Fit Brains consists of a series of over sixty brain training games designed to help people improve mental skills: language, focus, speed, memory, logic, and visual processing. Fit Brains calculates a Fit Brains Index (FBI), which it claims to be a measure of performance across these six areas. Fit Brains games are intended to require different forms of cognition, such as pattern recognition, use of logic, spatial processing, short-term memory, and verbal recall. Each training session typically consists of playing five games, each of which is timed to last a minute. However, some training sessions are used to teach concepts such as emotion recognition or to have users log their mental state. The scientific basis of the activities within Fit Brains is unclear, and the literature which Rosetta Stone has provided to justify them has largely focused on everyday cognitive activities, rather than on short-duration, stylized activities like those within Fit Brains.
Fit Brains makes no clinical claims about its benefits. Under its description of the benefits, the Fit Brains website states, “Fit Brains combines fun and engaging brain games with specially designed tracking tools to help users of all ages engage all areas of their brain in an entertaining fashion. Our games offer a varied and exciting workout across multiple areas of the brain.”[i] Fit Brains should be considered a game with no proven clinical benefit.
Ease of Use and User Experience
Fit Brains is easy and intuitive to use. The user experience is highly-polished and feels similar to most casual puzzle games. As the games are timed and each last one minute, they are best suited for people who can devote their undivided attention to them. (Untimed puzzle games are often more suitable for situations in which people are unable to devote their undivided attention, such as when riding on a subway.) Each of the various games within Fit Brains has a different set of instructions. Instructions are given at the beginning of each game, so it is not necessary for users to recall how to play the games.
Fit Brains can be accessed on the web or a smartphone. The web-based version of Fit Brains was tested in the Chrome Browser on a computer running Windows 10. The app-based version was tested on an iPhone 6S running iOS 9.3 and on a BLU R1 HD running Android 6.0. Fit Brains performed appropriately on all the platforms, and scaled its interface properly for the resolutions of the two smartphones. The user account could be used on all the platforms, making it easy to transition between devices as necessary. Users may register a free account without providing billing information.
Appropriateness of Content
The content is appropriate for anyone able to read and follow instructions at a 5th grade level. The instructions for the games are partially pictorial, but require the user to be able to read to fully understand them. For instance, the “Missing Pieces” game has one line of instructions: “Watch objects drop through a funnel, and choose the missing piece.” The games are largely suitable for people of all ages, although the game requiring users to match words with equivalent words from other languages is best suited for people who have a basic vocabulary in French, Italian, and Spanish. While no medical content is presented within Fit Brains, users are taught to define their emotions and are occasionally asked to log their mental state. Logging does not involve using a traditional questionnaire like the GAD-7 or PHQ-9, and trends are not shown to users.
Appropriateness of Feedback
The games each provide immediate feedback to the user. After each move within the game, the user is informed if the move is correct or not. Furthermore, the change in the user’s Fit Brains Index (FBI) is shown at the end of each session to provide longitudinal feedback. It would be helpful if the methodology behind the FBI were revealed, as during testing, Fit Brains claimed that there had been improvements in all areas except focus after the games in the training session were deliberately played as incorrectly as possible. A substantial decrease in performance which a lay person might suggest indicates cognitive decline was still registered as an overall improvement by Fit Brains.
The games within Fit Brains each offer a different form of cognitive challenge. For instance, the Stroop Test game requires the user to focus on the meaning of words rather than on how they are displayed. There are also games which require users to identify which shapes they have previously seen, to remember the positions of Mahjongg tiles, and to identify the shadows cast by various objects. The games are diverse, as they are intended to each require one or more of the six areas which Fit Brains targets (language, focus, speed, memory, logic, and visual processing).
Ease of Account Management
A Fit Brains account may be created and managed complete online or by using a smartphone. Only an email address is required to join. Users may optionally provide their gender, age, and educational attainment. There appear to be issues with the account management feature, as the demographic settings did not always carry over between platforms.
Fit Brains was developed by Paul Nussbaum, Ph.D., a board-certified clinical psychologist and geropsychologist with a specialization in neuropsychology.[ii] While the Fit Brains website claims that Fit Brains is “backed by a strong scientific Board of Advisors”, no specific advisors are named.[iii] Fit Brains makes minimal claims about its benefits, but intersperses its claims with unrelated findings on Alzheimer Disease prevention.
No scientific study has ever directly shown a benefit from Fit Brains. However, in marketing Fit Brains, Rosetta Stone highlights four studies which suggest that brain training activities might be beneficial.
