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Introduction: UK Exercise Referral Systems (ERS) have been developed to encourage physical activity in the general population. This systematic review investigated the effectiveness and cost-effectiveness of ERS. Identification of factors influencing ERS uptake, adherence and success were also investigated.Methods: Studies were identified from Medline, Cochrane and Pascal and bibliographies of relevant papers. Interventions providing access to ERS (randomized controlled trials or controlled trials), experimental or qualitative studies, and meta-analyses were included.Results: Twenty six studies met the inclusion criteria. Compared with usual care, ERS showed an increased number of participants who achieved 90-150 minutes of physical activity of at least moderate intensity per week. However, no significant difference in long-term outcomes (e.g., quality of life, body mass index, glycated haemoglobin, anxiety) were identified between ERS and comparator groups. Cost-effectiveness analysis suggested that ERS were more cost-effective for participants with co-morbid medical conditions. A higher adherence rate was associated with better effectiveness of ERS.Discussion: Limited evidence supports the efficacy of ERS to increase physical activity or improve health outcomes. This evidence-based analysis could support the development of effective ERS in France.