See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/341966607

Brain Gym exercises versus standard exercises for institutionalised older

people with cognitive impairment: a randomised controlled study

Article  in  Asian Journal of Gerontology and Geriatrics · June 2020

DOI: 10.12809/ajgg-2019-383-oa

CITATION READS
1 385

4 authors, including:

J. M. Cancela Carral Carlos Ayán

University of Vigo University of Vigo
211 PUBLICATIONS   1,434 CITATIONS    193 PUBLICATIONS   1,432 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Judo y Discapacidad Visual View project

Use of physical exercise for the improvement of cognitive aspects View project

All content following this page was uploaded by Miguel Adriano Sanchez-Lastra on 06 June 2020.

The user has requested enhancement of the downloaded file.

 Asian J Gerontol Geriatr 2020;15(1):?–? | https://doi.org/10.12809/ajgg-2019-383-oa

Brain Gym exercises versus standard ORIGINAL ARTICLE

exercises for institutionalised older
people with cognitive impairment: a
randomised controlled study
José M Cancela1,2, PhD, Ángel Casal1, BsC, Miguel A Sánchez-Lastra1,2, MsC,
Carlos Ayán2, PhD
1
HealthyFit Research Group, Faculty
of Educational Sciences and Sports,
ABSTRACT University of Vigo, Campus A Xunqueira
s/n E-36005 Pontevedra, Spain
Background. This study compared the effects of Brain Gym (BG) 2
Department of Special Didactics, Faculty
exercises versus standard exercise (SE) on cognitive function, of Educational Sciences and Sports,
University of Vigo, Campus A Xunqueira
functional independence, physical fitness, and quality of life among s/n E-36005 Pontevedra, Spain
institutionalised older adults with cognitive impairment.
Methods. Institutionalised older adults with cognitive impairment
were randomly assigned to either SE group or BG group. Participants
performed two 1-hour sessions per week for 10 weeks. Cognitive
function, functional independence, fitness level, and quality of life
(QoL) of participants were assessed.
Results: A total of 55 participants were assigned to the SE group
(n=19) or the BG group (n=36). Of them, 17 in the SE group and 33 in
the BG group completed >80% of the sessions. The two groups were
comparable in terms of baseline characteristics. Participants in both
BG and SE groups had a slight decline in cognitive function, functional
independence, and physical-related QoL, as well as minor improvement
in fitness level and mental-related QoL. The effects produced by either
programme was similar (F1,76=0.063-1.986, p=0.163). Both programmes
had similar effects on participants, and neither the level of cognitive
impairment nor the programme had any significant effect.
Conclusions. BG and SE have similar effects on cognitive function,
functional independence, QoL, and fitness levels among institutionalised Correspondence to: Miguel A Sánchez-Lastra,
older adults with cognitive impairment. Faculty of Educational Sciences and Sports,
University of Vigo, Campus A Xunqueira
s/n E-36005 Pontevedra, Spain. Email:
Key words: Cognitive dysfunction; Exercise; Institutionalization misanchez@uvigo.es

INTRODUCTION different ways.2

Cognitive training and physical exercise have been Brain Gym® (BG) combines mental and physical
regarded as useful strategies to improve the cognitive training and is a movement-based programme to
function in older people with cognitive impairment.1 improve learning capabilities through mind-body
Physical exercise improves the metabolic activity exercises.3 BG can be more pleasant for older adults
of the brain, whereas cognitively demanding tasks who tend not to participate conventional exercises. In
increase the number of dendritic branches and the addition, it might have a positive effect on cognitive
level of synaptic plasticity. Therefore, a combination function.4 Scientific evidence regarding the effects of
of both therapies may have synergistic effects that BG as physiotherapy/rehabilitation is controversial.
positively influence various cognitive domains in One study reported that BG-based exercise resulted

© 2020 The Hong Kong Geriatrics Society and Hong Kong Association of Gerontology. CC BY-NC-ND 4.0 1
Cancela et al

in significant cognitive improvements in terms of the research protocol. The Ethics Committee of the
visual scanning, verbal tracking, and delayed recall,5 Faculty of Education and Sport Science (Ref: 2-2402-
whereas another study reported no significant 16) approved the study, and all participants gave
improvements in cognitive performance and fitness their informed consent. The full trial protocol of the
level.6 Both studies were carried out in healthy active study is registered and available at ClinicalTrials.gov
older people. (Ref: NCT03368482).

