Isolated physical activity programs during pregnancy and postpartum: Meta-analysis of randomized trials with usual-care controls on depressive and anxiety symptoms

Abstract

OBJECTIVE: This study systematically evaluated the isolated effects of physical activity on depressive and anxiety symptoms during the perinatal period. METHODS: This systematic review was registered in PROSPERO (CRD42022301284) and conducted in accordance with the Cochrane Handbook and PRISMA guidelines. Randomized controlled trials were included if they assessed the effects of standalone physical activity interventions on depressive or anxiety symptoms in pregnant or postpartum women. Eligible trials involved physical activity interventions of any type, frequency, intensity, or duration, provided that the control group received usual care or no intervention without additional active components. Prevention-oriented trials and symptomatic/treatment-oriented trials were analyzed separately according to baseline population profile. RESULTS: Out of 10,938 records identified, 17 trials met the inclusion criteria. In prevention-oriented trials, physical activity was associated with lower depressive symptom scores during both the antenatal period (SMD: -0.52, 95% CI: -0.75 to -0.30; I² = 46%; seven trials; low-certainty evidence) and the postpartum period (SMD: -0.33, 95% CI: -0.57 to -0.09; I² = 86%; seven trials; very low-certainty evidence). For antenatal anxiety symptoms, physical activity did not show a clear effect compared with no intervention (SMD: -0.03, 95% CI: -0.31 to 0.25; I² = 0%; three trials; very low-certainty evidence). In a separate exploratory analysis of symptomatic/treatment-oriented trials, physical activity was associated with lower postpartum depressive symptom scores compared with no intervention (SMD: -0.38, 95% CI: -0.72 to -0.04; I² = 28%; three trials; very low-certainty evidence). Exploratory secondary analyses suggested favorable effects of structured physical activity and programs conducted three times per week for approximately 60 min on depressive symptoms, although the certainty of evidence was low or very low. CONCLUSIONS: Isolated physical activity interventions during the antenatal and postpartum periods may be associated with lower depressive symptom scores, particularly in prevention-oriented trials. A separate exploratory synthesis also suggested lower postpartum depressive symptom scores among symptomatic/treatment-oriented populations. However, the certainty of evidence was low to very low, and substantial clinical and methodological heterogeneity limits confidence in the magnitude and generalizability of these findings. Evidence for antenatal anxiety symptoms remains insufficient and inconclusive.