The use of Personalised Interactive Music Systems (PIMS) may provide benefits in promoting physical activity levels. This systematic review and meta-analysis was conducted to assess the overall impact of PIMS in physical activity and exercise domains. Separate random effects meta-analyses were conducted for outcomes in physical activity levels, physical exertion, rate of perceived exertion (RPE), and affect. In total, 18 studies were identified. Of these, six studies (with 17 total intervention arms) reported data on at least one outcome of interest, from which an effect size could be calculated. PIMS were significantly associated with beneficial changes in physical activity levels (g = 0.49, CI [0.07, 0.91], p = 0.02, k = 4, n = 76) and affect (g = 1.68, CI [0.15, 3.20], p = 0.03, k = 4, n = 122). However, no significant benefit of PIMS use was found for RPE (g = 0.72, CI [- 0.14, 1.59], p = 0.10, k = 3, n = 77) or physical exertion (g = 0.79, CI [-0.64, 2.10], p = 0.28, k = 5, n = 142). Overall, results support the preliminary use of PIMS across a variety of physical activities to promote physical activity levels and positive affect.