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 Diabetes Mellitus (DM) is a chronic metabolic disorder caused by hyperglycemia, impaired insulin secretion, and insulin resistance. Type 2 diabetes mellitus (T2DM) is associated with an increased risk for cognitive dysfunction. Cognitive motor dual task blindfold training (CMDBT) forces the brain to process motor tasks in one of the four procedural memory centers: the basal ganglia, cerebellum, supplementary motor area, and premotor cortex. Hence, it helps improve cognition in patients with T2DM. Methods A randomized control study was conducted on 62 subjects with type 2 diabetes mellitus. Pre-interventional measures were measured using the MoCA scale to assess cognition. The experimental group [n=31] underwent Cognitive motor dual task blindfold training, along with aerobic training. The control group [n=31] received conventional aerobic and resistance exercises. The subjects in both the groups received the intervention for 12 weeks. Post interventional outcomes were measured using the MoCA scale in subjects with T2DM. Results Statistical analysis of the data revealed that there was a significant improvement in cognitive function in experimental group A subjects, with a significant difference observed in group A compared to group B. The P value of MoCA was 0.0001 in experimental group A subjects. Conclusion Cognitive motor dual-task training (CMDTT) is more effective in increasing cognition in subjects with T2DM. Statistical analysis showed that group A (CMDTT) showed greater improvement in cognitive function than the control group. 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F1000Research 2025, 14 :592 ( https://doi.org/10.12688/f1000research.162466.1 ) 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 THE EFFECT OF VISUAL DEPRIVATION DURING COGNITIVE MOTOR DUAL TASK TRAINING ON COGNITIVE FUNCTION IN TYPE 2 DIABETES MELLITUS [version 1; peer review: 1 approved with reservations] 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 Jun 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 Diabetes Mellitus (DM) is a chronic metabolic disorder caused by hyperglycemia, impaired insulin secretion, and insulin resistance. Type 2 diabetes mellitus (T2DM) is associated with an increased risk for cognitive dysfunction. Cognitive motor dual task blindfold training (CMDBT) forces the brain to process motor tasks in one of the four procedural memory centers: the basal ganglia, cerebellum, supplementary motor area, and premotor cortex. Hence, it helps improve cognition in patients with T2DM. Methods A randomized control study was conducted on 62 subjects with type 2 diabetes mellitus. Pre-interventional measures were measured using the MoCA scale to assess cognition. The experimental group [n=31] underwent Cognitive motor dual task blindfold training, along with aerobic training. The control group [n=31] received conventional aerobic and resistance exercises. The subjects in both the groups received the intervention for 12 weeks. Post interventional outcomes were measured using the MoCA scale in subjects with T2DM. Results Statistical analysis of the data revealed that there was a significant improvement in cognitive function in experimental group A subjects, with a significant difference observed in group A compared to group B. The P value of MoCA was 0.0001 in experimental group A subjects. Conclusion Cognitive motor dual-task training (CMDTT) is more effective in increasing cognition in subjects with T2DM. Statistical analysis showed that group A (CMDTT) showed greater improvement in cognitive function than the control group. 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 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :592 ( https://doi.org/10.12688/f1000research.162466.1 ) 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 )  There is a newer version of this article available. Suppress this message for one day. 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 T1DM, T2DM, an autoimmune illness marked by the death of beta cells that produce insulin, is primarily brought on by reduced insulin action, commonly referred to as “insulin resistance,” along with varied degrees of insulin shortage. 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. As per the International Diabetes Federation (IDF), 850 billion US dollars were spent on adult diabetes-related medical treatment worldwide in 2017. In India, the prevalence of T2DM is rapidly increasing, with significant public health implications. 4 , 5 Type 2 diabetes is not only a metabolic disorder but also a significant risk factor for cognitive decline and dementia. 6 – 8 The mechanisms underlying this association include hyperphosphorylation of tau protein, which is a key feature in insulin dysregulation and Alzheimer’s disease. 9 – 11 The chronic development of advanced glycation end products (AGEs) may result from increased blood glucose levels. 12 Even though the development of AGEs considers the pathophysiology of dementia and Alzheimer’s disease, people with dementia who also have type 2 diabetes have been shown to exhibit more AGEs and microglial activation than people with dementia alone. 