Effects of exercise on depression in postmenopausal women: a pairwise and network meta-analysis of randomized controlled trials

Background: Exercise is a promising non-pharmacological therapy for depression; however, it is unclear whether exercise interventions are effective for postmenopausal women, and which ones work best. Methods: Electronic searches in PubMed, Web of Science, SPORTDiscus, CNKI, The Cochrane Library, PsycINFO, EMBASE, and CINAHL Plus were conducted to identify articles published through 1 March 2024, and included randomized controlled trials that examined the effectiveness of exercise interventions on depression in postmenopausal women. Mean changes (± standard deviations) in depression scores, assessed using various scales, were extracted to calculate standardized mean differences (SMDs). These SMDs were then pooled using a random effects model in a pairwise meta-analysis. Additionally, a Frequentist network meta-analysis employing a random effects model was conducted to evaluate the efficacy of different exercise types. Results: This study included 26 studies involving 2,170 participants. In pairwise meta-analysis, exercise has shown a clinically significant positive impact on depression in postmenopausal women (SMD=-0.71, 95% confidence interval (95% CI)=-0.94–-0.48, P<0.001; ^{I 2 =78%). In network meta-analysis, mind-body exercise (SMD=-0.98, 95% CI=-1.28–-0.68) and aerobic exercise (SMD=-0.58, 95% CI=-0.88–-0.29) significantly reduced the level of depression compared to the control group, and there was a significant trend for stretching, resistance exercise, and concurrent training. Mind-body exercise had the highest probability of being the most effective intervention. Exercise interventions also showed positive effects on anxiety. Conclusion: For postmenopausal women, exercise interventions are a clinically effective antidepressant therapy, with mind-body exercise most likely being the optimal type, followed by aerobic exercise. Trial registration: This meta-analysis was prospectively registered with PROSPERO (registration number: CRD42024505425).}