevant literature. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Sport Medicine, Geriatrics, Sport Psychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Leite NJC. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.184769.r407289 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v2#referee-response-407289 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Selvakumar DK. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.184769.r406650 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v2#referee-response-406650 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Aug 2025 Dr Kiruthika Selvakumar , Universiti Tunku Abdul Rahman, Sungai Long, Selangor, Malaysia Approved VIEWS 0 https://doi.org/10.5256/f1000research.184769.r406650 The authors have addressed all the ... Continue reading READ ALL The authors have addressed all the suggested revisions. No further remarks. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Physiotherapy, Headache, Migraine, Stroke Rehabilitation, Paediatric Rehabilitation, Geriatric Rehabilitation, Scoliosis and Low pain pain I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Selvakumar DK. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.184769.r406650 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v2#referee-response-406650 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 17 Jun 2025 Views 0 Cite How to cite this report: Selvakumar DK. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.178674.r395444 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v1#referee-response-395444 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Jul 2025 Dr Kiruthika Selvakumar , Universiti Tunku Abdul Rahman, Sungai Long, Selangor, Malaysia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.178674.r395444 Dear Editor-in-Chief/ Authors, Enclosed is the suggestions for further consideration. Introduction: The introduction is comprehensive and well-structured, covering the relationship between variables; however, the authors can consider the following suggestions: ... Continue reading READ ALL Dear Editor-in-Chief/ Authors, Enclosed is the suggestions for further consideration. Introduction: The introduction is comprehensive and well-structured, covering the relationship between variables; however, the authors can consider the following suggestions: The aim of the study/research gap is weakly stated, and the hypothesis is only brief. The background lacks a research question and objective. Rationale for using blindfold training specifically for the T2DM population is not clear. Definition and clarification on CMBT are introduced towards the end; the physiology behind this training and how it is different from dual-task or physical cognitive training approaches would strengthen the objective of the study. Methods: The grammatical errors in the methodology are to be corrected. The sample size included was 62, but the sample size calculation methods or dropout calculations were not provided in this study. Since the study design is RCT, whether the study followed the CONSORT guidelines is not clear. The study lacks an explanation of blinding, primary, and secondary outcome measures. Details on allocation concealment mechanism, randomisation allocation, generation or enrolment were discussed. Since both groups underwent training, an interim analysis including safety, efficacy and compliance checks can be included. Results: Inconsistency in terminologies described (the methodology mentions group A, but the results section mentions it as group 1). Poor grammar and sentence construction. The normality of data is not included. Did the study encounter any dropouts? If so, how was the data managed for result analysis? Data collection sheet – the title of the table – error to be corrected. Discussion: The paragraph structure is inconsistent or intermixed with literature and not clearly separated. The statement “T2DM patients’ cognitive deterioration is largely due to vascular damage caused by protein accumulation on the blood vessel walls” is a pathological explanation lacking citation and not a study result, but it’s included in the results section. Statement “This demonstrates CMDBT’s potential as a successful cognitive rehabilitation intervention for patients with type 2 diabetes” is vague and needs rephrasing. Authors are highly encouraged to look at the sentence restructuring and phrasing. Weak critical comparison with literature: especially Eggenberger et al. (2015) and Hewston et al. (2013), whether these studies align or diverge with the current study, and justification for this is not included. Some of the references need to be updated (example: 2004, 2005, 2008). Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Physiotherapy, Headache, Migraine, Stroke Rehabilitation, Paediatric Rehabilitation, Geriatric Rehabilitation, Scoliosis and Low pain pain I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Selvakumar DK. Reviewer Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.178674.r395444 ) The direct URL for this report is: https://f1000research.com/articles/14-592/v1#referee-response-395444 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 23 Aug 2025 J Anandh Raj , Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, 144411, India 23 Aug 2025 Author Response Dear Editor and Reviewer, We thank you for your constructive review and helpful suggestions. We have addressed each point in detail below and revised the manuscript accordingly to improve clarity, ... Continue reading Dear Editor and Reviewer, We thank you for your constructive review and helpful suggestions. We have addressed each point in detail below and revised the manuscript accordingly to improve clarity, rigor, and scientific quality. Introduction We have clarified the research aim, hypothesis, and rationale earlier in the introduction as requested. The rationale for blindfold training in T2DM is now more explicitly explained with supporting citations. CMDBT is defined and distinguished from other dual-task approaches earlier in the text. Methods Grammatical errors have been corrected. A detailed sample size calculation with dropout considerations is added. CONSORT adherence is clearly stated, and a flow diagram is included (Figure 1). Blinding procedures and primary outcome measures are described more explicitly. Randomization and allocation concealment methods are clarified. Interim safety, compliance monitoring details are included. Results Group terminology is now consistent throughout (Group A and B). Grammar and sentence structure are improved for clarity. Normality testing results (Shapiro-Wilk) are added. No dropouts occurred; analysis was intention-to-treat; this is now clearly stated. Table titles and figure captions have been corrected. Discussion Paragraphs are restructured for better flow and separation of study findings, literature context, and mechanisms. Pathophysiological explanations are moved from results