[01] Izyan Hayati Binti Ishak, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [02] Jaslyn Yeap Wen Xin, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [03] Allveanna Loimin, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [04] Lein Teck Wei, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia. [05] Hans Jeffry Bin Shapan Chakbarty, Faculty of Medicine, Melaka Manipal Medical College, Manipal Academy of Higher Education (MAHE), Melaka, Malaysia.

Cognitively stimulating leisure activities has been known to give benefits to a certain brain function. In medical school, continuous concentration and fast response is needed by the students. Jigsaw puzzles and coloring are age-friendly and easily available activities. The aim of this research is to determine whether jigsaw puzzles and colouring activities are helpful in improving the brain cognitive activity. A pilot randomized controlled trial was conducted from December 2019 to January 2020 in Melaka Manipal Medical College, Muar Campus, Johor, Malaysia. Demographic data were collected using questionnaire, including inclusion and exclusion criteria. We recruited volunteers to select sample and participants were randomized into intervention group and control group by block randomisation. Cognitive functions were measured, in terms of concentration and reaction time, before and after interventions were introduced. Mean and standard deviation values for pre-intervention and post-intervention score, mean difference, P-value and 95% confidence intervals were derived from paired t-test and unpaired t-test. Overall, 20 medical students were introduced with a session of jigsaw puzzle activity and another 20 medical students were introduced with colouring activity. It was found out that there is an improvement in reaction time of both intervention and control group but it is insignificant when analysing the data by using paired t-test. Surprisingly, in paired t-test as well, there is a decline in concentration in the intervention group but this finding is not significant as well. However, there is a significant improvement in concentration for the control group after the intervention after a paired t-test was done. Therefore, we recommend that jigsaw puzzle is still a good practice for general population to regularly indulge in leisure problem solving activities such as jigsaw puzzles and colouring for smaller children as it would benefit them in the long run.

Jigsaw Puzzles, Colouring, Cognitive Function, Cognitive Stimulating Leisure Activity (CSLA), Randomized Controlled Trial, Medical Students

