Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Advertisement

npj Digital Medicine
  • View all journals
  • Search
  • My Account Login
  • Content Explore content
  • About the journal
  • Publish with us
  • Sign up for alerts
  • RSS feed
  1. nature
  2. npj digital medicine
  3. articles
  4. article
Effectiveness, acceptability, adherence, and safety of exergaming for depressive symptoms: a systematic review and meta-analysis
Download PDF
Download PDF
  • Article
  • Open access
  • Published: 25 February 2026

Effectiveness, acceptability, adherence, and safety of exergaming for depressive symptoms: a systematic review and meta-analysis

  • Di Tang1,2,
  • Chang Liu3,
  • Jinde Liu4,
  • Tong Liu5,
  • Ruisi Ma6 &
  • …
  • Kim-wai Raymond Sum1 

npj Digital Medicine , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Diseases
  • Health care
  • Medical research
  • Psychology

Abstract

Depression is a pervasive global disorder affecting 350 million people. Exergaming has emerged as a unique intervention for improving depressive symptoms by combining video games with physical exercise. However, existing evidence regarding its therapeutic effects remains inconsistent across studies. This systematic review and meta-analysis evaluated the effectiveness, safety, acceptability, adherence, and cost-effectiveness of exergaming interventions for depressive symptoms. We searched six major databases (PubMed, Cochrane Library, Scopus, PsycInfo, SPORTDiscus, and Web of Science) from inception to April 30, 2025, identifying 58 controlled trials involving 3614 participants. Using a multilevel random-effects model, we found that exergaming demonstrated a moderate, significant reduction in depression symptoms (g = −0.40, 95% CI: −0.56 to −0.25, p < 0.0001), with significant moderating effects observed for intervention frequency (showing larger effects for >3 times/week) and control group type (larger effects compared to no intervention/usual care). Additionally, a trend toward significance was found for age (p = 0.07), with larger effects observed in older adults (≥60 years). Furthermore, exergaming interventions showed high adherence rates, a good safety profile, and reasonable cost-effectiveness. Future larger-scale randomized controlled trials are needed to confirm these findings, alongside studies with extended follow-up periods to evaluate long-term sustainability.

Similar content being viewed by others

Effect and acceptability of different exercise modes on adult patients with clinically diagnosed depression: a network meta-analysis

Article Open access 29 September 2025

Assessment of goal-directed behavior and prospective memory in adult ADHD with an online 3D videogame simulating everyday tasks

Article Open access 08 June 2023

Exploring the interrelationships among physical exercise, visuospatial working memory, and depression symptoms in university students

Article Open access 22 December 2025

Data availability

The datasets generated and/or analyzed during the current study, including the extracted study characteristics and outcome data used for meta-analyses, are available from the corresponding author upon reasonable request.

References

  1. Ferrari, A. J. et al. Burden of depressive disorders by country, sex, age, and year: findings from the Global Burden of Disease Study 2010. PLoS Med. 10, e1001547 (2013).

    Google Scholar 

  2. Bromet, E. et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 9, 90 (2011).

    Google Scholar 

  3. World Health Organization. Depression and Other Common Mental Disorders. https://www.who.int/publications/i/item/depression-global-health-estimates.

  4. Rugulies, R. Depression as a predictor for coronary heart disease: a review and meta-analysis1 1The full text of this article is available via AJPM Online at. Am. J. Prev. Med. 23, 51–61 (2002).

    Google Scholar 

  5. Jacobson, N. C. & Newman, M. G. Anxiety and depression as bidirectional risk factors for one another: a meta-analysis of longitudinal studies. Psychol. Bull. 143, 1155–1200 (2017).

    Google Scholar 

  6. Pinquart, M. & Duberstein, P. R. Depression and cancer mortality: a meta-analysis. Psychol. Med. 40, 1797–1810 (2010).

    Google Scholar 

  7. Santomauro, D. F. et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet 398, 1700–1712 (2021).

    Google Scholar 

  8. Cullen, W., Gulati, G. & Kelly, B. D. Mental health in the COVID-19 pandemic. QJM Int. J. Med. 113, 311–312 (2020).

    Google Scholar 

  9. Holmes, E. A. et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 7, 547–560 (2020).

    Google Scholar 

  10. Malhi, G. S. et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust. N. Z. J. Psychiatry 55, 7–117 (2021).

    Google Scholar 

  11. Cipriani, A. et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 391, 1357–1366 (2018).

    Google Scholar 

  12. Cuijpers, P. et al. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry 19, 92–107 (2020).

    Google Scholar 

  13. Cuijpers, P. et al. Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World Psychiatry 20, 283–293 (2021).

    Google Scholar 

  14. Cuijpers, P. et al. Psychologic treatment of depression compared with pharmacotherapy and combined treatment in primary care: a network meta-analysis. Ann. Fam. Med. 19, 262–270 (2021).

    Google Scholar 

  15. McHugh, R. K. & Barlow, D. H. The dissemination and implementation of evidence-based psychological treatments: a review of current efforts. Am. Psychol. 65, 73–84 (2010).

    Google Scholar 

  16. Gundlach, A. & Knight, K. D. Practice guideline for the treatment of patients with major depressive disorder. American Psychiatric Association. Am. J. Psychiatry 161, 1 (2021).

    Google Scholar 

  17. Jakobsen, J. C. et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and trial sequential analysis. BMC Psychiatry 17, 58 (2017).

