Purpose <p>The study determined whether an exergame training (EXT) resulted in greater improvements in health-related outcomes compared to traditional moderate-intensity continuous training (MICT).</p> Methods <p>In total, 47 individuals (age 30±11 years) were randomized into an EXT (n = 24) and an MICT group (n = 23). Throughout the eight-week intervention period, the EXT group attended 20–30 min of EXT three times a week while the MICT group completed 20–45 min of MICT three times a week. Before and after the intervention, BMI, waist-to-height ratio, body fat (BF), resting heart rate (HR), root mean square of successive differences between normal heartbeats (RMSSD), standard deviation of all normal-to-normal intervals (SDNN), average time interval between consecutive R-waves (MeanRR), high-frequency power, low-frequency power, ratio of LF to HF power, enjoyment, systolic (SBP) as well as diastolic blood pressure, and peak oxygen consumption (VO₂peak) were compared using linear mixed models.</p> Results <p>The analyses revealed main effects of time for BF, HR, RMSSD, SDNN, MeanRR, high-frequency power, and SBP (<i>ps</i>&lt;.05). A main effect of group was found for enjoyment (<i>p</i>&lt;.05) with higher values in the EXT group. Group-by-time interactions (<i>ps</i>&lt;.05) were observed for HR, SBP, and VO₂peak, indicating differential changes over time between groups. The EXT showed a steeper decline in HR and SBP compared to MICT, while demonstrating a greater increase in VO₂peak.</p> Conclusions <p>The EXT was more effective than the MICT in improving VO₂peak, HR, and SBP. The EXT seems to represent a more effective and more attractive alternative to MICT for health promotion.</p> Trial registration number <p>NCT05894031.</p> Graphical abstract <p></p>