[01] Regular crosswords and number puzzles linked to sharper brain in later life [Internet]. ScienceDaily. ScienceDaily; 2019 [cited 2019 Dec 23]. Available from: https://www.sciencedaily.com/releases/2019/05/190516082349.htm [02] Fissler P, Küster OC, Loy LS, Laptinskaya D, Rosenfelder MJ, von Arnim CAF, et al. Jigsaw Puzzles As Cognitive Enrichment (PACE) - the effect of solving jigsaw puzzles on global visuospatial cognition in adults 50 years of age and older: study protocol for a randomized controlled trial [Internet]. Trials. BioMed Central; 2017 [cited 2019 Dec 24]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5588550/ [03] Lampit A, Hallock H, Valenzuela M. Computerized cognitive training in cognitively healthy older adults: a systematic review and meta-analysis of effect modifiers [Internet]. PLoS medicine. Public Library of Science; 2014 [cited 2019 Dec 26]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236015/ [04] Zelinski EM, Spina LM, Yaffe K, Ruff R, Kennison RF, Mahncke HW, et al. Improvement in memory with plasticity-based adaptive cognitive training: results of the 3-month follow-up [Internet]. Journal of the American Geriatrics Society. U.S. National Library of Medicine; 2011 [cited 2019 Dec 26]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21314646 [05] Hardy JL, Nelson RA, Thomason ME, Sternberg DA, Katovich K, Farzin F, et al. Enhancing Cognitive Abilities with Comprehensive Training: A Large, Online, Randomized, Active-Controlled Trial [Internet]. PloS one. Public Library of Science; 2015 [cited 2019 Dec 26]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557999/ [06] Spencer-Smith M, Klingberg T. Benefits of a working memory training program for inattention in daily life: a systematic review and meta-analysis [Internet]. PloS one. Public Library of Science; 2015 [cited 2019 Dec 26]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368783/ [07] Fissler P, Kolassa I-T, Schrader C. Educational games for brain health: revealing their unexplored potential through a neurocognitive approach [Internet]. Frontiers in psychology. Frontiers Media S. A.; 2015 [cited 2019 Dec 26]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513287/ [08] The editors of Encyclopaedia Britannica. Jigsaw puzzle [Internet]. Encyclopaedia Britannica. Encyclopaedia Britannica, inc.; 2015 [cited 2019 Dec 19]. Available from: https://www.britannica.com/topic/jigsaw-puzzle [09] Puzzle History. [cited 2019 Dec 23]. Available from: https://web.archive.org/web/20001019002453/http://www.jigsaw-puzzle.org/jigsaw-puzzle-history.html [10] History of Puzzles [Internet]. Puzzle Warehouse. [cited 2019 Dec 23]. Available from: https://www.puzzlewarehouse.com/history-of-puzzles/ [11] Sudoku and Changes in Working Memory Performance for Older Adults and Younger Adults [Internet]. Taylor & Francis. [cited 2019 Dec 23]. Available from: https://www.tandfonline.com/doi/full/10.1080/01924788.2016.1272390?src=recsys [12] Chapman SB. Do Brain Games Really Boost Brain Power? [Internet]. Psychology Today. Sussex Publishers; 2014 [cited 2019 Dec 24]. Available from: https://www.psychologytoday.com/us/blog/make-your-brain-smarter/201403/do-brain-games-really-boost-brainpower [13] Ferreira N, Owen A, Mohan A, Corbett A, Ballard C. Associations between cognitively stimulating leisure activities, cognitive function and age-related cognitive decline [Internet]. International Journal of Geriatric Psychiatry. Wiley Online Library; 2014 [cited 2019 Dec 23]. Available from: https://www.uwo.ca/bmi/owenlab/pdf/2014 - Ferreira - Geriatric Psychiatry.pdf [14] Dykens EM. Are jigsaw puzzle skills `spared' in persons with Prader‐Willi syndrome? [Internet]. Wiley Online Library. John Wiley & Sons, Ltd (10.1111); 2008 [cited 2019 Dec 24]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/1469-7610.00025 [15] Litwin H, Schwartz E, Damri N. Cognitively Stimulating Leisure Activity and Subsequent Cognitive Function: A SHARE-based Analysis [Internet]. The Gerontologist. Oxford University Press; 2017 [cited 2019 Dec 23]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5881687/ [16] Rundek T, Bennett DA. Cognitive leisure activities, but not watching TV, for future brain benefits [Internet]. Neurology. Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology; 2006 [cited 2019 Dec 26]. Available from: https://n.neurology.org/content/66/6/794.short [17] Saczynski, S. J, Jonsdottir, K. M, Sigurdsson, Sigurdur, et al. White Matter Lesions and Cognitive Performance: The Role of Cognitively Complex Leisure Activity [Internet]. OUP Academic. Oxford University Press; 2008 [cited 2019 Dec 26]. Available from: https://academic.oup.com/biomedgerontology/article/63/8/848/567376 [18] Lachman ME, Agrigoroaei S, Murphy C, Tun PA. Frequent Cognitive Activity Compensates for Education Differences in Episodic Memory [Internet]. The American Journal of Geriatric Psychiatry. Elsevier; 2013 [cited 2019 Dec 26]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S106474811260267X [19] Prensky, M. (2001). Digital game-based learning. New York: McGraw-Hill https://www.researchgate.net/publication/318706210_DIGITAL_GAME-BASED_LEARNING_FOR_THE_NET_GENERATION_PERCEPTIONS_OF_UNIVERSITY_STUDENTS [20] Hong J-C, Hwang M-Y, Tam K-P, Lai Y-H, Liu L-C. Effects of cognitive style on digital jigsaw puzzle performance: A GridWare analysis [Internet]. Computers in Human Behavior. Pergamon; 2012 [cited 2019 Dec 26]. Available from: https://www.sciencedirect.com/science/article/pii/S0747563211002809 [21] Kiili K. Digital game-based learning: Towards an experiential gaming model [Internet]. The Internet and Higher Education. JAI; 2005 [cited 2019 Dec 26]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1096751604000776 [22] Prieto A, Mayas J, Toril P, Pita C, Ponce de Leon L, Reales JM, et al. Brain training with non-action video games enhances aspects of cognition in older adults: a randomized controlled trial [Internet]. Frontiers in Aging Neuroscience. Frontiers; 2014 [cited 2019 Dec 24]. Available from: https://www.frontiersin.org/articles/10.3389/fnagi.2014.00277/full#h2 [23] Miller KJ, Dye RV, Kim J, Jennings JL, O'Toole E, Wong J, et al. Effect of a Computerized Brain Exercise Program on Cognitive Performance in Older Adults [Internet]. The American Journal of Geriatric Psychiatry. Elsevier; 2013 [cited 2020 Jan 6]. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1064748113001176 [24] Lough CL, Rice MS, Lough LG. Choice as a Strategy to Enhance Engagement in a Colouring Task in Children with Autism Spectrum Disorders [Internet]. Wiley Online Library. John Wiley & Sons, Ltd; 2012 [cited 2020 Jan 6]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/oti.1337 [25] Lancioni GE, Perilli V, Singh NN, O'Reilly MF, Cassano G. A man with severe Alzheimer's disease stops wandering during a picture colouring activity [Internet]. Taylor & Francis Online. 2011 [cited 2020 Jan 14]. Available from: https://www.tandfonline.com/doi/abs/10.3109/17518423.2011.575439 [26] Fissler P, Kuster OC, Laptinskaya D, Loy LS, Kolassa I-T, Von Arnim CAF. Jigsaw Puzzling Taps Multiple Cognitive Abilities and Is a Potential Protective Factor for Cognitive Aging [Internet]. Frontiers. Frontiers in Aging Neuroscience; 2018 [cited 2020 Jan 14]. Available from: https://www.frontiersin.org/articles/10.3389/fnagi.2018.00299/full [27] Nicola J. Holt, Leah Furbert, Emily Sweetingham. Cognitive and affective benefits of coloring: Two randomized controlled crossover studies [Internet]. Taylor & Francis Online. 2019 [cited 2020 Jan 14]. Available from: https://osf.io/r6w8v/download?format=pdf [28] C. S, R. K. Early puzzle play: A predictor of preschoolers' spatial transformation skill. [Internet]. APA PsychNET. American Psychological Association; [cited 2020 Jan 14]. Available from: https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0025913