    Google Scholar 

  18. Wise, J. NICE guidance on depression: 35 health organisations demand “full and proper” revision. BMJ 365, l2356 (2019).

    Google Scholar 

  19. Strawbridge, R. et al. Augmentation therapies for treatment-resistant depression: systematic review and meta-analysis. Br. J. Psychiatry 214, 42–51 (2019).

    Google Scholar 

  20. Swift, J. K. & Greenberg, R. P. Premature discontinuation in adult psychotherapy: a meta-analysis. J. Consult. Clin. Psychol. 80, 547–559 (2012).

    Google Scholar 

  21. Moitra, M. et al. The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: a systematic review and Bayesian meta-regression analysis. PLoS Med. 19, e1003901 (2022).

    Google Scholar 

  22. Thornicroft, G. et al. Undertreatment of people with major depressive disorder in 21 countries. Br. J. Psychiatry 210, 119–124 (2017).

    Google Scholar 

  23. Luo, C. et al. A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: a systematic review and meta-analysis. eClinicalMedicine 24, 100442 (2020).

  24. Erbe, D., Eichert, H.-C., Riper, H. & Ebert, D. D. Blending face-to-face and internet-based interventions for the treatment of mental disorders in adults: systematic review. J. Med. Internet Res. 19, e6588 (2017).

    Google Scholar 

  25. Torous, J. et al. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry 20, 318–335 (2021).

    Google Scholar 

  26. Heissel, A. et al. Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. Br. J. Sports Med. 57, 1049–1057 (2023).

    Google Scholar 

  27. Noetel, M. et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ 384, e075847 (2024).

    Google Scholar 

  28. Singh, B. et al. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br. J. Sports Med. 57, 1203–1209 (2023).

    Google Scholar 

  29. Recchia, F. et al. Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression: a systematic review and network meta-analysis of randomised controlled trials. Br. J. Sports Med. 56, 1375–1380 (2022).

    Google Scholar 

  30. Association, A. P. Practice guideline for the treatment of patients with major depressive disorder (third edition). American Psychiatric Association. Am. J. Psychiatry 167, 1 (2010).

    Google Scholar 

  31. National Collaborating Centre for Mental Health (UK). Depression: The Treatment and Management of Depression in Adults (Updated Edition) (British Psychological Society, 2010).

  32. Kvam, S., Kleppe, C. L., Nordhus, I. H. & Hovland, A. Exercise as a treatment for depression: a meta-analysis. J. Affect. Disord. 202, 67–86 (2016).

    Google Scholar 

  33. Schuch, F. B. et al. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J. Psychiatr. Res. 77, 42–51 (2016).

    Google Scholar 

  34. Gordon, B. R. et al. Association of efficacy of resistance exercise training with depressive symptoms: meta-analysis and meta-regression analysis of randomized clinical trials. JAMA Psychiatry 75, 566–576 (2018).

    Google Scholar 

  35. Li, J., Theng, Y.-L. & Foo, S. Effect of exergames on depression: a systematic review and meta-analysis. Cyberpsychol. Behav. Soc. Netw. 19, 34–42 (2016).

    Google Scholar 

  36. Staiano, A. E. & Calvert, S. L. Exergames for physical education courses: physical, social, and cognitive benefits. Child Dev. Perspect. 5, 93–98 (2011).

    Google Scholar 

  37. Lieberman, D. A. et al. The Power of Play: Innovations in Getting Active Summit 2011. Circulation 123, 2507–2516 (2011).

    Google Scholar 

  38. O’Loughlin, E. K. et al. Exergaming in youth and young adults: a narrative overview. Games Health J. 9, 314–338 (2020).

    Google Scholar 

  39. Oh, Y. & Yang, S. Defining exergames & exergaming. in Proceedings of Meaningful Play 2010 21–23 (2010).

  40. Peng, W., Crouse, J. C. & Lin, J.-H. Using active video games for physical activity promotion: a systematic review of the current state of research. Health Educ. Behav. 40, 171–192 (2013).

    Google Scholar 

  41. Chao, Y.-Y., Scherer, Y. K. & Montgomery, C. A. Effects of using Nintendo WiiTM exergames in older adults: a review of the literature. J. Aging Health 27, 379–402 (2015).

    Google Scholar 

  42. Biddiss, E. & Irwin, J. Active video games to promote physical activity in children and youth: a systematic review. Arch. Pediatr. Adolesc. Med. 164, 664–672 (2010).

    Google Scholar 

  43. Baranowski, T., Buday, R., Thompson, D. I. & Baranowski, J. Playing for real: video games and stories for health-related behavior change. Am. J. Prev. Med. 34, 74–82.e10 (2008).

    Google Scholar 

  44. Sardi, L., Idri, A. & Fernández-Alemán, J. L. A systematic review of gamification in e-Health. J. Biomed. Inform. 71, 31–48 (2017).

    Google Scholar 

  45. Cacciata, M. et al. Effect of exergaming on health-related quality of life in older adults: a systematic review. Int. J. Nurs. Stud. 93, 30–40 (2019).

    Google Scholar 

  46. van Santen, J. et al. Effects of exergaming in people with dementia: results of a systematic literature review. J. Alzheimer’s. Dis. 63, 741–760 (2018).

