Abstract Background Active computer gaming (ACG) is a method of facilitating physical activity in older people to improve health outcomes. Purpose The purpose of this study was to update and extend a systematic review of the evidence for ACG to determine its effects on physical and cognitive health in older adults. Data Sources MEDLINE, EMBASE, CENTRAL in the Cochrane Library, and PsycINFO databases were searched from the date of the previous review (2011) to May 2016. Study Selection Eligible articles were randomized controlled trials (RCTs) investigating the effect of ACG in adults aged 65 and older. Data Extraction Thirty-five studies were eligible for inclusion. Two review authors independently conducted data extraction, risk-of-bias assessment, and coding of behavior change techniques. Outcomes of interest were analyzed as continuous data and pooled as standardized mean differences (SMD) and 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to determine the quality of the evidence. Data Synthesis Behavior change techniques (N = 106) were coded in the included studies (mean = 3.02). Data were pooled for 5 main outcomes of interest. Significant moderate effects in favor of ACG were observed for balance (SMD = 0.52, 95% CI = 0.24 to 0.79; 17 studies; 743 participants), for functional exercise capacity when intervention delivery was >120 minutes per week (SMD = 0.53, 95% CI = 0.15 to 0.90; 5 studies; 116 participants), and for cognitive function (SMD = –0.48, 95% CI = –0.80 to 0.17; 8 studies; 459 participants). There was no significant effect observed for functional mobility or fear of falling. Limitations The quality of the evidence for all comparisons was graded low or very low. Conclusions At present there is very little confidence that ACG improves physical and cognitive outcomes in older adults.