13 The moderate to severe vasculopathies seen in dementia and type 2 diabetes are largely caused by endothelial dysfunction. Microalbuminuria, an indicator of endothelial dysfunction, is found in individuals with type 2 diabetes and is associated with accelerated cognitive deterioration. Damage to endothelial cells caused by protein buildup on blood vessel walls increases the creation of reactive oxygen species and decreases the production of vasodilatory factors, which lowers cerebral blood flow and causes neurovascular uncoupling and neuronal damage. 8 , 12 Verbal fluency, executive function, processing speed, memory, and overall cognitive function all diminish more quickly in people with type 2 diabetes. 14 In treating cognitive impairment in T2DM, resistance training is used to improve cognitive function as resistance training protects from degeneration in specific subregions of the hippocampus. 15 – 17 A 6-month multi-modal exercise program has improved cognitive function during rehabilitation. This multi-model exercise program showed good benefits on cognitive deterioration in individuals with type 2 diabetes. 15 , 16 Physical - cognitive training is a technique used in adults with T2DM along with cognitive impairment, which gave better results in improving the cognitive function. The intervention included moderate-intensity exercises combined with cognitive training. 17 , 18 Aerobic exercise training improves insulin sensitivity, glycemic control, and cognitive function. These improvements are frequently attributed to adaptations linked to chronic exercise, such as improvements in cardiorespiratory fitness, adjustments to energy balance, and decreases in total or regional adiposity. 19 One type of neurological exercise therapy used to help older persons with type 2 diabetes recover from cognitive impairment is the mind-motor approach. Patients with type 2 diabetes saw an improvement in their cognitive function as a result. 20 Dual task training: Although cognitive training and exercise are acknowledged as viable methods for addressing cognition, it is feasible that combining the two simultaneously (dual-task) may have complementary or shared mechanisms that enable larger cognitive benefits than either one alone. 21 – 23 This synergistic approach aligns with the guided plasticity facilitation framework, which emphasizes that simultaneity of physical and cognitive stimulation maximizes neuroplasticity by leveraging exercise-induced molecular changes (e.g., increased BDNF levels) during cognitive task performance. 24 By performing a cognitive task concurrently with motor training, a technique known as MCDTT can more successfully fortify the functional connections between motor cognitive brain regions, promoting cerebral cortex activation and improving walking ability. Improving motor dysfunction makes it easier for the cerebral cortex to become active while helping the brain to remodel. 25 The ability to walk is a unique behavior that distinguishes humans from other species. Autonomic conscious modulation of casual posture and stress feedback control and information processing through visual, proprioceptive, vestibular, and additional sensory experiences are all part of the control processes. 26 , 27 External stimulation triggers endogenous brain regeneration strategies that promote cortical activation through motor training and cognitive behaviors as stroke patients gradually regain their functional abilities. It speeds up information processing by encouraging brain restoration and the expansion of cortical neuronal connections. 25 Researchers have also discovered, using radiography, that dual-task training improves the hemodynamics of the dorsolateral prefrontal cortex. Simultaneously, central activation decreases following dual-task training, suggesting a reduced processing load following training. 28 , 29 Blindfolding is a technique used for visual deprivation to train individuals through intuition and sensory substitution. Blindfold is not the end goal, but it helps to stimulate and improve the brain’s abilities. The blindfold technique can boost our brain and balance the left and right hemispheres of the brain, including activating intention capacity, which helps individuals do things with their closed eyes 30 Paul Bach-y-Rita et al. was the first to propose the sensory substitution. A non-invasive method for preventing amputation on one sense is sensory replacement, which involves supplying information through a different route. It re-establishes a sense of surroundings in individuals. 31 A complete sensory modality conveys information to the visual perception regions of the brain (occipital lobe and visual cortex) during sensory replacement, enabling an individual to comprehend and identify sight. Brain structures associated with various sensory modalities can receive information from a single modality. Information from the touch receptors is transmitted to the visual cortex via touch-to-visual sensory substitution for processing and perception. Individuals’ eyes were closed in the blindfold activity, and they were asked to use touch to determine the colour of the ball/object. Tactile-visual sensory substitution occurs when individuals describe their perceptual experiences with a specific object. Sensory substitution has not only provided impressive practical results among those with visual impairments but has also developed neural plasticity. 