to discussion. Vague statements are rephrased for precision. Literature comparisons with Eggenberger et al. and Hewston et al. include discussion on alignment and divergence. Some outdated references have been updated with recent literature. We appreciate the opportunity to improve our manuscript based on your expert feedback and believe the revisions have enhanced the quality and transparency of the work. Sincerely, J Anandh Raj On behalf of all authors Dear Editor and Reviewer, We thank you for your constructive review and helpful suggestions. We have addressed each point in detail below and revised the manuscript accordingly to improve clarity, rigor, and scientific quality. Introduction We have clarified the research aim, hypothesis, and rationale earlier in the introduction as requested. The rationale for blindfold training in T2DM is now more explicitly explained with supporting citations. CMDBT is defined and distinguished from other dual-task approaches earlier in the text. Methods Grammatical errors have been corrected. A detailed sample size calculation with dropout considerations is added. CONSORT adherence is clearly stated, and a flow diagram is included (Figure 1). Blinding procedures and primary outcome measures are described more explicitly. Randomization and allocation concealment methods are clarified. Interim safety, compliance monitoring details are included. Results Group terminology is now consistent throughout (Group A and B). Grammar and sentence structure are improved for clarity. Normality testing results (Shapiro-Wilk) are added. No dropouts occurred; analysis was intention-to-treat; this is now clearly stated. Table titles and figure captions have been corrected. Discussion Paragraphs are restructured for better flow and separation of study findings, literature context, and mechanisms. Pathophysiological explanations are moved from results to discussion. Vague statements are rephrased for precision. Literature comparisons with Eggenberger et al. and Hewston et al. include discussion on alignment and divergence. Some outdated references have been updated with recent literature. We appreciate the opportunity to improve our manuscript based on your expert feedback and believe the revisions have enhanced the quality and transparency of the work. Sincerely, J Anandh Raj On behalf of all authors Competing Interests: The authors declare that they have no relevant financial or non-financial competing interests that could be perceived to influence the judgments reported in this article. All authors have disclosed any potential conflicts, and no conflicts exist related to this work. Close Report a concern Author Response 03 Oct 2025 J Anandh Raj , Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, 144411, India 03 Oct 2025 Author Response Dear Reviewers, We sincerely thank you for the thorough and constructive feedback on our manuscript. We greatly appreciate the time and effort you have taken to provide valuable suggestions. We ... Continue reading Dear Reviewers, We sincerely thank you for the thorough and constructive feedback on our manuscript. We greatly appreciate the time and effort you have taken to provide valuable suggestions. We have carefully revised the manuscript in line with your comments, and below we provide a detailed, point-by-point response. Introduction Aim of the study and hypothesis : Thank you for this observation. We have revised the introduction to clearly state the research gap, aim, and a more explicit hypothesis. Research question and objective : We have added a clearly defined research question and an explicit objective at the end of the introduction section. Rationale for blindfold training in T2DM population : Additional explanation has been incorporated to clarify why blindfold training may enhance sensory substitution and cognitive engagement specifically in T2DM patients, supported by relevant references. Clarification of CMDBT definition and physiology : We have restructured the introduction to define CMDBT earlier and included an explanation of its underlying physiological basis, highlighting how it differs from conventional dual-task or physical-cognitive training. Methods Grammatical corrections : The methodology section has been thoroughly revised for grammar and clarity. Sample size calculation : We have now provided details of the sample size calculation method, including assumptions used, and clarified dropout considerations. CONSORT guidelines : We have revised the manuscript to state that the trial adhered to CONSORT guidelines, and included a flow diagram in the supplementary material. Blinding and outcomes : The revised manuscript specifies the type of blinding employed (assessor blinding), and explicitly lists the primary and secondary outcome measures. Randomisation and allocation concealment : Details on random sequence generation, allocation concealment, and enrolment procedures have been added for clarity. Interim analysis : A statement has been added explaining compliance and safety monitoring during the intervention, though no formal interim efficacy analysis was planned. Results Inconsistent terminologies : All group identifiers have been standardized (Group A/Group B) throughout the manuscript for consistency. Grammar and construction : The results section has been carefully revised for clarity and grammar. Normality testing : Details of the normality test (Shapiro–Wilk) have been added to the statistical analysis section. Dropouts : Information on participant retention and dropouts, along with how missing data was handled (intention-to-treat analysis), has been included. Data collection sheet/table title error : The table titles have been corrected. Discussion Paragraph structure : The discussion has been restructured to separate study findings from supporting literature more clearly. Pathological explanation in results section : The statement regarding vascular damage was relocated to the discussion and now includes appropriate citations. Vague conclusion statement : The statement on CMDBT effectiveness has been rephrased to be more precise and evidence-based. Sentence restructuring : The discussion has been revised for sentence flow and clarity. Critical comparison with literature : We have added a detailed comparison with Eggenberger et al. (2015) and Hewston et al. (2013), highlighting alignment and differences with our study findings. Updated references : Several outdated references have been replaced with recent publications to strengthen the discussion. Conclusion: We believe these revisions have improved the clarity, scientific rigor, and overall quality of the manuscript. We thank the reviewers once again for their valuable input, which has substantially strengthened our work. Respectfully, J Anandh Raj Dear Reviewers, We sincerely thank you for the thorough and constructive feedback on our manuscript. We greatly appreciate the time and effort you have taken