Effects of different physical activity interventions on depressive symptoms in menopausal women: a systematic review and network meta-analysis

Abstract

Background: Depression in peri- and post-menopausal women burdens families and health systems. Physical activity is recognized as a complementary therapy for menopausal depressive symptoms, but prior studies lack direct comparisons of intervention types. This network meta-analysis fills this gap by evaluating multiple physical activity modalities via direct and indirect comparisons, establishing an evidence-based hierarchy to guide clinical decisions and provide actionable guidance for managing depression in these women. Methods: A systematic search across four databases (PubMed, Cochrane Library, Embase, Web of Science) identified randomized controlled trials (RCTs) on physical activity for depression in peri- and post-menopausal women. Search timeframe: database inception to April 2025. Two independent researchers selected studies, extracted data, and assessed quality via the Cochrane Risk of Bias Tool. We conducted frequentist network meta-analyses (Stata/SE 15.1) integrated direct and indirect evidence. Surface Under the Cumulative Ranking Curve (SUCRA) ranked interventions by efficacy probabilistically, with higher values indicating superior outcomes. Results: Twenty-three RCTs were ultimately included in the meta-analytical synthesis. The results demonstrated superior therapeutic efficacy of aerobic exercise in alleviating depressive symptoms among peri-and post-menopausal women (SUCRA = 78.7%), closely followed by multi mode motion (SUCRA = 78.1%). Stretching exercise and mind-body exercises also achieved clinically meaningful improvements, with respective SUCRA values of 72.6% and 45.4%. Conclusion: Our findings show aerobic exercise, multimodal motion, and stretching best reduce depressive symptoms in peri- and post-menopausal women. Clinicians should prioritize aerobic exercise; multi modal motion programs (combining aerobic and stretching) may boost adherence for those seeking variety. Despite physical activity’s proven antidepressant effects, key challenges include developing theory-based strategies to support long-term adherence, especially amid menopausal physiological changes that hinder consistent exercise. Trial registration: This study has been registered on PROSPERO (CRD420251026378).