Diabetes is a major public health issue characterized by metabolic disturbances resulting from unstable insulin secretion, insulin resistance, or both [1]. Over the past decade, the prevalence of diabetes has increased rapidly due to factors such as population aging, genetic predisposition, unhealthy dietary habits, sedentary lifestyles, and rising obesity rates associated with urbanization [2]. Metabolic imbalances in type 2 diabetes (T2DM) can affect brain health and intensify several neurodegenerative processes [3], reinforcing the complex relationship between T2DM and cognitive disorders [4]. Clinical evidence indicates that inhibitory control, flexibility, and working memory scores are lower in patients with type 2 diabetes compared to age-matched non-diabetic patients [5]. Moreover, the risk of executive function impairment in middle-aged and older patients with type 2 diabetes is higher than in healthy age-matched individuals [6]. Some studies emphasize that elderly women with diabetes are more likely to experience cognitive impairment compared to men of the same age group [7,8].

Inflammation affects cognition through mechanisms involving cytokines, which interact with receptors on peripheral nerves, transmit neural signals to the central nervous system, and activate microglia to produce more cytokines [9]. Cytokines can also cross the blood–brain barrier and interact with brain cells, particularly in older adults with elevated levels of inflammatory markers [10]. In individuals with diabetes, cognitive impairments associated with inflammation and cytokine activity are often more pronounced. This may be attributed to chronic systemic inflammation and its prolonged impact on the brain, increased accumulation of advanced glycation end-products, and greater permeability of the blood–brain barrier to inflammatory mediators. Furthermore, diabetes is associated with increased microglial activation, elevated oxidative stress, and central insulin resistance—all of which may synergistically promote neuroinflammation and neuronal dysfunction, thereby accelerating cognitive decline [[11], [12], [13]].

Tumor necrosis factor (TNF), a key cytokine involved in cognitive impairment, can exert either neuroprotective or neurodegenerative effects depending on its concentration. A study on bipolar disorder demonstrated poorer executive function in those with higher TNF levels [14]. Similarly, high levels of interleukin-10 (IL-10), an anti-inflammatory cytokine, have been associated with lower executive function and cognitive speed. Recent studies found cognitive decline, especially in executive function, in women with high IL-10 levels at risk for Alzheimer's [15]. While changes in individual cytokines predict immune performance, the balance between pro- and anti-inflammatory cytokines is crucial. Only a limited number of studies have investigated the role of the TNF/IL-10 ratio in the regulation of neuroinflammation, particularly in the context of type 2 diabetes.

Regular physical exercise is an effective non-pharmacological strategy for the treatment and prevention of T2DM [16]. Both regular aerobic and resistance exercise have been shown to exert beneficial effects on outcomes related to type 2 diabetes, including improved glucose control, reduced inflammation, enhanced insulin sensitivity, and decreased cardiovascular risk [17], —all of which may contribute to improved cognitive function [18]. Moreover, one approach to managing the complexity of physical exercise is through engaging in dual-task activities. Strong evidence suggests that simultaneously performing physical/motor and cognitive tasks can preserve or enhance cognitive performance during aging more effectively than engaging in either task alone [19].

Numerous studies have confirmed the effects of regular physical exercise on inflammatory cytokines in diabetes [20,21]. Exercise modulates cytokine responses in the immune system and regulates adipose tissue, potentially contributing to anti-inflammatory effects [21,22]. However, the specific effects of different types of physical exercise, varying in intensity and duration, on cytokine balance have been investigated in only a limited number of studies.

Participation in physical/motor exercise combined with simultaneous cognitive training (dual-task training) has been shown to enhance cognitive performance beyond the effects of either intervention alone [23]. Moreover, home-based exercise programs can help older adults overcome common barriers, such as lack of motivation, the need to leave home, mobility limitations (e.g., fear of falling), and inadequate transportation infrastructure and associated costs [24]. Given the growing global aging population, the rising prevalence of type 2 diabetes, the greater likelihood of cognitive impairment in women, and the lack of comprehensive home-based exercise guidelines for improving cognitive function in this group, this study aims to investigate the effects of a 12-week multi-task exercise intervention on executive function, selected metabolic indicators associated with diabetes, physical fitness, and the balance between TNF and IL-10 levels in women aged 50–75 with type 2 diabetes.