to provide valuable suggestions. We have carefully revised the manuscript in line with your comments, and below we provide a detailed, point-by-point response. Introduction Aim of the study and hypothesis : Thank you for this observation. We have revised the introduction to clearly state the research gap, aim, and a more explicit hypothesis. Research question and objective : We have added a clearly defined research question and an explicit objective at the end of the introduction section. Rationale for blindfold training in T2DM population : Additional explanation has been incorporated to clarify why blindfold training may enhance sensory substitution and cognitive engagement specifically in T2DM patients, supported by relevant references. Clarification of CMDBT definition and physiology : We have restructured the introduction to define CMDBT earlier and included an explanation of its underlying physiological basis, highlighting how it differs from conventional dual-task or physical-cognitive training. Methods Grammatical corrections : The methodology section has been thoroughly revised for grammar and clarity. Sample size calculation : We have now provided details of the sample size calculation method, including assumptions used, and clarified dropout considerations. CONSORT guidelines : We have revised the manuscript to state that the trial adhered to CONSORT guidelines, and included a flow diagram in the supplementary material. Blinding and outcomes : The revised manuscript specifies the type of blinding employed (assessor blinding), and explicitly lists the primary and secondary outcome measures. Randomisation and allocation concealment : Details on random sequence generation, allocation concealment, and enrolment procedures have been added for clarity. Interim analysis : A statement has been added explaining compliance and safety monitoring during the intervention, though no formal interim efficacy analysis was planned. Results Inconsistent terminologies : All group identifiers have been standardized (Group A/Group B) throughout the manuscript for consistency. Grammar and construction : The results section has been carefully revised for clarity and grammar. Normality testing : Details of the normality test (Shapiro–Wilk) have been added to the statistical analysis section. Dropouts : Information on participant retention and dropouts, along with how missing data was handled (intention-to-treat analysis), has been included. Data collection sheet/table title error : The table titles have been corrected. Discussion Paragraph structure : The discussion has been restructured to separate study findings from supporting literature more clearly. Pathological explanation in results section : The statement regarding vascular damage was relocated to the discussion and now includes appropriate citations. Vague conclusion statement : The statement on CMDBT effectiveness has been rephrased to be more precise and evidence-based. Sentence restructuring : The discussion has been revised for sentence flow and clarity. Critical comparison with literature : We have added a detailed comparison with Eggenberger et al. (2015) and Hewston et al. (2013), highlighting alignment and differences with our study findings. Updated references : Several outdated references have been replaced with recent publications to strengthen the discussion. Conclusion: We believe these revisions have improved the clarity, scientific rigor, and overall quality of the manuscript. We thank the reviewers once again for their valuable input, which has substantially strengthened our work. Respectfully, J Anandh Raj Competing Interests: No potential conflict of interest relevant to this article was reported. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 23 Aug 2025 J Anandh Raj , Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, 144411, India 23 Aug 2025 Author Response Dear Editor and Reviewer, We thank you for your constructive review and helpful suggestions. We have addressed each point in detail below and revised the manuscript accordingly to improve clarity, ... Continue reading Dear Editor and Reviewer, We thank you for your constructive review and helpful suggestions. We have addressed each point in detail below and revised the manuscript accordingly to improve clarity, rigor, and scientific quality. Introduction We have clarified the research aim, hypothesis, and rationale earlier in the introduction as requested. The rationale for blindfold training in T2DM is now more explicitly explained with supporting citations. CMDBT is defined and distinguished from other dual-task approaches earlier in the text. Methods Grammatical errors have been corrected. A detailed sample size calculation with dropout considerations is added. CONSORT adherence is clearly stated, and a flow diagram is included (Figure 1). Blinding procedures and primary outcome measures are described more explicitly. Randomization and allocation concealment methods are clarified. Interim safety, compliance monitoring details are included. Results Group terminology is now consistent throughout (Group A and B). Grammar and sentence structure are improved for clarity. Normality testing results (Shapiro-Wilk) are added. No dropouts occurred; analysis was intention-to-treat; this is now clearly stated. Table titles and figure captions have been corrected. Discussion Paragraphs are restructured for better flow and separation of study findings, literature context, and mechanisms. Pathophysiological explanations are moved from results to discussion. Vague statements are rephrased for precision. Literature comparisons with Eggenberger et al. and Hewston et al. include discussion on alignment and divergence. Some outdated references have been updated with recent literature. We appreciate the opportunity to improve our manuscript based on your expert feedback and believe the revisions have enhanced the quality and transparency of the work. Sincerely, J Anandh Raj On behalf of all authors Dear Editor and Reviewer, We thank you for your constructive review and helpful suggestions. We have addressed each point in detail below and revised the manuscript accordingly to improve clarity, rigor, and scientific quality. Introduction We have clarified the research aim, hypothesis, and rationale earlier in the introduction as requested. The rationale for blindfold training in T2DM is now more explicitly explained with supporting citations. CMDBT is defined and distinguished from other dual-task approaches earlier in the text. Methods Grammatical errors have been corrected. A detailed sample size calculation with dropout considerations is added. CONSORT adherence is clearly stated, and a flow diagram is included (Figure 1). Blinding procedures and primary outcome measures are described more explicitly. Randomization and allocation concealment methods are clarified. Interim safety, compliance monitoring details are included. Results Group