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

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.