From play to prevention: Exergames for preventing falls in older adults. Systematic review and meta-analysis

Introduction:
Exergames combine physical exercise with interactive digital gameplay and are increasingly incorporated into fall-prevention programmes for older adults. By integrating gamified features such as real-time feedback, goal setting, and progress tracking, exergames may enhance motivation, engagement, and adherence to exercise. Despite growing interest, the effectiveness of exergaming interventions in reducing falls and fall-related injuries, as well as key implementation outcomes including adherence, acceptability, and cost-effectiveness, has not been comprehensively synthesised.

Methods:
We conducted a systematic review of randomised controlled trials (RCTs) evaluating exergaming interventions in adults aged 60 years or older. MEDLINE, EMBASE, CINAHL Plus, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from inception. Primary outcomes included fall rate, number of fallers, and injurious falls. Secondary outcomes comprised balance, mobility, concerns about falling, adherence, acceptability, quality of life, and cost-effectiveness. Risk of bias was assessed using the RoB 2.0 tool, and certainty of evidence was evaluated using GRADE. Findings were synthesised narratively and, where appropriate, pooled using meta-analysis.

Results:
Nine RCTs involving 1,385 participants met the inclusion criteria. Exergaming interventions may reduce overall fall rates by approximately 50% compared with all control conditions (incidence rate ratio 0.50, 95% CI 0.46–0.56). At 12-month follow-up, fewer participants receiving exergames experienced falls compared with usual care (risk ratio 0.75, 95% CI 0.61–0.92). However, no consistent reductions were observed at 3- or 6-month follow-up or when compared with alternative active interventions. Exergames significantly reduced concerns about falling compared with evidence-based controls. Other secondary outcomes showed little to no difference, with substantial heterogeneity across studies.

Conclusion:
Low- to moderate-certainty evidence suggests that exergames may reduce fall rates and the number of fallers compared with usual care, supporting their potential role as an adjunct to fall-prevention strategies for older adults. Nevertheless, heterogeneity, limited sample sizes, and short follow-up periods underscore the need for larger, well-designed trials to inform routine implementation.