By Hanna Ozbeki
Editor’s Note: This article, written by Hanna Ozbeki as a FACTS elective student, summarizes the findings of Ji et al.’s 2024 study, “Meta-analysis of the Effect of Different Exercise Modalities in the Prevention and Treatment of Perinatal Depression.” The authors found that exercise—particularly guided exercises and yoga—can help prevent and treat perinatal depression. As summer encourages us to embrace healthy routines and time outdoors, these findings highlight a holistic approach to maternal health that parallels the principles of fertility awareness-based methods (FABMs), recognizing the important connection between lifestyle, mental health, and reproductive well-being.
Introduction
This article discusses the increasing prevalence of perinatal depression (PND) and the necessity for prevention and treatment, specifically examining the role of different exercise modalities.[1] PND refers to depressive symptoms that occur throughout pregnancy and after delivery or miscarriage, with a global prevalence ranging from 10% to 33%.[2] PND significantly impacts the pregnant woman’s quality of life through physical and psychological effects and can lead to serious outcomes, such as increased intrauterine distress and premature birth in addition to risk of cognitive and intellectual development of the baby.[3]
“Perinatal depression refers to depressive symptoms that occur throughout pregnancy and after delivery or miscarriage, with a global prevalence ranging from 10% to 33%.”
Naturally, prenatal depression is the strongest risk factor of postpartum depression, leading to even more serious outcomes like potential emotional and physical harm to the infant.[4][5] Therefore, the need for prevention and treatment of PND has become increasingly important. Exercise is of growing interest as a safe, low-cost intervention. The article by Ji et al. (2024) is a meta-analysis comparing various exercise programs (yoga, aerobic exercise, strength training, and water exercise) for preventing or treating depression during the perinatal period.[1]
Methodology
A meta-analysis was conducted to explore the various types of exercise modalities used in perinatal depression from randomized controlled trials since July 20, 2022.
They searched major databases, selecting trials that tested any exercise intervention for pregnant or postpartum women with depression outcomes. The meta-analysis included 48 trials with a total of 5,282 women. Various exercise types were compared, including mind–body exercises (e.g. yoga), aerobic and resistance training, pelvic floor workouts, aquatic exercise, “stroller walking,” and other structured routines. In most trials, women were screened for depression before and after the exercise program using standardized scales. Because pregnancy makes blinding difficult, most studies could not mask participants or instructors, increasing the risk of bias.
Results
The meta-analysis found that exercise interventions had modest but meaningful effects on perinatal depression with outcomes varying by timing and type. Overall, prenatal exercise reduced the incidence of new-onset depression, though effect sizes were relatively small. For preventing depression before birth, yoga had the greatest benefit, followed by combined aerobic exercise and resistance training. When used to treat women already experiencing prenatal depression, guided physical exercise showed a stronger (moderate) effect. Structured classes labeled “gymnastics” in the study produced the largest reduction in symptoms, followed by pelvic floor training and aerobic activities.
“For preventing depression before birth, yoga had the greatest benefit, followed by combined aerobic exercise and resistance training.”
In the postpartum period, exercise was less powerful as a preventive measure. Yoga again appeared most helpful, but the overall preventive effect on postpartum depression was modest. By contrast, exercise used as a treatment for established postpartum depression had a moderate effect size. In that analysis, aerobic and water-based exercises showed significant benefit, along with “fertility dance” routines. Meanwhile, light activities, like stroller walking, were less effective. Overall, exercise appeared to have greater benefits as a treatment for existing perinatal depression than as an approach to prevent its onset. Prenatal exercise programs tended to work better than postpartum programs.
Discussion
It is important to note that the studies were not blinded, which poses a potential risk to the interpretation of the accuracy of the results and future implementation. This research showed that exercise appears to be more effective as a treatment for existing perinatal depression than as a preventive intervention. It showed that the effects of exercise are generally greater during pregnancy than during the postpartum period.
“This research showed that exercise appears to be more effective as a treatment for existing perinatal depression than as a preventive intervention… (and) the effects of exercise are generally greater during pregnancy than during the postpartum period.”
This research is highly relevant to women’s health and fertility planning. By improving maternal mood, exercise interventions could support healthier pregnancies and postpartum care. For example, better maternal mental health tends to improve parenting behaviors, breastfeeding success, and mother–baby bonding, which are all important for healthy infant development. In a fertility-awareness context, postpartum depression can complicate plans for spacing or adding children. Depressed mothers may struggle more with exclusive breastfeeding and using the lactational amenorrhea method of family planning. Untreated depression can delay recovery and may increase unplanned pregnancies if attention to family planning lapses. Thus, integrating exercise-based support in prenatal care could indirectly improve family-planning outcomes by promoting well-being.
“By improving maternal mood, exercise interventions could support healthier pregnancies and postpartum care … (as) better maternal mental health tends to improve parenting behaviors, breastfeeding success, and mother–baby bonding”
Mind–body practices like yoga may be particularly helpful in preventing prenatal depression. Future research should determine whether the social support inherent in group exercise classes contributes to improved mental health outcomes. Studies are also needed to clarify whether supervised, structured exercise programs are more effective than home-based routines for preventing and treating perinatal depression.
Exercise is a low-risk intervention that can still make a real difference. It also aligns well with the overall goals of family planning and women’s health. Clinicians should feel confident suggesting physical activity, especially during pregnancy, to support mental well-being.
References
[1] Ji, M., Li, R., & Xu, Y. (2024). Meta-analysis of the effect of different exercise modalities in the prevention and treatment of perinatal depression. Journal of affective disorders, 350, 442-451.
[2] Obstetric Subgroup, Society of Obstetrics and Gynecology, Chinese Medical Association, 2021. Experts consensus on screening and diagnosis of perinatal depression. Chinese Journal of Obstetrics and Gynecology 56 (8), 521–527.
[3] Xu, Lixia, 2018. Effect of antenatal depression on the mode of delivery, complications and perinatal outcome in women with gestational diabetes mellitus. China Maternal and Child Health 33 (14), 3167–3168.
[4] Edmond, K. M. (2017). The importance of interventions to improve maternal mental health. Journal of Tropical Pediatrics, 63(1), 1-3.
[5] Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Archives of women’s mental health, 6(4), 263-274
ABOUT THE AUTHOR
Dr. Hanna Ozbeki a first year psychiatry resident at Mount Sinai Morningside/West in New York City. She graduated from A.T. Still University School of Osteopathic Medicine in Arizona in May 2026 and holds an MPH in Health Promotion from George Washington University (2022). Her interests lie at the intersection of psychiatry and public health, and she hopes to bring both perspectives to her future clinical and research work.
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