The Science behind Stepwave.
Stepwave is built on the pioneering ‘Brain-IT’ concept. It was developed, tested and refined through six years of research with one goal: helping people build brain-body resilience to stay fit for longer. The program has been validated in multiple clinical studies and published in leading peer-reviewed journals.
How Brain-IT was co-developed, validated, and refined.
Brain-IT was collaboratively developed, validated, and refined by a team of world-leading researchers in partnership with users, clinicians, and industry experts — so the science actually fits your real-world routine.
We included adults diagnosed with “mild neurocognitive disorder” (also called “mild cognitive impairment”) in our clinical studies — the earliest clinical stage of cognitive decline where people remain functionally inependent in daily life, but are at increased risk for dementia.
Participants were recruited through partnering (memory) clinics and trained under real-world conditions in their homes, not in a controlled lab environment.
19 peer-reviewed publications:
Direct Brain-IT work
A blueprint for exergames development
Rather than adapting an off-the-shelf game or developing an intervention top-down, the team defined methodological steps on how a brain-body exercise videogame (= exergame) for dementia prevention should optimally be developed. That method became the foundation everything else was built on and ensured that we found a good balance between evidence-based practice and involving target users to maximize value for everyday practice.
Manser & de Bruin 2021 · Frontiers in Physiology
Read the Paper— PDF
Supporting research & the wider field
Using heart signals to read effort
We reviewed the literature and showed that simple heart signals can reveal how your body and brain respond to effort and recovery. These findings built the basis for tuning the exercises to your physiological response — not to a generic schedule — and help us better personalize our programs.
Manser et al. 2021a · Frontiers in Physiology
Read the Paper — PDF
Direct Brain-IT work
Patients and clinicians shape the design
For us, it was very important to know what people needed to stay engaged with dementia in the long run. Therefore, we asked both people with early cognitive decline and clinicians to describe what they wanted, needed and disliked, and how the games and the intervention program should be designed. This collaborative design process helped us tailor the games, the pace, the support, and the way a session feels.
Manser et al 2023a. · JMIR Serious Games
Read the Paper — PDF
The trial plan, published before data collection
Before a single participant was tested, the complete trial plan was submitted for publication: who would take part, for how long, what exactly participants do, and what would be measured and how. That is what makes the later results verifiable rather than merely claimed.
Manser et al. 2023c · JMIR Research Protocol
Read the Paper — PDF
First tests in real life
Could people living with the first signs of cognitive difficulties actually use the system at home — and would they want to keep using it? The pilot trial said yes, and showed precisely which parts of the program needed to be further improved.
Manser et al. 2023d · Frontiers in Aging Neuroscience
Read the Paper — PDF
Supporting research & the wider field
A new way to measure enjoyment
We developed and validated a new German questionnaire for measuring how much people actually enjoy brain-body exergaming. A program you do not enjoy is a program you will not keep doing — so enjoyment had to become measurable.
Direct Brain-IT work
The complete Brain-IT thesis
The full Brain-IT program — the concept, co-design, development and evaluation — brought together and successfully defended as a doctoral thesis at ETH Zurich.
Manser 2024 · Doctoral thesis, ETH Zurich
Read the thesis — PDF
The full Brain-IT concept
Everything came together here: Move. Think. Breathe. Delivered through enjoyable exercise videogames that are personalized to each individual’s capacity, participation, and progress. Clinically proven effective: 2.5× more people improved compared to usual care. And people loved it — 121 % adherence, and 95 % stayed engaged over the 12-week testing period. This is the concept Stepwave delivers today — and it won the Vontobel Award for Age(ing) Research 2024.
Manser & de Bruin 2024 · Alzheimer’s & Dementia
Read the Paper — PDF
Supporting research & the wider field
Setting the right training intensity
How reliably can heart signals show what a session is really demanding of you? This study’s findings set the standard now used to combine heart signals, game performance measures, and your feedback to keep your training challenging so that it impacts on your brain-body health, but without ever overloading you.
Manser & de Bruin 2024b · BMC Sports Science, Medicine and Rehabilitation
Read the Paper — PDF
What makes brain-body games work
We reviewed all available international evidence to answer one question: which training ingredients, and how much of them, really improve thinking? We showed that stepping videogames that embed cognitive challenges, are performed at moderate intensity, and in a hybrid setting combining group exercises with home-based individual training yield the strongest benefits. Stepwave was built to match those answers to maximize the impact on your brain-body health.
