Effects of non-immersive exergames on executive functions in healthy older adults. A systematic review and meta-analysis

Introduction: Exergames have been proposed as an innovative and accessible strategy to stimulate cognitive functions in older adults. However, available evidence has shown heterogeneous and methodologically limited findings. Objective: The aim was to evaluate the effects of chronic exergame interventions on the main dimensions of cold executive functions in cognitively healthy older adults, compared with active or passive control groups. Methodology: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Randomized and non-randomized trials lasting at least eight weeks were included if they compared exergames with control groups and reported pre- and post-intervention measures of executive functions using validated instruments. Searches were conducted on PubMed, Scopus, Web of Science, and CINAHL Complete. Results: Ten studies were included, applying programs through platforms such as Nintendo Wii, Xbox Kinect, and Nintendo Switch. The meta-analysis revealed very small and non-significant effects on working memory, cognitive flexibility, and inhibition, with moderate to high heterogeneity across studies. Sensitivity analyses confirmed the robustness of the results. Discussion: The findings partially coincided with previous reviews, although differences in duration, intensity, and type of exergame explained the heterogeneity. It was highlighted that, despite their limited cognitive effectiveness, exergames offer motivational and adherence benefits. Conclusions: Exergames may specifically benefit inhibition in older adults, while effects on working memory and cognitive flexibility remain uncertain.