BackgroundConventional exercises (CEs) can provide health benefits for older adults, but the long-term exercise adherence rate is low. As an emerging, stimulating, and self-motivating strategy, exergames (EGs) are defined as combinations of exercises and games that users carry out through physical actions. They can promote exercise, but the health effects of EGs versus CEs on the physical function and mental health (cognitive function, depression, and quality of life) of older adults remain controversial.ObjectiveThe aim of the study is to compare the health benefits of EGs versus those of CEs for the physical function and mental health of older adults.MethodsA comprehensive search was conducted from the earliest available date to February 2023 in the following 6 databases: PubMed, Web of Science, Embase, Cochrane, CINAHL, and PsycINFO. All English-language randomized controlled trials comparing the effects of EGs versus those of CEs on the physical function and mental health of older adults, with nearly same physical activity between the 2 interventions, were included. Risk of bias was independently evaluated by 2 authors using the Cochrane risk of bias in randomized trials tool. Two authors independently extracted data. We followed theCochrane Handbook of Systematic Reviews of Interventionsto process and analyze the data for meta-analysis. Standardized mean differences (SMDs) and 95% CIs were used for continuous data, and random models were used for analyses.ResultsWe included 12 studies consisting of 919 participants in total. Of these, 10 studies were eventually included in the meta-analysis. The results showed that EGs versus CEs exhibited no significant differences in physical (P=.13;τ2=0.31;χ26=26.6;I2=77%; SMD=0.37; 95% CI –0.11 to 0.86) or cognitive function (P=.63;τ2=0.01;χ23=3.1;I2=4%; SMD=0.09; 95% CI –0.27 to 0.44) effects.ConclusionsOur findings indicate no significant difference between EGs and CEs in improving the physical function and cognitive function of older adults. Future studies are required to compare the effects of EGs versus those of CEs on cognitive function according to cognitive status, quantify the “dose-effect” relationship between EGs and health benefits, and evaluate the effects of different types and devices of EGs with regard to the health benefits of older adults.Trial RegistrationPROSPERO CRD42022322734; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=322734