VIRTUAL REALITY AND EXERGAMING FOR FALL PREVENTION IN OLDER ADULTS: A REVIEW OF CLINICAL EFFICACY AND PATIENT ENGAGEMENT
Abstract
Background: Falls are a primary cause of injury and loss of independence among older adults. Digital technologies like virtual reality (VR) and exergaming are increasingly used to enhance balance and mobility, yet their overall clinical efficacy requires synthesis.
Objective: This review consolidates evidence from 2015–2024 regarding the effectiveness of VR and exergaming interventions on fall prevention, specifically examining balance, functional mobility, dual-task performance, and patient engagement.
Methods: A narrative review was conducted using PubMed to identify peer-reviewed studies, including randomized controlled trials and meta-analyses. The review included interventions targeting balance or fall risk in adults aged 60 and older.
Results: The synthesized evidence indicates that both VR and exergaming yield significant improvements in balance, gait adaptability, and dual-task performance. These interventions utilize multisensory feedback and gamification to integrate cognitive and motor skills, thereby supporting motor learning and adherence. However, findings concerning actual reductions in fall incidence remain mixed due to methodological variations and limited long-term follow-up.
Conclusion: VR and exergaming serve as effective, engaging complementary tools for fall prevention. While they reliably improve functional outcomes, future research must focus on standardizing protocols and evaluating long-term efficacy to support clinical implementation.
References
Moreland, B., Kakara, R., & Henry, A. (2020). Trends in nonfatal falls and fall-related injuries among adults aged ≥65 years—United States, 2012–2018. MMWR. Morbidity and Mortality Weekly Report, 69(27), 875–881. https://doi.org/10.15585/mmwr.mm6927a5
MacKay, S., Sherrington, C., & Clemson, L. (2021). Fear of falling in older adults: A scoping review of recent literature. Canadian Geriatrics Journal, 24(4), 379–394. https://doi.org/10.5770/cgj.24.521
Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(1), CD012424. https://doi.org/10.1002/14651858.CD012424.pub2
Valenzuela, T., Okubo, Y., Woodbury, A., Lord, S. R., & Delbaere, K. (2018). Adherence to technology-based exercise programs in older adults: A systematic review. Journal of Geriatric Physical Therapy, 41(1), 49–61. https://doi.org/10.1519/JPT.0000000000000095
Mirelman, A., Rochester, L., Maidan, I., Del Din, S., Alcock, L., Nieuwboer, A., Ryland, D., Nackaerts, E., Hrasensky, E., Landau, E., Bertucco, M., Brodie, M. A., Lord, S. R., Pesenty, D., Eitan, V., & Hausdorff, J. M. (2016). Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): A randomised controlled trial. The Lancet, 388(10050), 1170–1178. https://doi.org/10.1016/S0140-6736(16)31325-3
Corregidor-Sánchez, A. I., Segura-Fragoso, A., Rodríguez-Hernández, M., Jiménez-Rojas, C., & Polonio-López, B. (2020). Can exergames contribute to improving walking capacity in older adults? A systematic review and meta-analysis. Maturitas, 132, 40–48. https://doi.org/10.1016/j.maturitas.2019.12.006
Skjæret, N., Nawaz, A., Morat, T., Schoene, D., Helbostad, J. L., & Vereijken, B. (2016). Exercise and rehabilitation delivered through exergames in older adults: An integrative review of technologies, safety and efficacy. International Journal of Medical Informatics, 85, 1–16. https://doi.org/10.1016/j.ijmedinf.2015.10.008
Huang, W.-Y., Chang, S.-T., Lee, C.-H., Liou, I.-H., & Cherng, R.-J. (2024). Effects of virtual reality on the balance performance of older adults: A systematic review and meta-analysis. Journal of Physical Therapy Science, 36(8), 457–470. https://doi.org/10.1589/jpts.36.457
Di Lorito, C., Long, A., Byrne, A., Harwood, R. H., Gladman, J. R. F., Schneider, S., Logan, P., & van der Wardt, V. (2021). Exercise interventions for older adults: A systematic review of meta-analyses. Journal of Sport and Health Science, 10(1), 29–47. https://doi.org/10.1016/j.jshs.2020.06.003
Chen, X., Wu, L., Feng, H., Ning, H., Wu, S., Hu, M., Jiang, D., Chen, Y., Jiang, Y., & Liu, X. (2023). Comparison of exergames versus conventional exercises on the health benefits of older adults: Systematic review with meta-analysis of randomized controlled trials. JMIR Serious Games, 11, e42374. https://doi.org/10.2196/42374