Results are similar in people with cognitive Participants were randomly assigned to either
impairment. In a randomised controlled trial of standard exercises (SE) group or BG group by an
27 older adults with dementia, a 6-week training independent researcher blinded to baseline data in
programme based on BG exercises significantly a ratio of 1:2 (given that a lower adherence in the
improved the sustained attention and visual BG group was expected). Participants in both groups
memory.7 In a quasi-experimental study of people performed two 1-hour sessions per week for 10
with cognitive impairment, cognitive function weeks. All sessions were monitored by a specialist in
improved after taking part in a short BG programme.8 physical exercise with experience in administration
However, a cognitive enhancement gymnastics of BG. Participants in the SE group took part in a
programme (with exercises similar to those in the BG traditional physical exercise programme aimed at
manual) for octogenarians with dementia found no increasing the range of mobility and coordination,
significant effect on cognitive function or autonomy with focus on the lower limbs. Participants in the BG
to perform activities of daily living.9 None of these group performed six of the following BG exercises
studies compared the potential benefits of BG with in every training session: ‘cross crawl’, ‘gravity glider’,
those of traditional exercises. A comparative study of ‘arm activation’, ‘belly breathing’, ‘hook-ups’, ‘think
institutionalised people with cognitive impairment of an X’, ‘lazy eights’, ‘elephant’, ‘space buttons’,
reported that a BG exercise-based programme did ‘the owl’, ‘energy yawn’, ‘balance buttons’, and ‘the
not significantly improve the cognitive function or energizer’. All exercises were executed from a sitting
functional independence, and had the same effects position and followed the tenets of the BG work
as a traditional exercise programme.10 Nevertheless, routine (Table 1).
the study lacks a control group.
The main differences between the BG and SE
Therefore, we designed a randomised controlled groups are the aim of these tasks and the approach
trial to compare BG with traditional exercises, taken. Coordination work in the SE group was linked
with an aim to identify the potential benefits of to the strength, mobility, and bodily awareness
BG exercises on the cognitive function, functional needed to perform the basic lower body movements
independence, physical fitness, and quality of life required by activities of daily living. This was intended
(QoL) among institutionalised older people with to improve performance of independent movements
cognitive impairment. and reduce the risk of falling. Whereas the BG
programme consists of a structured intervention
Methods of non-aerobic physical exercise that combines
specific patterns of crossing movements of the
This study was carried out in three nursing homes head, eyes, and extremities together with brain and
in Spain that provide long-term residential (in- breathing exercises. The creators claim that regular
patient) care. Participants were recruited through BG exercises lead to stimulation and integration of
collaboration between the University of Vigo and different parts of the brain, particularly the corpus
a company that manages residential care homes. callosum. This results in a faster and more integrated
Inclusion criteria were age >65 years, mean score communication between the two hemispheres,
of ≤24 in the Spanish version of the Mini-Mental essential for high-level reasoning.12
State Examination (MMSE),11 and ability to follow
instructions. Those with medical condition that Each participant’s age, sex, level of education,
hindered or prevented completion of all evaluation pathologies, and medication parameters were
tests were excluded. All participants and their obtained from medical records. Cognitive function
families were informed about the characteristics of was assessed using the Spanish version of the

2 Asian Journal of Gerontology & Geriatrics Vol 15 No 1 June 2020

 Brain Gym exercises versus standard exercises for institutionalised older people with cognitive impairment

