Effects of virtual reality-based meditative and mind-body interventions on psychological and well-being outcomes in middle-aged and older adults: a systematic review and meta-analysis

Background Virtual reality (VR)-based meditative and mind-body interventions may support psychological health in middle-aged and older adults, but evidence across psychological, well-being, and pain-related outcomes remains fragmented. This review evaluated their effects in these populations. Methods Eight bibliographic databases were searched from inception and rerun with the refined strategy on August 29, 2026; supplementary searches were completed through September 4, 2026. Eligible randomized controlled trials (RCTs) evaluated VR-based meditative or mind-body interventions in study samples meeting prespecified age criteria (explicit recruitment at age ≥ 45 years, sample mean/median age ≥ 45 years, or ≥ 70% aged ≥ 45 years). Risk of bias was assessed using RoB 2. Hedges’ g values were pooled using REML random-effects models with Knapp–Hartung inference. Exploratory subgroup analyses and sensitivity analyses were conducted, and certainty was assessed using GRADE. Results Twenty-one RCTs were included; 16 contributed to quantitative synthesis and five to structured narrative synthesis. Primary pooled analyses showed lower anxiety ( g = − 0.39, 95% CI − 0.64 to − 0.15; P = 0.004) and depressive symptom scores ( g = − 0.33, 95% CI − 0.66 to − 0.002; P = 0.049) with VR-based interventions. Primary estimates for stress, mindfulness, positive affect, negative affect, well-being, and pain were not statistically significant. Exploratory anxiety subgroup analyses yielded nominal between-subgroup P values < 0.05 for intervention type ( P = 0.033) and comparator type ( P = 0.006) and were treated as hypothesis-generating. Anxiety findings were generally robust, whereas depressive-symptom findings were less stable across sensitivity analyses. In post hoc analyses restricted to studies meeting study-level ≥ 60-year criteria, confidence intervals excluded the null for anxiety and depressive symptoms but were imprecise for other outcomes. Certainty was low for anxiety, depressive symptoms, mindfulness, positive affect, and well-being and very low for stress, negative affect, and pain. Conclusions VR-based meditative and mind-body interventions were associated with lower anxiety and depressive symptom scores, but the clinical importance of these standardized differences remains uncertain. Evidence for other outcomes was inconclusive. Larger, well-designed RCTs with rigorous comparators and longer follow-up are needed. Systematic review registration PROSPERO CRD420261395296.