32 Cognitive-motor dual-task training is a non-pharmacological approach that combines regular mental and physical activity to maintain or improve cognitive skills. Such skills include attention, cognitive flexibility, problem solving, observation, comprehension, intuition, reasoning, and memory. This technique boosts cognitive abilities by strengthening neural connections in the brain, which improves the brain’s ability to process and understand information. Mental exercise sessions focusing on improving cognitive and intuitive skills are known as cognitive training, such as memory, focus, attention, and observation. This can help maintain or improve certain aspects of cognition. 33 In T2DM, Cognitive Motor dual task blindfold training (CMDBT) may be beneficial for cognitive function improvement along with motor improvement that result in exercise capacity enhancement along with decreased risk of other types of diabetes onset-associated complications including dementia, diabetic myopathy, sarcopenia, neuropathy. Anticipated hypothesis of proposed study is that CMDBT can improve cognitive function in T2DM individuals. 11 Method Based on the literature, cognitive motor dual-task training has been conducted on cognition, but there is no adequate evidence in type 2 diabetes mellitus. This study was approved by the 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. The study ensures that All participants provided written informed consent before data collection. The investigator was collected the data regarding baseline assessment of demographic data of name, age, gender, height, weight, duration of the disease, HbA1C and Mini mental state examination score. After the collection of data of base line assessment then the subjects was allocated with random block envelope method to experimental (CMDBT) group A, and conventional (control) group B. Research design: Experimental design- Single blinded Randomized Controlled Trial Study population: Study includes patients diagnosed with Type 2 diabetes mellitus Sampling method: Random sampling method with 1:1 parallel arm allocation ratio with lottery method Study design: Experimental study – Randomized control trial (Clinical Trial Registry of India no: CTRI/2024/01/061956) Study setting: The study was conducted at the physiotherapy OPD in the Apollo District Headquarters Hospital, Murukambattu, Chittoor-517001, Andhra Pradesh, India. Sample size: Total sample size: 62 subjects were randomly allocated to each group of 31. Sampling method: Random sampling method, 1:1 ratio parallel with lottery technique. Treatment duration: One session a day, 3 days/week, for 12 consecutive weeks. Inclusion criteria: • Subjects with T2DM • HbA1c value above 6.5mmol/dL • Subjects with education level >5 years (need to read and write). • 5-10 years of diabetes duration from diagnosis • Both male and female genders are included. • Subjects who signed consent and willing to participate. Exclusion criteria: • Patients who are not willing and not cooperative. Musculoskeletal anomalies • Pressure sores and Pressure ulcers • Any exposure to radiological X rays or therapy since past 6 months. • Any microvascular circulation defects • Diabetic neuropathy patients • Patients with unstable vitals • Patients with cardiac anomalies • Malignant tumors Outcome measures: Montreal cognitive assessment (MoCA). Procedure 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 in the intervention group received a structured, multicomponent training regimen delivered in 3 sessions per week for 12 weeks, totaling 36 sessions. Each session combined progressive cognitive motor dual task blindfold exercises with conventional physiotherapy, all performed while wearing a blindfold on a treadmill to enhance dual-task demands and minimize visual cues. If any discomfort was experienced, participants were allowed rest breaks during the session. Cognitive training targeted working memory (via digit span and word list recall tasks, with sequence length increasing every four weeks), visuospatial skills (through auditory instruction to interpret and set clock times, progressing from standard to oblique and advanced positions), executive function (using serial arithmetic and verbal sequencing tasks with escalating complexity and time constraints), attention (via digit ordering and auditory detection tasks with progressively greater demands), and language processing (including verbal memory and fluency tasks with increasing delay and time pressure). All cognitive motor dual task blindfold exercise were administered in 10 trials per session, with task difficulty systematically increased every four weeks to ensure adaptive challenge. In parallel, conventional physiotherapy comprised resistance training of moderate intensity (50–69% of one-repetition maximum, using a moderate resistance band) targeting the shoulder, elbow, wrist, hip, knee, and ankle joints with 10 repetitions per exercise, as well as aerobic training of moderate intensity (55 to <70% of maximum heart rate) conducted through cycling and treadmill walking. This integrated, dual-task approach was designed to simultaneously enhance cognitive and physical capacities while maintaining consistent dosage and progressive difficulty throughout the intervention period. Control group Participants in the control group received conventional physiotherapy consisting of moderate-intensity resistance training (50–69% of one-repetition maximum) and moderate-intensity aerobic training. Resistance exercises targeted the shoulder, elbow, wrist, hip, knee, and ankle, using a moderate resistance band for 10 repetitions per exercise. Aerobic training was performed at 55–70% of maximum heart rate (HRmax) through cycling and treadmill walking. All interventions were administered once per day, three days per week over a 12-week period, ensuring a total of 36 sessions for each component. Statistical analysis Statistical analysis was performed using IBM SPSS Statistics 30 version 34 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). 