Structured exercise cuts depression, anxiety, and stress in university students with large to moderate effects

ObjectiveTo compare the effects of different exercise interventions on depression, anxiety, and stress in university students and to identify outcome-specific patterns and relevant prescription features using network meta-analysis.MethodsA systematic review and network meta-analysis of randomized controlled trials was conducted following PRISMA guidelines. PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched from inception to 31 October 2025. Eligible studies included university students aged 18 years or older, structured exercise interventions lasting at least 4 weeks, and validated measures of depressive symptoms, anxiety symptoms, or perceived stress. Pairwise random-effects meta-analyses and random-effects network meta-analyses were performed. Effects were summarized as standardized mean differences (SMDs) with 95% confidence intervals (95% CIs), and treatments were ranked using the surface under the cumulative ranking curve.ResultsTwenty-five RCTs involving 2,127 students were included. Compared with control conditions, exercise was associated with improvements in depression (SMD −1.07, 95% CI −1.38 to −0.75; I2 = 87.6%), anxiety (SMD −0.69, 95% CI −1.00 to −0.38; I2 = 87.1%), and stress (SMD −0.45, 95% CI −0.73 to −0.16; I2 = 75.2%). These effects should be interpreted cautiously due to substantial heterogeneity and variation in outcome measures. Network meta-analysis indicated outcome-specific patterns: mind–body exercise and aerobic exercise were most consistently associated with favorable outcomes for depression; mind–body exercise showed clearer associations for anxiety, whereas team sports and resistance-based approaches appeared favorable but were supported by limited evidence; aerobic exercise was linked to the strongest comparative effect for stress. Exploratory subgroup analyses suggested that sessions of 30–59 min were more frequently associated with benefits for depression and anxiety, whereas stress benefits were more often observed with sessions of 30 min or longer. Moderate to vigorous intensity and higher weekly frequency were associated with more favorable anxiety and stress outcomes, although these findings should be considered exploratory rather than definitive.ConclusionExercise interventions are associated with improvements in depression, anxiety, and stress in university students, with outcome-specific patterns varying by modality. Exploratory findings suggest that time-efficient, moderate to vigorous exercise could inform future research on student mental health promotion.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261379734.