Background: Active video games (AVGs) have become popular and have been investigated for their therapeutic purposes. However, the effect of AVGs on patients with knee osteoarthritis (OA) remains uncertain.

Objective: We aimed to compare the effects of AVGs with those of traditional therapeutic exercise on patients with knee OA.

Method: This was a prospective single-blind, randomized controlled trial. Participants (n = 80) with knee OA were allocated to the AVGs group (n = 40) or therapeutic exercise group (n = 40). Both groups received treatment 3 times a week for 4 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and secondary outcome measures were the World Health Organization Quality of Life-Brief Vision, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, physical functional performance (including time for 10-m walking and for ascending and descending stairs), Biodex Stability System, Chronic Pain Grade Questionnaire, and Work Ability Index. The patients were evaluated at baseline, 2 and 4 weeks after treatment, and 1 and 3 months after treatment completion.

Results: Both groups showed significant time effect in the pain subcategory of the WOMAC (p = 0.047). However, we found no significant group × time interaction effect between the groups at any follow-up assessments for pain (p = 0.066), stiffness (p = 0.284), or physical function (p = 0.179) for the WOMAC. Among the secondary outcomes, we found significant group × time effects favoring the AVG group in dynamic balance (p = 0.020), and physical functional performance including 10-m walking time (p = 0.002) and stair ascent time (p = 0.005), and the physical domain of health (p = 0.032).

Conclusions: Therapeutic exercises and playing AVGs similarly improved the pain of patients with knee OA; however, playing AVGs improved dynamic balance, physical functional performance, and physical health more than therapeutic exercises did.