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. No adjustments for multiple comparisons were applied, as the study prioritized identifying preliminary effects for future confirmatory trials. Results In CMDBT group (Group-1), 21 (67.7%) males & 10 (32.3%) females had mean, standard deviation of age 51.35±5.43yrs, duration of diabetes had been 9.06 ± 3.57, educational level was 11.81 ± 3.08, HbA1c value was 7.70 ± 1.21, BMI was 27.52 ± 2.22 kg/m 2 , Mini mental state score was 27.42 ± 1.31. In the Control group (Group-2), 18 (58.1%) males & 13 (41.9 %) females having mean as well as standard deviation of age had been 50.90±5.07yrs, duration of diabetes had been 9.71 ± 3.53, educational level was 11.06 ± 3.26, HbA1c value was 7.81 ± 1.27, BMI was 27.53 ± 1.97 kg/m 2 , Mini mental state score was 27.35 ± 1.11 participated. Every demographic measure in 2 groups had not been statistically significant ( p > 0.05) from one another, demonstrating homogeneity of 2 groups. 37 The study revealed significant within-group improvements in cognitive function across both intervention arms. Participants in Group A (Cognitive-Motor Dual-Task Training with Blindfold) exhibited a clinically meaningful enhancement in global cognition, as evidenced by Montreal Cognitive Assessment (MoCA) scores increasing from a pre-intervention mean of 25.81 ± 1.74 to 29.13 ± 0.76 post-intervention ( t = 6.32 , df = 30 , p < 0.0001 ) ( Table 1 ). This 3.32-point gain exceeded the minimal clinically important difference (MCID) of 2.3 points for MoCA, accompanied by a 56% reduction in score variability (standard deviation: 1.74 to 0.76), indicating consistent treatment effects shown in Figure 1 . In contrast, Group B (Moderate-Intensity Aerobic Exercises) demonstrated a smaller yet statistically significant improvement, with MoCA scores rising from 25.77 ± 1.45 to 26.71 ± 1.37 ( t = 6.02 , df = 30 , p = 0.0006 ) ( Table 2 ). The 0.94-point increase did not surpass the MCID, and the marginal reduction in variability (standard deviation: 1.45 to 1.37) suggested heterogeneous responses to aerobic training shown in Figure 2 . Figure 1. Graphical representation of Means of pre and post values of MoCA within experimental Group A. 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 CONTROL Group B. 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 Between-group comparisons further underscored the superiority of blindfolded dual-task training. Post-intervention MoCA scores differed significantly between Group A ( 29.13 ) and Group B ( 26.71 ), with a 2.42-point disparity ( p < 0.0001 ) ( Table 3 ). This finding highlights the added neurocognitive benefits of integrating sensory deprivation into dual-task protocols. Effect size analysis reinforced these results, with Group A demonstrating a large Cohen’s d of 1.89, compared to a moderate effect ( d = 0.65 ) in Group B shown in Figure 3 . Clinically, the magnitude of improvement in Group A aligns with thresholds linked to reduced dementia risk in longitudinal studies of diabetic populations, emphasizing the potential of blindfolded cognitive-motor interventions to mitigate diabetes-related cognitive decline. These outcomes advocate for the inclusion of sensory-enhanced dual-task training in rehabilitation protocols to optimize cognitive outcomes in type 2 diabetes mellitus. Figure 3. Graphical representation of Means of post values of MoCA between Group A & Group B. 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 Discussion The results showed that cognitive motor dual-task training, along with aerobic and resisted exercises, improved significantly ( p < 0.0001) the groups’ cognitive scores before and after the tests. A statistically significant difference was observed when these groups were compared. Cognitive motor dual-task training and traditional therapy have different effects on type 2 diabetes mellitus patients’ mental abilities. T2DM patients’ cognitive deterioration is largely due to vascular damage caused by protein accumulation on the blood vessel walls. This process harms endothelial cells, promotes decreased synthesis of vasodilating substances, and generates reactive oxygen species. Consequently, the cerebral blood flow decreases, leading to neurovascular dysfunction and neuronal damage. This pathophysiological mechanism causes an accelerated decline in cognitive domains such as global cognition, processing speed, executive function, verbal fluency, and memory. Motor cognitive dual-task training (MCDTT) intervention may improve the functional relationship between motor and cognitive brain regions. This type of training enhances gait performance and encourages brain activation. Additionally, it promotes neuroplasticity, which helps patients with neurological abnormalities and motor dysfunctions. Dual-task training is