    Google Scholar 

  47. Benzing, V. & Schmidt, M. Exergaming for children and adolescents: strengths, weaknesses, opportunities and threats. J. Clin. Med. 7, 422 (2018).

    Google Scholar 

  48. Peng, Y. et al. Virtual reality exergames for improving physical function, cognition and depression among older nursing home residents: a systematic review and meta-analysis. Geriatr. Nur. 57, 31–44 (2024).

    Google Scholar 

  49. Barry, G., Galna, B. & Rochester, L. The role of exergaming in Parkinson’s disease rehabilitation: a systematic review of the evidence. J. Neuroeng. Rehabil. 11, 33 (2014).

    Google Scholar 

  50. Höchsmann, C., Schüpbach, M. & Schmidt-Trucksäss, A. Effects of exergaming on physical activity in overweight individuals. Sports Med. 46, 845–860 (2016).

    Google Scholar 

  51. Ambrosino, P., Fuschillo, S., Papa, A., Di Minno, M. N. D. & Maniscalco, M. Exergaming as a supportive tool for home-based rehabilitation in the COVID-19 pandemic era. Games Health J. 9, 311–313 (2020).

    Google Scholar 

  52. Viana, R. B. & de Lira, C. A. B. Exergames as coping strategies for anxiety disorders during the COVID-19 quarantine period. Games Health J. 9, 147–149 (2020).

    Google Scholar 

  53. Drazich, B. F. et al. Exergames and depressive symptoms in older adults: a systematic review. Games Health J. 9, 339–345 (2020).

    Google Scholar 

  54. Andrade, A., Correia, C. K. & Coimbra, D. R. The psychological effects of exergames for children and adolescents with obesity: a systematic review and meta-analysis. Cyberpsychol. Behav. Soc. Netw. 22, 724–735 (2019).

    Google Scholar 

  55. Yen, H.-Y. & Chiu, H.-L. Virtual reality exergames for improving older adults’ cognition and depression: a systematic review and meta-analysis of randomized control trials. J. Am. Med. Dir. Assoc. 22, 995–1002 (2021).

    Google Scholar 

  56. Huang, K. et al. Exergame-based exercise training for depressive symptoms in adults: a systematic review and meta-analysis. Psychol. Sport Exerc. 63, 102266 (2022).

    Google Scholar 

  57. Fernandes, C. S. et al. Impact of exergames on the mental health of older adults: a systematic review and GRADE evidence synthesis. Games Health J. 11, 355–368 (2022).

    Google Scholar 

  58. Kashi, S. K. & Saatchian, V. Effectiveness of exergame intervention on depressive symptoms, daily living activities, and fear of falling in older adults: a systematic review and meta-analysis of randomized controlled trials. Clin. Gerontol. 49, 5–19 (2026).

  59. Cheung, D. S. K. et al. The effects of exergaming on the depressive symptoms of people with dementia: a systematic review and meta-analysis. J. Clin. Nurs. 34, 1648–1664 (2025).

    Google Scholar 

  60. Marques, L. M., Uchida, P. M. & Barbosa, S. P. The impact of Exergames on emotional experience: a systematic review. Front. Public Health 11, 1209520 (2023).

  61. O’Loughlin, E. K., Dugas, E. N., Sabiston, C. M. & O’Loughlin, J. L. Prevalence and correlates of exergaming in youth. Pediatrics 130, 806–814 (2012).

    Google Scholar 

  62. O’Loughlin, E. K. et al. The change in exergaming from before to during the COVID-19 pandemic among young adults: longitudinal study. JMIR Serious Games 11, e41553 (2023).

    Google Scholar 

  63. Ellis, L. A. et al. COVID-19 as ‘game changer’ for the physical activity and mental well-being of augmented reality game players during the pandemic: mixed methods survey study. J. Med. Internet Res. 22, e25117 (2020).

    Google Scholar 

  64. Takei, K., Morita, S. & Watanabe, Y. Acceptability of physical therapy combined with nintendo ring fit adventure exergame for geriatric hospitalized patients. Games Health J. 13, 33–39 (2024).

    Google Scholar 

  65. Tena-Monferrer, S. & Fandos-Roig, J. C. Nintendo and COVID-19: From Stockout to Increasing Sales. https://doi.org/10.4135/9781529793864 (SAGE Publications, 2022).

  66. Bond, S., Laddu, D. R., Ozemek, C., Lavie, C. J. & Arena, R. Exergaming and virtual reality for health: implications for cardiac rehabilitation. Curr. Probl. Cardiol. 46, 100472 (2021).

    Google Scholar 

  67. Born, F., Abramowski, S. & Masuch, M. Exergaming in VR: the impact of immersive embodiment on motivation, performance, and perceived exertion. in Proc. 2019 11th International Conference on Virtual Worlds and Games for Serious Applications (VS-Games) 1–8. https://doi.org/10.1109/VS-Games.2019.8864579 (2019).

  68. Sakamoto, H. et al. Could video game-based physical rehabilitation substitute for conventional physiotherapy in patients with glioma? A proof-of-concept study. Support. Care Cancer 33, 52 (2024).

    Google Scholar 

  69. Klompstra, L., Hägglund, E., Jaarsma, T., Kato, N. P. & Strömberg, A. Effects of exergaming and yoga on exercise capacity and physical and mental health in heart failure patients: a randomized sub-study. Eur. J. Cardiovasc. Nurs. 24, 389–398 (2025).

