Patrick Manser

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Patrick

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0000-0003-3300-6524

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Publications 1 - 10 of 19

Beyond FITT - How Density Can Improve the Understanding of the Dose-Response Relationship Between Physical Activity and Brain Health
Herold, Fabian; Zou, Liye; Theobald, Paula; et al. (2024)
SportRxiv
Research on physical activity and health, including planned and structured forms such as acute and chronic physical exercise, has focused on understanding potential dose-response relationships. Traditionally, the variables of (i) Frequency, (ii) Intensity, (iii) Time, (iv) and Type (known as the FITT principle) have been used to operationalize the dose of physical activity. In this article, we describe the limitations of FITT and propose that it should be complemented by the underappreciated variable density, which defines the temporal distribution of physical activity stimuli within a single bout of physical activity or between successive bouts of physical activity relative to time spent resting (e.g., in napping/sleeping or sedentary behaviors). Using the field of physical activity and brain health as an example, we discuss challenges and opportunities for further research to use density to improve our understanding of dose-response relationships between physical activity and health-related outcomes.
PEMOCS: theory derivation of a concept for PErsonalized MOtor-Cognitive exergame training in chronic Stroke—a methodological paper with an application example
Huber, Simone K.; Manser, Patrick; de Bruin, Eling (2024)
Frontiers in Sports and Active Living
Background: Coping with residual cognitive and gait impairments is a prominent unmet need in community-dwelling chronic stroke survivors. Motor-cognitive exergames may be promising to address this unmet need. However, many studies have so far implemented motor-cognitive exergame interventions in an unstructured manner and suitable application protocols remain yet unclear. We, therefore, aimed to summarize existing literature on this topic, and developed a training concept for motor-cognitive exergame interventions in chronic stroke. Methods: The development of the training concept for personalized motor-cognitive exergame training for stroke (PEMOCS) followed Theory Derivation procedures. This comprised (1.1) a thorough (narrative) literature search on long-term stroke rehabilitation; (1.2) a wider literature search beyond the topic of interest to identify analogies, and to induce creativity; (2) the identification of parent theories; (3) the adoption of suitable content or structure of the main parent theory; and (4) the induction of modifications to adapt it to the new field of interest. We also considered several aspects of the “Framework for Developing and Evaluating Complex Interventions” by the Medical Research Council. Specifically, a feasibility study was conducted, and refining actions based on the findings were performed. Results: A training concept for improving cognitive functions and gait in community-dwelling chronic stroke survivors should consider the principles for neuroplasticity, (motor) skill learning, and training. We suggest using a step-based exergame training for at least 12 weeks, 2–3 times a week for approximately 45 min. Gentile's Taxonomy for Motor Learning was identified as suitable fundament for the personalized progression and variability rules, and extended by a third cognitive dimension. Concepts and models from related fields inspired further additions and modifications to the concept. Conclusion: We propose the PEMOCS concept for improving cognitive functioning and gait in community-dwelling chronic stroke survivors, which serves as a guide for structuring and implementing motor-cognitive exergame interventions. Future research should focus on developing objective performance parameters that enable personalized progression independent of the chosen exergame type.
