Evaluating the Cognitive Impact of Exergames in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis (Preprint)

BACKGROUND Cognitive decline in older adults is a growing global concern. Exergames, which combine physical exercise with cognitive training in an interactive digital environment, have shown promise in mitigating this decline. OBJECTIVE To assess the effectiveness of exergames in improving cognitive function among community-dwelling older adults through a systematic review and meta-analysis. METHODS A systematic search was conducted across PubMed, ScienceDirect, SpringerLink, ACM, and IEEE databases for studies published between January 2014 and June 2024. Studies were included if they: (1) involved participants with mean age ≥60 years, (2) implemented exergame interventions in community settings, (3) included pre- and post-cognitive assessments, and (4) provided sufficient data for effect size calculation. The analysis examined effects across different populations (healthy, mild cognitive impairment [MCI], and dementia), exergame types, and various cognitive domains. RESULTS Ten studies comprising 690 participants (EXG=350, Control=340) met inclusion criteria. The pooled effect size was 0.1327 (95% CI 0.066-0.199, P< .001), indicating significant positive effects of exergames on cognition. Subgroup analyses revealed that individuals with MCI showed the largest benefits (g=0.256, 95% CI 0.11-0.40, P=.003), followed by cognitively healthy older adults (g=0.132, 95% CI 0.03-0.23, P=.013). Aerobic exergames (g=0.12, 95% CI 0.01-0.22, P=.002) and combined aerobic and non-aerobic exergames (g=0.291, 95% CI 0.12-0.46, P=.002) demonstrated significant effects, but not in non-aerobic exergame. Among cognitive domains, memory (g=0.179, 95% CI 0.03-0.33, P=.021) and processing speed (g=0.337, 95% CI 0.31-0.37, P< .001) showed significant improvements. CONCLUSIONS Exergames provide significant cognitive benefits for community-dwelling older adults, with particularly strong effects for individuals with MCI. Combined aerobic and non-aerobic exergames appear most effective. These findings support the use of exergames as a practical tool for cognitive enhancement in community and residential environments.