OBJECTIVE: The objective of this review was to systematically evaluate the effectiveness of exergaming on walking in older adults. In addition, the aim was to investigate the relationship between the exergaming effect and age, baseline walking performance, exercise traits, technology used and the risk of bias. METHODS: A literature search was carried out in the databases Medline, CINAHL, CENTRAL, Embase, WoS, PsycINFO and PEDro up to January 10, 2020. Studies with a randomized controlled trial (RCT) design, people >= 60 years of age without neurological disorders, comparison group with other exercise or no exercise, and walking related outcomes were included. Cochrane RoB2, meta-analysis, meta-regression, and GRADE were used to estimate quality, treatment effect, covariates' effect, and the certainty of evidence, respectively. RESULTS: In the studies included (n = 66), the overall risk of bias was low (n = 2), unclear (n = 48) or high (n = 16). Compared with comparison groups, exergaming interventions were more effective for walking improvements (SMD -0.21; 95% CI -0.36 to -0.06; 3,102 participants, 58 studies; moderate-quality evidence) and more or equally effective (SMD -0.32; 95% CI -0.64 to 0.00; 1,028 participants, 13 studies; low-quality evidence) after nonexergaming follow-up. The strongest effect for covariates was observed with the type of comparison group, explaining 18.6% of the variance. CONCLUSIONS: For older adults without neurological disorders, exergame-based training improved walking, and improvements were maintained at follow-up. Greater benefits were observed when exergaming groups were compared to inactive comparison groups. To strengthen the evidence, further RCTs on the effectiveness of gamified exercise intervention are needed. IMPACT: Exergaming has effect equivalent to other types of exercising on improving walking in older adults. Physical therapists and other rehabilitation professionals may consider exergaming as a promising form of exercise in this age group.

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