Mechanical aeration is critical for maintaining water quality and enhancing fish productivity in intensive aquaculture systems. This study aimed to evaluate the efficacy of three aeration techniques (vertical turbine splash, fixed paddle wheel, and semi-movable paddle wheel) on Nile tilapia (Oreochromis niloticus) growth, blood biochemical parameters, water quality, and economic outcomes. Tilapia fingerlings (Initial weight: 70 ± 5 g) were reared in semi-rectangular concrete tanks (99 m³) for 90 days under three aeration treatments (3 replicates each). Water parameters (dissolved oxygen [DO], temperature, total ammonia nitrogen [TAN], unionized ammonia [UIA]), growth performance (final body weight [FBW], feed conversion ratio [FCR], specific growth rate [SGR]), serum biochemical markers, and economic metrics (total revenue, benefit-cost ratio) were analyzed. The results revealed that the vertical turbine aerator significantly reduced UIA (0.017 mg/L) compared to fixed (0.047 mg/L) and semi-movable paddle wheel (0.042 mg/L; P < 0.05). While fixed and semi-movable paddles maintained higher DO levels (5.08–5.07 mg/L). The turbine system achieved superior growth rates (FBW: 310.3 g vs. 298.0–304.3 g; P < 0.001) and better FCR (1.406 vs. 1.428–1.446; P = 0.049). Additionally, the integration of condition factor (K) and length-weight relationship (LWR) analysis revealed superior somatic growth and health status under the turbine treatment, further supporting its biological and commercial benefits. Biochemical stress markers (e.g., glucose) were elevated in fixed paddle treatments, indicating potential stress from unidirectional water flow. Economic analysis showed no significant differences in profit margins, though the turbine system generated higher total revenue. In conclusion, vertical turbine aerators optimize water quality and growth efficiency, while paddle wheels enhance DO but may induce stress. Strategic aeration selection balances environmental, biological, and economic sustainability in tilapia farming.