{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T15:02:06Z","timestamp":1781017326360,"version":"3.54.1"},"reference-count":28,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"unspecified","delay-in-days":13,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,8]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Effective management of type 2 diabetes mellitus (T2DM) in older adults requires interventions that address both metabolic control and functional capacity. Exercise improves insulin sensitivity, glucose uptake and cardiometabolic health, while high-protein diets support muscle mass preservation, satiety and glycaemic regulation. Evidence suggests that integrating structured exercise with a high-protein diet may provide additive benefits; however, research evaluating this combined approach in older adults with T2DM, particularly in low-resource settings, is limited. This study aims to determine whether a 12-week multimodal exercise programme combined with a high-protein diet improves glycaemic control and broader health outcomes compared with exercise alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>In this randomised controlled trial (RCT), 140 adults aged \u226560 years with T2DM will be allocated 1:1 to an experimental group (multimodal exercise with high-protein diet, n=70) or a control group (multimodal exercise alone, n=70). All participants will engage in three supervised exercise sessions per week for 12 weeks. Additionally, the experimental group will follow a high-protein diet that provides approximately 30% of total energy from protein, with a 500-kcal daily energy deficit. The primary outcome is glycaemic control, measured by Glycated haemoglobin (HbA1c). Secondary outcomes include anthropometric measures, fasting blood glucose, lipid profile, functional capacity (6-minute walk test) and health-related quality of life Short Form-36 Health Survey (SF-36). All outcomes will be assessed at baseline, postintervention (week 12) and follow-up (week 24). Participants, outcome assessors and statisticians will remain blinded. Intervention fidelity, adherence and safety will be systematically monitored, and final results will be analysed using SPSS (v.26.0). The study will follow ethical standards and comply with Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and Consolidated Standards of Reporting Trials (CONSORT) guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The protocol has been approved by the Institutional Review Board of the Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (Approval No.: PTR-JUST\/IRB\/2025\/09\/192404) and registered with the Clinical Trials Registry of India. Findings will be disseminated via peer-reviewed journals, conference presentations and structured knowledge-sharing sessions to inform clinical practice in diabetes management.<\/jats:p>\n                    <jats:p>\n                      Trial registration number:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\" xlink:href=\"NCT092509\">NCT092509<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-118313","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T14:13:58Z","timestamp":1781014438000},"page":"e118313","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of multimodal exercise programme combined with high-protein diet on glycaemic control in older adults with type 2 diabetes mellitus: study protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct092509","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2999-5039","authenticated-orcid":false,"given":"Suraiya Yesmin","family":"Sharna","sequence":"first","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9764-9174","authenticated-orcid":false,"given":"Kazi Md Azman","family":"Hossain","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meer Hossain","family":"Hero","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Bangladesh Health Professions Institute, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Atikur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Bangladesh Health Professions Institute, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jannatul Ferdous","family":"Rikti","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paroshmoni Biswas","family":"Mim","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Al","family":"Amin","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"2026060906451742000_16.5.e118313.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0194127","article-title":"Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses","volume":"13","author":"Bellou","year":"2018","journal-title":"PLoS ONE"},{"key":"2026060906451742000_16.5.e118313.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-025-04072-4","article-title":"Effect of hypoglycemic agents with weight loss effect plus a high protein diet and moderate exercise on diabetes remission in adults with obesity and type 2 diabetes: a randomized controlled trial","volume":"23","author":"Zhang","year":"2025","journal-title":"BMC Med"},{"key":"2026060906451742000_16.5.e118313.3","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.cnur.2006.07.011","article-title":"Type 2 diabetes mellitus","volume":"41","author":"Skelly","year":"2006","journal-title":"Nurs Clin North Am"},{"key":"2026060906451742000_16.5.e118313.4","unstructured":"Magliano DJ , Boyko EJ . Global picture. In: IDF DIABETES ATLAS - NCBI Bookshelf 2021. 2021. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK581940\/"},{"key":"2026060906451742000_16.5.e118313.