# The Effects of Exergames on Muscle Architecture: A Systematic Review and Meta-Analysis
###### Abstract  
Muscle architectural parameters play a crucial role in the rate of force development, strength, and sports performance. On the other hand, deteriorated muscle architectural parameters are associated with injuries, sarcopenia, mortality, falls, and fragility. With the development of technology, exergames have emerged as a complementary tool for physical therapy programs. The PRISMA 2020 statement was followed during the systematic review and meta-analysis. CENTRAL, CINAHL, PROQUEST, PubMed, and OpenGrey databases were searched last time on 22 September 2021. In total, five controlled trials were included in the systematic review. Twelve weeks of virtual dance exercise (Dance Central game for Xbox 360\({}^{\text{th}}\)) showed a medium effect on the improvement of hammstrings (\(g=0.55\), 95% CI (\(-0.03\), 1.14), \(\text{I}^{2}=0\%\)) and the quadriceps femoris muscle cross-sectional area (\(g=0.58\), 95% CI (\(0.1,1.00\)), \(\text{I}^{2}=0\%\)) in community-dwelling older women. Additionally, a four-week virtual balance-training program (the ProKin System) led to significant increments in the cross-sectional areas of individual paraspinal muscles (14.55-46.81%). However, previously investigated exergame programs did not show any medium or large effects on the architectural parameters of the medial gastrocnemius muscle in community-dwelling older women. Distinct exergame programs can be used as a complementary therapy for different prevention and rehabilitation programs.  
interactive features, it has been stated that exergames might increase commitment to exercise [46; 47; 48; 49]. Exergames, which mimic cycling, dancing, running, walking, playing a sport modality, and resistance training, have become commercially available [50; 51; 52; 53; 54; 55; 56]. Nowadays, exergames have been used in various rehabilitation programs for cerebral palsy, Parkinson's disease, stroke, obesity, or sarcopenia [57]. A review article pointed out that using exergames in physical therapy resulted in similar improvements as with conventional therapy in most cases [57].  
Numerous systematic reviews have focused on the effects of exergames on several outcomes, including anxiety level [53], balance [58; 59; 60; 61], cardiac rehabilitation [62; 63], childhood obesity [64; 65], cognition [66; 77; 68; 79; 80; 81; 82; 83; 84; 85; 86; 87; 88; 89; 90; 91; 92; 93; 94; 95; 96; 97; 98; 99;  
The eligibility criteria included studies (1) investigating the effects of an exergame intervention; (2) presenting magnetic resonance imaging (MRI) or ultrasound measured alterations in one or more specifically defined muscle architectural parameter(s) as an outcome; (3) that were a full-text journal article; (4) written in the English language.  
Duplicate records were removed by using the EndNote \(\mathcal{X}^{9}\) computer program [90]. After the removal of duplicates, the remaining records were independently screened by the first (N.S.) and second authors (G.Y.) in a blinded status via Raysan--a web and mobile app for systematic reviews [91]. Similarly, data extraction of the eligible studies was independently performed by the lead (N.S.) and second (G.Y.) authors. Disagreements about selecting the studies and extracting data were solved by discussion between the lead (N.S.) and second (G.Y.) authors, and the third author (T.Y.) was considered as referee in the case of unsolved disagreements. The first and second authors were blind to each other's decisions during the whole screening process. In the case of the absence of full-text versions of the articles, the articles were obtained by contacting the Bangor University and Tokyo Metropolitan University libraries.