JMIR Publications

ABSTRACT

Though exergames attract considerable research interest as tools for preserving cognitive function in older adults, a decade of meta-analytic evidence reveals a persistent gap between theoretical promise and empirical demonstration: exergames rarely outperform conventional motor-cognitive training and do not generate the sustained engagement that preventive benefit requires. These results reflect limitations that are structural: the field focused predominantly on clinical populations rather than primary prevention; training concepts borrowed from rehabilitation protocols rather than grounded in the specific neuroplastic mechanisms of the exergaming medium; and virtual environments that are digitally sophisticated but culturally and aesthetically neutral, systematically excluding the stimulation that converging evidence from neuro-aesthetics, cultural epidemiology, and narrative neuroscience identifies as a core active ingredient of brain health promotion. To address these limitations simultaneously, this Viewpoint introduces Motor-cognitive Active Gamified Immersive Cultural (MAGIC) exergames, defined as “virtual reality solutions in which motor-cognitive interactions are embedded in artistic content, cultural heritage, or historically situated narrative to exploit optimal neurobiological substrates of the intervention”. Drawing on an integrated theoretical framework, we develop mutually reinforcing mechanistic pillars: multimodal sensorimotor engagement within ecologically valid immersive environments; semantic and narrative activation of memory systems; emotional and autobiographical resonance as a dopaminergic driver of learning consolidation and sustained participation; and the re-engineering of physical effort evaluation from aversive to appetitive through aesthetic pleasure and narrative absorption. A fundamental implication is that in MAGIC exergames, motivation is not engineered through gamification mechanics — it is released by the intrinsic value of inhabiting a culturally meaningful world. We further argue MAGIC exergames correspond to a specific use that is, Cultural Snacking, which consists of the serialization of MAGIC content into brief, narratively open daily episodes of 5 to 10 minutes, designed for 3 to 5 daily consumptions across varied contexts. This dosing architecture is compatible with the motivational profile of healthy older adults who do not identify as patients or trainees. The paper opens perspectives with a design and research agenda structured around three priorities: characterizing MAGIC exergames by the type of motor-cognitive interactions they deliver rather than by the technology platform; conducting mechanistic neuroimaging investigations targeting the specific biomarkers of neuroplastic benefit that creative cultural engagement is expected to produce; and building the intersectoral innovation ecosystem that brings cultural institutions, digital health teams, and older adults together as co-designers. Without waiting for MAGIC-specific trials, we invite the digital medicine, public health, and silver economy communities to recognize that museums, heritage sites, and cultural institutions are potentially the most ecologically valid, intrinsically motivating, and cost-effective substrates for a new generation of brain health exergames that are as meaningful as they are effective. The scientific, institutional, and economic conditions for this convergence already exist.