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000461","article-title":"Prevalence of, and risk factors for, diabetes and prediabetes in Bangladesh: Evidence from the national survey using a multilevel Poisson regression model with a robust variance","volume":"2","author":"Hossain","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2026060906451742000_16.5.e118313.6","doi-asserted-by":"crossref","DOI":"10.3390\/ijms252010959","article-title":"Efficacy of a High-Protein Diet to Lower Glycemic Levels in Type 2 Diabetes Mellitus: A Systematic Review","volume":"25","author":"Flores-Hern\u00e1ndez","year":"2024","journal-title":"Int J Mol Sci"},{"key":"2026060906451742000_16.5.e118313.7","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-094895"},{"key":"2026060906451742000_16.5.e118313.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-009-0126-3"},{"key":"2026060906451742000_16.5.e118313.9","doi-asserted-by":"publisher","DOI":"10.2337\/dc13-2042"},{"key":"2026060906451742000_16.5.e118313.10","doi-asserted-by":"publisher","DOI":"10.2337\/db11-0857"},{"key":"2026060906451742000_16.5.e118313.11","doi-asserted-by":"publisher","DOI":"10.3945\/an.115.011171"},{"key":"2026060906451742000_16.5.e118313.12","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jcjd.2022.11.005","article-title":"Effect of Combined Exercise Training on Physical and Cognitive Function in Women With Type 2 Diabetes","volume":"47","author":"Ghodrati","year":"2023","journal-title":"Can J Diabetes"},{"key":"2026060906451742000_16.5.e118313.13","doi-asserted-by":"crossref","unstructured":"Thomas D , Elliott E . Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 2001. doi:10.1002\/14651858","DOI":"10.1002\/14651858.CD002968"},{"key":"2026060906451742000_16.5.e118313.14","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18126273","article-title":"Lifestyle Interventions to Improve Glycemic Control in Adults with Type 2 Diabetes Living in Low-and-Middle Income Countries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs)","volume":"18","author":"O\u2019Donoghue","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2026060906451742000_16.5.e118313.15","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.20146","article-title":"Effectiveness of multi-component exercise in individuals with type 2 diabetes: a systematic review and meta-analysis","volume":"13","author":"Sun","year":"2025","journal-title":"PeerJ"},{"key":"2026060906451742000_16.5.e118313.16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2025-106756","article-title":"Intervention effects of optimised carbohydrate diet in patients with type 2 diabetes: study protocol for a randomised controlled crossover trial","volume":"15","author":"Lu","year":"2025","journal-title":"BMJ Open"},{"key":"2026060906451742000_16.5.e118313.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2025-002527","article-title":"Multicentre randomised controlled trial protocol comparing structured physical exercise programme (SPEP) and medication versus conventional care for glycaemic control in type 2 diabetes mellitus","volume":"11","author":"Yesmin Sharna","year":"2025","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2026060906451742000_16.5.e118313.18","doi-asserted-by":"crossref","unstructured":"Fathy SA , Meligi AE , AlWakil SS , et al . Comparison of different diet plans on patients with type 2 diabetes. Egypt J Intern Med 2024;36. doi:10.1186\/s43162-024-00318-4","DOI":"10.1186\/s43162-024-00318-4"},{"key":"2026060906451742000_16.5.e118313.19","doi-asserted-by":"crossref","DOI":"10.1186\/s13063-024-08660-2","article-title":"Twenty-four weeks of combined training in different environments, aquatic and land, in the type 2 diabetes management (Aquatic and Land Exercise for Diabetes -ALED): protocol of a randomized clinical trial","volume":"26","author":"Leonel","year":"2025","journal-title":"Trials"},{"key":"2026060906451742000_16.5.e118313.20","unstructured":"Shafii N , Ismail TST , et al . Evaluation of hba1c using high performance liquid chromatography and capillary electrophoresis in type 2 diabetes mellitus patients suspected to have haemoglobin variant. 2023. Available: https:\/\/mail.mmsjournals.org\/index.php\/mmj\/article\/view\/615"},{"key":"2026060906451742000_16.5.e118313.21","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-03498-w"},{"key":"2026060906451742000_16.5.e118313.22","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-1728"},{"key":"2026060906451742000_16.5.e118313.23","doi-asserted-by":"publisher","DOI":"10.4137\/BMI.S38440"},{"key":"2026060906451742000_16.5.e118313.24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.576"},{"key":"2026060906451742000_16.5.e118313.25","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.53.9.2375"},{"key":"2026060906451742000_16.5.e118313.26","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-004-1511-7"},{"key":"2026060906451742000_16.5.e118313.27","doi-asserted-by":"publisher","DOI":"10.2991\/jegh.k.191028.001"},{"key":"2026060906451742000_16.5.e118313.28","doi-asserted-by":"publisher","DOI":"10.3945\/an.115.008821"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-118313","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T14:14:06Z","timestamp":1781014446000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-118313"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,14]]},"published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1136\/bmjopen-2026-118313"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-118313","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}