Exergames are becoming increasingly significant in rehabilitation, medical care, and therapy that emphasize individuals. The purpose of the current study was to compare how school-aged children with intellectual disabilities responded cognitively and anxiously to cooperative, competitive, and solo activities. This pretest-posttest randomized controlled trial inquiry involved three groups. Recruitment and assignment of thirty children with developmental impairments to the Cooperative Game Group (CGG), Competitive Game Group (CmGG), and Solitary Game Group (SGG) took place. For eight weeks, the exergame program was carried out twice a week. Measures of the program's outcomes, such as anxiety and behaviours, were taken both before and after it. The differences between the groups were compared using a one-way ANOVA, while changes within the groups were examined using a paired sample t-test. While all groups exhibited a considerable improvement in memory, attention, and visual special ability, the CGG and CmGG had a significantly higher level of attention than the SGG. Furthermore, the language was significantly improved (p<0.05) only in the CGG. The CGG was the only one to show significant improvements in all anxiety subscales when compared to the CmGG. Notably, the CGG showed significant gains in the subscales measuring general anxiety disorder, separation anxiety, and obsessive-compulsive disorder (p0.05). Only social phobia was improved in the CmGG, whereas worries of physical harm, social phobia, and general anxiety were improved in the SGG. According to this research, competitive and cooperative games can be utilized to enhance cognitive capacities, and for kids with developmental impairments, cooperative games can be the most useful way to lower anxiety when compared to other game genres.