A balance exercise is only useful if you keep doing it. That is where “exergaming” — games controlled by body movement — may earn a place alongside conventional training. The screen supplies a goal and immediate feedback; the person supplies the stepping, reaching and weight-shifting.
A new systematic review suggests this approach can improve measured balance in older adults living with chronic conditions. It does not show that buying a game system prevents falls. The practical lesson is narrower: well-chosen, progressive and preferably supervised games can make evidence-based movements more engaging. [1]
What the new review found
The review included 11 randomized controlled trials with 442 participants, whose weighted mean age was about 67. Participants had conditions including stroke, Parkinson’s disease and diabetes. The programmes used Nintendo Wii Fit or Microsoft Kinect, ran for four to 16 weeks, and usually involved two or three sessions per week. [1]
Five trials contributed to a pooled Berg Balance Scale result. Exergaming improved scores by an average 2.93 points versus control, with a 95% confidence interval from 0.44 to 5.41. Three studies contributed to the Dynamic Gait Index result, which favoured exergaming by 0.72 points. These were statistically significant differences, but the review did not establish that they translated into fewer falls, fewer injuries or more independent living. The balance result also varied substantially between studies (I² = 69.1%). [1]
The evidence is therefore encouraging, not definitive. Seven of the 11 trials had “some concerns” in the review’s risk-of-bias assessment. Populations, programmes and outcome measures differed, most follow-up was short, and fewer than 10 studies contributed to each pooled outcome, so publication bias could not be assessed formally. [1]
The game is not the active ingredient
The useful parts of exergaming are familiar: repeated sit-to-stand movements, stepping, reaching, weight shifts and feedback. A screen can add structure and motivation, but it does not turn an unsuitable exercise into a safe one.
That distinction appears in an earlier UK cluster-randomized trial. In 18 assisted-living facilities, 106 participants were assigned to usual advice or a tailored 12-week strength-and-balance game programme supported by physiotherapists or trained assistants. The intervention improved the Berg Balance Scale by an adjusted 6.2 points. Self-reported fall rates over three months also favoured the game group, but follow-up was short, the result came from a supported programme in assisted living, and the authors called for prospective one-year fall tracking. [2]
The trial was funded through Innovate UK’s programme linked to MIRA Rehab, the system used in the study. One author disclosed directing a non-profit company that trains instructors in the underlying exercise programmes; no other conflicts were declared. This context does not negate the result, but it matters when translating one tailored system into a claim about consumer games generally. [2]
A safer way to try it
Start with the movement goal, not the gadget. International falls guidelines recommend balance-challenging and functional exercises such as stepping and sit-to-stand, individualized and progressed over time. For community-dwelling older adults, they recommend sessions at least three times weekly for at least 12 weeks, continuing longer for greater effect. [3]
If a game helps deliver those movements consistently, use it as an adjunct. Choose a clear floor area, stable footwear and a nearby support that will not move. Begin with slow, predictable tasks; stop if the game asks for a movement that feels unsafe. A family member can help with setup, but someone with impaired balance, neurological disease or a recent fall should ask a physiotherapist to select and progress the exercises.
Risk level matters. The guidelines advise targeted strength-and-balance exercise or physiotherapy for people with balance problems, and a multifactorial assessment for those at high risk — for example after recurrent falls, an injurious fall, frailty, a prolonged inability to get up or suspected loss of consciousness. In those situations, a game should not replace assessment of medicines, vision, cardiovascular causes, the home environment and other contributors. [3]
What this means in practice
For older adults and families
If a game gets someone to practise balance exercises regularly instead of not exercising, it may modestly improve balance. If they already do a good, progressive balance programme, we do not know whether putting it on a screen adds anything. Choose the format they will actually use. A game is not proven to prevent falls and should not replace professional assessment after recent or repeated falls. [1,3]
For rehabilitation and care teams
Exergaming is best viewed as a way to deliver exercise—not as a better treatment. It may add motivation, repetition and feedback. In assisted living, one supported programme improved balance compared with advice and an exercise leaflet, but it was not compared with an equally supported conventional class. Use it as a supervised addition or pilot, not a replacement for staff, assessment or established strength-and-balance work. [1–3]
Bottom line
Exergaming may improve balance-test scores when it helps people exercise more consistently. It has not been shown to work better than a well-run non-gaming programme, or to prevent falls, injuries or loss of independence. Its main value is making useful exercise easier to repeat.