Effects of aerobic exercise on depression, anxiety, and quality of life in older adults: a systematic review and meta-analysis

Depression, anxiety, and reduced quality of life are common concerns in older adults. Aerobic exercise may offer an accessible non-pharmacological approach to improving psychological health, but current evidence remains inconsistent. This systematic review and meta-analysis aimed to evaluate the effects of aerobic exercise on depressive symptoms, anxiety symptoms, and quality of life in older adults. PubMed, Web of Science, Scopus, and EBSCOhost were searched from 1 January 2000 to 15 May 2026. Randomized controlled trials and prospective non-randomized controlled intervention studies with a concurrent comparator were eligible. Only randomized controlled trials were included in the quantitative syntheses, whereas non-randomized controlled studies were summarized narratively. Studies had to enroll an older-adult sample and report depression, anxiety, or quality-of-life outcomes. Randomized trials were assessed with RoB 2 and non-randomized studies with ROBINS-I. Random-effects meta-analyses were conducted in R using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and certainty of evidence was evaluated using GRADE. Twenty-one studies involving 2,686 participants were included. Pooled estimates favored aerobic exercise for depressive symptoms (SMD = − 0.47, 95% CI − 0.71 to − 0.23; I 2 = 62.5%) and anxiety symptoms (SMD = − 0.74, 95% CI − 0.96 to − 0.52; I 2 = 0.0%). No study had a low overall risk of bias. Overall quality of life favored aerobic exercise in the primary analysis (SMD = 0.80, 95% CI 0.34 to 1.26), but heterogeneity was very high (I 2 = 90.1%) and the trim-and-fill-adjusted estimate included no effect (SMD = 0.19, 95% CI − 0.39 to 0.77), indicating substantial uncertainty. Therefore, the quality-of-life finding should be interpreted cautiously. GRADE certainty was very low for depression and quality-of-life outcomes and low for anxiety. Very-low-certainty evidence suggests that aerobic exercise may reduce depressive symptoms, whereas low-certainty evidence suggests a reduction in anxiety symptoms among older adults. Evidence for an improvement in overall quality of life remains uncertain because of methodological limitations, very high heterogeneity, and possible publication bias or small-study effects. Registration: Open Science Framework ( https://doi.org/10.17605/OSF.IO/YX9UN ).