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BackgroundMusic is widely used in aerobic exercise, but its effects in physically active adults remain difficult to interpret because performance, perceptual, physiological, and psychological outcomes have often been examined separately. This review evaluated whether music-related interventions in aerobic exercise contexts are associated with performance, fatigue-related perceptions, physiological responses, and psychological outcomes in physically active adults.MethodsPubMed, Web of Science, EBSCOhost, Scopus, ScienceDirect, CNKI, Wanfang Data, and VIP Database were searched from inception to March 3, 2026, without language restrictions. Experimental studies comparing music-related conditions with no-music or other non-musical controls in aerobic exercise were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias; a third reviewer resolved disagreements. Meta-analyses were performed in Review Manager 5.4 using standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs). Certainty of evidence was assessed using GRADE.ResultsFifteen studies involving 339 participants were included. Music was associated with better fixed-duration aerobic exercise performance (SMD = 0.39, 95% CI 0.08 to 0.70; I² = 30%), longer time to exhaustion in the primary analysis (SMD = 1.89, 95% CI 0.44 to 3.33; I² = 95%), lower rating of perceived exertion (SMD = −0.36, 95% CI −0.67 to −0.04; I² = 0%), and lower blood lactate concentration (MD = −0.86 mmol/L, 95% CI −1.45 to −0.26; I² = 57%). Heart rate was not significantly affected (MD = −1.16 beats/min, 95% CI −3.57 to 1.26; I² = 18%). GRADE certainty was moderate for rating of perceived exertion, low for fixed-duration performance, heart rate, and blood lactate, and very low for time to exhaustion.ConclusionMusic during aerobic exercise appears most consistently associated with reduced perceived exertion. Performance and physiological effects were more outcome-dependent and should be interpreted cautiously.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261354074, identifier CRD420261354074.