New approaches are needed to address low physical activity levels among older adults and to promote daily physical activity tailored to their interests and abilities. This study aimed to review the current literature analyzing the physiological demands of exergames in older adults. A systematic database search was conducted in October 2020 and March 2022. A total of 3,540 studies were screened, and 16 were incorporated into the data analysis. The studies included 527 participants, 61% female, with a mean age of 72.3 ± 4.7 years. Analyzed physiological parameters included mean heart rate, rate of perceived exertion, and metabolic equivalents or oxygen uptake. Exergames are capable of offering light- to moderate-intensity activity for older adults (mean heart rate: 108 ± 9.1 bpm; mean rate of perceived exertion: 11.5 ± 1.8; metabolic equivalents: 2.7 ± 0.7). Although implications are positive, high diversity was found in the study design according to intervention duration and assessment of physiological parameters.