OBJECTIVE: To synthesise meta-analytic outcomes from randomised controlled trials examining exercise effects on depression and anxiety across all population groups, including children and adults with both clinically diagnosed and subclinical symptoms, excluding those with pre-existing chronic physiological conditions.

DESIGN: Meta-meta-analysis (Preferred Reporting Items for Overviews of Reviews (PRIOR) framework).

DATA SOURCES: Five electronic databases were searched for eligible meta-analyses published from inception to 31 July 2025.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Meta-analyses of randomised controlled trials examining exercise interventions for the management of depression and anxiety symptoms were included. To avoid contamination effects, meta-analyses exclusively focused on populations in which chronic physiological conditions were excluded. Study selection was undertaken in duplicate by two independent reviewers.

RESULTS: 63 studies (81 meta-analyses, 1079 component studies and 79 551 participants) were included. Exercise reduced depression (standardised mean difference (SMD)=-0.61, 95% CI -0.69 to -0.54) and anxiety (SMD=-0.47, 95% CI -0.59 to -0.36) symptoms, with aerobic exercise demonstrating the most substantial impact on both depression and anxiety symptoms. The greatest benefits by population group for depression were seen in emerging adults aged 18-30 and postnatal women. Greater reductions in depression were associated with exercise in group and supervised settings. Exercise of shorter duration and at lower intensity was most strongly associated with anxiety reduction.

CONCLUSION AND RELEVANCE: The findings of the study support that exercise based interventions, in all formats and parameters, can help mitigate depression and anxiety symptoms across all population categories. These results can help health professionals provide targeted, cost effective, evidence based support that aligns with individual profiles and preferences.

TRIAL REGISTRATION: PROSPERO CRD42020210651.

FM/GP/Mental Health rater

The study provides valuable guidance for physical activity for a specific subgroup of patients.

FM/GP/Mental Health rater

As a family doctor who manages many patients with anxiety and depression, this study highlights and affirms the advice I give about the importance of exercise as a coequal leg of the three-legged treatment stool, alongside medication and psychotherapy. Evidence like this should increase the possibility of being able to prescribe an exercise group/class for depression or anxiety that would be covered by health insurance.

Psychiatry rater

This isolates the effect of exercise on depression and anxiety across clinically diagnosed and non-clinical populations.