Manser et al. 2024a · Ageing Research Reviews
Read the Pape — PDF
Detecting early cognitive change
Two studies on detection: a short German screening test for early cognitive change was validated, and heart-rate variability was examined as an additional early marker. Training people early only works if early changes can be spotted reliably.
Manser & de Bruin 2024 · BMC Geriatrics
Read the Paper — PDF
Czopek-Rowinska et al. 2024 · Frontiers in Aging Neuroscience
Read the Paper — PDF
Direct Brain-IT work
The game measures your progress
Data from two randomized trials showed that how you play reflects how you think and progress. Well-designed game performance metrics can therefore become an ongoing, effortless measure of your participation and progress — and give you valuable feedback in your brain-body health journey.
Kaiser et al. 2025 · JMIR Serious Games
Read the Paper — PDF
MRI shows structural brain changes
MRI scans taken before and after the Brain-IT program showed early scientific indications of positive structural changes in the trained brain regions that are associated with memory and self-regulation. The benefit was not only visible on paper — it was visible in the brain.
Manser et al. 2025a · Alzheimer’s Research & Therapy
Read the Paper — PDF
Supporting research & the wider field
Exergames as real prevention
An international review positioning brain-body exergames as a serious instrument for health promotion and disease prevention — not entertainment with a health label attached. We set out where this kind of training belongs in everyday care and how it should be designed to maximize benefits for brain-body health.
Manser et al 2025b · Neuroscience & Biobehavioral Reviews
Read the Paper — PDF
Direct Brain-IT work
MRI shows improved brain function
MRI scans taken before and after the Brain-IT program showed early scientific indications of positive functional changes in the trained brain regions that are associated with memory and self-regulation. This confirms earlier findings that the benefits are not only visible on paper — but also visible in the brain.
Supporting research & the wider field
A guideline for other teams
Based on the learnings from the way Brain-IT was built, we put together an international team of experts who formalized a new international consensus guideline, so that other teams can learn from our leadership and co-design, develop, and evaluate tailored training concepts to the same standard.
Manser et al. 2026a · Journal of Medical Internet Research
Read the Paper — PDF
Exergames enter the textbooks
We were invited to write the exergame chapter of an international handbook on physical activity and cognitive neuroscience — the reference work students and researchers in the field learn from. It traces how exergames moved from leisure-time entertainment to a superior way of delivering exercise for the brain. That is exactly the shift Stepwave is built on.
Manser & de Bruin · In: Zou, Ji, Herold & Chen (Eds.), The Handbook of Physical Activity and Cognitive Neuroscience · Routledge
Exercise impacts Brain Networks
We reviewed the literature and show that physical, motor, and cognitive exercise can reshape large-scale brain networks while providing additional support for synergistic benefits of combined motor-cognitive training (for example through exergames) for brain health.
Gennaro et al. 2026 · Ageing Research Reviews
Read the Paper — PDF
Brain-IT into Practice.
Six years of research showed that Brain-IT works. The next step is making the program available to the broader public and embedding it into a health model focused on maintaining and strengthening brain-body resilience. That work started in August 2026.
Our vision
To transform “exergame as medicine” from a niche area of research into a core pillar of modern preventative healthcare — prescribed, reimbursed, and routinely implemented, so that acting early becomes the default rather than the exception.
To make this vision happen, Stepwave is collaborating with:
Our goals are:
Identifying the legal and procedural requirements, and co-designing concepts for integrating Brain-IT into practice — within existing healthcare structures and through Stepwave health hubs.
Developing intelligent assistance algorithms that support clinicians in delivering Brain-IT, freeing up more time for direct patient care.
Iterative optimization of our concepts and technologies, so that every round of feedback makes the next version better.
Turning a collection of individual, simple mini-games into a cohesive, exciting video game — embedding personalized dementia prevention within a gripping story.
Evaluating how the optimized program performs in everyday practice during a short, supervised test phase of two to four weeks.
Supported by
Interested in staying up to date, or in contributing to our research and development?
What improved — and how it was measured.
‘Brain-IT ’ didn't focus on a single outcome. Researchers evaluated cognition, brain structure, brain function, physical performance, and long-term adherence to understand how participants changed over time.
2.5 x more People improved
100% of participants perceived the training as useful, and 55% showed measurable cognitive improvements that noticeably eased their daily lives already after 3 months — compared to only 23% in the control group continuing their usual routines.
