BACKGROUND: Acute hospitalisation is a recognised risk factor for adverse outcomes in older adults, including hospital-associated disability. Post-discharge exercise interventions might mitigate physical and cognitive decline, although the few meta-analyses performed previously present limitations. This systematic review and meta-analysis aimed to evaluate the effect of post-discharge exercise interventions on health-related outcomes in older adults. METHODS: A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect was conducted following PRISMA 2020 guidelines on May 16, 2025. Randomised controlled trials published from Jan 1, 2000, to May 16, 2025, were included. These studies assessed the effectiveness of muscular strength and endurance exercises in older adults (aged 60 years and older) discharged from acute hospitalisation. There were no language filters. Two reviewers independently screened studies using the PICOS framework, extracted data from published reports, and assessed methodological quality using the Physiotherapy Evidence Database scale. Data were pooled using a random-effects model. This systematic review and meta-analysis is registered with PROSPERO, CRD42025630147. FINDINGS: The search yielded 2868 results, of which 17 articles (1458 participants) met inclusion criteria, with a mean Physiotherapy Evidence Database score of 7.3 (SD 0.9) out of 10, indicating moderate to high quality. Post-discharge exercise significantly improved physical function (standardised mean difference (SMD) 0.78 (95% CI 0.52 to 1.05), p < 0.0001). No significant effects were observed for health-related quality of life (SMD 0.23 (-0.04 to 0.51), p = 0.098) or readmission risk (risk ratio 0.64 (95% CI 0.39 to 1.05), p = 0.076). Exercise effects on functional independence, cognitive function, frailty, and mortality were synthesised descriptively due to insufficient data for meta-analysis. The main sources of heterogeneity were the outcome assessment tools and the exercise protocols. No evidence of risk of bias was found using either selection models (p > 0.05) or Egger's test (p > 0.05) for any of the outcomes. INTERPRETATION: Post-discharge exercise interventions are effective at improving physical function in older adults following acute hospitalisation; however, effects on other health-related outcomes remain inconclusive. Future studies should establish optimal post-discharge exercise modalities, dosages, and delivery strategies tailored to individual patient needs. Advancing these priorities could improve patient outcomes and health-care system efficiency. FUNDING: None.

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