Impact of postpartum physical activity on maternal depression and anxiety: a systematic review and meta-analysis

Objective To examine the influence of postpartum exercise on maternal depression and anxiety. Design Systematic review with random effects meta-analysis and meta-regression. Data sources Online databases up to 12 January 2024, reference lists, recommended studies and hand searches. Eligibility criteria Randomised controlled trials (RCTs) and non-randomised interventions of any publication date or language were included if they contained information on the Population (postpartum people), Intervention (subjective or objective measures of frequency, intensity, duration, volume, type, or mode of delivery of exercise), Comparator (no exercise or different exercise measures), and Outcome (postpartum depression, anxiety prevalence, and/or symptom severity). Results A total of 35 studies (n=4072) were included. Moderate certainty evidence from RCTs showed that exercise-only interventions reduced the severity of postpartum depressive symptoms (19 RCTs, n=1778, SMD: −0.52, 95% CI −0.80 to –0.24, I 2 =86%, moderate effect size) and anxiety symptoms (2 RCTs, n=513, SMD: −0.25, 95% CI −0.43 to −0.08, I 2 =0%, small effect size), and the odds of postpartum depression by 45% (4 RCTs, n=303 OR 0.55, 95% CI 0.32 to 0.95, I 2 =0%) compared with no exercise. No included studies assessed the impact of postpartum exercise on the odds of postpartum anxiety. To achieve at least a moderate reduction in the severity of postpartum depressive symptoms, postpartum individuals needed to accumulate at least 350 MET-min/week of exercise (eg, 80 min of moderate intensity exercise such as brisk walking, water aerobics, stationary cycling or resistance training). Conclusions Postpartum exercise reduced the severity of depressive and anxiety symptoms and the odds of postpartum depression.