(Manser et al. 2025 and 2023)
Every participant completed the same battery of validated neuropsychological tests before and after the 12-week program. A improvement was only counted when it passed a pre-defined threshold defined by the scientific literature for an improvement that is considered large enough to be noticeable in daily life. We compared whether the rate of improvement differed between ‘Brain-IT’ and usual care.
Brain changes
‘Brain-IT’ training showed early scientific indications of positive changes in the trained brain regions that are associated with memory and self-regulation. (Manser et al. 2026)
Brain scans (with magnetic resonance imaging) were taken before and after training for 12-weeks with ‘Brain-IT’. Study participants laid in the magnetic resonance scanner for about 35 min. We performed different measurements, during which participants had to lay still, focus on a target on the screen, or perform memory tasks. We explored whether we can measure any structural and functional changes in the brain regions the training targets — those associated with memory and self-regulation — and compared differences between ‘Brain-IT’ and usual care.
121 % Adherence
Participants performed, on average, 21% more sessions than instructed — because they perceived the training as useful, fun, and effective. (Manser et al. 2025, 2023)
The system logged every session automatically, so adherence is not self-reported. It is the number of sessions actually completed divided by the number prescribed over the 12 weeks — which is why a figure above 100 % means people trained more than they were asked to.
>95 % Stayed engaged
Most participants completed the 12-week program and wanted to continue afterwards because it naturally became part of their weekly routine. (Manser et al. 2025)
We recorded how many participants finished the full 12 weeks, and asked at the end whether they wanted to carry on. Only one participant dropped out during the ‘Brain-IT’ training. Importantly, however, this drop-out was due to personal reasons and not related to this person’s satisfaction or performance with the program.
2.5 x more People improved
Participants following the ‘Brain-IT’ program were substantially more likely to achieve meaningful improvements than those receiving usual care. Importantly, given that the study participants already had cognitive deficits, a stable performance is also a success. However, since there are still people who did not show a measurable success (constant performance or improvement), we are now working on further improving the personalization of our program to maximize benefits for all participants.
What we observed inside the brain.
The research program did not only look at behaviour. Brain imaging was used to explore whether changes could also be detected in the brain regions the training targets — especially those associated with memory and resilience in self-regulation.
Participants training with ‘Brain-IT’ showed early scientific indications of positive structural changes in the hippocampus, the region most critical for memory formation and one of the first areas affected by Alzheimer's disease.
These are initial exploratory findings from a small trial that are encouraging enough to justify the further research now under way. Of note, these observations are reported here as scientific results rather than product claims — and additional research is needed to confirm whether these early signals translate to delaying symptom progression and/or preventing dementia.
Beyond structure: brain function
A separate analysis explored brain activity patterns and found signs of improvements in how the brain functioned at rest and during memory tasks, which were associated with the cognitive improvements participants showed. This work is still undergoing peer review and, similar to the structural results presented above, does not allow any definitive statements or claims about dementia prevention — but it is why brain function remains part of what we measure.
Why > 95% stayed engaged.
Long-term adherence is one of the biggest challenges in exercise for brain-body resilience and healthy longevity. ‘Brain-IT’ achieved high participation because training became part of participants' weekly routines that they enjoyed — not a medical obligation.
The bigger picture: exergames and healthy longevity.
‘Brain-IT’ is part of a growing body of international research showing that personalized brain-body exergames can improve physical and cognitive performance, improve brain-body resilience, and help people stay fit for longer.
- Exercise and Healthy Longevity
Tailored exercise programs have proven effective in helping older adults maintain their functional capacities, extending their health span, and enhancing their quality of life. Therefore, global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults recommend implementing tailored multidomain exercises — like ‘Brain-IT’ and its delivery via the Stepwave care model — for health promotion and disease prevention. (Izquierdo et al. 2025)
But why exactly does Stepwave work with exergames for that manner?
- Superior adherence compared to conventional exercise
The superior enjoyment with gamified exercises deliver in an accessible digital format that can also be used at home were consistently shown to explain superior adherence to exergame- and other digital health technology-enhanced training compared to conventional approaches (Manser et al. 2025, Dubbeldam et al. 2024, Valenzuela et al. 2018, Rüth et al. 2023)
- Superior effectiveness over conventional exercise
Step-based brain-body exergames can outperform conventional exercise or brain games for cognitive outcomes because they offer unique advantages for tailoring interventions beyond conventional approaches (Manser et al. 2025). Furthermore, integrating and performing brain and body exercise simultaneously has been shown more effective than training either one alone, while there are first indications that the frequent, short sessions that can be implemented with home-based exergames or their combination with regular group sessions may lead to greater benefits than long weekly sessions (Manser et al. 2024).
