BACKGROUND: Active computer gaming (ACG) is a method of facilitating physical activity in older people to improve health outcomes. PURPOSE: The purpose of this study was to update and extend a systematic review of the evidence for ACG to determine its effects on physical and cognitive health in older adults. DATA SOURCES: Medline, Embase, CENTRAL in the Cochrane Library, and PsycINFO databases were searched from the date of the previous review (2011) to May 2016. STUDY SELECTION: Eligible articles were randomized controlled trials (RCTs) investigating the effect of ACG in adults aged 65 and older. DATA EXTRACTION: Thirty-five studies were eligible for inclusion. Two review authors independently conducted data extraction, risk-of-bias assessment, and coding of behavior change techniques (BCTs). Outcomes of interest were analyzed as continuous data and pooled as standardized mean differences (SMD) and 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of the evidence. DATA SYNTHESIS: Behavior change techniques (n = 106) were coded in the included studies (mean 3.02). Data were pooled for 5 main outcomes of interest. Significant moderate effects in favor of ACG were observed for balance (SMD 0.52, 95% CI 0.24 to 0.79; 17 studies; 743 participants), for functional exercise capacity when intervention delivery was > 120 minutes per week (SMD 0.53, 95% CI 0.15 to 0.90; 5 studies; 116 participants), and for cognitive function (SMD -0.48, 95% CI -0.80 to 0.17; 8 studies; 459 participants). There was no significant effect observed for functional mobility or fear of falling. Limitations: The quality of the evidence for all comparisons was graded low or very low. CONCLUSIONS: At present there is very little confidence that ACG improves physical and cognitive outcomes in older adults.

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