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

BACKGROUND: 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. METHODS: 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. FINDINGS: 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. INTERPRETATION: 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. FUNDING: None.