Journal of Aging and Physical Activity, 2015, 23, 653  -658

http://dx.doi.org/10.1123/japa.2014-0044
© 2015 Human Kinetics, Inc. Original Research

Efficacy of Brain Gym Training on the Cognitive Performance

and Fitness Level of Active Older Adults: A Preliminary Study
José M. Cancela, Mª Helena Vila Suárez, Jamine Vasconcelos, Ana Lima, and Carlos Ayán

This study evaluates the impact of Brain Gym (BG) training in active older adults. Eighty-five participants were assigned to four training
groups: BG (n = 18), BG plus water-based exercise (n = 18), land-based exercise (n = 30), and land plus water-based exercise (n = 19). The
effects of the programs on the attention and memory functions were assessed by means of the symbol digit modality test. The two-min step and
the eight-foot up-and-go tests were used to evaluate their impact on fitness level. No program had a significant influence on the participant’s
cognitive performance, while different effects on the sample’ fitness levels were observed. These findings suggest that the effects of BG on the
cognitive performance and fitness level of active older adults are similar to those obtained after the practice of a traditional exercise program.
Whether BG is performed in isolation or combined with other exercise programs seems to have no influence on such effects.

Keywords: cognition, physical exercise, fitness, attention, memory

The rapidly-growing literature strongly suggests that physical
activity (PA) can have a positive impact on brain aging (Lauten-
schlager, Cox, & Cyarto, 2012). Indeed, the findings of several
randomized trials of the effect of PA on cognition in healthy older
adults have confirmed the existence of potential benefits, particularly
on executive function, attention, and processing speed (Smith et al.,
2010). This positive effect of exercise in cognition has been related
to an increment of hippocampal volume (a structure sensitive to
exercise-induced change via neurogenesis and cell proliferation)
and level of brain-derived neurotrophic factor (BDNF) (involved in
cell growth and survival and memory promotion) (Hauer, Schwenk,
Zieschang, Essig, Becker, & Oster, 2012). Regarding the above-
mentioned, studies involving animal models have shown that PA
can stimulate angiogenesis, brain perfusion, and neurovascular
integrity (Swain et al., 2003). Finally, it has been suggested that
a higher level of fitness through increased physical activity might
have a positive effect on neuropathologic substrates, and it might
lead to decreased whole-brain and medial temporal lobe atrophy
in older adults (Makizako et al., 2011).
Most of the studies in this regard have focused on analyzing the
effects of typical PA interventions (Ahlskog, Geda, Graff-Radford,
& Petersen, 2011). For instance, it has been observed that aerobic
exercise, mainly brisk walking and/or jogging, has been associ-
ated with modest improvements in attention, memory, processing
speed, and executive function among seniors (Smith et al., 2010).
Similarly, scientific evidence has shown that muscular resistance
training can lead to improvements in memory (short- and long-term)
and verbal reasoning, while strength and balance training exercises
can enhance fluid intelligence in this population (Liu-Ambrose &
Donaldson, 2009).
It has been observed that although some evidence exists,
cognitive benefits may be obtained by means of alternative PA
training programs (Forte et al., 2013).There is still a need for
studies aimed at identifying the effects of such exercise therapies
Cancela, Vila Suárez, and Ayán are with the Faculty of Education and Sports
Science, University of Vigo, Pontevedra, Spain. Vasconcelos and Lima are
with the HealthyFit Research Group, University of Vigo, Pontevedra, Spain.
Address author correspondence to Mª Helena Vila Suárez at evila@uvigo.es.
on healthy older adults. In this regard, Brain Gym, a movement-
based program originally designed for children with learning
disabilities on the assumption that physical movement enhances
learning ability (Dennison & Dennison, 1994), is an interesting
field of research. Brain Gym is a structured nonaerobic physical
exercise intervention in which a combination of specific patterns
of crossing movements of the head, eyes, and extremities are
performed together with brain and breathing exercises. According
to its founders, the regular performance of Brain Gym results in
stimulation and integration of different parts of the brain, espe-
cially the corpus callosum, which, in the long term, makes com-
munication between the two hemispheres faster and promotes a
more integrated form for high-level reasoning (Dennison, 1985).
However, there is little evidence to support the claims made
about the benefits of Brain Gym since scientific research has
failed to support the assertion that this educational kinesiology
therapy improves academic learning (Hyatt, 2007). Moreover,
its theoretical underpinning has also been subject to criticism by
neuroscientists and by educators with expertise in neuroscience
and cognition (Stephenson, 2009).
In spite of all this, it has been suggested that Brain Gym can
be considered as a useful physical therapy strategy for older adults,
since it can have a positive impact on brain functioning (Drabben-
Thiemann, Hedwig, & Kenklies, 2002). In this regard, Yágüez,
Shaw, Morris, and Matthews (2011) conducted a small random-
ized controlled trial which showed that the performance of Brain
Gym can enhance cognitive performance, specifically attention and
memory, in older adults with dementia (Yágüez et al., 2011). Simi-
larly, Sidiarto, Kusumoputro, Munir, and Nugroho (2003) carried
out a quasi-experimental study involving a group of healthy older
adults who improved their cognitive performance after taking part
in an intervention based on the performance of specific patterns of
movements and brain exercises, very similar to the ones described in
the Brain Gym manual. Nevertheless, regarding the benefits of Brain
Gym in the cognitive performance and fitness level of community-
dwelling older individuals, scientific evidence is scarce. Moreover,
no research has compared the effects of this therapy with traditional
exercise interventions or has analyzed its potential benefits when
it is included as part of a more comprehensive physical exercise
program. This study aims to fill this gap.
653
 654  Cancela et al.
Methods
Participants
Eligible individuals were community-dwelling older adults who
had been taking part in a PA program during the previous five
years. This program, which was offered by the council of their local
town every year, was aimed at improving the functional capacity
of the participants by means of the performance of water-based
exercise, however, it did not include Brain Gym’s realization or
similar exercises destined to ameliorate cognitive performance.
For the purpose of the current study, inclusion criteria were older
adults between ages 65–80 with absence of a clinical diagnosis
of dementia and independent ambulation. People who presented
any comorbidities or any acute illness that would make training
inappropriate, individuals who had already participated in Brain
Gym sessions, or those who were taking part in any other physical
exercise or memory training program different to the one offered
in the present research were excluded.
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The research protocol followed the guidelines provided by the
Helsinki Statement about biomedical research for humans (18th
Medical Assembly, 1964; revised 1983 in Italy and 1989 in Hong
Kong) at the international level, and the Arrangement for Preserva-
tion of Human Rights and Dignity with Respect to Biological and
Medical Applications (IR1999; B.O.E. 251, 1999) at the national
level. The study was approved by the local ethics committee, and
written informed consent was provided by all participants.
Measurements
Academic Background and Medication.  An ad hoc self-com-
pletion questionnaire was administered to obtain information about
the educational attainment of the sample and the type of medication
that individuals were taking.
Self-Perceived Physical and Cognitive Health.  A Likert-type
scale was used to assess the perceived fitness level and the existence
of memory problems (range 1–5 points; lower scores indicate worse
fitness level and greater memory problems).
Mental Processing, Attention, and Memory Functions.  These
cognitive variables were assessed by means of the Spanish-validated
version of the symbol digit modality test (SDMT) (Smith, 2002).
This test involves filling nonsense symbol blanks with matching
numbers to a specific code. The scoring ranged from 0–110, with
higher scores representing better performance.
Fitness Level.  The two-min step test (2MST) (Rikli & Jones, 1999)
was used to assess aerobic endurance. This test determines the rep-
etitions a person can do by stepping in place alternately raising the
knees to a height halfway between the iliac crest and middle of the
patella in 2 min. Agility, power, dynamic balance, and speed were
assessed by means of the eight-foot up-and-go test (8FGT) (Rikli,
& Jones, 1999). This test measures the time it takes to get out of a
chair, walk eight feet to and around a cone, and return to the chair.
The assessment was carried out by two physiotherapists and two
physical exercise specialists, who were blind to group allocation,
one week before and one week after the intervention.
Intervention
People were told in advance the types of programs which were
going to be developed as well as the exact date in which they were
going to take place. Then they were asked about scheduled prefer-
ences to assist with the study as well as the program they would like
JAPA Vol. 23, No. 4, 2015
to participate in. They were also informed both aspects would be
taken into account to include them in one of our programs, with the
purpose of motivating the participants and getting a good adherence
level during the study. According to their time availability and PA
preferences, participants were allocated to two groups, the Brain
Gym (BG) or traditional exercise (TG) program. BG program par-
ticipants took part in a 1-hr weekly session, performing 15 exercises
focusing on fine motor involvement, balance, and hand-eye coordi-
nation. TG program participants attended 1-hr weekly sessions of
land-based training, which included callisthenic exercises aimed at
improving dynamic balance, coordination, and aerobic capacity. The
possibility of adding a 1-hr weekly session of water-based exercise
to the program was offered to participants in both groups. Thus,
four different groups were set up: BG, BG + water-based exercise,
land-based exercise, and land + water-based exercise. The total
intervention duration was 16 weeks. Water-based and land-based
sessions were monitored by a specialist with previous experience
administering physical exercise programs for older adults. He also
recorded attendance and dropouts. BG sessions were monitored
by a physiotherapist experienced in applying this type of physical
therapy. The characteristics of the sessions can be seen in Table 1.
Data and Statistical Analysis
Means and standard deviations for the whole group were calculated
for all continuous variables. Discrete variables were described by
percentage. All continuous variables were tested for normality by
Kolmogorov-Smirnov statistics. With the aim of analyzing intra-
group behaviors of each one of the variables, a variability analysis
was realized by confidence interval and coefficient of variation
calculus in every group and during the two moments of the analysis.
Paired-sample tests were also used to assess changes from preinter-
vention to postintervention (16 weeks) in each one of the programs.
A repeated-measures MANOVA test was conducted to analyze the
effect of the intervention programs in the cognitive performance and
fitness level of the sample. The Bonferroni multiple comparisons test
was used to compare specific means. Also, 2 × 4 mixed MANOVAs
(moment × program) were used, with a moment factor (pretest and
posttest) and program factor (BG, BG + water exercise, land-based
exercise, land + water-based exercise), considering dependent
variables as: SDMT, 2MST, and 8FGT. Pearson’s correlation coef-
ficient (r) was accomplished with the aim of determining degrees
of association between the ad hoc questionnaire and the objective
tests employed during the study. Significance was accepted at p <
.05. All data were analyzed using Statistical Package for the Social
Sciences 17.0 (IBM, Inc., Chicago, IL).
Results
A total of 85 individuals volunteered and finished the study. The
characteristics of the participants, which were distributed depend-
ing on the program in which they took part, can be seen in Table 2.
Baseline assessment showed that the group distribution was
homogeneous. The variability analysis accomplished by means of
the confidence interval (CI) and the coefficient of variation (CV)
indicated that intragroup variability of the physical analyzed vari-
ables was low (CV < 32) while cognitive variables were elevated
(CV > 62). According to the results obtained, none of the four
programs had a significant effect on mental processing, attention,
or memory function. However, the performance of BG seemed to
improve significantly the participants’ self-perceived cognitive
health (Table 3). The difference between pre- and postintervention
scores obtained in the 8FGT showed that patients significantly
 Efficacy of Brain Gym Training   655

Table 1  Exercise Interventions

Land-Based Exercise
Warm-up exercises (10 min)
Gentle walking
–Walking different directions
–Walking with long deliberate steps
–Walking with small deliberate steps
–Walking while raising knees
Active joint motion range
General exercises (45 min)
Aerobic dance exercises (25 min)
–Low impact aerobic movements (120 beats
per min)
General motor coordination (10 min)
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Water-Based Exercise
Warm-up exercises (10 min)
Gentle walking
–Walking different directions
–Walking while shifting support (heels, on
tiptoe)
–Marching (raising knees-heels/legs apart-
crossed/arms in-out of the water)
Gentle stretching
General exercises (45 min)
Group games (15 min)
–Passing a ball among the participants
–Throwing balls into dispersed hoops in the
water
Brain Gym
Warm-up exercises (10 min)
Gentle walking
–Walking different directions
–Walking with long deliberate steps
–Walking with small deliberate steps
–Walking while raising knees
Active joint motion range
General exercises (30 min)
–Belly breathing (1 min)
–Cross-lateral walking in place (2 min)
–Lazy eight (2 min)
–Elephant (2 min)

–Bouncing a ball while walking
–Throwing a rolling ball to a partner while
walking
–Throwing a ball in the air to a partner while
walking
Balance (10 min)
–Walking between cones:
Steady cadence (zig-zag movements)
Different walking cadences (changing the
direction)
Mild jogging between cones
Balance and coordination (15 min)
–Standing and holding the pool wall, wide
stance, with support, and shift weight left
and right, forward and backward as far as
possible
–Standing on one leg while the other leg
pushes and pulls a “noodle” (long float)
–Riding on a noodle and maintaining balance
–Standing with one leg on a noodle
–Standing with both legs on the noodle and
maintaining
–Standing with wide stance while being
pushed by a partner in different directions
Relaxation (15 min)
–Standing and holding the pool wall, wide
stance, with support, inserting the head in the
water (breathing out underwater)
–Lying supine in the water
–Slow swimming
–Cross-lateral walking in place (2 min)
–Neck rolls (1 min with eyes open/1 min
with eyes closed)
–Cross-lateral walking in place (1 min)
–The owl (2 min)
–Cross-lateral walking in place (1 min)
–Arm activation (1 min for each arm)
–Cross-lateral walking in place (1 min)
–Foot flex (1 min for each foot)
–Cross-lateral walking in place (1 min)
–Calf-pump (1 min for each leg)
–The grounder (1 min for each leg)
–Gravity glider (1 min)
–Cross-lateral walking in place (1 min)
–Brain buttons (1 min)
–Cross-lateral walking in place (1 min)
–Earth buttons (1 min)
–Cross-lateral walking in place (1 min)
–Balance buttons (1 min)
–Cross-lateral walking in place (1 min)

Cooling-off activities (5 min) Cooling-off activities (5 min) Cooling-off activities (5 min)

General stretching exercises General stretching exercises General stretching exercises

increased their agility, power, dynamic balance, and speed regard-
less of the program to which they were allocated. The results
obtained in the 2MST showed that only those who participated in
programs including land-based exercise sessions showed a signifi-
cant improvement in their aerobic level.
Table 4 shows the results obtained due to the compara-
tive study accomplished by 2 × 4 mixed MANOVA (moment
× program), which showed that there was a difference between
intervention groups in the analyzed dependent variables. Invariant
tests also indicated that there was intervention effect differences on
individual 2MST (F[3,77] = 4.433, p = .06, η2 = .147) and 8FGT
JAPA Vol. 23, No. 4, 2015
(F[3,77] = 4.031, p = .010, η2 = .136). There were not differences
for SDMT (F[3,77] = 0 .342, p = 0 .795, η2 = .013). Bonferroni
multiple comparison tests indicated the absence of differences in
the programs on the object study variables (SDMT, 2MST, 8FGT).
Correlational analyses accomplished by means of Pearson’s (r)
correlation indicated the absence of association between the ad
hoc questionnaire of cognitive health perception and the SDMT
(r = .113; p = .356). This analysis showed the existence of sig-
nificant associations between the ad hoc questionnaire of physical
health perception and the 2MST (r = .378; p = .001) and 8FGT
(r = –.206; p = .042).
 656  Cancela et al.
Table 2  Characteristics of the Sample (n = 85)
Brain Gym
Variable (n = 18)
Age, M (SD) 71.94 (7.13)
Physical activity program
Years in the previous physical activity program, M (SD) 4.50 (3.78)
Sex
Women, n (%) 16 (88.8)
Medication
Medication to improve memory, n (%) 5 (26.7)
Other pathologies, n (%) 18 (100)
Academic background
No education, n (%) 6 (33.3)
Primary education, n (%) 11 (61.1)
Secondary education, n (%) 1 (5.5)
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Higher education, n (%) – –
Discussion
This research was aimed at determining the effect of Brain Gym
on the cognition and fitness level of healthy older adults, as well
as finding out whether its effects were more significant that those
produced by a traditional exercise program. Obtained results indicate
that none of the four exercise programs had significant effects on
the cognitive functions related to mental processing, attention, and
memory as assessed by means of the SDMT. Thus, it seems that
Brain Gym practice, whether it is the only exercise or it is combined
with a water-based program, is not more effective than classical
physical exercise programs when improving cognitive performance.
This contradicts the results of previous investigations. For instance,
Drabben-Thiemannet al. (2002) reported beneficial effects of using
Brain Gym on people who had been diagnosed with dementia, and
Yágüez et al. (2011) found significant improvements in sustained
attention and visual memory in people with Alzheimer’s-type
dementia after applying this therapy. Two different reasons may
explain the fact that no effects were found in our research. First,
it could be thought that the reduced weekly frequency of the
Brain Gym program may not be enough to enhance the cognitive
performance of the sample. However, Yágüez et al. (2011) found
some benefits after applying the program once per week for only
six weeks. These differences could have appeared because that
program included longer sessions (90 min) and longer exercises
(2–3 min, which suggest that the volume of Brain Gym sessions
accomplished by people in this study could not have been enough
to incite changes in cognitive performance.
Secondly, taking into account the characteristics of the sample
from the two previously-mentioned studies, it could be hypothesized
that the effect of Brain Gym depends on the individual’s cognitive
state. Thus, healthy older adults would not obtain the same benefit
as older people suffering from dementia. Nevertheless, Sidiarto et
al. (2003) informed that mentally healthy older populations may
experience significant improvements in different cognitive functions
after Brain Gym practice.
In relation to this, it is important to point out that the initial mean
values obtained from the sample of this study in the SDMT may be
classified as too low (Sheridan et al., 2006). The sample would be
between percentile 19 and percentile 28, according to the reference
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Brain Gym + Water Land-Based Land + Water-Based
Exercise (n = 18) Exercise (n = 30) Exercise (n = 19)
69.89 (6.91) 71.19 (5.06) 67.95 (4.98)
5.06 (3.13) 4.82 (3.54) 4.00 (3.54)
11 (61.1) 23 (76.6) 13 (68.4)
6 (33.3) 10 (33.3) 5 (26.3)
18 (100) 30 (100) 19 (100)
4 (22.2) 2 (6.6) 1(5.2)
13 (72.2) 14 (46.6) 18 (94.7)
1 (5.5) 1 (3.3) –
– –
values published about a population from the same country and of
similar age (Peña-Casanova et al., 2009). Although the people who
volunteered for this study did not present a clinical diagnosis of
dementia, it may be possible that they presented some type of mild
cognitive decline, considering the low mean score obtained in the
SDMT. This has been already proposed in other studies which have
used this test as a cognitive screening tool (Cherbuin, Sachdev, &
Anstey, 2010). Under these circumstances, it may be reasonable to
speculate the possibility of the Brain Gym program having a protec-
tive effect, somehow hindering or hampering the aforementioned
mild cognitive decline. This idea could also help to explain why the
traditional exercise program had no significant effect on the cognitive
variables assessed by the SDMT, despite the fact that it produced
some improvements in the aerobic level. Nevertheless, the lack of an
inactive control group makes this idea just a mere hypothesis, thus
it cannot be considered as an evident result in this study.
In relation to the effects of the different interventions, which
were carried out on the fitness level of the sample, it was observed
that the participants in the groups with land-based exercise were
the only ones who improved their aerobic level. This may be a con-
sequence of the training session’s content because the Brain Gym
program had no aerobic component and the water-based exercise
program focused on relaxing and toning up. Indeed, only land-based
sessions included aerobic exercise.
Finally, all the programs had similar effects on agility, balance,
speed, power, and self-perceived physical health. This was some-
how the expected result, as their sessions included postural control
exercises and tasks aimed at enhancing coordination, balance, and
motor ability in general.
The fact that no differences were found regarding the effects
on cognitive performance of both Brain Gym and traditional train-
ing may be considered an original contribution of this research. As
to the authors’ knowledge, no comparative study on the effects of
the Brain Gym has been published to date. Regarding this aspect of
investigation, it is necessary to point out that although it is true that
Brain Gym practice had effects on the cognitive health perceived by
participants, this was evaluated with an ad hoc questionnaire, which
was not validated and whose obtained results did not correlate with
the ones obtained in the SDMT test. This is the reason why this result
might be due to an information slant instead of the intervention per se.
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Table 3  Effects of the Different Exercise Programs on the Cognitive Variables

SDMT Cognitive Health
Program Pre M (SD) 95% CI CV Post M (SD) 95%CI CV t student Pre M (SD) 95% CI CV Post M (SD) 95%CI CV t student
t = –.689 t = –3.063
Brain Gym 13.53 (8.47) 9.17–17.88 62.60 14.12 (7.78) 10.11–18.11 55.09 3.78 (0.81) 3.30–4.10 21.42 4.22 (0.73) 3.80–4.55 17.29
Sig = .501 Sig = .007
Brain Gym + t = –.507 t = –2.915
19.29 (9.17) 14.57–24.00 47.53 19.94 (8.23) 15.71–24.17 41.27 4.00 (0.84) 3.55–4.44 21.00 4.33 (0.68) 3.94–4.64 15.70
water exercise Sig = .619 Sig = .010
Land-based t = .376 t = 1.852
16.17 (6.70) 14.24–21.86 41.43 15.87 (7.00) 11.82–19.00 44.10 3.47 (1.07) 2.92–4.01 30.83 3.29 (1.10) 2.72–3.86 33.43
exercise Sig = .710 Sig = .083
Land + water- 18.06 (7.66) 12.79–19.09 42.41 18.94 (7.86) 15.01–22.86 41.49 t = –.829 3.84 (1.21) 3.65–4.45 31.51 3.94 (0.80) 3.54–4.34 20.30 t = 1.458
based exercise Sig = .419 Sig = .163
Abbreviations: SDMT = symbol digit modalities test; CI = confidence interval; CV = coefficient of variation.

JAPA Vol. 23, No. 4, 2015

Table 4  Effects of the Different Exercise Programs on the Physical Variables
2MST 8FGT Physical Health
Pre M Post M Pre M Post M Pre M Post M
Program (SD) 95% CI CV (SD) 95%CI CV t stud. (SD) 95% CI CV (SD) 95% CI CV t stud. (SD) 95% CI CV (SD) 95%CI CV t stud.
Brain Gym 79.76 70.96– 20.02 76.71 69.69– 14.44 t = .938 6.78 6.03– 16.96 5.91 5.00– 12.52 t = 6.963 3.78 3.37– 21.42 4.16 3.91– 12.25 t = –2.364
(15.97) 88.53 (13.93) 83.30 (1.15) 7.62 (0.74) 6.42 (0.81) 4.17 (0.51) 4.42
Sig = .362 Sig = .001 Sig = .030
Brain Gym + 87.89 80.93– 23.17 85.33 77.10– 31.66 t = .987 6.38 5.71– 15.51 5.28 4.62– 29.35 t = 7.432 4.11 3.73– 18.49 4.38 4.13– 11.41 t = –2.051
water exercise (20.37) 98.95 (27.02) 97.36 (0.99) 6.97 (1.55) 5.91 (0.76) 4.48 (0.50) 4.63
Sig = .331 Sig = .001 Sig = .046
Land-based 84.13 76.17– 20.83 90.13 82.57– 16.67 t = –2.632 6.42 5.94– 14.79 5.77 5.04– 18.02 t = 4.912 3.71 3.19– 26.68 4.11 3.80– 14.59 t = –2.915
exercise (17.53) 91.09 (15.03) 97.68 (0.95) 6.89 (1.04) 5.96 (0.99) 4.21 (0.60) 4.42
Sig = .013 Sig =.001 Sig = .010
Land + water- 83.89 76.92– 15.43 94.89 83.87– 16.53 t = –3.113 6.22 5.75– 13.98 5.16 4.21– 8.91 t = 6.111 4.16 3.82– 16.58 4.47 4.22– 11.40 t = –2.051
based exercise (12.95) 90.18 (15.69) 102.79 (0.87) 6.67 (0.46) 5.08 (0.69) 4.48 (0.51) 4.72
Sig = .006 Sig = .001 Sig = .045
Abbreviations: 2MST = two-min step test; 8FGT = eight-foot up-and go test; CI = confidence interval; CV = coefficient of variation; t student = t student.

657
 658  Cancela et al.
In any case, the absence of different effects between the two
modalities, as assessed by objective and previously-validated tests,
seems to be in line with the findings obtained by other authors who
have carried out similar studies. Thus, Forte et al. (2013) observed
that multicomponent training (simultaneous performance of cogni-
tive tasks and physical exercises) and traditional training (muscular
resistance exercises) had the same effect on different cognitive
variables in healthy older adults.
Similarly, Barnes et al. (2013) observed that the combination
of mental training and physical exercise in a sample of older adults
with cognitive complaints did not produce greater effects on the
cognitive performance than those produced by a physical exercise
program which lacked this component.
The scarce existing studies on the effects of Brain Gym show
different methodological weaknesses, such as the absence of a con-
trol group (Drabben-Thiemannet al., 2002; Sidiarto et al., 2003) or
the small sample size (Yágüez et al., 2011). An attempt to overcome
these weaknesses has been made in this study. However, this research
also has certain limitations of its own, especially those related to the
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sample characteristics. For instance, the entire sample was made up
of people willing to exercise and who were allowed to participate
in the preferred program. This facilitated adherence to the program,
but it limits generalization and it could provoke a self-selection bias.
Similarly, the sample consisted of people who had been taking part
in physical exercise programs for five years. Consequently, a possible
ceiling effect on the variables under study must be taken into account.
Finally, the participants showed very low mean values in the SDMT,
which implies that their cognitive level could be somewhat affected.
Therefore, the data may have been contaminated by the sampling
cognitive profile. Regarding the above-mentioned, certain limitations
related to methodological design, such as the lack of an inactive control
group, the fact that group distribution was not randomized, and the
employment of ad hoc questionnaires which were not tested for valid-
ity, must be acknowledged so as to interpret the results with caution.
Future randomized comparative studies should include sedentary
samples which consist of older adults who do not present any type of
cognitive complain, so that the results here presented can be contrasted.
Conclusion
The results of this study indicate that the effects of Brain Gym on
the cognitive performance and fitness level of community-dwelling
older individuals are similar to those obtained after the practice of
a traditional exercise program. Whether Brain Gym is performed in
isolation or combined with other exercise programs seems to have
no influence on the effects produced by this physical therapy. This
finding must be confirmed by investigations which include sedentary
older populations who do not present any type of cognitive complaint.
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