# Augmented Reality and Virtual Reality in Exergaming
## 4 Discussion
### Outcomes and Implications
Therefore, it can be inferred that the combination of physical and mental activity through XR exergames can be more effective than traditional exercise alone. The relationship between XR-based exergaming and the broader field of digital medicine, which is _\"poised to transform biomedical research, clinical practice and the commercial sector\"_[201], should also be considered. Both areas capitalize on emerging technologies to support health and well-being, but their goals and contexts of use often differ. Digital medicine capitalizes on advanced technologies, such as artificial intelligence, machine learning, and big data analytics, to support the diagnosis, treatment, and management of disease, typically involving clinical oversight and targeting specific patient populations [202]. Given its scope and nature, digital medicine heavily relies on interoperability and data integrity [203]. On the contrary, XR exergaming primarily aims to promote physical activity, engagement, and general well-being, often among healthy individuals. While it may be used for prevention and rehabilitation purposes, its core design typically emphasizes accessibility, enjoyment, and motivation rather than clinical outcomes. This distinction between promoting health in healthy individuals and treating illness in patients highlights different priorities in design, evaluation, and implementation. Finally, it is important to note that although the studies generally reported positive outcomes, there was a significant disparity in the types of technologies adopted. Specifically, the overwhelming majority of studies focused on exploring the use of VR in exergaming (n = 432, perc. = 84.05%). Fewer studies examined the use of AR in exergaming (n = 52, perc. = 10.12%) while significantly fewer studies focused on mixed reality (n = 18, perc. = 3.50%) and XR (n = 11, perc. = 2.14%). Only a single study (0.19%) explored exergaming within the metaverse. The related outcomes can also be seen in Figure 11.  
The predominance of VR in exergaming research can be attributed to its technological maturity, wide availability, and ability to provide fully immersive and controlled environments. These qualities make VR especially suitable for experimental designs, clinical applications, and rehabilitation settings where consistency and standardization are essential. Despite its promising potential, AR has received considerably less attention in exergaming research compared to VR. This limited focus can be attributed to several factors, including the technological challenges of AR deployment, such as device compatibility, reliance on real-world environments, and variability in the settings of physical environments. Additionally, AR applications often require more complex development to integrate physical activity with real-time environmental overlays. The lack of established AR exergaming platforms and fewer commercial tools compared to VR have also contributed to its underrepresentation in the literature, despite its unique advantages, such as increased accessibility, lower cost, and the potential for seamless integration into everyday environments. However, this technological disparity limits the generalizability of findings and highlights a critical research gap. The limited exploration of AR, mixed reality, XR, and metaverse applications highlights the need for broader investigation into these emerging platforms, particularly given their unique features and advantages. Figure 11: Exergaming applied technology distribution.