OBJECTIVES: Symptoms of anxiety and anxiety disorders negatively impact the quality of life of older adults. Physical activity is a potentially accessible intervention with other health benefits and minimal risk, yet its impact on anxiety in older adults is unclear. DESIGN: Systematic review and meta-analysis. SETTING: Included databases were MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO and CINHAL were searched from inception to June 23, 2023. PARTICIPANTS, INTERVENTIONS, MEASUREMENTS: We included randomized controlled trials of older adults who reported anxiety symptoms or disorders at baseline, that compared physical activity interventions with a non-physical activity comparator. All steps were done in duplicate, and certainty of evidence was with Grading of Recommendations, Assessment, Development, and Evaluations. Random effects meta-analyses were performed. RESULTS: 10,763 citations were reviewed, 13 studies were included in meta-analyses. At baseline, participants self-reported low to moderate levels of anxiety and different levels of fitness. In the meta-analysis, the physical activity intervention had a medium effect in decreasing the severity of anxiety symptoms compared to the control (standardized mean differences (SMD) - 0.66
95 % Confidence Interval (CI) - 0.89, - 0.43). Subgroup analyses indicated reductions in symptom severity when only assessing the effects of in-person interventions (SMD: - 0.59
95 %CI: - 0.79, - 0.38), studies of participants without pre-existing diseases (SMD: - 0.74
95 % CI: - 0.99, - 0.50), resistance training (SMD: - 0.76
95 % CI: - 1.15, - 0.38) and aerobic exercise (SMD: - 0.82
95 % CI: - 1.15, - 0.49). Studies had small sample sizes and high risk of bias. CONCLUSIONS: Physical activity reduces symptoms of anxiety in older adults and is an acceptable and promising intervention to incorporate into care planning.