Table 1
Standard exercises versus Brain Gym exercises

Standard exercises Brain Gym® exercises

Warm-up (15 min)
a) Ankle mobility: With heel support and the foot slightly elevated, perform the following:
1. Dorsal and plantar flexion movements.
2. Abduction (eversion) and adduction (inversion) movements.
Sets: 1 complete sequence of the 2 exercises, alternating right and left foot.
Duration: Each exercise lasts 20 s.
Sequence: Follow the established order.
b) Ankle mobility: With toe support and the foot slightly elevated, perform the following:
1. Dorsal and plantar flexion movements.
2. Abduction (eversion) and adduction (inversion) movements.
Sets: 1 complete sequence of the 2 exercises, alternating right and left foot.
Duration: Each exercise lasts 20 s.
Sequence: Follow the established order.
c) Same as exercise a), but using both feet simultaneously.
d) Same as exercise b), but using both feet simultaneously.
Main part (35 min)
a) Knee flexion and extension alternating right and left leg. Heel touches the a) Knee flexion and extension alternating right
ground at the end of each extension. and left leg. Heel touches the ground at the
Sets: 3 complete sequences. end of each extension.
Repetitions: Each exercise is performed 10 times. Sets: 3 complete sequences.
Resting time: 30 s. Repetitions: Each exercise is performed 10 times.
b) Hip abduction-adduction. Resting time: 30 s.
Sets: 3 complete sequences. b) Brain Gym® exercise.
Repetitions: Each exercise is performed 10 times. Sets: 3 complete sequences.
Resting time: 30 s. Repetitions: Each exercise is performed 10 times.
c) Perform the following kinetic chain sequence of movements using both legs: Resting time: 30 s.
Extension – Flexion – Abduction – Adduction.
Sets: 3 complete sequences. • Cross crawl.
Repetitions: Each exercise is performed 10 times. • Gravity glider.
Resting time: 30 s. • Arm activation.
d) Perform the following kinetic chain sequence of movements, first with the right • Belly breathing.
leg, and then with the left leg: Extension – Flexion – Abduction – Adduction. • Hook-ups.
Sets: 3 complete sequences. • Think of an X.
Repetitions: Each exercise is performed 10 times. • Lazy 8s.
Resting time: 30 s. • Elephant.
e) Starting with the right leg, perform an alternating sequence of circular • Space buttons.
movements (ankle-knee-hip) relying on toe support. Change direction of • The owl.
rotation after the 5th time. • Energy yawn.
Sets: 2 complete sequences. • Balance buttons.
Repetitions: Each exercise is performed 10 times. • The energizer.
Resting time: 30 s.
f) Using both legs simultaneously, perform an alternating sequence of circular
movements (ankle-knee-hip) relying on toe support. Change direction of
rotation after the 5th time.
Sets: 2 complete sequences.
Repetitions: Each exercise is performed 10 times.
Resting time: 30 s.
g) Starting with the right leg, perform an alternating sequence of circular
movements (ankle-knee-hip) without toe support. Change direction of rotation
after the 5th time.
Sets: 2 complete sequences.
Repetitions: Each exercise is performed 10 times.
Resting time: 30 s.
Cooling-off (10 min)
a) Directed breathing.
Duration: 5 minutes.
b) General stretching exercise.
Duration: 10 s per muscular group.
Total duration: 5 minutes.

MMSE,11 which has been used to assess the effects assessment in older adults.14 The Spanish version
of exercise training on cognitive function of people of the Barthel Index15 and the 12-Item Short-
with mild cognitive impairment.13 In Spain, it is the Form Health Survey (SF-12)16 were used to assess
most widely used test for standardised cognitive functional independence and QoL, respectively.

Asian Journal of Gerontology & Geriatrics Vol 15 No 1 June 2020 3

Cancela et al

A neurologist and occupational therapists who Results

were blinded to group allocation administered the
tests for cognitive function, QoL, and functional Of 176 participants, 55 met the inclusion criteria
independence. The fitness level was assessed using and were assigned to the SE group (n=19) or the
the Five-Chair Stands test17 by the same person who BG group (n=36). Two dropouts were registered in
monitored the intervention. the SE group and three in the BG group. Therefore,
17 participants (mean age, 85.00±7.40 years) in the
The Kolmogorov-Smirnov normality test revealed SE group and 33 participants (mean age, 81.68±8.33
that all the quantitative variables were normally years) in the BG group completed >80% of the
distributed. The two groups were compared using sessions (Figure 1). The two groups were comparable
the Student’s t-test for independent variables or the in terms of baseline characteristics (Table 2).
Chi square test for categorical variables. Analysis of
variance was applied to each variable, and outcomes Participants in both BG and SE groups had a
were interpreted according to the main effects slight decline in MMSE score for cognitive function
and interactions. The within-group factor was the (-7.17% vs -2.88%), Barthel Index for functional
moment and assessed change in outcome between independence (-2.31% vs -3.72%), and SF-12
two time points (baseline, post-test). The between- physical component summary score (-11.80% vs
group factor was the type of programme. Analysis of -12.69%), as well as minor improvement in fitness
variance was performed to analyse the differential level and SF-12 mental component summary score.
effect of SE versus BG with respect to the moment. A The moment × programme analysis indicated that
graphical analysis of improvements and involutions the magnitude of the effects produced by either
was carried out to determine the effect of the level of programme was similar (F1,76=0.063-1.986, p=0.163,
cognitive impairment on the variables under study. Table 3). Both programmes had similar effects
SPSS (Windows version 22; IBM Corp, Armonk on participants, and neither the level of cognitive
[NY], US) was used for data analyses. A p value of impairment nor the programme had any significant
<0.05 was considered statistically significant. effect (Figure 2).