    Google Scholar 

  70. Hsieh, R.-L., Chen, Y.-R. & Lee, W.-C. Short-term effects of exergaming on patients with chronic low back pain: a single-blind randomized controlled trial. Musculoskelet. Sci. Pract. 75, 103248 (2025).

    Google Scholar 

  71. Yuenyongchaiwat, K. et al. Effects of virtual exercise on cardio-pulmonary performance and depression in cardiac rehabilitation phase I: a randomized control trial. Physiother. Res. Int. 29, e2066 (2024).

    Google Scholar 

  72. Wong, A. K. C. et al. The effect of young people–assisted, individualized, motion-based video games on physical, cognitive, and social frailty among community-dwelling older adults with frailty: randomized controlled trial. JMIR Serious Games 12, e57352 (2024).

    Google Scholar 

  73. Swinnen, N. et al. The feasibility of a stepping exergame prototype for older adults with major neurocognitive disorder residing in a long-term care facility: a mixed methods pilot study. Disabil. Rehabil. 46, 896–910 (2024).

    Google Scholar 

  74. Nuic, D. et al. Home-based exergaming to treat gait and balance disorders in patients with Parkinson’s disease: a phase II randomized controlled trial. Eur. J. Neurol. 31, e16055 (2024).

    Google Scholar 

  75. Massah, N., Kahrizi, S. & Neblett, R. Comparison of the acute effects of virtual reality exergames and core stability exercises on cognitive factors, pain, and fear avoidance beliefs in people with chronic nonspecific low back pain. Games Health J. 14, 233–241 (2025).

    Google Scholar 

  76. Ferreira, S. et al. Effects of multimodal exercise with augmented reality on cognition in community-dwelling older adults. J. Am. Med. Dir. Assoc. 25, 104954 (2024).

    Google Scholar 

  77. Alves, I. et al. Exergame-based rehabilitation for cancer patients undergoing abdominal surgery: Effects on pain, anxiety, depression, and fatigue - A pilot study. Eur. J. Oncol. Nurs. 72, 102665 (2024).

    Google Scholar 

  78. Abbas, R. L. et al. Effect of adding virtual reality training to traditional exercise program on pain, mental status and psychological status in unilateral traumatic lower limb amputees: a randomized controlled trial. Games Health J. 13, 245–251 (2024).

    Google Scholar 

  79. Abd-Alrazaq, A. et al. The effectiveness of serious games for alleviating depression: systematic review and meta-analysis. JMIR Serious Games 10, e32331 (2022).

    Google Scholar 

  80. Jóźwik, S., Cieślik, B., Gajda, R. & Szczepańska-Gieracha, J. Evaluation of the impact of virtual reality-enhanced cardiac rehabilitation on depressive and anxiety symptoms in patients with coronary artery disease: a randomised controlled trial. J. Clin. Med. 10, 2148 (2021).

    Google Scholar 

  81. Vieira, Á, Melo, C., Machado, J. & Gabriel, J. Virtual reality exercise on a home-based phase III cardiac rehabilitation program, effect on executive function, quality of life and depression, anxiety and stress: a randomized controlled trial. Disabil. Rehabil. Assist. Technol. 13, 112–123 (2018).

    Google Scholar 

  82. Buckinx, F. et al. The effects of GAMotion (a giant exercising board game) on physical capacity, motivation and quality of life among nursing home residents: a pilot interventional study. Exp. Gerontol. 138, 110983 (2020).

    Google Scholar 

  83. Stanmore, E. K. et al. The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55 years and older in UK assisted living facilities: a multi-centre, cluster randomised controlled trial. BMC Med. 17, 49 (2019).

    Google Scholar 

  84. Andrade, A., Correia, C. K., Cruz da, W. M. & Bevilacqua, G. G. Acute effect of exergames on children’s mood states during physical education classes. Games Health J. 8, 250–256 (2019).

    Google Scholar 

  85. Mohr, D. C. et al. The selection and design of control conditions for randomized controlled trials of psychological interventions. Psychother. Psychosom. 78, 275–284 (2009).

    Google Scholar 

  86. Ekkekakis, P. Honey, I shrunk the pooled SMD! Guide to critical appraisal of systematic reviews and meta-analyses using the Cochrane review on exercise for depression as example. Ment. Health Phys. Act. 8, 21–36 (2015).

    Google Scholar 

  87. Benitez-Lugo, M.-L., Suárez-Serrano, C., Galvao-Carmona, A., Vazquez-Marrufo, M. & Chamorro-Moriana, G. Effectiveness of feedback-based technology on physical and cognitive abilities in the elderly. Front. Aging Neurosci. 14, 1050518 (2022).

  88. Chao, Y.-Y., Scherer, Y. K., Montgomery, C. A., Wu, Y.-W. & Lucke, K. T. Physical and psychosocial effects of wii fit exergames use in assisted living residents: a pilot study. Clin. Nurs. Res. 24, 589–603 (2015).

    Google Scholar 

  89. Cicek, A., Ozdincler, A. R. & Tarakci, E. Interactive video game-based approaches improve mobility and mood in older adults: a nonrandomized, controlled tri̇al. J. Bodyw. Mov. Ther. 24, 252–259 (2020).

    Google Scholar 

  90. Eggenberger, P., Wolf, M., Schumann, M. & de Bruin, E. D. Exergame and balance training modulate prefrontal brain activity during walking and enhance executive function in older adults. Front. Aging Neurosci. 8, 66 (2016).

