Home-based exercise in postmenopausal and older women: effects on body composition, physical function, cardiometabolic health, and quality of life—a systematic review and meta-analysis

Background Home-based exercise (HBE) has received increasing attention as a low-cost and accessible strategy, although the durability of its effects and of long-term participation remains uncertain. Postmenopausal women frequently experience unfavorable changes in body composition, muscle strength, physical function, and cardiometabolic health. This review evaluated the effects of HBE on these outcomes and on health-related quality of life (HRQoL) in postmenopausal and older women. Methods PubMed, Web of Science, Cochrane Library, and Embase were searched from inception to March 2026. Randomized controlled trials of home-based exercise in postmenopausal and older women were included. The review followed the PRISMA 2020 statement, was retrospectively registered in INPLASY, and used the Cochrane Risk of Bias 2 tool; data were synthesized in R using the meta package. Results Nineteen randomized controlled trials involving 1,128 postmenopausal and older women were included. Pooled results showed that home-based exercise significantly reduced body mass index (BMI) (MD = −0.57 kg/m 2 , 95% CI: −0.71 to −0.43; I 2 = 0%) and significantly improved health-related quality of life (HRQoL) (SMD = 0.51, 95% CI: 0.08 to 0.94; I 2 = 76%). Effects on the Timed Up-and-Go test (TUGT) (MD = −0.64 s, 95% CI: −1.57 to 0.30), the five-times sit-to-stand test (5 × STS) (MD = −1.92 s, 95% CI: −4.36 to 0.52), handgrip strength (MD = 1.43 kg, 95% CI: −1.02 to 3.88), the six-minute walk test (MD = 35.16 m, 95% CI: −59.96 to 130.29), body fat percentage (MD = −0.31%, 95% CI: −0.65 to 0.03), and triglycerides (MD = −8.96 mg/dL, 95% CI: −19.45 to 1.52) did not reach statistical significance. Conclusion Home-based exercise may reduce BMI and improve HRQoL in postmenopausal and older women, although the certainty of this evidence was moderate and very low, respectively. Effects on physical function and cardiometabolic markers remain inconclusive, with prediction intervals crossing the null for the most heterogeneous outcomes. Given the small number of trials per outcome, further well-designed randomized controlled trials with standardized prescriptions, longer follow-up, and routine adherence and adverse-event monitoring are needed. Systematic review registration https://inplasy.com/inplasy-2026-4-0094/ , identifier INPLASY202640094.