Which exercise strategies improve postpartum depression? A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Postpartum depression adversely affects both mothers and infants and remains an important issue in maternal health. This meta-analysis examined the overall effects of exercise interventions on postpartum depressive symptoms and explored whether programme characteristics influenced treatment outcomes. METHODS: A systematic search of major databases was conducted to identify randomized controlled trials evaluating exercise interventions for postpartum depression. Sixteen studies met the inclusion criteria. Pooled effects were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using meta-analytic models. Subgroup analyses were performed according to intervention format, exercise modality, initiation timing, weekly frequency, intervention duration, and reporting of delivery mode. Publication bias was assessed using funnel plots and Egger's regression test. RESULTS: Sixteen randomized controlled trials were included in the analysis. Overall, exercise interventions were associated with a significant reduction in postpartum depressive symptoms (SMD = -0.69, 95% CI -1.02 to -0.36). In subgroup analyses, mind-body exercise showed the largest effect, while aerobic exercise was also associated with symptom improvement. Interventions lasting 12 weeks or less showed stronger effects than longer programmes. No statistically significant subgroup differences were observed for intervention format, weekly frequency, timing of initiation, or reporting of delivery mode, although studies initiating exercise postpartum and those involving vaginal delivery tended to show greater benefit. Sensitivity analyses indicated that the pooled findings were stable. CONCLUSION: Exercise interventions may help reduce postpartum depressive symptoms. The findings suggest that exercise modality and programme duration may influence effectiveness, with interventions lasting no more than 12 weeks showing greater benefit. These results support the inclusion of structured exercise in postpartum care while highlighting the need for further high-quality trials to determine optimal exercise prescriptions for postpartum women. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, identifier: CRD420251160668.