Rambo fights with a knife, guns and grenades. Completing these opens up the ability to determine which weapons to take into a level. Next to the main mission goals there are optional challenges provided by Colonel Trautman. Up to three can be assigned simultaneously. By killing people and completing sections experience is earned to assign skill points and unlock perks. Once activated, time slows down, there is unlimited ammo, and enemies glow orange and provide health when killed. While fighting Rambo builds up a wrath meter.

Other gameplay elements include a cover system through arrows on the screen, active reload for double ammunition, and a kill cam for precise shots. Sometimes an enemy has an exclamation mark over the head and needs to be killed quickly, or his shot is lethal. Lots of enemies need to be killed and the player is rewarded with a multiplier for linking kills. Sometimes the two gameplay concepts are combined in stealth sections. In those sections the player is encouraged to shoot hands and legs to disarm opponents instead of killing them directly.

These are often combined with non-lethal takedowns using quick time events. Instead the camera guides the player through the levels while the player moves the cross-hair in a first-person view to take out enemies. The gameplay is based around the rail shooter concept and does not offer freedom of movement. It consists of a series of sequences from the three movies in chronological order, preceded by a flashback tutorial level set in Vietnam. Rambo: The Video Game is a first-person shooter based on the three Rambo action movies starring Sylvester Stallone, released between 19.

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