Background: University students often combine declining physical activity with elevated psychological distress, yet campus exercise provision is frequently unstructured. 

Purpose: This narrative review synthesised recent evidence (2023–2026) on the effects of structured exercise programmes on physical fitness and mental health among university students. 

Approach: Six evidence syntheses, including one umbrella review, were identified through targeted searches and appraised narratively. 

Findings: Exercise was consistently associated with lower anxiety, depression and stress, and high-intensity interval training (HIIT) improved body composition, cardiorespiratory fitness and muscle strength. 

Gaps: However, certainty of evidence was often low to very low, heterogeneity was substantial, and primary trials were frequently small and incompletely reported. No single exercise mode could be declared superior, and long-term maintenance and sex-specific responses remain poorly studied. 

Implications: Progressive, multicomponent programmes of around eight weeks or longer appear reasonable to embed in physical education and student support services, provided adherence, fidelity and safety are monitored. 

Conclusion: Structured exercise is a promising adjunct for student fitness and mental health, but optimal dosage and mechanisms remain provisional pending theory-informed, longer-term trials.