Active video games build strength and balance in later life

Muscle strength and balance underpin independence in later life, and losing them raises the risk of falls and the fear of falling that often shrinks an older person's world. Conventional therapies can maintain these capacities, but engagement is a perennial challenge. Exergaming — physical training delivered through interactive video games — has been proposed as a more engaging alternative, yet individual trials have tested different consoles, games and doses. This systematic review and meta-analysis asked directly whether exergaming can match or beat conventional therapies for strength, balance and fear of falling in healthy older people.

The authors searched six databases — PubMed, Medline, CINAHL Complete, Scopus, the Cochrane Library and Web of Science — with no start-date restriction up to May 2025, registering the protocol on PROSPERO. Methodological quality and certainty of evidence were assessed using PRISMA, TESTEX, RoB 2 and GRADE tools. From 3,224 records, 25 randomised controlled trials were included, covering 2,078 participants with a mean age of 71.5 years, of whom at least 80% were women. Outcomes included the timed up-and-go test, the 8-TUG, maximal isometric handgrip strength and the 30-second chair stand test, with subgroup analyses by console type, game and training dosage.

Seven overall and 10 subgroup meta-analyses showed significant improvements in favour of exergaming on the timed up-and-go, 8-TUG, maximal isometric handgrip strength and 30-second chair stand tests. In the timed up-and-go subgroups, improvements favoured exergaming by console and game type with very large effects (ES 1.42-2.56) and by training dosage (ES 2.07-2.77), with the frequency benefit appearing only at three or more sessions per week (ES 2.91). The 30-second chair stand test also improved with training dosage, with very large effects (ES 1.42-2.49). Meta-regression identified minutes per session as a predictor for the chair stand test (R2 = 0.43, p = 0.02).

This pooled analysis strengthens the case that exergaming is not merely a novelty but an effective alternative to conventional therapies for building strength and balance in healthy older people. It extends earlier single trials by quantifying how console choice, game type and training dosage shape the outcome, and by suggesting a frequency threshold of at least three sessions per week for mobility gains. Open questions remain: the sample was overwhelmingly female, the consoles and games varied widely, and optimal session length and programme duration are still to be pinned down.

For older adults — or anyone helping a parent stay strong and steady — this is a reason to take active video games seriously as genuine exercise rather than a gimmick. The pooled trials suggest exergaming can improve the same real-world capacities that conventional programmes target: getting out of a chair, moving quickly and safely, and grip strength. The finding that mobility gains appeared with three or more sessions per week suggests consistency mattered more than any particular game. As ever with meta-analyses, individual results varied, and the evidence base skews heavily towards women in their early seventies.