Effects of physical activity on depressive and anxiety symptoms of women in the menopausal transition and menopause: a comprehensive systematic review and meta-analysis of randomized controlled trials

BackgroundDepression and anxiety may significantly affect women in the menopausal transition and menopause. In addition to traditional treatment strategies such as hormone therapy, antidepressants, and psychotherapy, physical activity (PA) have been increasingly studied, but there is no consensus about their role in menopausal women with depression and anxiety. ObjectiveThe current study aimed to evaluate the effect of PA on the severity of depressive (DS) and anxiety (AS) symptoms in women during the menopausal transition and menopause. MethodsWe searched for relevant published studies in PubMed, Embase, Web of Science, Cochrane Library, and CINAHL prior to 8 April 2024, focusing on randomized controlled trials documenting the effect of physical activity on DS and AS, and assessed study quality using the Newcastle-Ottawa Scale. ResultsThe data used for meta-analysis were derived from 21 studies (DS, n = 9; AS, n = 1; DS and AS combined, n = 11) involving 2020 participants. The results showed that PA groups demonstrated a statistically significant effect of depressive symptoms versus controls (DS [SMD: -0.66, 95% CI: -0.99 to -0.33; P < 0.001]; AS [SMD: -0.55, 95% CI: -0.82 to -0.27; P < 0.001]). As subgroup analyses demonstrated, physical exercise also reduced depressive symptom of women in menopausal status (SMD =-0.56, 95% CI: -0.96 to - 0.17, p = 0.006, I-2 = 69%), postmenopausal status (SMD =-0.94, 95% CI: -1.46 to - 0.42, p = 0.0004, I-2 = 94%), and both in menopausal transition and postmenopausal status (SMD =-0.30, 95% CI: -0.49 to - 0.12, p = 0.001, I-2 = 0%), while it only reduced anxiety symptom of postmenopausal women (SMD =-0.96, 95% CI: -1.49 to - 0.43, p = 0.0004, I-2 = 89%). Low-intensity and moderate-intensity exercise both produced increasingly benefits over depressive and anxiety symptoms. However, there is no statistically significant effect of exercise intensity on both depressive symptom and anxiety symptom. ConclusionPhysical activities with low to moderate intensity can impart remarkable improvements for managing menopausal women with depression and anxiety.