  91. Gomes, G. C. V. et al. Feasibility, safety, acceptability, and functional outcomes of playing Nintendo Wii Fit PlusTM for frail older adults: a randomized feasibility clinical trial. Maturitas 118, 20–28 (2018).

    Google Scholar 

  92. Jahouh, M. et al. Impact of an intervention with Wii video games on the autonomy of activities of daily living and psychological–cognitive components in the institutionalized elderly. Int. J. Environ. Res. Public. Health 18, 1570 (2021).

    Google Scholar 

  93. Khushnood, K., Altaf, S., Sultan, N., Mehmood, R. & Qureshi, S. Role of Wii Fit exer-games in improving balance confidence and quality of life in elderly population. J. Pak. Med. Assoc. 71, 2130–2134 (2021).

    Google Scholar 

  94. Lee, K. Home-based exergame program to improve physical function, fall efficacy, depression and quality of life in community-dwelling older adults: a randomized controlled trial. Healthcare 11, 1109 (2023).

    Google Scholar 

  95. Levy, F. et al. Fear of falling: efficacy of virtual reality associated with serious games in elderly people. Neuropsychiatr. Dis. Treat. 12, 877–881 (2016).

    Google Scholar 

  96. Liu, W. Effects of virtual reality exercise on promoting physical activity and health among college students: a 4-week randomized controlled trial. PhD thesis, University of Minnesota (2021).

  97. Rendon, A. A. et al. The effect of virtual reality gaming on dynamic balance in older adults. Age Ageing 41, 549–552 (2012).

    Google Scholar 

  98. Rica, R. L. et al. Effects of a Kinect-based physical training program on body composition, functional fitness and depression in institutionalized older adults. Geriatr. Gerontol. Int. 20, 195–200 (2020).

    Google Scholar 

  99. Rodrigues, E. V. et al. Effects of dance exergaming on depressive symptoms, fear of falling, and musculoskeletal function in fallers and nonfallers community-dwelling older women. Rejuvenation Res. 21, 518–526 (2018).

    Google Scholar 

  100. Schoene, D. et al. Interactive cognitive-motor step training improves cognitive risk factors of falling in older adults – a randomized controlled trial. PLoS ONE 10, e0145161 (2015).

    Google Scholar 

  101. Wan Yunus, F., Tan, X. Z. & Romli, M. H. Investigating the feasibility of exergame on sleep and emotion among university students. Games Health J. 9, 415–424 (2020).

    Google Scholar 

  102. Monteiro-Junior, R. S. et al. Virtual reality–based physical exercise with exergames (physex) improves mental and physical health of institutionalized older adults. J. Am. Med. Dir. Assoc. 18, 454.e1–454.e9 (2017).

  103. Moret, B., Nucci, M. & Campana, G. Effects of exergames on mood and cognition in healthy older adults: a randomized pilot study. Front. Psychol. 13 (2022).

  104. Sturnieks, D. L. et al. Exergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trial. Nat. Med. 30, 98–105 (2024).

    Google Scholar 

  105. Unver, G., Tuna, H. I. & Alparslan, G. B. The effect of virtual reality application on pain, functional independence, and depression in the older adults: a pilot study. J. Gen. Med. Genel Tıp Derg. 33, 205–211 (2023).

    Google Scholar 

  106. Carvalho, M. S. de et al. Effects of exergames in women with fibromyalgia: a randomized controlled study. Games Health J. 9, 358–367 (2020).

    Google Scholar 

  107. Cavusoglu, I., Tarakci, D., Zenginler Yazgan, Y. & Yavuz, S. Comparison of effectiveness of Nintendo Wii-based exergaming and home-based fun video exercises in pediatric patients with chronic kidney disease. Int. J. Rehabil. Res. 46, 26 (2023).

    Google Scholar 

  108. Collado-Mateo, D., Dominguez-Muñoz, F. J., Adsuar, J. C., Garcia-Gordillo, M. A. & Gusi, N. Effects of exergames on quality of life, pain, and disease effect in women with fibromyalgia: a randomized controlled trial. Arch. Phys. Med. Rehabil. 98, 1725–1731 (2017).

    Google Scholar 

  109. García-Bravo, S. et al. Effects of virtual reality on cardiac rehabilitation programs for ischemic heart disease: a randomized pilot clinical trial. Int. J. Environ. Res. Public. Health 17, 8472 (2020).

    Google Scholar 

  110. Li, W. H., Chung, J. O. & Ho, E. K. The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. J. Clin. Nurs. 20, 2135–2143 (2011).

    Google Scholar 

  111. Lin, Y.-T., Lee, W.-C. & Hsieh, R.-L. Active video games for knee osteoarthritis improve mobility but not WOMAC score: A randomized controlled trial. Ann. Phys. Rehabil. Med. 63, 458–465 (2020).

    Google Scholar 

  112. Polat, M., Kahveci, A., Muci, B., Günendi, Z. & Kaymak Karataş, G. The effect of virtual reality exercises on pain, functionality, cardiopulmonary capacity, and quality of life in fibromyalgia syndrome: a randomized controlled study. Games Health J. 10, 165–173 (2021).