Development and initial validation of the German version of the Exergame Enjoyment Questionnaire (EEQ-G)
Manser, Patrick; Huber, Simon; Seinsche, Julia; et al. (2023)
PLoS ONE
Background: Analyzing and adjusting training programs to increase exercise enjoyment is crucial to achieve long-term adherence and thus also maximize health benefits. The Exergame Enjoyment Questionnaire (EEQ) is the first questionnaire specifically developed to monitor exergame enjoyment. To be used in German speaking countries, the EEQ must be translated, cross-culturally adapted, and tested on its psychometric properties. Objectives: The aim of this study was to develop (i.e., translate and cross-culturally adapt) the German Version of the EEQ (EEQ-G) and investigate its psychometric properties. Methods: Psychometric properties of the EEQ-G were tested using a cross-sectional study design. Each participant performed two consecutive exergame sessions (i.e., ‘preferred’ and ‘unpreferred’ condition) in randomized order and rated the EEQ-G as well as reference questionnaires. Internal consistency of the EEQ-G was assessed by calculating Cronbach’s α. Construct validity was assessed by calculating Spearman’s rank correlation coefficients (rs) between the scores of the EEQ-G and reference questionnaires. Responsiveness was analyzed by performing a Wilcoxon signed-rank test between the median EEQ-G scores of the two conditions. Results: Fourty-three healthy older adults (HOA; mean age = 69.4 ± 4.9 years; 53.5% females) were included. Cronbach’s α of the EEQ-G was 0.80. The rs values between the EEQ-G and reference questionnaire scores for intrinsic motivation, game enjoyment, physical activity enjoyment, and external motivation were 0.198 (p = 0.101), 0.684 (p < 0.001), 0.277 (p = 0.036), and 0.186 (p = 0.233), respectively. The EEQ-G was rated higher in the ‘preferred’ than the ‘unpreferred’ condition (p < 0.001, r = 0.756). Conclusion: The EEQ-G has high internal consistency and is responsive to changes in exergame enjoyment. The highly skewed data with ceiling effects in some of the reference questionnaires deem the construct validity of the EEQ-G to be inconclusive and thus in need of further evaluation.
Brain-IT: Targeting the Brain using Information Technology for Secondary Prevention of mild Neurocognitive Disorder
Manser, Patrick (2024)
Introduction: Effective interventions to mitigate one of the key challenges for aging societies, neurocognitive disorders, are urgently needed. A collaborative international guideline recently recommended physical exercise (PE) for secondary prevention of mild neurocognitive disorder (mNCD). Physical exercises that integrate cognitive exercises and are combined with resonance breathing guided by heart rate variability biofeedback (HRV-BF) target various relevant mechanisms of action to alleviate the pathological state in mNCD. However, this novel intervention approach has not yet been investigated. Methods: We systematically designed, developed, and evaluated a novel training concept (called ‘Brain-IT’) specifically for older adults with mNCD that implements this novel intervention approach. The projects’ methodology followed the guidelines of the Medical Research Council for the development and evaluation of complex interventions as well as the Multidisciplinary Iterative Design of Exergames (MIDE) - Framework. Primary end users (individuals with mNCD), secondary end users (physiotherapists, occupational therapists, healthcare professionals), exergaming researchers, as well as experts from the exergaming industry were continuously involved to facilitate the acceptance and transfer of the resulting training concept into clinical practice. Results: In the first phase of the project, we successfully determined a set of design requirements for the 'Brain-IT' training concept in collaboration with 10 experts and 8 individuals with mNCD. This set of design requirements formed the basis for phase 2, where a first prototype of the 'Brain-IT' training concept was co-designed and developed. We iteratively tested and refined this prototype until we achieved an "acceptable" (= feasible, usable, safe, and well accepted) solution. In the final randomized controlled trial (RCT), we observed statistically significant effects with large effect sizes for global cognitive performance, immediate verbal recall, and delayed verbal recall in favor of the intervention group. 55 % of participants showed a clinically relevant improvement in global cognitive functioning in response to training. The remaining (underpowered) statistical analyses revealed no significant effects, but favorable changes in descriptive statistics with small to moderate effects in favor of the intervention group, particularly with regards to quality of life. Conclusion: Our rigorous methodological approach resulted in a user-centered, personalized, and highly innovative training concept. Notably, we revealed, to the best of our knowledge, as the first research team, that this novel intervention approach of combining exergame training with biofeedback-guided resonance breathing is not only safe, feasible, and highly accepted by individuals with mNCD, but also highly effective in improving cognitive performance. Confirmatory RCTs are warranted to (i) be able to conclude about potential near- and far-transfer effects of the training; (ii) investigate whether the observed improvements in cognitive performance translate to affecting the rates of progression to or onset of dementia; (iii) test the implementation of the training in clinical practice; and (iv) elucidate the underlying biological mechanisms of action.
