Effects of exercise interventions on health-related quality of life in healthy older adults: a systematic review and meta-analysis of randomized controlled trials

Exercise is widely recommended to support healthy ageing, but its effects on health-related quality of life (HRQoL) in healthy older adults remain uncertain. This systematic review and meta-analysis evaluated structured exercise effects on overall, physical, and mental HRQoL and explored potential moderators. PubMed, Web of Science, Embase, the Cochrane Library, and CNKI were searched from inception to June 2026 for randomized controlled trials in healthy adults aged ≥ 60 years. Random-effects meta-analyses used Hedges’ g with 95% confidence intervals (CIs). Heterogeneity, 95% prediction intervals (PIs), sensitivity analyses, subgroup analysis, exploratory univariable meta-regression, and GRADE certainty were assessed. Thirteen randomized controlled trials were included. Ten studies contributed 14 comparisons to overall HRQoL, and 12 studies contributed 18 comparisons to both physical and mental HRQoL. Exercise improved overall HRQoL (g = 0.78, 95% CI 0.45–1.11; I² = 80%), physical HRQoL (g = 1.50, 95% CI 1.04–1.96; I² = 67%), and mental HRQoL (g = 0.41, 95% CI 0.23–0.60; I² = 40%). Corresponding 95% PIs were − 0.29 to 1.85, 0.65 to 2.35, and − 0.07 to 0.89; PIs crossed the null for overall and mental HRQoL. Exercise modality did not significantly modify the overall effect ( P = 0.17). Meta-regression identified inverse associations with session duration (β = −0.17 per 10-min increase, P = 0.003) and female proportion (β = −0.12 per 10-percentage-point increase, P = 0.019); other moderators were non-significant. Excluding derived composite overall HRQoL scores did not materially alter the findings. Adherence was reported in five of 13 trials (68.7%–88%). Certainty was low for overall and physical HRQoL and moderate for mental HRQoL. Structured exercise may improve overall, physical, and mental HRQoL in healthy older adults. However, heterogeneity and PIs crossing the null for overall and mental HRQoL indicate that effects may vary across settings, and future studies may observe smaller or null effects. Current evidence does not establish superiority of any exercise modality or dose, and no specific prescription can be recommended with confidence. Subgroup and meta-regression findings should be considered hypothesis-generating and require confirmation in adequately powered trials. INPLASY202670005.