Physical activity and perinatal depression and anxiety: a global umbrella review and meta-meta-analysis
Physical activity reduces perinatal depressive symptoms and may reduce anxiety, especially with yoga.
*Umbrella review of randomized trial reviews; Level 1a.
Citation
Mohr E, Ludwig-Walz H, Pieper D, et al. Physical activity and perinatal depression and anxiety: a global umbrella review and meta-meta-analysis. eClinicalMedicine. 2026;98:104054.
Background
Depression and anxiety are common during pregnancy and after birth. Medication concerns and limited access to therapy make safe, low-cost options important.
Patients
Women during pregnancy or up to 1 year after birth. Reviews were excluded if they included drug or psychotherapy co-interventions, or women with health problems other than depression or anxiety.
Intervention
Physical activity programs, including yoga, walking, aerobic exercise, and mixed activities, at light, moderate, vigorous, or mixed intensity.
Control
Usual care, no intervention, waitlist, or non-exercise active controls.
Outcome
Depressive and anxiety symptoms, commonly measured with Edinburgh Postnatal Depression Scale (0–30), Center for Epidemiologic Studies Depression Scale (0–60), and State-Trait Anxiety Inventory (20–80).
Follow-up Period
Pregnancy through the postpartum period, varying by included trial.
Results
| Finding | Effect |
|---|---|
| Any physical activity for perinatal depressive symptoms | SMD −0.56 (95% CI −0.93 to −0.19) |
| Light-intensity activity for depressive symptoms | SMD −0.52 (95% CI −0.81 to −0.23) |
| Moderate-intensity activity for depressive symptoms | SMD −0.43 (95% CI −0.64 to −0.22) |
| Yoga for depressive symptoms | SMD −0.55 (95% CI −0.95 to −0.15) |
| Yoga for prenatal anxiety symptoms | SMD −0.85 (95% CI −1.29 to −0.42) |
SMD = standardized mean difference; larger negative values mean greater symptom improvement. CI = confidence interval.
The evidence certainty was moderate. Controls were usually usual care or no exercise, not a single established treatment.
Limitations
Included reviews had critically low quality ratings, mainly from reporting gaps. Anxiety evidence was limited. Interventions, scales, and follow-up varied, and clinical importance for patients was uncertain.
Funding
No specific funding; no industry involvement reported.
Clinical Application
Recommend safe light or moderate activity, including yoga or walking, as an adjunct for perinatal mood symptoms, not a replacement for needed treatment.
Discussion
Sign in to join the discussion.
In this umbrella review with meta-meta-analysis of RCT-based systematic reviews, physical activity interventions reduced perinatal depressive symptoms (SMD −0.56, 95% CI −0.93 to −0.19); given critically low AMSTAR-2 ratings and overlap concerns, how valid and applicable is this evidence for changing perinatal mental health counseling? The authors reported a standardized mean difference (SMD) of −0.56 for physical activity versus non-physical-activity comparators on perinatal depressive symptoms. What is the best interpretation of this result?