Design Considerations for an Exergame-Based Training Intervention for Older Adults With Mild Neurocognitive Disorder: Qualitative Study Including Focus Groups With Experts and Health Care Professionals and Individual Semistructured In-depth Patient Interviews
Manser, Patrick; Adcock-Omlin, Manuela; de Bruin, Eling (2023)
JMIR Serious Games
Background: Exergames have attracted growing interest in the prevention and treatment of neurocognitive disorders. The most effective exergame and training components (ie, exercise and training variables such as frequency, intensity, duration, or volume of training and type and content of specific exergame scenarios) however remain to be established for older adults with mild neurocognitive disorders (mNCDs). Regarding the design and development of novel exergame-based training concepts, it seems of crucial importance to explicitly include the intended users' perspective by adopting an interactive and participatory design that includes end users throughout different iterative cycles of development. Objective: This study aimed to determine the capabilities, treatment preferences, and motivators for the training of older adults with mNCD and the perspectives of individuals on training goals and settings and requirements for exergame and training components. Methods: A qualitative study including expert focus groups and individual semistructured in-depth patient interviews was conducted. Data were transcribed to a written format to perform qualitative content analysis using QCAmap software. Results: In total, 10 experts and health care professionals (80% females) and 8 older adults with mNCD (38% females; mean age 82.4, SD 6.2 years) were recruited until data saturation was observed. Conclusions: The psychosocial consequences of patients' self-perceived cognitive deterioration might be more burdensome than the cognitive changes themselves. Older adults with mNCD prefer integrative forms of training (such as exergaming) and are primarily motivated by enjoyment or fun in exercising and the effectiveness of the training. Putting the synthesized perspectives of training goals, settings, and requirements for exergames and training components into context, our considerations point to opportunities for improvement in research and rehabilitation, either by adapting existing exergames to patients with mNCDs or by developing novel exergames and exergame-based training concepts specifically tailored to meet patient requirements and needs.
Beyond “just” fun: The role of exergames in advancing health promotion and disease prevention
Manser, Patrick; de Bruin, Eling; Temprado, Jean-Jacques; et al. (2025)
Neuroscience & Biobehavioral Reviews
Applying innovations in digital health technologies, such as exergames, has been recommended by official bodies like the World Health Organization for health promotion and disease prevention across various populations and age groups. Given a key advantage of interactive and gamified digital health technologies is promoting user engagement, a substantial proportion of studies have implemented recreational exergames - games primarily designed to make specific activities more fun and entertaining. In this article, we aim to move beyond the benefits of “just” providing a more engaging environment for physical and motor-cognitive activities/exercises by shedding light on serious exergame features that enhance the ecological validity of exercises and offer unique advantages for tailoring interventions beyond conventional approaches. To this end, we review the roles and mechanisms of specific exergame features in supporting adherence to relevant behavior change, neuroscience, and exercise science principles, and integrate our findings into the ‘Beyond “Just” Fun of Exergames Framework’. This framework (i) implements a definition and classification approach to harmonize and provide more nuanced terminology for specific application scenarios of exergame technologies, and (ii) delineates best practices for the theoretically grounded selection and implementation of exergame features in health promotion and primary through tertiary disease prevention (including rehabilitation). By introducing this framework, we aim to support a paradigm shift by guiding game designers, researchers, and exercise and therapy practitioners from entertainment-centered recreational solutions towards serious exergames that are purposefully designed with adequate theoretical underpinnings, thereby unlocking the full potential of exergame-enhanced interventions for individuals and public health needs.
Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder – A Methodological Paper
Manser, Patrick; de Bruin, Eling (2021)
Frontiers in Aging Neuroscience
Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users’ capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects. Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The ‘Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health’ (Li et al., 2020). Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated. Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in “real life” settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.
