Effects of different types of mind-body exercises on depressive symptoms in older adults: a systematic review and network meta-analysis.

BACKGROUND: Depressive symptoms in older adults (≥60 years) have a global prevalence of 10-20%, linked to physiological decline, neurotransmitter imbalances and other factors, burdening families and healthcare resources. Existing treatments (pharmacological and non-pharmacological) have limitations, while mind-body exercises hold intervention potential due to their "mind-body linkage" trait-yet comparative effectiveness studies across different types are lacking. METHODS: Systematic searches were conducted across four databases (PubMed, Cochrane Library, Embase, Web of Science) for randomized controlled trials (RCTs) on mind-body exercises for depressive symptoms in older adults. The search spanned from database inception to December 30, 2025. Two researchers independently screened studies, extracted data, and assessed quality using the Cochrane Risk of Bias Tool 2 (RoB2). Frequentist network meta-analysis (Stata 15.1) synthesized direct and indirect evidence, and the Surface Under the Cumulative Ranking Curve (SUCRA) ranked interventions by efficacy probability. RESULTS: In the network meta-analysis of 23 randomized controlled trials, SUCRA rankings were: Tai Chi (83.3%), Pilates (71.0%), Yoga (66.3%), Qigong (59.4%), and Square Dancing (26.8%). However, Pilates was based on only 2 trials, and several comparisons had 95% CIs crossing the null, warranting cautious interpretation of the rankings. CONCLUSION: This study fills the precision evidence gap for mind-body exercise interventions in specific older adult populations. It suggests Tai Chi as the preferred non-drug intervention for depressive symptoms in older adults without cognitive impairment or other physical/mental disorders. Pilates, Yoga, and Qigong can be flexibly chosen per individual strength, flexibility, and social needs, while Square Dancing suits only low-risk individuals with mild loneliness-related depression. The findings support stratified clinical reference options / preliminary suggestions, backing mind-body exercises as a safe, suitable strategy for depression in older adults. Future research should standardize intervention parameters, include broader language databases, develop personalized plans, and conduct long-term follow-up and sensitivity analyses, and directly test proposed mechanisms. SYSTEMATIC REVIEW REGISTRATION: This study has been registered on PROSPERO (CRD420261289637).