BACKGROUND: Promoting the mental well-being of older people has been neglected. AIM: To examine the clinical and cost-effectiveness of exercise and physical activity interventions on mental well-being in people aged 65+. DESIGN: Systematic review, meta-analysis, economic model. METHODS: Reports published in English, identified by searching 25 databases, 11 websites and references lists of systematic reviews. Eligible studies were those with a comparison or control group or offering qualitative evidence; exercise and physical activity interventions for people aged 65 and above living at home, in the community, in supported housing or in residential care homes; including outcome measures of mental well-being, not simply measures of depression or anxiety. Low-quality studies were excluded from the data synthesis. RESULTS: An overall effect of exercise on mental well-being was found (standardised effect size 0.27; CI 0.14 to 0.40). The included interventions were designed for older people, targeted those who are sedentary and delivered in a community setting, primarily through a group-based approach led by trained leaders. As a minimum, the evidence would suggest two exercise sessions per week, each of 45 min duration. There is some indication that exercise can also improve the mental well-being of frail elders. Economic evidence indicated incremental cost-effectiveness ratios (compared with minimal intervention) of Great British Pounds 7,300 and Great British Pounds 12,100 per quality adjusted life year gained for community-based walking and exercise programmes, respectively. CONCLUSIONS: Mental well-being in later life is modifiable through exercise and physical activity. To generalise the findings, there is a need for more evidence of effectiveness from older people in the UK.

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