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Objectives This meta-analysis evaluated the effects of exercise interventions on key health outcomes in adults with SLE, including fatigue, physical function, aerobic capacity, disease activity, depression and pain.Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we systematically searched four databases up to February 2025 for randomised controlled trials (RCTs) in adults diagnosed with SLE according to the American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) criteria. Eligible studies examined aerobic, resistance or combined exercise as the sole intervention. Meta-analyses were conducted using Hedges’ g, the Risk of Bias 2 (ROB-2) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system used to assess bias and evidence quality.Results Twelve RCTs involving 470 participants were included. Exercise showed small-to-moderate improvements in fatigue (g=−0.53, 95% CI −0.81 to −0.25, p<0.001), physical function (g=0.46, 95% CI 0.23 to 0.68, p<0.001), aerobic capacity (g=0.47, 95% CI 0.22 to 0.71, p<0.001), depression (g=−0.36, 95% CI −0.64 to −0.09, p=0.01) and pain (g=−0.53, 95% CI −0.86 to −0.20, p<0.001), with no significant change in disease activity (g=0.18, 95% CI −0.16 to 0.51, p=0.30). Subgroup analyses suggested greater benefits with moderate-intensity programmes lasting 8–12 weeks. GRADE rated the evidence as moderate for fatigue, physical function, depression and pain, and low for other outcomes.Conclusion Exercise is an effective non-pharmacological therapy in SLE management, improving several physical and psychological outcomes. Individualised, moderate-intensity and supervised programmes are recommended. Further research should optimise intervention protocols and evaluate long-term safety.PROSPERO registration number CRD420251115953