{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:45:54Z","timestamp":1785735954464,"version":"3.56.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Postpartum depression is a common mental health condition after childbirth that can adversely affect maternal well-being, social functioning, and the mother\u2013infant relationship. Although pharmacotherapy, psychotherapy, and exercise rehabilitation are available, current evidence is derived mainly from pairwise comparisons, leaving the relative efficacy of different exercise interventions and the certainty of comparative evidence unclear. This study therefore conducted a systematic review and network meta-analysis to compare the effects of different exercise rehabilitation interventions on postpartum depression and to evaluate the certainty of the evidence for clinical decision-making and exercise prescription.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This systematic review and network meta-analysis was conducted according to a prespecified protocol. PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched from inception to March 1, 2026. Randomized controlled trials involving postpartum women were eligible for inclusion. Interventions were classified as active control (AC), exercise combined with other interventions (E+CI), lifestyle physical activity promotion (LPA), mind\u2013body exercise (MBE), passive control (PC), pelvic floor muscle training (PFMT), resistance training (RT), and structured aerobic exercise (SAE). The primary outcome was postpartum depression score treated as a continuous variable. Two reviewers independently screened studies, extracted data, and assessed risk of bias. A frequentist random-effects network meta-analysis was conducted to synthesize direct and indirect evidence, with results expressed as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Treatments were ranked using the surface under the cumulative ranking curve (SUCRA), the probability of being the best treatment, and mean rank. The certainty of evidence was evaluated using Confidence in Network Meta-Analysis (CINeMA) and Grading of Recommendations Assessment, Development and Evaluation (GRADE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 23 randomized controlled trials involving 2,752 postpartum women and 8 intervention\/control nodes were included. Most studies were judged as having some concerns, and a few were rated as high risk of bias. No statistically significant global inconsistency was identified. For the primary outcome, SAE significantly reduced postpartum depression scores compared with both passive control and active control, showing the clearest statistically supported comparative effects. MBE showed favorable point estimates and ranking-based performance; however, its key comparisons with passive and active control did not reach statistical significance. Subgroup analyses suggested that MBE may be more favorable among postpartum women with baseline depression, whereas SAE may be more favorable among women without baseline depression who were considered high-risk or included in preventive samples. Sensitivity analyses suggested that SAE was relatively robust, whereas MBE was more sensitive to the influence of individual studies. Overall, the certainty of evidence was low to very low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among postpartum women, SAE showed the most consistent statistically significant advantages in key comparisons and demonstrated greater robustness in sensitivity analyses. MBE also appeared promising based on favorable point estimates and ranking-based results, but its main comparisons with passive and active control were not statistically significant and should not be interpreted as definitive evidence of superiority. Therefore, current evidence suggests that SAE has the clearest comparative support, while MBE remains a potentially beneficial intervention that requires further confirmation. However, the available evidence is limited by risk of bias, small sample sizes, imprecision, and low overall certainty. Further high-quality randomized controlled trials with larger samples, head-to-head comparisons, and standardized outcome reporting are required to confirm the relative efficacy of different exercise rehabilitation interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n                      , identfier CRD420261352226.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1889186","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:30:09Z","timestamp":1785735009000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative effectiveness and certainty of exercise-based interventions for postpartum depressive symptoms: a systematic review and network meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"17","author":[{"given":"Kun","family":"Chen","sequence":"first","affiliation":[{"name":"School of Sports Training, Tianjin University of Sport","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahang","family":"Liu","sequence":"additional","affiliation":[{"name":"Office of Research and Graduate Education, Tianjin University of Sport","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Zhang","sequence":"additional","affiliation":[{"name":"School of Sports Training, Tianjin University of Sport","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijun","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Competitive Sports, Tianjin University