    Google Scholar 

  113. Wi, S. Y., Kang, J. H. & Jang, J. H. Clinical feasibility of exercise game for depression treatment in older women with osteoarthritis: a pilot study. J. Phys. Ther. Sci. 25, 165–167 (2013).

    Google Scholar 

  114. Zhou, H. et al. Application of wearables to facilitate virtually supervised intradialytic exercise for reducing depression symptoms. Sensors 20, 1571 (2020).

    Google Scholar 

  115. Maynard, L. G. et al. Effects of exercise training combined with virtual reality in functionality and health-related quality of life of patients on hemodialysis. Games Health J. 8, 339–348 (2019).

    Google Scholar 

  116. Ruivo, J. M. A. et al. In-class active video game supplementation and adherence to cardiac rehabilitation. J. Cardiopulm. Rehabil. Prev. 37, 274 (2017).

    Google Scholar 

  117. Turoń-Skrzypińska, A. et al. Impact of virtual reality exercises on anxiety and depression in hemodialysis. Sci. Rep. 13, 12435 (2023).

    Google Scholar 

  118. Cano-Mañas, M. J., Collado-Vázquez, S., Rodríguez Hernández, J., Muñoz Villena, A. J. & Cano-de-la-Cuerda, R. Effects of video-game based therapy on balance, postural control, functionality, and quality of life of patients with subacute stroke: a randomized controlled trial. J. Healthc. Eng. 2020, 5480315 (2020).

    Google Scholar 

  119. Ferraz, D. D. et al. The effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly patients with parkinson disease: a pilot randomized controlled single-blinded trial. Arch. Phys. Med. Rehabil. 99, 826–833 (2018).

    Google Scholar 

  120. Manser, P., Poikonen, H. & de Bruin, E. D. Feasibility, usability, and acceptance of “Brain-IT”—A newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: a pilot randomized controlled trial. Front. Aging Neurosci. 15, 1163388 (2023).

  121. Meldrum, D. et al. Effectiveness of conventional versus virtual reality–based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch. Phys. Med. Rehabil. 96, 1319–1328.e1 (2015).

    Google Scholar 

  122. Ozdogar, A. T., Ertekin, O., Kahraman, T., Yigit, P. & Ozakbas, S. Effect of video-based exergaming on arm and cognitive function in persons with multiple sclerosis: a randomized controlled trial. Mult. Scler. Relat. Disord. 40, 101966 (2020).

    Google Scholar 

  123. Ozdogar, A. T. et al. Effects and safety of exergaming in persons with multiple sclerosis during corticosteroid treatment: a pilot study. Mult. Scler. Relat. Disord. 63, 103823 (2022).

    Google Scholar 

  124. Ozdogar, A. T., Ertekin, O., Kahraman, T., Dastan, S. & Ozakbas, S. Effect of exergaming in people with restless legs syndrome with multiple sclerosis: a single-blind randomized controlled trial. Mult. Scler. Relat. Disord. 70, 104480 (2023).

    Google Scholar 

  125. Shin, J.-H., Bog Park, S. & Ho Jang, S. Effects of game-based virtual reality on health-related quality of life in chronic stroke patients: a randomized, controlled study. Comput. Biol. Med. 63, 92–98 (2015).

    Google Scholar 

  126. Song, G. B. & Park, E. C. Effect of virtual reality games on stroke patients’ balance, gait, depression, and interpersonal relationships. J. Phys. Ther. Sci. 27, 2057–2060 (2015).

    Google Scholar 

  127. Swinnen, N. et al. The efficacy of exergaming in people with major neurocognitive disorder residing in long-term care facilities: a pilot randomized controlled trial. Alzheimers Res. Ther. 13, 70 (2021).

    Google Scholar 

  128. Thomas, S. et al. Mii-vitaliSe: a pilot randomised controlled trial of a home gaming system (Nintendo Wii) to increase activity levels, vitality and well-being in people with multiple sclerosis. BMJ Open 7, e016966 (2017).

    Google Scholar 

  129. Tollár, J., Nagy, F. & Hortobágyi, T. Vastly different exercise programs similarly improve parkinsonian symptoms: a randomized clinical trial. Gerontology 65, 120–127 (2018).

    Google Scholar 

  130. Tollár, J. et al. Exercise effects on multiple sclerosis quality of life and clinical-motor symptoms. Med. Sci. Sports Exerc. 52, 1007–1014 (2020).

    Google Scholar 

  131. Zheng, J., Yu, P. & Chen, X. An evaluation of the effects of active game play on cognition, quality of life and depression for older people with dementia. Clin. Gerontol. 45, 1034–1043 (2022).

    Google Scholar 

  132. Hortobágyi, T. et al. Comparative effectiveness of 4 exercise interventions followed by 2 years of exercise maintenance in multiple sclerosis: a randomized controlled trial. Arch. Phys. Med. Rehabil. 103, 1908–1916 (2022).

    Google Scholar 

  133. Taylor, D. Physical activity is medicine for older adults. Postgrad. Med. J. 90, 26–32 (2014).

    Google Scholar 

  134. Chodzko-Zajko, W. J. et al. Exercise and physical activity for older adults. Med. Sci. Sports Exerc. 41, 1510–1530 (2009).

