Exercise-based interventions for internet gaming disorder: current evidence, mechanistic rationale, and the augmenting role of serious games and digital therapeutics

Background Internet gaming disorder (IGD) is an emerging public health concern among adolescents and young adults and is associated with adverse mental health, cognitive, academic and social outcomes. Exercise-based interventions may reduce IGD symptoms, but long-term adherence remains challenging. Emerging digital health technologies, including serious games, digital therapeutics, wearable devices, artificial intelligence (AI) and neuromodulation, may improve engagement, personalisation and behavioral change. Objective This narrative review synthesises current evidence on exercise-based interventions for IGD and examines the complementary roles of serious games, digital therapeutics, wearable technologies, AI-assisted personalisation and neuromodulation in treatment engagement, adherence, assessment and monitoring. It also identifies evidence gaps and priorities for future research. Methods A narrative review was performed based on literature identified through PubMed, Scopus, and Web of Science up to March 2026, with relevant later publications also considered. We synthesised evidence regarding exercise interventions and emerging digital health technologies for the prevention and management of IGD. Results Exercise-based interventions may reduce IGD symptoms and improve executive function and emotional regulation, although findings vary across modalities and protocols. Serious games and exergaming may enhance motivation and adherence, while digital therapeutics such as virtual reality-based interventions remain supported by limited clinical evidence. Neuromodulation, particularly transcranial direct current stimulation, may improve inhibitory control, although effects on craving are inconsistent and no trial has combined tDCS with exercise in IGD. Wearable and AI-assisted approaches have mainly been studied for IGD assessment, classification and behavioral monitoring, with no direct evidence of clinical outcome benefits. Adaptive intervention delivery has been demonstrated mainly in non-IGD digital health settings. Safety data are limited because adverse events were not consistently assessed or reported. Overall, evidence remains constrained by heterogeneous designs, small samples, inconsistent outcomes and limited long-term follow-up. Conclusion Combining exercise with digital health technologies is a conceptually promising but not yet empirically validated approach to improve IGD management. Future research should prioritise high-quality multicentre randomised controlled trials, standardised outcomes, long-term follow-up, mechanistic validation, real-world implementation and ethical considerations for AI-enabled interventions in adolescents.