terminology is now consistent throughout (Group A and B). Grammar and sentence structure are improved for clarity. Normality testing results (Shapiro-Wilk) are added. No dropouts occurred; analysis was intention-to-treat; this is now clearly stated. Table titles and figure captions have been corrected. Discussion Paragraphs are restructured for better flow and separation of study findings, literature context, and mechanisms. Pathophysiological explanations are moved from results to discussion. Vague statements are rephrased for precision. Literature comparisons with Eggenberger et al. and Hewston et al. include discussion on alignment and divergence. Some outdated references have been updated with recent literature. We appreciate the opportunity to improve our manuscript based on your expert feedback and believe the revisions have enhanced the quality and transparency of the work. Sincerely, J Anandh Raj On behalf of all authors Competing Interests: The authors declare that they have no relevant financial or non-financial competing interests that could be perceived to influence the judgments reported in this article. All authors have disclosed any potential conflicts, and no conflicts exist related to this work. Close Report a concern Author Response 03 Oct 2025 J Anandh Raj , Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, 144411, India 03 Oct 2025 Author Response Dear Reviewers, We sincerely thank you for the thorough and constructive feedback on our manuscript. We greatly appreciate the time and effort you have taken to provide valuable suggestions. We ... Continue reading Dear Reviewers, We sincerely thank you for the thorough and constructive feedback on our manuscript. We greatly appreciate the time and effort you have taken to provide valuable suggestions. We have carefully revised the manuscript in line with your comments, and below we provide a detailed, point-by-point response. Introduction Aim of the study and hypothesis : Thank you for this observation. We have revised the introduction to clearly state the research gap, aim, and a more explicit hypothesis. Research question and objective : We have added a clearly defined research question and an explicit objective at the end of the introduction section. Rationale for blindfold training in T2DM population : Additional explanation has been incorporated to clarify why blindfold training may enhance sensory substitution and cognitive engagement specifically in T2DM patients, supported by relevant references. Clarification of CMDBT definition and physiology : We have restructured the introduction to define CMDBT earlier and included an explanation of its underlying physiological basis, highlighting how it differs from conventional dual-task or physical-cognitive training. Methods Grammatical corrections : The methodology section has been thoroughly revised for grammar and clarity. Sample size calculation : We have now provided details of the sample size calculation method, including assumptions used, and clarified dropout considerations. CONSORT guidelines : We have revised the manuscript to state that the trial adhered to CONSORT guidelines, and included a flow diagram in the supplementary material. Blinding and outcomes : The revised manuscript specifies the type of blinding employed (assessor blinding), and explicitly lists the primary and secondary outcome measures. Randomisation and allocation concealment : Details on random sequence generation, allocation concealment, and enrolment procedures have been added for clarity. Interim analysis : A statement has been added explaining compliance and safety monitoring during the intervention, though no formal interim efficacy analysis was planned. Results Inconsistent terminologies : All group identifiers have been standardized (Group A/Group B) throughout the manuscript for consistency. Grammar and construction : The results section has been carefully revised for clarity and grammar. Normality testing : Details of the normality test (Shapiro–Wilk) have been added to the statistical analysis section. Dropouts : Information on participant retention and dropouts, along with how missing data was handled (intention-to-treat analysis), has been included. Data collection sheet/table title error : The table titles have been corrected. Discussion Paragraph structure : The discussion has been restructured to separate study findings from supporting literature more clearly. Pathological explanation in results section : The statement regarding vascular damage was relocated to the discussion and now includes appropriate citations. Vague conclusion statement : The statement on CMDBT effectiveness has been rephrased to be more precise and evidence-based. Sentence restructuring : The discussion has been revised for sentence flow and clarity. Critical comparison with literature : We have added a detailed comparison with Eggenberger et al. (2015) and Hewston et al. (2013), highlighting alignment and differences with our study findings. Updated references : Several outdated references have been replaced with recent publications to strengthen the discussion. Conclusion: We believe these revisions have improved the clarity, scientific rigor, and overall quality of the manuscript. We thank the reviewers once again for their valuable input, which has substantially strengthened our work. Respectfully, J Anandh Raj Dear Reviewers, We sincerely thank you for the thorough and constructive feedback on our manuscript. We greatly appreciate the time and effort you have taken to provide valuable suggestions. We have carefully revised the manuscript in line with your comments, and below we provide a detailed, point-by-point response. Introduction Aim of the study and hypothesis : Thank you for this observation. We have revised the introduction to clearly state the research gap, aim, and a more explicit hypothesis. Research question and objective : We have added a clearly defined research question and an explicit objective at the end of the introduction section. Rationale for blindfold training in T2DM population : Additional explanation has been incorporated to clarify why blindfold training may enhance sensory substitution and cognitive engagement specifically in T2DM patients, supported by relevant references. Clarification of CMDBT definition and physiology : We have restructured the introduction to define CMDBT earlier and included an explanation of its underlying physiological basis, highlighting how it differs from conventional dual-task or physical-cognitive training. Methods Grammatical corrections : The methodology section has been thoroughly revised for grammar and clarity. Sample size calculation : We have now provided details of the sample size calculation method, including assumptions used, and clarified dropout considerations. CONSORT guidelines : We have revised the manuscript to state that the trial adhered to CONSORT guidelines, and included a flow