Commercial exergames for rehabilitation of physical health and quality of life: a systematic review of randomized controlled trials with adults in unsupervised home environments

BACKGROUND: Commercial exergames are widely available tools that can support physical rehabilitation at home. However, the effects of the unsupervised use of commercial exergames in home environments are not yet clear. Hence, we provide a systematic review on the effects of unsupervised commercial exergaming at home on adults' physical health (RQ1) and quality of life (RQ2). We also scrutinize adults' experiences with exergaming at home regarding participant support, adherence, and adverse outcomes (RQ3). METHODS: We searched Web of Science, PsycINFO, PubMed, Embase, and CINAHL for peer-reviewed randomized controlled trials with adults in need of rehabilitation. Overall, 20 studies (1,558 participants, 1,368 analyzed) met our inclusion criteria. The quality of evidence was assessed with the Cochrane risk of bias tool. RESULTS: Effects of unsupervised commercial exergaming at home on physical health were higher in seven studies and similar in five studies regarding the respective comparison or control conditions; eight studies reported non-significant findings. Of the 15 studies that also examined effects on quality of life, improvements were higher in seven studies and similar in two studies regarding the respective comparison or control conditions; results were non-significant in six studies. Participant support consisted of setup of the exergaming system, instructions, training, and contact with participants. Adherence was high in eight studies, moderate in six studies, and low in one study. Adverse outcomes related to exergaming were found in four studies and were at most moderate. Concerning the quality of evidence, six studies were related to a high risk of bias due to outcome reporting bias or ceiling effects in the primary outcome. Additionally, 10 studies yielded some concerns, and four studies were related to a low risk of bias. DISCUSSION: This systematic review summarizes promising evidence that the unsupervised use of commercial exergames can support and complement rehabilitation measures in home environments. Still, future studies based on larger samples and using more recent commercial exergames are needed to obtain more high-quality evidence on the effects of different exercise prescriptions. Overall, considering the necessary precautions, the unsupervised use of commercial exergames at home can improve the physical health and quality of life in adults with needs for physical rehabilitation. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341189, identifier: PROSPERO, Registration number: CRD42022341189.