Effects of structured physical activity on body composition and body image perception in postmenopausal women: a systematic review and meta-analysis.

IMPORTANCE: Physical activity (PA) may mitigate adverse changes in body composition (BC) and body image (BI) in postmenopausal women; however, the magnitude and consistency of its effects remain unclear. OBJECTIVE: To systematically review and synthesize evidence from experimental studies examining the effects of structured PA interventions on BC parameters and BI perception in postmenopausal women (PROSPERO: CRD42024539791). EVIDENCE REVIEW: MEDLINE, Web of Science, and Scopus were searched for randomized controlled trials published in English from 2014 to 2025 reporting BC and/or BI outcomes. Risk of bias and certainty of evidence were assessed using the RoB 2.0 tool and the GRADE approach. Pooled mean differences (MDs) with 95% CIs were estimated using a random-effects model for body mass index (BMI), percentage of fat mass (%F), and waist-to-hip ratio (WHR). FINDINGS: After duplicate removal, 2,483 records were screened, and 13 trials involving 694 postmenopausal women met the inclusion criteria. Most studies had a low risk of bias or some concerns. Despite wide variation in frequency, intensity, type, and duration of PA interventions, meta-analyses suggested significant reductions (P < 0.001) in BMI (MD = -0.87 kg/m2; 95% CI: -1.20 to -0.55), %F (standardized MD: -0.53; 95% CI: -0.81 to -0.26), and WHR (MD = -0.03; 95% CI: -0.04 to 0.02). The heterogeneity was low for BMI and WHR (I2 = 0%) and moderate for %F (I2 = 57%) despite considerable within-study variability. Evidence on BI was limited and inconclusive, with only one study reporting preintervention and postintervention data. CONCLUSIONS AND RELEVANCE: Structured PA appears to improve key BC parameters in postmenopausal women. Evidence regarding BI is insufficient, emphasizing the need for rigorous, long-term trials to clarify PA's effects on BI. These findings may guide clinicians in recommending PA for postmenopausal women to improve BC, while highlighting a critical gap in evidence regarding BI.