beneficial for walking, a basic motor action that involves the brain, cerebellum, and brainstem and integrates sensory information. The use of blinded training methods improves cognitive processing and interhemispheric communication, further increasing brain activity. By allowing non-visual sensory data to be processed through the visual cortex and promoting neuronal plasticity, sensory substitution strategies are essential. It has been discovered that these modifications are advantageous for both visually impaired individuals and those undergoing cognitive rehabilitation. Eggenberger et al. (2015) investigated the effect of cognitive training in conjunction with physical activity on cognitive function in older persons. Verbal memory training with treadmill walking (MEMORY), virtual reality-based video game dancing (DANCE), and treadmill walking alone (PHYS) were the three groups of participants aged ≥70 years. Standardized assessments involved The Wechsler Adult Intelligence Scale-Revised (WAIS-R) was used to assess cognitive ability using the Digit Symbol Substitution Task (DSST), Executive Control Task, and Trail Making Test Part B (TMTB). According to their findings, cognitive-physical training considerably improved working memory, executive functioning, and attention switching, especially when used in a dual-task setting. The duration of the intervention also affected how much progress was observed. 35 The effects of dual-task training on gait performance of 65-year-olds with type 2 diabetes or older were also examined by Hewston et al. (2013). Participants were assigned to either the healthy control group (HC) or diabetes group (T2DM). Participants in the study completed a 6-meter path at their maximum and preferred walking speeds while completing a motor task (carrying a basket) or a cognitive task (serial subtraction). They found that the gait speed of people with type 2 diabetes was slower than that of people in good health. According to this study, dual-task training considerably improved gait performance in older adults with diabetes. This may be a useful strategy for enhancing motor function in this population. 36 The current investigation assessed the impact of the CMDBT in conjunction with aerobic workouts on cognitive function and muscle strength in individuals with T2DM. The Montreal Cognitive Assessment (MoCA) scores showed a statistically significant improvement. the 30-minute CMDBT sessions, which were followed by 30-minute moderate-intensity aerobic and resistance training, were economical and therapist-friendly. It is a good choice for inpatient rehabilitation settings because it is organized and time efficient. Additionally, according to the post-test results, Group A (CMDBT) showed more cognitive improvements than Group B (conventional therapy alone). This demonstrates CMDBT’s potential of the CMDBT as a successful cognitive rehabilitation intervention for patients with type 2 diabetes. Given these results, CMDBT should be used in clinical settings and in future studies to maximize its use in metabolic disorders and neurorehabilitation and further investigate its therapeutic advantages. Conclusion According to this study, 12 weeks of cognitive motor dual-task training produced substantial improvements in cognitive function in patients with type 2 diabetes. The results showed that cognitive motor dual-task training and aerobic exercises significantly increased post-interventional values within the groups; however, when group comparisons were made, cognitive motor dual-task training showed a statistically significant improvement in cognitive function compared to moderate-intensity aerobic exercises. The present findings provide a strong foundation for further studies and clinical implementation of CMDTT in improving cognitive T2DM patients’ function and general quality of life. 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. Recommandations 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 1 - CMDBT CONTROL GROUP 2 - 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 ). 37 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 38 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 1; peer review: 1 approved with reservations] . F1000Research 2025, 14 :592 ( https://doi.org/10.12688/f1000research.162466.1 ) 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 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 1; peer review: 1 approved with reservations] . 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 1; peer review: 1 approved with reservations] . 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 1; peer review: 1 approved with reservations] . 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 1; peer review: 1 approved with reservations] . 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 1; peer review: 1 approved with reservations] . 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 1; peer review: 1 approved with reservations] . 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 1; peer review: 1 approved with reservations] . 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 1; peer review: 1 approved with reservations] . 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 1; peer review: 1 approved with reservations] . 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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