Assessed for eligibility (n=176)

Excluded (n=121)
• Did not meet inclusion criteria (n=91)
• Declined to participate (n=30)

Randomised (n=55)

Standard exercises (n=19) Brain Gym® exercises (n=36)

• Death (n=1) • Death (n=2)

• Voluntary dropout (n=1) • Dropout:
Hospitalisation (n=1)

Completed (n=17) Completed (n=33)

Figure 1. Flowchart of recruitment of participants.

4 Asian Journal of Gerontology & Geriatrics Vol 15 No 1 June 2020

 Brain Gym exercises versus standard exercises for institutionalised older people with cognitive impairment

Table 2
Baseline characteristics of participants.
Brain Gym® exercises (n=33)* Standard exercises (n=17)* p Value
Age, y 81.68±8.33 85.00±7.40 0.421
Sex 0.675
Male 33.30 30.80
Female 66.70 69.20
Education level 0.187
No studies 92.90 80.0
Primary 7.10 20.0
Pathologies 0.061
High blood pressure 30.30 47.05
Arthrosis 15.15 35.29
Diabetes types I or II 9.09 11.76
Cardiopathy 48.48 76.47
Psychological 39.39 52.94
No. of medications 0.465
Psychotropic drug 69.69 76.47
Cardiovascular drug 78.78 88.23
No. of falls 0.29±0.60 0.50±0.67 0.052
Afraid to fall 0.332
Yes 67.90 48.4
No 32.10 51.6
* Data are presented as mean ± standard deviation or % of participants

Table 3
Cognitive function, functional independence, and quality of life of participants before and after standard exercises or Brain
Gym exercises

Test Baseline Post-test Factor (moment x

programme)
Brain Gym® Standard Brain Gym® Standard F p Value
exercises exercises exercises exercises
(n=33)* (n=17)* (n=33)* (n=17)*
Mini-Mental State Examination score 20.50±6.84 19.42±6.36 19.03±6.42 18.86±7.36 F1.76=0.063 0.802
Barthel Index 57.86±29.04 60.42±32.85 56.55±34.04 58.25±11.88 F1.76=1.619 0.261
Five-repetition sit-to-stand test, s 17.63±6.59 17.83±6.49 16.04±5.43 16.61±5.94 F1.77=0.009 0.927
12-item Short Form Health Survey
Physical Component Summary score 37.27±4.86 36.06±5.41 32.87±20.34 31.43±6.78 F1.79=1.986 0.163
Mental Component Summary score 46.06±5.95 42.76±8.44 46.70±8.93 43.71±6.21 F1.79=0.096 0.940
Ambulation score 0.37±0.15 0.32±0.14 0.41±0.15 0.33±0.16 F1.73=1.940 0.168
* Data are presented as mean ± standard deviation

Discussion independence, QoL, or fitness levels. Similar results

were reported on a sample of institutionalised
In the present study, BG exercise had similar effect octogenarian people with cognitive impairment.10
to standard exercise among institutionalised older However, another study has reported contrasting
adults with cognitive impairment, without any results.7 The lack of agreement could be due to
significant effect on cognitive levels, functional several reasons. First, the exercise protocols were

Asian Journal of Gerontology & Geriatrics Vol 15 No 1 June 2020 5

Cancela et al

did not have a significant effect on attention or

MMSE score of <14
memory functions.6 In one study the training
Standard exercises Brain Gym® exercises
programme combined sitting and standing exercises,5
Worse Improved
whereas participants of the present study remained
Ambulation score
in a sitting position. Second, in the present study
SF-12: Mental Component
Summary score
participants’ mean age was higher than that reported
SF-12: Physical Component
in a study,7 and may have effect on participants’
Summary score scope for improvement. Third, the time devoted to
Five-repetition sit-to-stand test, s BG exercise in the present study was 20 minutes,
whereas BG sessions were considerably longer (up
Barthel Index
to 2 hours) in another study.7
MMSE score