diagram in the supplementary material. Blinding and outcomes : The revised manuscript specifies the type of blinding employed (assessor blinding), and explicitly lists the primary and secondary outcome measures. Randomisation and allocation concealment : Details on random sequence generation, allocation concealment, and enrolment procedures have been added for clarity. Interim analysis : A statement has been added explaining compliance and safety monitoring during the intervention, though no formal interim efficacy analysis was planned. Results Inconsistent terminologies : All group identifiers have been standardized (Group A/Group B) throughout the manuscript for consistency. Grammar and construction : The results section has been carefully revised for clarity and grammar. Normality testing : Details of the normality test (Shapiro–Wilk) have been added to the statistical analysis section. Dropouts : Information on participant retention and dropouts, along with how missing data was handled (intention-to-treat analysis), has been included. Data collection sheet/table title error : The table titles have been corrected. Discussion Paragraph structure : The discussion has been restructured to separate study findings from supporting literature more clearly. Pathological explanation in results section : The statement regarding vascular damage was relocated to the discussion and now includes appropriate citations. Vague conclusion statement : The statement on CMDBT effectiveness has been rephrased to be more precise and evidence-based. Sentence restructuring : The discussion has been revised for sentence flow and clarity. Critical comparison with literature : We have added a detailed comparison with Eggenberger et al. (2015) and Hewston et al. (2013), highlighting alignment and differences with our study findings. Updated references : Several outdated references have been replaced with recent publications to strengthen the discussion. Conclusion: We believe these revisions have improved the clarity, scientific rigor, and overall quality of the manuscript. We thank the reviewers once again for their valuable input, which has substantially strengthened our work. Respectfully, J Anandh Raj Competing Interests: No potential conflict of interest relevant to this article was reported. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 3 VERSION 3 PUBLISHED 17 Jun 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 5 Version 3 (revision) 17 Oct 25 read read read read Version 2 (revision) 19 Aug 25 read read Version 1 17 Jun 25 read Dr Kiruthika Selvakumar , Universiti Tunku Abdul Rahman, Sungai Long, Malaysia Nilton João Chantre Leite , University of Évora, Évora, Portugal Arunachalam Ramachandran, , Madhav University, Abu Road, India Maria Rizzo , Messina University, Messina, Italy João Gabriel da Silveira Rodrigues , Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Rodrigues J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Nov 2025 | for Version 3 João Gabriel da Silveira Rodrigues , Universidade Federal de Minas Gerais, Belo Horizonte, State of Minas Gerais, Brazil 0 Views copyright © 2025 Rodrigues J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript entitled “The effect of visual deprivation during cognitive motor dual-task training on cognitive function in type 2 diabetes mellitus” evaluated the effectiveness of cognitive motor dual-task training (CMDBT) combined with aerobic and resistance exercises on cognitive function in individuals with type 2 diabetes mellitus (T2DM). The topic is relevant and adds valuable information regarding a novel intervention. However, although the manuscript addresses an interesting subject for the scientific community, several major issues need to be addressed before the study can be considered for publication. Major Comments The MoCA was originally conceptualized and validated as a cognitive screening tool, not as an instrument to assess the effectiveness or efficacy of an intervention. Please justify why this screening tool was selected for evaluating intervention outcomes. A previous study (DOI: 10.1016/j.diabres.2021.108700) investigated the effects of exercise training on specific cognitive domains in individuals with T2DM. The authors reported that exercise efficacy appears to be domain-specific, with improvements in attentional and executive processes, whereas processing speed and memory remained unchanged. In light of this evidence, the present manuscript should engage in a discussion with the aforementioned study to address the limitations of using the MoCA—which is a screening instrument and not designed to evaluate specific cognitive domains or intervention effects. Methods 3. From a physiological perspective, the repetition of acute exercise sessions can lead to chronic adaptations. Therefore, reporting adherence (i.e., the percentage of total sessions completed) for the intervention group is mandatory. 4. Intervention studies should account for potential dropouts when determining sample size to ensure sufficient statistical power. Please clarify why this adjustment was not performed in the present study. 5. In Figure 1, the authors should indicate how many participants were excluded during the initial recruitment phase due to the exclusion criteria. 6. Participants in the control group received standard conventional physiotherapy. However, previous studies have highlighted that physiotherapy interventions may also enhance neurotrophic factors (DOI: 10.1016/j.archger.2011.05.014). Please clarify how this potential confounding factor was addressed or controlled for in the current study. 7. The authors did not report the participants’ characteristics. Sociodemographic, metabolic, and cognitive characteristics of the participants were not reported. These data are essential for interpreting the findings and determining their generalizability. Please include this information. 8. Age and educational level are well known to influence MoCA performance. Therefore, it is crucial to include these parameters, along with other relevant variables, in the proposed Table 1 describing participant characteristics. 9. Some medications used to control blood glucose may affect cognitive function and MoCA scores. Considering the longitudinal design of this study, please include a description of the drug therapy prescribed to participants (pre- and post-intervention) to better contextualize this potential limitation. 10. The limitation session of this study is too small. IMO, several points raised in this letter should be added as study limitations. 11. Details of the exercise session, specially regarding the resistance exercise (exercise volume, rest, exercise number, sequence, etc) should be provided. