We thank T. Kawada for his interest in our article [1]. Our review sought to identify possible factors that can increase the risk of developing dementia/Alzheimer’s disease (AD) in patients with type 2 diabetes mellitus (T2DM) and to uncover evidence that regular physical exercise can positively affect these factors. We conclude that physical training may have the potential to reduce dementia/AD risk factors in T2DM patients.

We agree with T. Kawada [2] that the stage of the diabetic disease as well as possible comorbidities like hypertension or dyslipidemia in the mentioned studies could influence training-induced effects. However, it is generally difficult to gather the “net effect” of physical training (as postulated by Kawada) because most diabetic patients suffer from metabolic syndrome [3] and there are also many other factors that usually cannot be fully controlled for in intervention studies involving humans (e.g., diet or sleep behavior). Sex differences and aging were not discussed with reference to the association between T2DM, dementia and exercise training, but more studies must be carried out to arrive at convincing subgroup-specific analyses.

We further agree with T. Kawada that the dementia status should be checked and preventive strategies (including physical training) should start as early as possible during the development of T2DM.