Comparative impact of exercise‐based interventions for postpartum depression: A Bayesian network meta‐analysis

Abstract Objective The current study aimed to address and rank which exercise‐based interventions are preferable to standard care/no therapy or another exercise intervention for postpartum depression (PPD) management and provide estimates for future definitive evidence. Methods The authors systematically searched PubMed, Embase, the Web of Science, PsycInfo, and ClinicalTrails.gov for randomized controlled trials (RCTs) on exercise‐based interventions for PPD from their inception to May 9, 2023. Included were RCTs of exercise‐based interventions for PPD with at least 4 weeks' duration. The pooled effects of intervention comparisons were generated by the Bayesian random‐effects model, and the quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development, and Evaluations framework. Results Twelve RCTs (1260 women; mean age, 20–35 years) comparing exercise‐based interventions with usual care/no therapy were included. Exercise effectively treats depressive symptoms (standard mean difference [SMD], −0.81 [95% confidence interval (CI), −1.20 to −0.42], P < 0.001). Pram walking was significantly associated with a reduction of depressive symptoms during the postpartum period (SMD, −1.00 [95% CI, −2.60 to −0.10], P = 0.020), as well as yoga (SMD, −0.73 [95% CI, −1.84 to −0.43], P < 0.001) and supervised mixed exercise (SMD, −0.77 [95% CI, −1.67 to −0.01], P = 0.041) compared with usual care/no therapy. In indirect comparisons, pram walking (surface under the cumulative ranking curve, 58.9%) was better than yoga (SMD, −0.28 [95% CI, −1.86 to 1.22], P = 0.322) and supervised mixed exercise (SMD, −0.23 [95% CI, −1.59 to 1.12], P = 0.358). However, the difference was not statistically significant. The confidence in evidence was very low to moderate. Conclusion In women with PPD, all commonly prescribed physical exercises were effective alternative or complementary treatments. However, pram walking may perform better in improving the symptoms of PPD.