Exercise modalities and dose-response associations with anxiety and depression in postmenopausal women: a network meta-analysis and model-based dose-response study.

OBJECTIVE: This study aimed to compare the effects of different exercise modalities and explore the dose-response relationship between weekly exercise dose and symptoms of anxiety and depression in postmenopausal women. METHODS: This review included 23 randomized controlled trials involving 2,298 postmenopausal women. The main modality-level quantitative analyses included 17 studies for anxiety and 19 studies for depression, and were conducted using network meta-analysis (NMA) combined with Bayesian model-based dose-response analysis. Change-from-baseline standardized mean differences were used as effect measures. Exercise dose was standardized as weekly metabolic equivalent of task minutes (MET-min/week). Exercise interventions were classified as aerobic training (AT), mind-body training (FT), and combined aerobic and resistance training (AT+RT) for the main modality-level analyses. Resistance training (RT) was represented by only one study and was therefore not included in the main NMA or in ranking by the surface under the cumulative ranking curve (SUCRA). RESULTS: Exercise interventions were generally associated with greater improvements in anxiety and depressive symptoms than control conditions. In the modality-level ranking, mind-body training showed the highest probability of benefit for both outcomes, although some comparisons were supported by limited evidence. Dose-response analyses suggested nonlinear associations, with more favorable model-derived effects generally observed at moderate weekly exercise doses rather than at very high doses. CONCLUSION: Exercise may help reduce anxiety and depressive symptoms in postmenopausal women, and mind-body training appears to be a promising modality. However, these findings should be interpreted cautiously because evidence certainty was limited and the dose estimates were model-derived. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD420251243356.