of Sport","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-med-041217-011106","article-title":"Postpartum depression: pathophysiology, treatment, and emerging therapeutics","volume":"70","author":"Stewart","year":"2019","journal-title":"Annu Rev Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3122\/jabfm.2023.230061r1","article-title":"Perinatal depression: a guide to detection and management in primary care","volume":"36","author":"Dama","year":"2024","journal-title":"J Am Board Fam Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2018.08.001","article-title":"Prevalence and incidence of postpartum depression among healthy mothers: a systematic review and meta-analysis","volume":"104","author":"Shorey","year":"2018","journal-title":"J Psychiatr Res"},{"key":"B4","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1038\/s41398-021-01663-6","article-title":"Mapping global prevalence of depression among postpartum women","volume":"11","author":"Wang","year":"2021","journal-title":"Transl Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-024-02038-z","article-title":"Postpartum depression: a clinical review of impact and current treatment solutions","volume":"84","author":"Dennis","year":"2024","journal-title":"Drugs"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1249\/mss.0000000000001941","article-title":"Benefits of physical activity during pregnancy and postpartum: an umbrella review","volume":"51","author":"DiPietro","year":"2019","journal-title":"Med Sci Sports Exerc"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jshs.2023.12.004","article-title":"A review of public health guidelines for postpartum physical activity and sedentary behavior from around the world","volume":"13","author":"Evenson","year":"2024","journal-title":"J Sport Health Sci"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2024-108478","article-title":"Impact of postpartum physical activity on maternal depression and anxiety: a systematic review and meta-analysis","volume":"59","author":"Deprato","year":"2025","journal-title":"Br J Sports Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp17x692525","article-title":"Does aerobic exercise reduce postpartum depressive symptoms? a systematic review and meta-analysis","volume":"67","author":"Pritchett","year":"2017","journal-title":"Br J Gen Pract"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0287650","article-title":"Effectiveness of aerobic exercise in the prevention and treatment of postpartum depression: meta-analysis and network meta-analysis","volume":"18","author":"Xu","year":"2023","journal-title":"PloS One"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.7326\/m14-2385","article-title":"The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann Intern Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.ad","article-title":"GRADE: an emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"Bmj"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003082","article-title":"CINeMA: an approach for assessing confidence in the results of a network meta-analysis","volume":"17","author":"Nikolakopoulou","year":"2020","journal-title":"PloS Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-14-971","article-title":"A comparison of a social support physical activity intervention in weight management among post-partum Latinas","volume":"14","author":"Keller","year":"2014","journal-title":"BMC Public Health"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1080\/07399332.2017.1295049","article-title":"Exercise as an adjunct treatment for postpartum depression for women living in an inner city-a pilot study","volume":"38","author":"Forsyth","year":"2017","journal-title":"Health Care Women Int"},{"key":"B17","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1080\/01674820903212136","article-title":"A randomized clinical trial of exercise to alleviate postpartum depressed mood","volume":"30","author":"Da Costa","year":"2009","journal-title":"J Psychosom Obstet Gynaecol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp08x277195","article-title":"Feasibility of an exercise intervention for women with postnatal depression: a pilot randomised controlled trial","volume":"58","author":"Daley","year":"2008","journal-title":"Br J Gen Pract"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.323.7313.593","article-title":"Conservative management of persistent postnatal urinary and faecal incontinence: randomised controlled trial","volume":"323","author":"Glazener","year":"2001","journal-title":"Bmj"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-172x.2004.00478.x","article-title":"The effectiveness of a pram-walking exercise programme in reducing depressive symptomatology for postnatal women","volume":"10","author":"Armstrong","year":"2004","journal-title":"Int J Nurs Pract"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536x.2007.00192.x","article-title":"Effectiveness of an exercise support program in reducing the severity of postnatal depression in Taiwanese women","volume":"35","author":"Heh","year":"2008","journal-title":"Birth"},{"key":"B22","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.ctcp.2015.03.003","article-title":"Efficacy of yoga for depressed postpartum women: a randomized controlled trial","volume":"21","author":"Buttner","year":"2015","journal-title":"Complement Ther Clin Pract"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2020.102898","article-title":"Mums on