Huang, W.-Y., Chang, S.-T., Lee, C.-H., Liou, I.-H., & Cherng, R.-J. (2024). Effects of virtual reality on the balance performance of older adults: A systematic review and meta-analysis. Journal of Physical Therapy Science, 36(8), 457–470. https://doi.org/10.1589/jpts.36.457
Pacheco, T. B. F., de Medeiros, C. S. P., de Oliveira, V. H. B., Vieira, E. R., & de Cavalcanti, F. A. C. (2020). Effectiveness of exergames for improving mobility and balance in older adults: A systematic review and meta-analysis. Systematic Reviews, 9(1), 163. https://doi.org/10.1186/s13643-020-01421-7
Fang, Q., Ghanouni, P., Anderson, S. E., Touchett, H., Shirley, R., Fang, F., & Fang, C. (2020). Effects of exergaming on balance of healthy older adults: A systematic review and meta-analysis of randomized controlled trials. Games for Health Journal, 9(1), 11–23. https://doi.org/10.1089/g4h.2019.0016
Leal, J. C., Belo, V. S., Morselli Santos, I., Ferreira, R. V., Nascimento de Melo, S., & da Silva, E. S. (2023). Exergames in older adult community centers and nursing homes to improve balance and minimize the risk of falls in older adults: A systematic review and meta-analysis. Healthcare, 11(13), 1872. https://doi.org/10.3390/healthcare11131872
Saragih, I. D., Chen, Y.-M., Suarilah, I., Susanto, H., & Lee, B.-O. (2025). Virtual reality intervention for fall prevention in older adults: A meta-analysis. Journal of Nursing Scholarship, 57(5), 759–775. https://doi.org/10.1111/jnu.70028
Fang, Q., Ghanouni, P., Anderson, S. E., Touchett, H., Shirley, R., Fang, F., & Fang, C. (2020). Effects of exergaming on balance of healthy older adults: A systematic review and meta-analysis of randomized controlled trials. Games for Health Journal, 9(1), 11–23. https://doi.org/10.1089/g4h.2019.0016
Pacheco, T. B. F., de Medeiros, C. S. P., de Oliveira, V. H. B., Vieira, E. R., & de Cavalcanti, F. A. C. (2020). Effectiveness of exergames for improving mobility and balance in older adults: A systematic review and meta-analysis. Systematic Reviews, 9(1), 163. https://doi.org/10.1186/s13643-020-01421-7
Ren, Y., Lin, C., Zhou, Q., Yingyuan, Z., Wang, G., & Lu, A. (2023). Effectiveness of virtual reality games in improving physical function, balance and reducing falls in balance-impaired older adults: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 108, 104924. https://doi.org/10.1016/j.archger.2023.104924
Zahedian-Nasab, H., Jaberi, A., Shirazi, F., Lotfi, M., & Rajabi, M. (2021). Effect of virtual reality exercises on balance and fall in elderly people with fall risk: A randomized controlled trial. BMC Geriatrics, 21(1), 509. https://doi.org/10.1186/s12877-021-02462-w
Lee, J., Okubo, Y., et al. (2024). Effects of immersive virtual reality training on balance, gait and mobility in older adults: A systematic review and meta-analysis. Gait & Posture, 110, 129–137. https://doi.org/10.1016/j.gaitpost.2024.03.009
Chen, X., Wu, L., Feng, H., Ning, H., Wu, S., Hu, M., Jiang, D., Chen, Y., Jiang, Y., & Liu, X. (2023). Comparison of exergames versus conventional exercises on the health benefits of older adults: Systematic review with meta-analysis of randomized controlled trials. JMIR Serious Games, 11, e42374. https://doi.org/10.2196/42374
Rodríguez-Almagro, D., Achalandabaso-Ochoa, A., Ibáñez-Vera, A. J., Góngora-Rodríguez, J., & Rodríguez-Huguet, M. (2024). Effectiveness of virtual reality therapy on balance and gait in the elderly: A systematic review. Healthcare, 12(2), 158. https://doi.org/10.3390/healthcare12020158
Wang, L.-T. (2024). Effects of semi-immersive virtual reality exercise on the quality of life of community-dwelling older adults: Three-month follow-up of a randomized controlled trial. Digital Health, 10, 20552076241237391. https://doi.org/10.1177/20552076241237391
Hernández-Martínez, J., Ramos-Espinoza, F., Muñoz-Vásquez, C., Guzmán-Muñoz, E., Herrera-Valenzuela, T., Branco, B. H. M., Castillo-Cerda, M., & Valdés-Badilla, P. (2024). Effects of active exergames on physical performance in older people: An overview of systematic reviews and meta-analysis. Frontiers in Public Health, 12, 1250299. https://doi.org/10.3389/fpubh.2024.1250299
Copyright (c) 2026 Michał Pietrucha, Filip Kowal, Kamila Krzyżanowska, Jakub Król, Adrian Dyląg, Maciej Łydka, Justyna Lewandowska, Natalia Libudzic, Julia Łaciak, Marta Godyń
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
