General Medicine · Medical Literature
Exergaming Interventions for Preventing Falls and Injurious Falls in Older People: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Abstract
Exergames, which combine physical exercise with interactive gameplay, are increasingly being incorporated into fall prevention programs for older adults. Gamified elements, such as real-time feedback and progress tracking, may enhance motivation, engagement, and adherence. Although several systematic reviews have examined the effects of exergaming on balance and physical function, fewer have focused specifically on clinically meaningful outcomes, such as falls and injurious falls, or on indicators that may influence real-world adoption of exergames. This study aimed to evaluate the effectiveness of exergaming interventions for preventing falls and injurious falls in people aged ≥60 years and to synthesize evidence on implementation-related outcomes, including adherence, acceptability, concerns about falling, quality of life, adverse events, and cost-effectiveness. MEDLINE, Embase, CINAHL Plus, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to February 2025 for randomized controlled trials evaluating exergaming interventions in older adult populations across all settings. Outcomes included fall rate, number of fallers and injurious falls, and implementation-related secondary outcomes. Risk of bias was assessed using RoB 2.0, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were synthesized narratively and, where appropriate, pooled using meta-analysis. Nine studies (N=1385) met the inclusion criteria. Comparator-specific analyses suggested that exergaming may reduce fall rates compared with active intervention comparators, although the magnitude and certainty of effect varied, and substantial heterogeneity was present across analyses. Moderate-certainty evidence also suggested that exergames reduced the number of older adults experiencing one or more falls at 12-month follow-up compared with usual care (risk ratio 0.75, 95% CI 0.61-0.92). Evidence for injurious falls, quality of life, concerns about falling, adherence, acceptability, and cost-effectiveness was limited or inconsistent. When pooled across all control groups, exergaming interventions were associated with a lower overall fall rate than comparator interventions (incidence rate ratio 0.53, 95% CI 0.41-0.68), although substantial heterogeneity was present (I²=76%). Low- to moderate-certainty evidence suggests that exergames 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. However, substantial heterogeneity, modest sample sizes, and limited long-term follow-up reduce confidence in these estimates, and more rigorous, large-scale trials are needed before routine implementation can be recommended. This review extends previous exergaming syntheses by focusing on clinically meaningful outcomes, including falls and injurious falls, while also considering implementation-related factors relevant to real-world uptake.
Clinical relevance
Falls remain a leading cause of morbidity and mortality in adults aged ≥60 years, and engagement with conventional fall prevention exercise programs is a persistent clinical challenge. This systematic review and meta-analysis addresses a gap in the literature by focusing specifically on clinically meaningful endpoints—fall rates and injurious falls—rather than surrogate measures such as balance scores, in a population where novel engagement strategies are urgently needed. The incorporation of implementation-related outcomes (adherence, acceptability, cost-effectiveness) makes this work directly relevant to clinicians and health systems considering real-world adoption of exergaming platforms.
Key findings
1. Nine RCTs (N=1,385 older adults, aged ≥60 years) met inclusion criteria; evidence certainty was rated low to moderate using GRADE methodology. 2. Moderate-certainty evidence demonstrated that exergaming reduced the proportion of older adults experiencing ≥1 fall at 12-month follow-up compared with usual care (RR 0.75, 95% CI 0.61–0.92). 3. When pooled across all control groups, exergaming was associated with a significantly lower overall fall rate (IRR 0.53, 95% CI 0.41–0.68), though substantial heterogeneity was present (I²=76%), limiting interpretability of this pooled estimate. 4. Comparator-specific subgroup analyses suggested exergaming may reduce fall rates versus active intervention comparators, although effect magnitude and certainty varied across analyses. 5. Evidence for injurious falls, quality of life, concerns about falling, adherence, acceptability, and cost-effectiveness was limited or inconsistent across included studies, precluding firm conclusions on these secondary outcomes. 6. Risk of bias was assessed with RoB 2.0; modest sample sizes and limited long-term follow-up were identified as key methodological limitations reducing confidence in effect estimates.
Practice implications
Exergaming may be considered as an adjunctive strategy within multicomponent fall prevention programs for community-dwelling or residential older adults (≥60 years) who demonstrate poor adherence or engagement with conventional exercise, given moderate-certainty evidence of a 25% relative reduction in the number of fallers versus usual care at 12 months (RR 0.75). Clinicians should prioritize patient selection based on motivation barriers rather than replace evidence-based exercise modalities, as exergaming currently lacks sufficient evidence to stand alone, particularly regarding injurious fall prevention, cost-effectiveness, and long-term durability of effect. Routine implementation should be deferred pending large-scale, methodologically rigorous RCTs with standardized outcome reporting, adequate follow-up (≥12 months), and prospective assessment of adverse events and implementation fidelity.