Background <p>Cardiac rehabilitation (CR) has been shown to improve outcomes in patients undergoing coronary artery bypass grafting (CABG); however, its specific effects on elderly CABG patients remain unclear. This meta-analysis aims to evaluate the benefits of CR for elderly patients undergoing CABG.</p> Methods <p>A comprehensive search was conducted across PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, and Wanfang Data databases for prospective studies on CR interventions in elderly CABG patients, from study inception through February 19, 2025. Two independent researchers screened articles that met the inclusion criteria. Key outcomes included all-cause mortality, cardiovascular mortality, all-cause hospitalization, health-related quality of life (HRQoL), and functional capacity. Meta-analysis was performed using Review Manager 5.3 software.</p> Results <p>Six studies involving 621 patients were included. Interventions lasted between 6 and 12 weeks, with follow-up durations ranging from 6 weeks to 6 months. None of the studies reported data on all-cause mortality, cardiovascular mortality, or all-cause hospitalization. Meta-analysis of HRQoL showed no significant improvements in either the physical component summary (WMD: 5.92 [-0.26, 12.1], <i>p</i> = 0.08) or the mental component summary (WMD: 5.92 [-0.14, 1.80], <i>p</i> = 0.28). However, individual studies suggested potential benefits of CR in specific functional domains.</p> Conclusion <p>This meta-analysis found no statistically significant improvements in the physical or mental health components of HRQoL following CR in elderly CABG patients, based on limited short-term evidence. Some studies indicated potential benefits in functional capacity and physical activity adherence. Clinicians should consider individualized CR programs while acknowledging the existing evidence gaps.</p> Systematic review registration <p>PROSPERO CRD420251017085.</p>