Are there other benefits of exergame-enhanced interventions?
- Falls prevention
Exergame-enhanced interventions may reduce fall rates, particularly in comparisons with active intervention control groups, and may reduce the number of fallers compared with usual care. These findings indicate that exergaming may offer a useful adjunct to established fall prevention strategies for older adults, particularly where sustained engagement with conventional exercise is challenging (Eost-Telling et al. 2026)
- Emotional well-being
Evidence shows that exergame-enhanced interventions also improve emotional well-being (Marques et al. 2023)
Overall, what can I learn from that regarding healthy longevity?
Given all these benefits illustrated above, exergames are considered a serious instrument for health promotion and disease prevention — not entertainment with a health label attached (Manser et al. 2025). Therefore, experts globally recommend exergame-enhanced interventions for both brain-body health and emotional well-being (Maggio et al. 2025, Manser et al. 2025, Hernandez-Martinez et al. 2024, Manser et al. 2024, Singh et al. 2024, and Marques et al. 2023).
At Stepwave, we make the best of current exergame research available to you, and and empower you with the knowledge, community, and structured support throughout all steps of your personalized brain-body health journey.
Ready to experience the science in practice?
Vontobel Award for Age(ing) Research 2024
Awarded for the rigorous, participatory approach behind Brain-IT — finding the right balance between scientific theory and the real-world needs of users and health professionals, that later culminated in consensus-based guidelines for the field (Manser et al. 2026).
Peer-reviewed publications.
The co-development and validation of the ‘Brain-IT’ program has been published in internationally recognized peer-reviewed journals across neuroscience, ageing and digital health.
2026
Exergame as Medicine? Functional Brain Adaptations Linked to Cognitive Gains in Neurocognitive Disorders: Exploratory Randomized Controlled Trial
Manser, Rosio, Schmidt, Michels & de Bruin (in press)
2025
Manser, Rosio, Schmidt, Michels & de Bruin. Alzheimer's Research & Therapy
Kaiser, de Bruin & Manser. JMIR Serious Games
2024
“Brain-IT”: Exergame training with biofeedback breathing in neurocognitive disorders.
Manser & de Bruin. Alzheimer's & Dementia
Manser (Doctoral Thesis) ETH Zurich Resarch Collection
2023
Manser, Poikonen & de Bruin. Frontiers in Aging Neuroscience
Manser, Michels, Schmidt, Barinka & de Bruin. JMIR Research Protocols
Manser, Adcock-Omlin & de Bruin. JMIR Serious Games
2021
Manser & de Bruin. Frontiers in Aging Neuroscience
Further publications
2026
Exergames – from Leisure Time Fun and Games to Superior Exercise Delivery for Enhancing Cognition.
Manser & de Bruin · In: Zou, Ji, Herold & Chen (Eds.), The Handbook of Physical Activity and Cognitive Neuroscience · Routledge
Manser, Hardeman, Wallin, Moulaee Conradsson, Leavy, Albrecht, Roerdink, Temprado, de Bruin & Franzén · J Med Internet Res
2025
Beyond “just” fun: The role of exergames in advancing health promotion and disease prevention.
Manser, de Bruin, Temprado, Bherer & Herold · Neuroscience & Biobehavioral Reviews
2024
Manser, Herold & de Bruin · Ageing Research Reviews
Manser & de Bruin · BMC Geriatrics
Diagnostic Accuracy of Heart Rate Variability as a Screening Tool for Mild Neurocognitive Disorder.
Czopek-Rowinska, de Bruin & Manser · Frontiers in Aging Neuroscience
Manser & de Bruin · BMC Sports Science, Medicine and Rehabilitation
2023
Manser, Huber, Seinsche, de Bruin & Giannouli · PLOS ONE
2021
Manser, Thalmann, Adcock, Knols & de Bruin · Frontiers in Physiology
Published in
Ready to experience the science in practice?
Join the waiting list, refer someone who could benefit, or reach out if you'd like to bring Stepwave to your practice or organisation.
Stepwave is currently intended for brain-body engagement, health promotion, and performance training, educational purposes, and wellness, and is based on the recommendations of a global expert consensus on promoting physical and brain health. It has not yet been certified as a medical device, and we therefore make no claim that our technology is intended for the diagnosis, treatment, cure, relief, monitoring, or prevention of diseases or health conditions.