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

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.