Effects of exergaming on brain health in aging: a scoping review of current evidence.

Background: The rapid aging of the global population has increased the need for engaging, scalable interventions to support brain health in aging populations. Exergaming, which integrates physical activity with game-based cognitive demands, has shown promise in this regard. Objective: This scoping review aimed to map and synthesize current evidence on electrophysiological, functional, structural, and molecular (BDNF) markers associated with exergaming in older adults, and to identify whether existing comparative studies suggest benefits beyond or comparable to traditional exercise. Methods: This review was conducted as a scoping review and reported in accordance with the PRISMA extension for Scoping Reviews (PRISMA-ScR). PubMed, Scopus, Web of Science, and PsycINFO were searched from inception to October 20, 2025. Two independent reviewers screened records and charted data, with disagreements resolved by a third reviewer. Results: We included 22 studies (17 randomized controlled trials and 5 non-randomized controlled trials). Electrophysiologically, eight studies reported changes in event-related potential components and theta/alpha rhythm power. Functionally, several studies reported reduced task-related prefrontal activation or altered resting-state connectivity, although these changes may reflect neural efficiency, motor automaticity, task familiarization, or a combination of these processes. Structurally, two of three MRI studies reported increased gray matter volume or attenuated volume decline in selected regions. At the molecular level, seven studies measured peripheral BDNF, but between-group superiority over traditional exercise was inconsistent. Conclusion: Current evidence suggests that exergaming may be associated with favorable changes in several markers of brain health in older adults, including neuroelectrical activity, task-related and resting-state brain function, selected structural indices, and peripheral BDNF. However, the evidence remains preliminary because studies differ substantially in population, intervention content, dose, comparator, and outcome measurement. Claims about cognitive-motor synergy and causal pathways linking BDNF, brain structure, functional efficiency, and cognition should therefore be interpreted as hypotheses for future research rather than established conclusions. Comparable effects should be interpreted as showing that game-based delivery can preserve exercise-related benefits, not as proof that gaming itself adds a distinct neurobiological effect. Overall, the current evidence more strongly supports comparability and potential implementation value than a distinct neurobiological advantage of gaming.