Efficacy of exergame interventions on muscle strength in older adults: A systematic review and meta-analysis

BACKGROUND: The decline in muscle strength among older adults significantly affects their quality of life and independence, while increasing the risk of falls and associated complications. Given the limitations of traditional resistance training, there is an urgent need for innovative interventions to address these challenges effectively. OBJECTIVE: This study evaluated the efficacy of exergames in improving muscle strength among older adults, focusing on handgrip strength, (lower body strength), arm curl (upper body strength), and knee extension. METHODS: A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines and registered on PROSPER(CDR42024588218). Databases searched included PubMed, Embase, MEDLINE, Web of Science, and CINAHL were searched from inception to 11 September 2024. Eligible 22 high-quality RCTs were included with a PEDro score ≥ 6. The analysis compared exergames to control or usual care groups in enhancing muscle strength. RESULTS: A total of 22 RCTs involving 1312 participants were included. Versus usual care: Exergames significantly improved handgrip strength (SMD = 2.82, 95 %CI[0.42,5.21], P < 0.001) and chair stand (SMD = 2.69, 95 %CI[2.37,3.00], P < 0.001), but both had extreme heterogeneity (I² = 98 %). Arm curl showed significant effects (SMD = 7.99, 95 %CI[7.34,8.65], P < 0.001) with high publication bias and heterogeneity (I² = 95 %); Versus non-exercise controls: Handgrip strength results were non-robust (SMD = -0.80, 95 %CI[-1.33,-0.28], P = 0.003, I² = 95 %); chair stand had no significant difference (SMD = 0.17, 95 %CI[-0.16,0.50], P = 0.32, I² = 95 %). Knee extension analysis was invalid due to conflicting effect directions in 2 studies. CONCLUSION: Insufficient evidence due to heterogeneous comparators for improving handgrip strength and chair stand (lower body strength) in older adults when compared to usual care. However, conclusions are limited by extreme between-study heterogeneity (I² = 95 %-98 %), small total sample size (n = 1312), high publication bias for some outcomes, and lack of direct comparisons with traditional interventions (e.g., resistance training). Findings are limited by lack of standardized usual care definitions (64 % of studies). More homogeneous, large-scale studies are needed to validate efficacy.