    Google Scholar 

  135. Gabriel, D. A., Kamen, G. & Frost, G. Neural adaptations to resistive exercise. Sports Med. 36, 133–149 (2006).

    Google Scholar 

  136. Adkins, D. L., Boychuk, J., Remple, M. S. & Kleim, J. A. Motor training induces experience-specific patterns of plasticity across motor cortex and spinal cord. J. Appl. Physiol. 101, 1776–1782 (2006).

    Google Scholar 

  137. Jessup, J. V., Horne, C., Vishen, R. K. & Wheeler, D. Effects of exercise on bone density, balance, and self-efficacy in older women. Biol. Res. Nurs. 4, 171–180 (2003).

    Google Scholar 

  138. Oinas-Kukkonen, H. & Harjumaa, M. Persuasive systems design: key issues, process model and system features 1. in Routledge Handbook of Policy Design (Routledge, 2018).

  139. Davis, F. A Technology Acceptance Model for Empirically Testing New End-User Information Systems. PhD Thesis (Massachusetts Institute of Technology, 1985).

  140. Taylor, L. M., Kerse, N., Frakking, T. & Maddison, R. Active video games for improving physical performance measures in older people: a meta-analysis. J. Geriatr. Phys. Ther. 41, 108 (2018).

    Google Scholar 

  141. Kappen, D. L., Mirza-Babaei, P. & Nacke, L. E. Older adults’ physical activity and exergames: a systematic review. Int. J. Hum. Comput. Interact. 35, 140–167 (2019).

    Google Scholar 

  142. Rhodes, R. E., Fiala, B. & Conner, M. A review and meta-analysis of affective judgments and physical activity in adult populations. Ann. Behav. Med. 38, 180–204 (2009).

    Google Scholar 

  143. Ekkekakis, P., Parfitt, G. & Petruzzello, S. J. The pleasure and displeasure people feel when they exercise at different intensities. Sports Med. 41, 641–671 (2011).

    Google Scholar 

  144. Lin, H.-H., Wang, Y.-S. & Chou, C.-H. Hedonic and utilitarian motivations for physical game systems use behavior. Int. J. Hum. Comput. Interact. 28, 445–455 (2012).

    Google Scholar 

  145. Sinclair, J., Hingston, P. & Masek, M. Considerations for the design of exergames. in Proc. 5th international conference on Computer graphics and interactive techniques in Australia and Southeast Asia 289–295. https://doi.org/10.1145/1321261.1321313. (ACM, 2007).

  146. Göbel, S., Hardy, S., Wendel, V., Mehm, F. & Steinmetz, R. Serious games for health: personalized exergames. in Proc. 18th ACM International Conference on Multimedia 1663–1666. https://doi.org/10.1145/1873951.1874316 (ACM, 2010).

  147. Venkatesh, V. & Davis, F. D. A theoretical extension of the technology acceptance model: four longitudinal field studies. Manag. Sci. 46, 186–204 (2000).

    Google Scholar 

  148. Venkatesh, V., Thong, J. Y. L. & Xu, X. Consumer acceptance and use of information technology: extending the unified theory of acceptance and use of technology. MIS Q 36, 157–178 (2012).

    Google Scholar 

  149. Rhodes, R. E., Warburton, D. E. R. & Bredin, S. S. D. Predicting the effect of interactive video bikes on exercise adherence: an efficacy trial. Psychol. Health Med. 14, 631–640 (2009).

    Google Scholar 

  150. Carlson, M. C. et al. Association between executive attention and physical functional performance in community-dwelling older women. J. Gerontol. Ser. B 54B, S262–S270 (1999).

    Google Scholar 

  151. Grigsby, J., Kaye, K., Baxter, J., Shetterly, S. M. & Hamman, R. F. Executive cognitive abilities and functional status among community-dwelling older persons in the san luis valley health and aging study. J. Am. Geriatr. Soc. 46, 590–596 (1998).

    Google Scholar 

  152. La Greca, A. M. & Harrison, H. M. Adolescent peer relations, friendships, and romantic relationships: do they predict social anxiety and depression? J. Clin. Child Adolesc. Psychol. 34, 49–61 (2005).

    Google Scholar 

  153. Cole, M. G. & Dendukuri, N. Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. Am. J. Psychiatry 160, 1147–1156 (2003).

    Google Scholar 

  154. Chen, Y., Zhang, Y., Guo, Z., Bao, D. & Zhou, J. Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis. J. Neuroeng. Rehabil. 18, 164 (2021).

    Google Scholar 

  155. Lapierre, N., Um Din, N., Belmin, J. & Lafuente-Lafuente, C. Exergame-assisted rehabilitation for preventing falls in older adults at risk: a systematic review and meta-analysis. Gerontology 69, 757–767 (2023).

    Google Scholar 

  156. Fang, Q. et al. Effects of exergaming on balance of healthy older adults: a systematic review and meta-analysis of randomized controlled trials. Games Health J. 9, 11–23 (2020).

    Google Scholar 

  157. Nawaz, A. et al. Usability and acceptability of balance exergames in older adults: a scoping review. Health Inform. J. 22, 911–931 (2016).

    Google Scholar 

  158. Page, M. J. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372, n71 (2021).

    Google Scholar 

  159. Spitzer, R. L., Endicott, J. & Robins, E. Research diagnostic criteria: rationale and reliability. Arch. Gen. Psychiatry 35, 773–782 (1978).

    Google Scholar 

  160. Pollock, A. et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke. Cochrane Database Syst. Rev. CD001920. https://doi.org/10.1002/14651858.cd001920.pub3 (2014).

