Exergaming may reduce fall rates in older adults compared with usual care

When compared with usual care, exergames reduced the number of older adults experiencing one or more falls at 12-month follow-up by 25% (risk ratio 0.75, 95% CI 0.61–0.92, moderate-certainty evidence). Across all control groups pooled together, exergaming was linked to a 47% lower fall rate (incidence rate ratio 0.53, 95% CI 0.41–0.68), though substantial heterogeneity across studies suggests that effect size varied considerably. The review found limited or inconsistent evidence for effects on injurious falls specifically, quality of life, concerns about falling, long-term adherence, and cost-effectiveness. Key limitations included modest sample sizes in individual trials, substantial methodological heterogeneity (I²=76%), and limited long-term follow-up beyond 12 months. The authors note that exergaming may be particularly useful where engagement with conventional exercise is challenging, but stress that more rigorous, large-scale trials are needed before routine clinical implementation.

The heterogeneity across studies (I²=76%) suggests that effect varies depending on the specific exergame used, the control comparison (active exercise versus usual care made a difference), and participant characteristics—subgroup effects were present but insufficiently reported in source papers to extract precisely. The 25% relative risk reduction for fallers at 12 months versus usual care translates to a number needed to treat around 7–10 depending on baseline fall risk, making the effect clinically modest. Notably, the evidence for injurious falls specifically was sparse and inconsistent, meaning we cannot yet confidently say exergames prevent the most harmful outcomes. Adherence and acceptability were mentioned as implementation goals but rarely measured or reported rigorously; the authors found this a critical gap for predicting whether older adults will sustain exergaming use in practice. The mechanism likely involves improved balance, reaction time, and proprioception through gamified, repeated practice, but the review did not extract neuromotor outcomes alongside fall outcomes. Prior conventional exercise interventions show similar or larger fall risk reductions, suggesting exergames may be best positioned as an engaging alternative for those who drop out of traditional programs rather than as a replacement.