It was expected that standard exercise did not

have significant effects on participants’ cognitive
MMSE score of 14-19 level, as the sessions did not include aerobic or
Standard exercises Brain Gym® exercises
muscular exercises. In fact, the positive effects of
Worse Improved exercise on the cognitive function of people with
cognitive impairment have mainly been observed
Ambulation score
after aerobic and muscular training.13,18
SF-12: Mental Component
Summary score

SF-12: Physical Component In the present study, both BG and standard

Summary score
exercise resulted in slight decline in functional
Five-repetition sit-to-stand test, s independence. This in line with a study reporting that
Barthel Index the effects of physical rehabilitation on functional
independence in long-term care home residents
MMSE score
appear quite small and may not be applicable to
all residents.19 Nonetheless, it should be taken into
account that most activities in both programmes
MMSE score of 19-24
were performed in a sitting position, with the trunk
and the upper limbs barely moved. These body
Standard exercises Brain Gym® exercises

Worse Improved
parts are involved in most activities of daily living;
therefore, no efficient transference could be expected
Ambulation score
between the content of the exercise programme and
SF-12: Mental Component the participants’ functional independence. Therefore,
Summary score
SF-12: Physical Component other types of physical training programme
Summary score
are required to significantly improve functional
Five-repetition sit-to-stand test, s independence of institutionalised older adults with
Barthel Index
cognitive impairment.9,20

MMSE score
Both training programmes led to a slight increase
in participants’ fitness levels (assessed by the Five-
Chair Stand test). It is suggested that proprioception
Figure 2. Change of variables according to the degree may be an influential factor while executing sit-
of cognitive impairment measured by Mini-Mental State
Examination (MMSE). and-stand tests.21 Therefore, it is hypothesised
that mobility and coordination exercises (in both
programmes) have positive effect on proprioceptive
capacity.

different. The present study did not include drawing Neither of the programmes produced significant
activities, whereas the BG protocol in a sample of change in participants’ QoL. This was a predictable
healthy older adults that featured drawing activities result, as there was also no improvement in cognitive

6 Asian Journal of Gerontology & Geriatrics Vol 15 No 1 June 2020

 Brain Gym exercises versus standard exercises for institutionalised older people with cognitive impairment

