OBJECTIVE:To determine the effect of seated exercise on impairment, activity and participation levels of older adults living with a health condition or impairment. METHODS:A systematic search of health databases combined concepts of seated exercise and controlled trials. Selected trials were appraised for quality and results synthesised by calculating standardised mean differences (SMD) and conducting meta-analyses where appropriate. RESULTS:Fourteen randomised controlled trials met inclusion criteria. Compared to usual care or social activities, seated exercise had a large positive effect on cognition (SMD 1.20, 95% confidence interval 0.25, 2.16) with smaller effects on strength, spinal flexion, activity, depression and quality of life. There was no effect on balance or mobility. There were no positive effects when seated exercise was compared to weight-bearing and functional exercise. CONCLUSION:Seated exercise has a positive effect on cognition and is also of some benefit for older adults who are unable to exercise in upright positions.