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Physical exercise, exercise physiology, cognition, type 2 diabetes, older adults I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Rodrigues JGdS. Peer Review Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425726) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425726 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Rizzo M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Nov 2025 | for Version 3 Maria Rizzo , Messina University, Messina, Italy 0 Views copyright © 2025 Rizzo M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The manuscript "The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus" presents a methodologically rigorous and innovative RCT exploring the effects of visual deprivation during cognitive-motor training in individuals with Type 2 diabetes mellitus. It contributes novel insights into the role of sensory deprivation in enhancing cognitive outcomes through cross-modal plasticity mechanisms. The study is scientifically sound, well-documented, and clinically relevant, with appropriate methodology and transparent data sharing. Only minor editorial and structural improvements are recommended for clarity. 1. Minor editorial improvements could further enhance readability, particularly by simplifying long sentences in the Introduction and Discussion. 2. Although technically sound, the manuscript could benefit from a brief justification of why the 12-week intervention period was chosen, referencing similar cognitive-motor training durations from prior literature. 3. It would be helpful to include a short paragraph in Data Availability summarizing how to access the dataset from figshare to guide readers unfamiliar with the platform. 4. Statistical analyses are appropriate and correctly interpreted. Use of both p -values and effect sizes (Cohen’s d ) is commendable. The authors verified assumptions of normality and variance homogeneity before applying parametric tests. Results are reported with adequate precision, including mean ± SD and confidence intervals. The discussion accurately reflects the magnitude and clinical relevance of findings (MCID of 2.3 points for MoCA). The Authors can add in disccussion section "Future studies could incorporate multivariate analyses (e.g., ANCOVA) to control for potential covariates such as age, baseline cognitive status, or education level." 5. To strengthen the impact, the authors could include a short paragraph discussing potential neurophysiological mechanisms (e.g., BDNF modulation) to bridge behavioral outcomes and neural plasticity. 6. Ensure consistency in abbreviation usage (e.g., CMDBT, CMDT). Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Physiology and Behavior I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Rizzo M. Peer Review Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425730) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425730 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Ramachandran, A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Nov 2025 | for Version 3 Arunachalam Ramachandran, , Madhav University, Abu Road, Rajasthan, India 0 Views copyright © 2025 Ramachandran, A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The research is well drafted and the research question dealt with is of good clinical significance, given the fact that T2DM is on the high and that too India is becoming the capital of Diabetes. I would suggest that the author include the content on how the cognitive factors affect the socio-psychological components of the patients in the introduction to emphasise the need for the study. also, I would suggest the author incorporate the impact of "Visual Deprivation" in the treatment process. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Neuro rehabilitation, Physiotherapy, Yoga and Virtual rehabilitation I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Ramachandran, A. Peer Review Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425729) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425729 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Selvakumar D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Oct 2025 | for Version 3 Dr Kiruthika Selvakumar , Universiti Tunku Abdul Rahman, Sungai Long, Selangor, Malaysia 0 Views copyright © 2025 Selvakumar D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions No further remarks.Approved Competing Interests No competing interests were disclosed. Reviewer Expertise Physiotherapy, Headache, Migraine, Stroke Rehabilitation, Paediatric Rehabilitation, Geriatric Rehabilitation, Scoliosis and Low pain pain I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Selvakumar DK. Peer Review Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.189242.r425022) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-592/v3#referee-response-425022 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Leite N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 16 Sep 2025 | for Version 2 Nilton João Chantre Leite , University of Évora, Évora, Portugal 0 Views copyright © 2025 Leite N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review this interesting manuscript. I have some recommendations to strengthen the presentation and impact of this work. ABSTRACT: 1. Background: The connection you make between dual-task training and cognitive function is very persuasive. To further focus the reader, please consider adding the objective of the study. 2. Methods: The methodology description is clear, but it might benefit from a slight reorganization to improve flow. It could be more straightforward to begin with the study design and randomization, then describe the interventions assigned to each group, and finally the assessment time points. 3. Results: Can the main message be condensed into a single sentence, integrating the " p" value and the average difference observed between the groups? INTRODUCTION: 1. I recommend reviewing the use of abbreviations throughout the manuscript. For clarity and consistency, ensure that each term is written in full upon its first appearance and then used consistently in all subsequent sections. 2. In the first paragraph, I recommend updating the epidemiological data on diabetes (e.g., prevalence, mortality, economic impact) using the latest figures from the International Diabetes Federation's Diabetes Atlas ." 3. Please add a supporting citation for the claim that “… blindfold training may uniquely amplify compensatory brain activation and multisensory integration in this population. By forcing dependence on non-visual sensory modalities, blindfold cognitive-motor dual-task training may serve as a stronger neuroplastic stimulus than training allowing visual input. METHODS: 1. Please consider relocating the first paragraph to the Introduction section and the paragraph on ethical approval to the Study Design section. 2. The sample size calculation is clearly presented. To further strengthen this section, could you please add a citation for the software/statistical method used or reference of the study from which the parameters were derived? 