functions or functional independence, and QoL is fitness level of active older adults: a preliminary study. J Aging
Phys Act 2015;23:653-8.
highly dependent on both factors.22 7. Yágüez L, Shaw KN, Morris R, Matthews D. The effects on
cognitive functions of a movement-based intervention in
Prescription of physical exercise to older patients with Alzheimer’s type dementia: a pilot study. Int J
Geriatr Psychiatry 2011;26:173-81.
adults should be carefully designed, specific, and
8. Sangundo MF. Effect of Brain Gym practice to cognitive function
individualised to each participant’s characteristics.23 of the elderly. Mutiara Medika 2016;9(2 Suppl 1):S86-94.
This aspect is frequently disregarded in this type 9. Han YS, Araki T, Lee PY, et al. Development and effect of a
cognitive enhancement gymnastics program for elderly people
of study.24 Programme implementation produced
with dementia. J Exerc Rehabil 2016;12:340-5.
similar effects, regardless of the participants’ level 10. Ayán C, Sánchez-Lastra MA, Cabanelas P, Cancela JM. Effects
of cognitive impairment. This finding may be useful of Brain Gym® exercises in institutionalized older adults with
cognitive impairment [in Spanish]. Rev Int Med Cienc Act Fis
in designing and prescribing physical exercise
Deporte. 2018;769-81.
programmes in institutionalised people with diverse 11. Lobo A, Saz P, Marcos G, et al. Revalidation and standardization
cognitive impairments. of the cognition mini-exam (first Spanish version of the Mini-
Mental Status Examination) in the general geriatric population
[in Spanish]. Med Clin (Barc) 1999;112:767-74.
Results of the present study could have been 12. Dennison P. Whole Brain Learning for the Whole Person.Ventura,
sounder if the sample size was larger, if the control CA: Edu-Kinesthetics; 1985.
group did not involve in any physical activity 13. Zheng G, Xia R, Zhou W, Tao J, Chen L. Aerobic exercise
ameliorates cognitive function in older adults with mild
programme, and if the training programmes were cognitive impairment: a systematic review and meta-analysis of
lengthier and a follow-up phase was included. These randomised controlled trials. Br J Sports Med 2016;50:1443-50.
limitations should be taken into consideration when 14. Llamas-Velasco S, Llorente-Ayuso L, Contador I, Bermejo-
Pareja F. Spanish versions of the Minimental State Examination
interpreting the results. (MMSE). Questions for their use in clinical practice [in Spanish].
Rev Neurol 2015;61:363-71.
Conclusion 15. Cabañero-Martínez MJ, Cabrero-García J, Richart-Martínez M,
Muñoz-Mendoza CL. The Spanish versions of the Barthel index
(BI) and the Katz index (KI) of activities of daily living (ADL): a
BG and SE have similar effects on cognitive function, structured review. Arch Gerontol Geriatr 2009;49:e77-84.
functional independence, QoL, and fitness levels 16. Vilagut G, Valderas JM, Ferrer M, Garin O, López-García E,
Alonso J. Interpretation of SF-36 and SF-12 questionnaires in
among institutionalised older adults with cognitive Spain: physical and mental components [in Spanish]. Med Clin
impairment. (Barc) 2008;130:726-35.
17. Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical
performance battery assessing lower extremity function:
Declaration association with self-reported disability and prediction of
mortality and nursing home admission. J Gerontol 1994;49:M85-
The authors have no conflict of interest to disclose. 94.
18. Yoon DH, Kang D, Kim HJ, Kim JS, Song HS, Song W. Effect
of elastic band-based high-speed power training on cognitive
REFERENCES function, physical performance and muscle strength in older
women with mild cognitive impairment. Geriatr Gerontol Int
1. Karr JE, Areshenkoff CN, Rast P, Garcia-Barrera MA. An empirical 2017;17:765-72.
comparison of the therapeutic benefits of physical exercise and 19. Crocker T, Forster A, Young J, et al. Physical rehabilitation for
cognitive training on the executive functions of older adults: a older people in long-term care. Cochrane Database Syst Rev
meta-analysis of controlled trials. Neuropsychology 2014;28:829- 2013;2:CD004294.
45. 20. Cancela Carral JM, Pallin E, Orbegozo A, Ayán Pérez C. Effects
2. Law LL, Barnett F, Yau MK, Gray MA. Development and initial of three different chair-based exercise programs on people older
testing of functional task exercise on older adults with cognitive than 80 years. Rejuvenation Res 2017;20:411-9.
impairment at risk of Alzheimer’s disease--FcTSim programme- 21. Whitney SL, Wrisley DM, Marchetti GF, Gee MA, Redfern MS,
-a feasibility study. Occup Ther Int 2013;20:185-97. Furman JM. Clinical measurement of sit-to-stand performance
3. Dennison G, Dennison P. Brain Gym®: Teacher’s Edition Revised. in people with balance disorders: validity of data for the Five-
Ventura, CA: Edu-Kinesthetics; 1994. Times-Sit-to-Stand Test. Phys Ther 2005;85:1034-45.
4. Ullmann G, Williams HG. The Feldenkrais Method® can 22. León-Salas B, Ayala A, Blaya-Nováková V, et al. Quality of life
enhance cognitive function in independent living older adults: a across three groups of older adults differing in cognitive status
case-series. J Bodyw Mov Ther 2016;20:512-7. and place of residence. Geriatr Gerontol Int 2015;15:627-35.
5. Sidiarto LD, Kusumoputro S, Samino S, Munir R, Nugroho W. 23. Vina J, Borras C, Sanchis-Gomar F, et al. Pharmacological
The efficacy of specific patterns of movements and brain exercises properties of physical exercise in the elderly. Curr Pharm Des
on the cognitive performance of healthy senior citizen in Jakarta. 2014;20:3019-29.
Med J Indones 2003;12:155-61. 24. Cancela JM, Ayán C, Varela S, Seijo M. Effects of a long-term
6. Cancela JM, Vila Suárez MH, Vasconcelos J, Lima A, Ayán C. aerobic exercise intervention on institutionalized patients with
Efficacy of Brain Gym training on the cognitive performance and dementia. J Sci Med Sport 2016;19:293-8.

Asian Journal of Gerontology & Geriatrics Vol 15 No 1 June 2020 7

View publication stats