Physical activity and perinatal depression and anxiety: a global umbrella review and meta-meta-analysis

Physical activity is increasingly recognized as a non-pharmacological intervention reducing the risk of perinatal depression and anxiety, but findings from previous meta-analyses are heterogeneous. This umbrella review synthesized evidence on the overall effects of physical activity on perinatal depression and anxiety in women, including by activity intensity and type.

We searched PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, Epistemonikos, DoPHER, CINAHL, Sports Medicine & Education Index for literature published between Jan 2014 and April 2026. Eligible systematic reviews assessed randomized controlled trials of the effect of physical activity interventions on perinatal depression and/or anxiety outcomes. Pairs of authors conducted data extraction, methodological quality (AMSTAR-2) and certainty of evidence (GRADE) assessments. Overlap between included systematic reviews was assessed using the corrected covered area. Random-effects meta-meta-analyses (a meta-analysis of meta-analyses) yielded standardized mean differences (SMDs) with 95% confidence intervals (95% CIs). PROSPERO registry: CRD42024538941.

A total of 4109 studies were retrieved and 20 systematic reviews with meta-analyses were included. Overlap was 8.49%. Overall physical activity reduces depressive symptoms during the perinatal period with moderate certainty of evidence (SMD: -0.56; 95%-CI: -0.93 to -0.19). Light-intensity physical activity (SMD: -0.52; 95% CI: -0.81 to -0.23) may have effects comparable to those of moderate (SMD: -0.43; 95% CI: -0.64 to -0.22) and mixed-intensity (SMD: -0.52; 95% CI: -0.80 to -0.24) interventions. Yoga (SMD: -0.55; 95%-CI: -0.95 to -0.15) and mixed activity (SMD: -0.54; 95%-CI: -0.70 to -0.38) may be particularly beneficial. PA may also be effective in reducing anxiety (SMD: -0.85, 95%-CI: -1.29 to -0.42), though research is more limited.

Light and moderate physical activity are positively associated with a reduction in perinatal depressive and anxiety symptoms in women. Physical activity should be recommended as a non-pharmacological, feasible, and cost-effective approach to address perinatal depression, and potentially anxiety, globally.

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