Falls remain the leading cause of injury-related death among adults over 65, and conventional balance training programs notoriously suffer from poor long-term adherence. A technology-based alternative that makes exercise feel less like medicine and more like play could meaningfully shift population-level fall burden — which is precisely what this large systematic review set out to quantify.
Drawing on randomized controlled trials identified across five major databases through February 2025 — including MEDLINE, Embase, and the Cochrane CENTRAL register — this meta-analysis evaluated exergaming interventions (interactive video game-based exercise platforms) in adults aged 60 and older across diverse care settings. The review went beyond typical proxy outcomes like balance scores or gait speed, targeting clinically hard outcomes: fall rate, number of fallers, and injurious falls. Secondary implementation outcomes — adherence rates, acceptability, fear of falling, quality of life, adverse events, and cost-effectiveness — were also synthesized, with evidence certainty graded using GRADE methodology and risk of bias assessed via RoB 2.0, the current gold-standard appraisal tool for trials.
This is a methodologically rigorous effort that addresses a genuine gap in the exergaming literature. Prior systematic reviews have largely emphasized physiological proxies rather than real-world fall events, so anchoring this analysis to injurious falls and implementation feasibility gives it unusual practical relevance for clinicians and public health planners. Exergaming platforms — from commercial systems like Nintendo Switch Sports to purpose-built rehabilitation devices — vary substantially in dose, interaction type, and required supervision, raising legitimate questions about which formats drive benefit. The inclusion of cost-effectiveness data is particularly valuable given that scalability depends on economic viability within healthcare systems. Key limitations inherent to this literature include high heterogeneity across platforms, relatively short intervention durations in most trials, and possible volunteer bias in recruited samples. Still, a well-powered meta-analysis focused on fall events rather than surrogate markers represents a meaningful advance — and potentially positions exergaming as a mainstream, evidence-backed fall-prevention modality rather than a novelty.