the move: a pilot randomised controlled trial of a home-based physical activity intervention for mothers at risk of postnatal depression","volume":"93","author":"Teychenne","year":"2021","journal-title":"Midwifery"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1017\/s0033291715000409","article-title":"A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial","volume":"45","author":"Daley","year":"2015","journal-title":"Psychol Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.mhpa.2013.11.002","article-title":"A randomized trial examining a physical activity intervention for the prevention of postpartum depression: the healthy mom trial","volume":"7","author":"Lewis","year":"2014","journal-title":"Ment Health Phys Activity"},{"key":"B26","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1186\/s12884-021-04257-8","article-title":"Randomized trial examining the effect of exercise and wellness interventions on preventing postpartum depression and perceived stress","volume":"21","author":"Lewis","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/ppc.12500","article-title":"The effectiveness of an exercise intervention in reducing the severity of postpartum depression: a randomized controlled trial","volume":"56","author":"Ozkan","year":"2020","journal-title":"Perspect Psychiatr Care"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20090139","article-title":"An exercise and education program improves well-being of new mothers: a randomized controlled trial","volume":"90","author":"Norman","year":"2010","journal-title":"Phys Ther"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-010-0729-x","article-title":"Impact of a health promotion intervention on maternal depressive symptoms at 15 months postpartum","volume":"16","author":"Surkan","year":"2012","journal-title":"Matern Child Health J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijnurstu.2017.09.009","article-title":"Effectiveness of aerobic gymnastic exercise on stress, fatigue, and sleep quality during postpartum: a pilot randomized controlled trial","volume":"77","author":"Yang","year":"2018","journal-title":"Int J Nurs Stud"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.2012.01490.x","article-title":"Effect of resistance training on body composition, self-efficacy, depression, and activity in postpartum women","volume":"24","author":"LeCheminant","year":"2014","journal-title":"Scand J Med Sci Sports"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-0979.2003.00229.x","article-title":"The effects of exercise and social support on mothers reporting depressive symptoms: a pilot randomized controlled trial","volume":"12","author":"Armstrong","year":"2003","journal-title":"Int J Ment Health Nurs"},{"key":"B33","doi-asserted-by":"publisher","first-page":"432","DOI":"10.4236\/health.2013.53058","article-title":"The effects of an exercise program on health-related quality of life in postpartum mothers: a randomized controlled trial","volume":"5","author":"Haruna","year":"2013","journal-title":"Health"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.15621\/ijphy\/2014\/v1i3\/53468","article-title":"A structured physical activity and health care education beats postpartum depression for primipara mothers: a pilot randomized controlled trial","volume":"1","author":"Thiruppathi","year":"2014","journal-title":"Int J Physiother"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1097\/01.jnr.0000387304.88998.0b","article-title":"Effects of postpartum exercise program on fatigue and depression during \"doing-the-month\" period","volume":"16","author":"Ko","year":"2008","journal-title":"J Nurs Res"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.explore.2025.103195","article-title":"Effectiveness of laughter yoga in reducing postpartum depression symptoms: a randomized controlled study","volume":"21","author":"Unver Koca","year":"2025","journal-title":"Explore (NY)"},{"key":"B37","doi-asserted-by":"publisher","first-page":"11766","DOI":"10.1038\/s41598-025-96165-6","article-title":"Virtual reality enhanced mindfulness and yoga intervention for postpartum depression and anxiety in the post COVID era","volume":"15","author":"Liu","year":"2025","journal-title":"Sci Rep"},{"key":"B38","doi-asserted-by":"publisher","first-page":"195","DOI":"10.24869\/psyd.2021.195","article-title":"Yoga's therapeutic effect on perinatal depression: a systematic review and meta-analysis","volume":"34","author":"Wang","year":"2022","journal-title":"Psychiatr Danub"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1111\/jjns.12650","article-title":"Depressive symptoms and heart rate variability in perinatal women: a narrative review","volume":"22","author":"Unno","year":"2025","journal-title":"Jpn J Nurs Sci"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2024.111033","article-title":"The relationship between BDNF and physical activity on depression","volume":"134","author":"Zarza-Rebollo","year":"2024","journal-title":"Prog Neuro-Psychopharmacol Biol Psychiatry"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1889186\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:30:10Z","timestamp":1785735010000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1889186\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":40,"alternative-id":["10.3389\/fpsyt.2026.1889186"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1889186","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"1889186"}}