Effectiveness of Physical Exercise Interventions on Psychological and Physiological Mental Health Outcomes in University Students – A Systematic Review and Meta-Analysis

Introduction: University students are at elevated risk for anxiety and depression, underscoring the need for effective and accessible mental health strategies. Physical exercise interventions (PEIs) are promising, yet existing reviews rarely integrate psychophysiological indicators of mental health that align with the Research Domain Criteria (RDoC; Cuthbert & Insel, 2010) framework. This framework encourages researchers to integrate multiple units of analysis to measure mental health across various neurobehavioral domains of functioning. This systematic review and meta-analysis examined the effectiveness of PEIs in improving psychological (self-reported) and physiological outcomes (e.g., HRV, cortisol, EEG) of depression and anxiety in university students. Methodology: Following PRISMA guidelines (Page et al., 2021), controlled designs evaluating PEIs in university students, assessing depression or anxiety through both subjective and physiological measures, were included. Fifteen studies (N = 1,049 students) were synthesized narratively, while 13 provided data for meta-analysis. Risk of bias was assessed using the PEDro scale (Boghal et al., 2005). A multilevel random-effects model in JASP was used to estimate pooled effect sizes, with intervention duration tested as a moderator. Results: Across all study designs, PEIs produced a significantly small effect on combined psychological and physiological outcomes (d = 0.30). Heterogeneity was moderate, sensitivity analyses supported robustness, and publication bias tests indicated no substantial bias. Intervention duration significantly moderated effects, with longer programs yielding greater benefits. Restricting analysis to randomized controlled trials, the effect increased to a small-to-moderate magnitude (d = 0.42). Narrative findings across exercise modalities were mixed: mind-body exercises (e.g., yoga, Tai Chi) and resistance training showed benefits, whereas aerobic exercise produced mixed effects. Discussion: Overall, PEIs appear to improve depression, anxiety, and selected physiological markers of mental health in university students, supporting exercise as a multidimensional intervention influencing multiple RDoC-relevant domains. However, methodological limitations, heterogeneity in intervention protocols and measurements, and limited physiological data underscore the need for rigorously designed trials integrating multiple units of analysis according to the RDoC framework.