  161. Murdoch, E. M. et al. The effectiveness of stress regulation interventions with athletes: a systematic review and multilevel meta-analysis of randomised controlled trials. Int. Rev. Sport Exerc. Psychol. 17, 145–181 (2024).

    Google Scholar 

  162. Liu, C., Liang, X. & Sit, C. H. P. Physical activity and mental health in children and adolescents with neurodevelopmental disorders: a systematic review and meta-analysis. JAMA Pediatr. 178, 247–257 (2024).

    Google Scholar 

  163. Fernández-Castilla, B. et al. Detecting selection bias in meta-analyses with multiple outcomes: a simulation study. J. Exp. Educ. 89, 125–144 (2021).

    Google Scholar 

  164. Peters, J. L., Sutton, A. J., Jones, D. R., Abrams, K. R. & Rushton, L. Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J. Clin. Epidemiol. 61, 991–996 (2008).

    Google Scholar 

  165. Schimmack, U. A Revised Introduction to the R-Index. Replicability-Index. https://replicationindex.com/2016/01/31/a-revised-introduction-to-the-r-index/ (2016).

Download references

Acknowledgements

This study received no funding.

Author information

Authors and Affiliations

  1. Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, China

    Di Tang & Kim-wai Raymond Sum

  2. The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China

    Di Tang

  3. Vanke School of Public Health, Tsinghua University, Beijing, China

    Chang Liu

  4. Faculty of Physical Education, Fudan University, Shanghai, China

    Jinde Liu

  5. School of Psychology and Mental Health, North China University of Science and Technology, Tangshan, China

    Tong Liu

  6. Faculty of Physical Education, Jinan University, Guangzhou, China

    Ruisi Ma

Authors
  1. Di Tang
    View author publications

    Search author on:PubMed Google Scholar

  2. Chang Liu
    View author publications

    Search author on:PubMed Google Scholar

  3. Jinde Liu
    View author publications

    Search author on:PubMed Google Scholar

  4. Tong Liu
    View author publications

    Search author on:PubMed Google Scholar

  5. Ruisi Ma
    View author publications

    Search author on:PubMed Google Scholar

  6. Kim-wai Raymond Sum
    View author publications

    Search author on:PubMed Google Scholar

Contributions

D.T., C.L., and K.R.S. formulated the research question and conceived the study. Literature screening, data extraction, and quality assessment were performed by D.T., C.L., and J.L. CL performed the data analysis and visualization, while D.T. wrote the initial draft. KRS provided supervision throughout the project and revised the initial manuscript. All authors (D.T., C.L., J.L., T.L., R.M., and K.R.S.) contributed to data interpretation, manuscript revision, and approved the final version. D.T. and K.R.S. have accessed and verified the data and were responsible for the decision to submit the manuscript.

Corresponding author

Correspondence to Kim-wai Raymond Sum.

Ethics declarations

Competing interests

All authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplementary information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tang, D., Liu, C., Liu, J. et al. Effectiveness, acceptability, adherence, and safety of exergaming for depressive symptoms: a systematic review and meta-analysis. npj Digit. Med. (2026). https://doi.org/10.1038/s41746-026-02479-8

Download citation

  • Received: 18 September 2025

  • Accepted: 13 February 2026

  • Published: 25 February 2026

  • DOI: https://doi.org/10.1038/s41746-026-02479-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Download PDF

Associated content

Collection

Effective Trialing of Digital Interventions

Advertisement

Explore content

  • Research articles
  • Reviews & Analysis
  • News & Comment
  • Collections
  • Follow us on X
  • Sign up for alerts
  • RSS feed

About the journal

  • Aims and scope
  • Content types
  • Journal Information
  • About the Editors
  • Contact
  • Editorial policies
  • Calls for Papers
  • Journal Metrics
  • About the Partner
  • Open Access
  • Early Career Researcher Editorial Fellowship
  • Editorial Team Vacancies
  • News and Views Student Editor
  • Communication Fellowship

Publish with us

  • For Authors and Referees
  • Language editing services
  • Open access funding
  • Submit manuscript

Search

Advanced search

Quick links

  • Explore articles by subject
  • Find a job
  • Guide to authors
  • Editorial policies

npj Digital Medicine (npj Digit. Med.)

ISSN 2398-6352 (online)

nature.com sitemap

About Nature Portfolio

  • About us
  • Press releases
  • Press office
  • Contact us

Discover content

  • Journals A-Z
  • Articles by subject
  • protocols.io
  • Nature Index

Publishing policies

  • Nature portfolio policies
  • Open access

Author & Researcher services

  • Reprints & permissions
  • Research data
  • Language editing
  • Scientific editing
  • Nature Masterclasses
  • Research Solutions

Libraries & institutions

  • Librarian service & tools
  • Librarian portal
  • Open research
  • Recommend to library

Advertising & partnerships

  • Advertising
  • Partnerships & Services
  • Media kits
  • Branded content

Professional development

  • Nature Awards
  • Nature Careers
  • Nature Conferences

Regional websites

  • Nature Africa
  • Nature China
  • Nature India
  • Nature Japan
  • Nature Middle East
  • Privacy Policy
  • Use of cookies
  • Legal notice
  • Accessibility statement
  • Terms & Conditions
  • Your US state privacy rights
Springer Nature

© 2026 Springer Nature Limited

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing