Brain Gym Exercise Give Benefit to Improve Cognitive Function among Elderly: A Systematic Review

Being elderly is potentially risk for the emerging of progressive neurodegenerative syndrome, including cognitive impairment. Various efforts have been made to minimize the negative impact. Brain gym is an alternative intervention that is widely used. A series of motion between the legs and hands employed to stimulate the brain to remain optimal. This study aims to determine whether brain gym exercise is beneficial for cognitive improvement among elderly in Indonesia. The systematic literature review was carried out from 28 May 2020 – 05 June 2020 at Semantic Scholar, Google Scholar, Garba Rujukan Digital (Garuda). Searching process employed keywords compiled using PICOS (Population, Intervention, Comparison and Outcomes) method and applied a filtering of articles using clinical trial or randomized controlled trial design, published in the last five years, and free/open access literature. There are 5 articles that meet the inclusion criteria: sample age 60 years and over, type of brain gym intervention, and focus on assessing cognitive function using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Indonesian Version (MoCA-Ina. Overall, the result shows in participants (n=211) experienced a significant increase in cognitive function (p<0.05). Indeed, additional outcomes were found, namely a decrease in stress levels and an increase in physical activity function .


INTRODUCTION
The World Health Organization (WHO) defines the elderly as individual or people aged 60 or more years (WHO, 2018). By 2050, one in six people in the world will be over 60 (16%). Regions where the share of the population aged 60 years or over is projected to double between 2019 and 2050, including North Africa and West Asia, Central and South Asia, East and South-East Asia, and Latin America and the Caribbean (Enniza, 2015). As has happened in several countries, Indonesia is also experiencing an increase in the elderly.
Based on data from the Central Statistics Agency in 2019, the percentage of the elderly reached 9.60% (Diana Sulis, Adiesty Ferilia, 2017). This shows that Indonesia is a country that will enter the era of an aging population because the number of people aged 60 years and over has exceeded the 7.0% figure. The number of the elderly for each category in Indonesia is respectively elderly (age group 60-69 years), middle elderly (age group 70-79 years), old elderly (age group 80+ years) namely 63.82%, 27.68%, and 8.50% (Amannullah Gantjang, 2019).
One of the most common problems experienced by the elderly is cognitive impairment. The Ministry of Health of the Republic of Indonesia stated that the mildest decline in cognitive function about 39% at aged 50-59 years and then plunge 8.03% more at 80 and over years (Ministry, 2016). The reduction is usually in aspects of orientation, registration, attention, calculation, memory, and speed of thinking (Batista DM, 2017). It greatly affects inability to carry out daily activities, causing dependence on others (Adelina, 2015). Furthermore, there are also changes in thinking power due to a decrease in body systems, emotional changes, and changes in judging something against a certain object (Hukmiyah et al., 2019). Hence, various efforts have been made to minimize the negative impact. One of the exercises as an intervention that is widely used is brain gym exercise. It is a series of simple motion exercises and is an alternative therapy that aims to accelerate the flow of blood and oxygen to the brain and stimulate both brains to work (Dennison, 2005). A series of motion between the legs and hands employed to stimulate the brain to remain optimal so that increase in self-confidence, stimulate the right and left brain, relax the brain, and improve cognitive function (Setiawan, Safitri, and Setiyajati, 2014). Indeed, the exercise can improve the cognitive abilities (Hukmiyah et al., 2019), lessen stress level and help to rise physical activity function (Azizah, et al., 2017;Basuki et al., 2018). However, this study aims to investigate whether brain gym exercise is beneficial for cognitive improvement among elderly in Indonesia.  (2017) (2017) and Ade Tedi Irawani (2019).

Intervention
Affording to the focus of the review, brain This is based on the theory when brain exercise is carried out continuously on a regular basis, the results will be much more effective. Brain exercise movements can activate three dimensions of the brain, where the concentration dimension can increase blood flow to the brain, increase oxygen reception, the lateral dimension will stimulate the coordination of the two hemispheres of the brain, namely the right and left brain, increase breathing, stamina, release tension and reduce fatigue. The focusing dimension is to remove the inhibition of concentration from the brain.  message. In general, in the form of repair and maintenance of cells (Khan and Scott, 2009;Huang et al., 2013;Ng et al., 2017).
Thus, it has an impact on the metabolic system that can be observed in the body's physiological system as seen on the barometer of vital sign measurements.

CONCLUSION
In short, brain gym has proven its effectiveness to improve cognitive function in the elderly in various studies that modify the technical intervention, but with doses that are still adjusted to the needs of the elderly. This can be used as a reference for program developers to implement in the community, to make sure every elderly stays fit, productive, and happy.