Feasibility, usability, and acceptance of “Brain-IT” - A newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: a pilot randomized controlled trial
Manser, Patrick; Poikonen, Hanna; de Bruin, Eling (2023)
Frontiers in Aging Neuroscience
Background: Exergames provide a promising new approach to implement simultaneous motor–cognitive training, which may support preventing the decline in cognitive functioning in older adults who have a mild neurocognitive disorder (mNCD). Objectives: To evaluate feasibility, system usability, and acceptance of “Brain-IT”, a newly developed training concept combining exergame-based motor-cognitive training and heart rate variability (HRV) guided resonance breathing for the secondary prevention of mNCD. Methods: A pilot randomized controlled trial (RCT) with an allocation ratio of 2:1 (i.e., intervention:control) was conducted. The control group proceeded with usual care. The intervention group performed a 12-week training according to the “Brain-IT” training concept implemented with the “Senso Flex” (Dividat AG) exergaming system in addition to usual care. Feasibility and usability outcomes were analyzed using descriptive statistics. User acceptance was analyzed qualitatively and using Friedman analysis of variance (ANOVA), as well as Wilcoxon signed-rank tests. Results: Eighteen participants (77.3 ± 9.8 years; 44.4% females) were included. On average, we recruited 2.2 participants per month, and 35.3% of the individuals contacted were included. The intervention group had an attrition rate of 20% and mean adherence and compliance rates of 85.0 and 84.1%, respectively. The mean system usability score, measured with the system usability scale, was 71.7. High levels of exergame enjoyment, an increase in exergame enjoyment, and internalization of training motivation with large effect sizes (p = 0.03, r = 0.75 and p = 0.03, r = 0.74, respectively), as well as acceptable perceived usefulness, were observed. Preliminary data on the effects of the “Brain-IT” training are promising. Conclusion: The feasibility and usability of the “Brain-IT” training are acceptable. However, frequent occurrences of technical problems and difficulties in using the exergame training system were identified as barriers to performing the “Brain-IT” training. To optimize feasibility, either improvements or alternative solutions are required in the hardware and software of the exergame used to implement the “Brain-IT” training. The “Brain-IT” training itself was well-accepted by older adults who have mNCD. Therefore, the effectiveness of the “Brain-IT” training concept should be investigated in future studies. Trial registration: clinicaltrials.gov/ct2/show/NCT04996654.
Estimating flexibility preferences to resolve temporal scheduling conflicts in activity-based modelling
Manser, Patrick; Haering, Tom; Hillel, Tim; et al. (2024)
Transportation
This paper presents a novel activity-based demand model that combines an optimisation framework for continuous temporal scheduling decisions (i.e. activity timings and durations) with traditional discrete choice models for non-temporal choice dimensions (i.e. activity participation, number and type of tours, and destinations). The central idea of our approach is that individuals resolve temporal scheduling conflicts that arise from overlapping activities, e.g. needing to work and desiring to shop at the same time, in order to maximise their daily utility. Flexibility parameters capture behavioural preferences that penalise deviations from desired timings. This framework has three advantages over existing activity-based modelling approaches: (i) the time conflicts between different temporal scheduling decisions including the activity sequence are treated jointly; (ii) flexibility parameters follow a utility maximisation approach; and (iii) the framework can be used to estimate and simulate a city-scale case study in reasonable time. We introduce an estimation routine that allows flexibility parameters to be estimated using real-world observations as well as a simulation routine to efficiently resolve temporal conflicts using an optimisation model. The framework is applied to the full-time workers of a synthetic population for the city of Lausanne, Switzerland. We validate the model results against reported schedules. The results demonstrate the capabilities of our approach to reproduce empirical observations in a real-world case study.
“Brain‐IT”: Exergame training with biofeedback breathing in neurocognitive disorders
Manser, Patrick; de Bruin, Eling (2024)
Alzheimer's & Dementia: The Journal of the Alzheimer's Association
INTRODUCTION The combination of exergame-based motor-cognitive training with resonance breathing guided by heart-rate variability biofeedback (HRV-BF) targets various relevant mechanisms of action to alleviate the pathological state in mild neurocognitive disorders (mNCD). METHODS This randomized controlled trial (RCT) investigated the effectiveness of adding this novel intervention approach to usual care in mNCD. The individualized intervention was delivered via the “Brain-IT” training concept, which was iteratively co-designed, tested, and refined with patient and public involvement. RESULTS We observed statistically significant effects with large effect sizes for global cognitive performance, immediate verbal recall, and delayed verbal recall in favor of the intervention group. Fifty-five percent of participants showed a clinically relevant improvement in response to training. DISCUSSION Confirmatory RCTs are warranted to investigate whether the observed improvements in cognitive performance translate to affecting the rates of progression to or onset of dementia and test the implementation of the training in clinical practice.

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