3. Please consider describing how the intensity of the interventions was controlled, and monitored across all participants and training sessions. 4. Please clarify whether participants' baseline physical activity levels were assessed and if activity was and controlled for during the trial. The interpretation of the results would be significantly strengthened by ruling out physical activity as a confounding variable. If this data is available, please present it. If not, this should be acknowledged as a study limitation, as differences in activity levels could offer an alternative explanation for the differential cognitive outcomes observed between the groups. 5. Please provide a description of the MoCA instrument and its specific subdomains (e.g., executive functions, memory, language, orientation, visuospatial abilities) that were assessed. This is essential for the reader to understand what cognitive functions are being analyzed. STATISTICAL ANALYSIS: 1. Please consider adding a citation for the Cohen's effect size cut-off values used. RESULTS: 1. I could not locate the baseline demographic and clinical characteristics in the cited source, [Anandh Raj J: Pretest and post test values of MoCA in Group A and B in Type 2 Diabetes Mellitus subjects. Dataset. figshare. 2025]. Please review this citation for accuracy. 2. A stated aim of this study, introduced in paragraph 7 of the Introduction, was to explore effects on MoCA subdomains. To fully address this aim, please present the analysis of these subdomains (e.g., executive functions, memory, language, orientation) in the Results section. This data is essential to provide a nuanced interpretation of the intervention's specific cognitive effects. 3. Please consider relocating the following paragraphs to the Discussion Section: "Clinically, the magnitude of improvement in Group A aligns with thresholds associated with reduced dementia risk in diabetic populations, highlighting the potential of integrating sensory deprivation to augment cognitive rehabilitation in type 2 diabetes mellitus." "These findings advocate for incorporating sensory-enhanced cognitive-motor dual-task training into rehabilitation protocols to optimize cognitive outcomes and potentially mitigate diabetes-associated cognitive decline." DISCUSSION: 1. To improve the focus of the Discussion, I recommend opening the section with the study's main research question. This will provide essential context for the interpretation of the findings that follow. 2. The arguments presented in the second and third paragraphs require supporting references. Please integrate citations from the relevant literature. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Sport Medicine, Geriatrics, Sport Psychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Leite NJC. Peer Review Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.184769.r407289) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-592/v2#referee-response-407289 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Selvakumar D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Aug 2025 | for Version 2 Dr Kiruthika Selvakumar , Universiti Tunku Abdul Rahman, Sungai Long, Selangor, Malaysia 0 Views copyright © 2025 Selvakumar D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have addressed all the suggested revisions. No further remarks. Competing Interests No competing interests were disclosed. Reviewer Expertise Physiotherapy, Headache, Migraine, Stroke Rehabilitation, Paediatric Rehabilitation, Geriatric Rehabilitation, Scoliosis and Low pain pain I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Selvakumar DK. Peer Review Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.184769.r406650) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-592/v2#referee-response-406650 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Selvakumar D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Jul 2025 | for Version 1 Dr Kiruthika Selvakumar , Universiti Tunku Abdul Rahman, Sungai Long, Selangor, Malaysia 0 Views copyright © 2025 Selvakumar D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (2) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Editor-in-Chief/ Authors, Enclosed is the suggestions for further consideration. Introduction: The introduction is comprehensive and well-structured, covering the relationship between variables; however, the authors can consider the following suggestions: The aim of the study/research gap is weakly stated, and the hypothesis is only brief. The background lacks a research question and objective. Rationale for using blindfold training specifically for the T2DM population is not clear. Definition and clarification on CMBT are introduced towards the end; the physiology behind this training and how it is different from dual-task or physical cognitive training approaches would strengthen the objective of the study. Methods: The grammatical errors in the methodology are to be corrected. The sample size included was 62, but the sample size calculation methods or dropout calculations were not provided in this study. Since the study design is RCT, whether the study followed the CONSORT guidelines is not clear. The study lacks an explanation of blinding, primary, and secondary outcome measures. Details on allocation concealment mechanism, randomisation allocation, generation or enrolment were discussed. Since both groups underwent training, an interim analysis including safety, efficacy and compliance checks can be included. Results: Inconsistency in terminologies described (the methodology mentions group A, but the results section mentions it as group 1). Poor grammar and sentence construction. The normality of data is not included. Did the study encounter any dropouts? If so, how was the data managed for result analysis? Data collection sheet – the title of the table – error to be corrected. Discussion: The paragraph structure is inconsistent or intermixed with literature and not clearly separated. The statement “T2DM patients’ cognitive deterioration is largely due to vascular damage caused by protein accumulation on the blood vessel walls” is a pathological explanation lacking citation and not a study result, but it’s included in the results section. Statement “This demonstrates CMDBT’s potential as a successful cognitive rehabilitation intervention for patients with type 2 diabetes” is vague and needs rephrasing. Authors are highly encouraged to look at the sentence restructuring and phrasing. Weak critical comparison with literature: especially Eggenberger et al. (2015) and Hewston et al. (2013), whether these studies align or diverge with the current study, and justification for this is not included. Some of the references need to be updated (example: 2004, 2005, 2008). Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Physiotherapy, Headache, Migraine, Stroke Rehabilitation, Paediatric Rehabilitation, Geriatric Rehabilitation, Scoliosis and Low pain pain I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (2) Author Response 23 Aug 2025 J Anandh Raj, Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, 144411, India Dear Editor and Reviewer, We thank you for your constructive review and helpful suggestions. We have addressed each point in detail below and revised the manuscript accordingly to improve clarity, rigor, and scientific quality. Introduction We have clarified the research aim, hypothesis, and rationale earlier in the introduction as requested. The rationale for blindfold training in T2DM is now more explicitly explained with supporting citations. CMDBT is defined and distinguished from other dual-task approaches earlier in the text. Methods Grammatical errors have been corrected. A detailed sample size calculation with dropout considerations is added. CONSORT adherence is clearly stated, and a flow diagram is included (Figure 1). Blinding procedures and primary outcome measures are described more explicitly. Randomization and allocation concealment methods are clarified. Interim safety, compliance monitoring details are included. Results Group terminology is now consistent throughout (Group A and B). Grammar and sentence structure are improved for clarity. Normality testing results (Shapiro-Wilk) are added. No dropouts occurred; analysis was intention-to-treat; this is now clearly stated. Table titles and figure captions have been corrected. Discussion Paragraphs are restructured for better flow and separation of study findings, literature context, and mechanisms. Pathophysiological explanations are moved from results to discussion. Vague statements are rephrased for precision. Literature comparisons with Eggenberger et al. and Hewston et al. include discussion on alignment and divergence. Some outdated references have been updated with recent literature. We appreciate the opportunity to improve our manuscript based on your expert feedback and believe the revisions have enhanced the quality and transparency of the work. Sincerely, J Anandh Raj On behalf of all authors View more View less Competing Interests The authors declare that they have no relevant financial or non-financial competing interests that could be perceived to influence the judgments reported in this article. All authors have disclosed any potential conflicts, and no conflicts exist related to this work. reply Respond Report a concern Author Response 03 Oct 2025 J Anandh Raj, Lovely Faculty of Applied Medical Sciences, Lovely Professional University, Phagwara, 144411, India Dear Reviewers, We sincerely thank you for the thorough and constructive feedback on our manuscript. We greatly appreciate the time and effort you have taken to provide valuable suggestions. We have carefully revised the manuscript in line with your comments, and below we provide a detailed, point-by-point response. Introduction Aim of the study and hypothesis : Thank you for this observation. We have revised the introduction to clearly state the research gap, aim, and a more explicit hypothesis. Research question and objective : We have added a clearly defined research question and an explicit objective at the end of the introduction section. Rationale for blindfold training in T2DM population : Additional explanation has been incorporated to clarify why blindfold training may enhance sensory substitution and cognitive engagement specifically in T2DM patients, supported by relevant references. Clarification of CMDBT definition and physiology : We have restructured the introduction to define CMDBT earlier and included an explanation of its underlying physiological basis, highlighting how it differs from conventional dual-task or physical-cognitive training. Methods Grammatical corrections : The methodology section has been thoroughly revised for grammar and clarity. Sample size calculation : We have now provided details of the sample size calculation method, including assumptions used, and clarified dropout considerations. CONSORT guidelines : We have revised the manuscript to state that the trial adhered to CONSORT guidelines, and included a flow diagram in the supplementary material. Blinding and outcomes : The revised manuscript specifies the type of blinding employed (assessor blinding), and explicitly lists the primary and secondary outcome measures. Randomisation and allocation concealment : Details on random sequence generation, allocation concealment, and enrolment procedures have been added for clarity. Interim analysis : A statement has been added explaining compliance and safety monitoring during the intervention, though no formal interim efficacy analysis was planned. Results Inconsistent terminologies : All group identifiers have been standardized (Group A/Group B) throughout the manuscript for consistency. Grammar and construction : The results section has been carefully revised for clarity and grammar. Normality testing : Details of the normality test (Shapiro–Wilk) have been added to the statistical analysis section. Dropouts : Information on participant retention and dropouts, along with how missing data was handled (intention-to-treat analysis), has been included. Data collection sheet/table title error : The table titles have been corrected. Discussion Paragraph structure : The discussion has been restructured to separate study findings from supporting literature more clearly. Pathological explanation in results section : The statement regarding vascular damage was relocated to the discussion and now includes appropriate citations. Vague conclusion statement : The statement on CMDBT effectiveness has been rephrased to be more precise and evidence-based. Sentence restructuring : The discussion has been revised for sentence flow and clarity. Critical comparison with literature : We have added a detailed comparison with Eggenberger et al. (2015) and Hewston et al. (2013), highlighting alignment and differences with our study findings. Updated references : Several outdated references have been replaced with recent publications to strengthen the discussion. Conclusion: We believe these revisions have improved the clarity, scientific rigor, and overall quality of the manuscript. We thank the reviewers once again for their valuable input, which has substantially strengthened our work. Respectfully, J Anandh Raj View more View less Competing Interests No potential conflict of interest relevant to this article was reported. reply Respond Report a concern Selvakumar DK. Peer Review Report For: The Effect Of Visual Deprivation During Cognitive Motor Dual Task Training On Cognitive Function In Type 2 Diabetes Mellitus [version 3; peer review: 2 approved, 2 approved with reservations, 1 not approved] . F1000Research 2025, 14 :592 ( https://doi.org/10.5256/f1000research.178674.r395444) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-592/v1#referee-response-395444 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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