Background: Personalised Interactive Music Systems (PIMS) are emerging as promising devices for enhancing physical activity and exercise outcomes. By leveraging real-time data and adaptive technologies, PIMS align musical features, such as tempo and genre with users’ physical activity patterns, including frequency and intensity, enhancing their overall experience. Objective: This exploratory systematic review and meta-analysis evaluates the effectiveness of PIMS across physical, psychophysical, and affective domains. Methods: Searches across nine databases identified 18 eligible studies, of which six (comprising 17 intervention arms) contained sufficient data for meta-analysis. Random-effects meta-analyses and meta-regression were performed to assess outcomes for physical activity levels, physical exertion, ratings of perceived exertion (RPE), and affective valence. Results: Results showed significant improvements in physical activity levels (g = 0.49, CI [0.07, 0.91], P = .02, k = 4) and affective valence (g = 1.65, CI [0.35, 2.96], P = .01, k = 4), with faster music tempo identified as a significant moderator (P = 0.03). No significant effects were observed for RPE (g = 0.72, CI [-0.13, 1.58], P = .10, k = 3) or physical exertion (g = 0.78, CI [-0.55, 2.11], P = .25, k = 5). Conclusions: Substantial heterogeneity and limited study quality indicate the need for more robust, randomised controlled trials to establish the efficacy of PIMS in diverse populations. Clinical Trial: PROSPERO CRD42023465941 Link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023465941