Optimizing exercise for perinatal depressive symptoms: A network meta-analysis of effective modalities and doses

While exercise is a promising strategy for alleviating perinatal depressive symptoms, its clinical potential remains unrealized due to ambiguity in optimal modalities and dosages, hindering targeted clinical prescription and the design of effective interventions. This study aimed to identify the most effective exercise type and dosage for reducing perinatal depressive symptoms severity.

Randomized controlled trials (RCTs) evaluating exercise for perinatal depressive symptoms were identified from four databases (from inception to November 2024). A comprehensive comparison of the effectiveness of various exercise modalities in alleviating perinatal depressive symptoms was conducted using a combination of network meta-analysis (NMA) and dose-response meta-analysis.

A total of 46 RCTs involving 5719 participants were included. In the NMA, Pilates ranked highest for reducing perinatal depressive symptoms, showing a marked effect [SMD = -1.25, 95 % CrI: (-2.14, -0.364)]. Yoga, aerobic exercise, and flexibility training followed, also showing notable effects. The optimal dose for substantial benefits was identified as approximately 360 MET-min/week. This is practically equivalent to engaging in two 30-min sessions per week for a duration of 12 weeks.

Our findings conclude that exercise modalities like Pilates and yoga are highly effective for alleviating perinatal depressive symptoms when prescribed at an optimal dose of approximately 360 MET-min/week. This is practically achievable through two 30-min sessions weekly for 12 weeks. These findings provide clinicians with actionable, evidence-based guidance for prescribing exercise to this population. Future research should prioritize head-to-head trials comparing leading modalities, such as Pilates and yoga, to further refine therapeutic guidelines.