Exercise-based interventions for postpartum depressive symptoms: a systematic review and network meta-analysis of exercise modality and weekly volume

Abstract

To synthesize randomized evidence on exercise-based interventions for postpartum depressive symptom scores and to explore comparative signals across exercise types and pragmatic weekly-volume categories using pairwise and network meta-analysis. Eight bibliographic databases were searched from inception and updated through July 23, 2026, with three trial registries searched in the final update, for randomized controlled trials of postpartum exercise interventions reporting Edinburgh Postnatal Depression Scale (EPDS) scores. Pairwise meta-analysis used mean differences (MDs), and network meta-analyses evaluated exercise-type and weekly-volume nodes. The review was registered in PROSPERO (CRD420251275738). Twenty-four randomized controlled trials involving 1, 792 unique participants (912 intervention and 880 control) were included. Exercise was associated with lower EPDS scores than usual care/non-exercise control (MD = -2.73, 95% confidence interval (CI) -3.57 to -1.88; I 2 = 95%), representing an average effect across highly heterogeneous studies. Delivery format showed no difference in an omnibus comparison across three reported categories (p = 0.29), and intervention composition also showed no subgroup difference (p = 0.66). Interventions lasting <12 weeks showed a larger pooled effect than those lasting ≥12 weeks (subgroup p = 0.009), but this was exploratory. In the exercise-type network, yoga/mind-body exercise ranked highest (surface under the cumulative ranking curve (SUCRA) = 94.2%) and was estimated to lower EPDS scores versus aerobic exercise (MD = -2.62, 95% CI -5.16 to -0.08); active-vs-active estimates were entirely indirect and network certainty was very low. The 45–90 min/week category ranked highest in the weekly-volume network (SUCRA = 84.6%), but no between-volume contrast was statistically significant. Exercise may reduce postpartum depressive symptom scores, but mixed prevention-oriented and treatment-oriented samples, substantial heterogeneity, co-interventions, and star-shaped networks preclude identifying an optimal exercise type or dose. Exercise may be considered as an adjunct within individualized postpartum mental-health care, not a substitute for clinical assessment or indicated treatment. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251275738 , identifier CRD420251275738.