Abstract This systematic review and meta-analysis aimed to assess virtual reality (VR)-based exercise effects on walking capacity, fall risk, and quality of life in healthy older adults. Five databases were searched up to January 2025. From 56 trials involving 2927 participants, VR improved six-minute walk distance (MD = 24.59, 95% CI: 20.90–28.28, p < 0.00001), gait speed (MD = 0.04, 95% CI: 0.01–0.07, p = 0.02), and Timed Up-and-Go test (MD = −0.67, 95% CI: −1.08 to −0.25, p = 0.001), while reducing fear of falling (SMD = −0.67, 95% CI: −1.01 to −0.33, p = 0.0001). Quality-of-life gains included physical (MD = 0.31, p = 0.009), environmental (MD = 0.42, p = 0.01), psychological (MD = 0.47, p = 0.003), and social health (MD = 0.31, p = 0.004). VR-based exercise is an effective, engaging tool to enhance mobility, lower fall risk, and promote functional independence and psychosocial well-being.

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