Effects of exercise on depression and anxiety in university students: a systematic review and meta-analysis

Background Although the positive effect of exercise on mental health is well known, its application in the treatment of mental health challenges among students has been limited and lacks systematic evaluation. The aim of this study was to investigate the effect of cardiorespiratory and muscular strength exercise on mental health among students in higher education facing mental health challenges. Methods Following PRISMA guidelines, a systematic search was conducted in six databases (Embase, Ovid MEDLINE, and APA PsycInfo via Ovid, CINAHL and SPORTDiscus via EBSCOhost, and Scopus) up to 8 April 2025. The search strategy included terms for the population (university students), intervention (exercise), and outcomes (mental health). Eligible studies included randomized controlled trials or quasi-experimental studies with a control group investigating the effect of cardiorespiratory and muscular strength exercise on mental health outcomes among students in higher education facing mental health challenges. Two independent reviewers performed screening and data extraction. Data were pooled in random-effects models, and standardized mean differences (SMDs) with 95% CI were calculated (SMDs: 0.2–0.4 = small, 0.5–0.7 = medium, and ≥0.8 = large effect sizes). Certainty of the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results Of 6,173 records screened, 11 RCTs and four quasi-experimental trials were included, comprising a total of 659 students. There was low-certainty evidence for large effects of exercise on symptoms of depression SMD=−1.05 (−1.49, −0.60), p 0.001 and anxiety SMD=−0.78 (−1.25, −0.31), p 0.01. There was very low-certainty evidence for the effect of exercise on anxiety sensitivity. Conclusion The results suggest medium to large effects of cardiorespiratory and muscular strength exercise on symptoms of depression and anxiety among students in higher education facing mental health challenges. These forms of exercise may be considered as potential treatment modalities for mental health challenges within the student health services. Systematic Review Registration PROSPERO CRD42023398623.