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Twisted! comes with a gyro sensor. The cartridge is a lot larger than in most Game Boy Advance games. Players tap the A button and twist the game around in order to play.
Like the other games, Twisted! has many microgames. These last for only a few seconds and involve a simple thing the player must do. The player starts with four lives. After about 12-15 microgames, he or she plays the boss level. If they win, they earn another life. If they lose, they lose a life. The game ends when they have run out of lives.
Wario has gotten seven of his friends to help make games for him. Each one has a different theme, or way to play.