Exergames linked to fewer falls in older adults

Falls are among the most consequential health events in later life, and getting older adults to stick with conventional balance and strength programmes is notoriously difficult. Exergames — video games you play with your body — bake in real-time feedback and progress tracking, which may keep people engaged where standard exercise fails. Previous systematic reviews have mostly asked whether exergames improve balance test scores or physical function; far fewer have asked the question that actually matters: do they prevent real falls, and injurious falls, in the real world? This review set out to answer exactly that, alongside practical questions like adherence, acceptability and cost.

The authors searched MEDLINE, Embase, CINAHL Plus, PsycINFO and the Cochrane CENTRAL register from inception to February 2025 for randomised controlled trials of exergaming interventions in adults aged 60 and over, across all settings. Outcomes included fall rate, the number of people who fell, injurious falls, and implementation-related outcomes such as adherence, acceptability, concerns about falling, quality of life, adverse events and cost-effectiveness. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Results were synthesised narratively and pooled by meta-analysis where appropriate.

Nine trials totalling 1,385 participants met the inclusion criteria. Pooled across all control groups, exergaming was associated with a lower overall fall rate (incidence rate ratio 0.53, 95% CI 0.41–0.68), though heterogeneity was substantial (I²=76%). Moderate-certainty evidence suggested 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). Comparator-specific analyses hinted at reduced fall rates even against active intervention comparators, though the size and certainty of effect varied. Evidence on injurious falls, quality of life, concerns about falling, adherence, acceptability and cost-effectiveness was limited or inconsistent.

This review extends earlier exergaming syntheses, which largely stopped at balance and physical-function surrogates, by focusing on the clinically meaningful endpoints of falls and injurious falls. The direction of effect supports the idea that gamified training can translate into fewer actual falls, not just better test scores. But the evidence base is thin: nine trials, modest sample sizes, substantial heterogeneity and limited long-term follow-up all temper confidence. Whether exergames beat well-delivered conventional fall-prevention programmes, whether they prevent injuries specifically, and whether they are cost-effective remain open questions requiring larger, more rigorous trials.

If you or someone you care about finds standard balance exercises tedious, this is a reason to think game-based movement is not a gimmick — the pooled trial evidence points towards genuinely fewer falls, particularly compared with usual care. The authors frame exergaming as a potential adjunct to established fall-prevention strategies, especially where staying engaged with conventional exercise is the sticking point. It is not yet evidence that exergames should replace anything, and the reviewers themselves stop short of recommending routine implementation. Treat this as an encouraging signal about making protective exercise something people actually want to do.