- The ACTIVE study found that people who underwent training in inductive reasoning experienced less functional decline in self-reported instrumental activities of daily living (IADL). Furthermore, the study found that cognitive training related to inductive reasoning, speed, and memory improved cognitive performance specific to the areas trained for 5 years after the initiation of the intervention.[iv] The training was not conducted using smartphones, as the study was published before smartphones existed.
- The Bronx Aging Study found that participation in leisure activities is associated with a reduced risk of dementia, even after adjusting for baseline cognitive status and excluding those who may have had preclinical dementia at the onset of the study.[v]
- The Religious Orders Study found that among nuns and priests, frequent participation in common cognitive activities is associated with reduced risk of Alzheimer Disease.[vi] However, the nature of the activities in the study are fundamentally different from the games within Fit Brains. Members of religious orders were asked whether they viewed television, listened to the radio, read newspapers, read magazines, read books, played games or puzzles, or went to museums on a daily basis, several times a week, several times a month, several times a year, or once a year or less. The responses were averaged into a composite measure, with no emphasis placed on engagement in puzzles.
- A literature review on the association between cognitive reserve and Alzheimer Disease suggested that life experiences and engagement in leisure activities may be associated with a reduced risk.[vii]
While all of these studies suggest that cognitive activities may be beneficial, they largely examine people engaged in real-world activities, such as reading books or playing cards with friends. None of the evidence calls for the use of a training regimen of smartphone games, although the ACTIVE study suggests that inductive reasoning training (not found within Fit Brains) may be beneficial.
Qualitative Review of Program Efficacy
There does not appear to be any evidence that Fit Brains can improve mental function or reduce cognitive decline. While there is general evidence that engaging on cognitively-intensive activities may be helpful, the evidence is largely based upon studies of people involved in everyday activities. Fit Brains sessions are different than everyday cognitive activities, as they tend to consist of five minute sessions of intense, timed exercises, rather than longer periods of less strenuous cognition. Fit Brains is not able to provide evidence that these mental “sprints” offer equivalent or superior benefits to the “long walks” which are the basis of most of the research on cognitive reserve. While there is no reason to think that Fit Brains may do harm, users seeking to enhance cognitive reserve may wish to consider increasing their engagement in the traditional cognitively-intensive activities which are at the foundation of the research in the area. Furthermore, traditional activities may offer a greater degree of social support than a smartphone game.
Estimate of Efficacy Relative to Similar Products
While Fit Brains is a highly-polished app and is a great source of entertainment, it is difficult to recommend it as a tool for achieving improved wellbeing. It is unclear whether any of the products in the brain training space are efficacious in reducing the likelihood that a person will experience Alzheimer Disease or any other form of significant cognitive decline. The Federal Trade Commission (FTC) fined Lumosity $2 million for deceptive claims related to brain training. Jessica Rich, Director of the FTC’s Bureau of Consumer Protection stated, “Lumosity preyed on consumers’ fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer’s disease.”[viii] While Fit Brains has been careful to avoid making such claims it is clear that the FTC has doubts about the efficacy of brain training products.
Fit Brains is a membership-based service available at many price points. This review was written by using only the “free” level of services, which consist of five minutes of daily training, as well as limited access to some of the Fit Brains games. Users wishing for more comprehensive access may select from a variety of options: $7.99 per month, $39.99 per year, $59.99 for two years, or $159.99 for a lifetime subscription.
[i] Frequently Asked Questions. Fit Brains. http://www.fitbrains.com/support/. Accessed December 1, 2016.
[ii] About Dr. Nussbaum. Dr. Nussbaum. http://www.paulnussbaum.com/about.html. Accessed December 1, 2016.
[iii] Frequently Asked Questions. Fit Brains. http://www.fitbrains.com/support/. Accessed December 1, 2016.
[iv] Willis SL, Tennstedt SL, Marsiske M, et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA. 2006;296(23):2805-14.
[v] Verghese J, Lipton RB, Katz MJ, et al. Leisure activities and the risk of dementia in the elderly. N Engl J Med. 2003;348(25):2508-16.
[vi] Wilson RS, De Leon CF, Barnes LL, Schneider JA, Bienias JL, Evans DA, Bennett DA. Participation in cognitively stimulating activities and risk of incident Alzheimer disease. Jama. 2002 Feb 13;287(6):742-8.
[vii] Scarmeas N, Stern Y. Cognitive reserve and lifestyle. J Clin Exp Neuropsychol. 2003;25(5):625-33.
[viii] Lumosity to pay $2 Million to settle FTC deceptive advertising charges for its “Brain Training” program. Federal Trade Commission. https://www.ftc.gov/news-events/press-releases/2016/01/lumosity-pay-2-million-settle-ftc-deceptive-advertising-charges. Published January 05, 2016. Accessed December 1, 2016.