Abstract

Objective: To estimate the effect of exercise on perinatal depressive symptoms, focusing on subclinical depression. Methods: Randomized controlled trials (RCTs) reporting Edinburgh Postnatal Depression Scale (EPDS) scores and evaluating perinatal exercise interventions were eligible. A systematic search was conducted in MEDLINE/PubMed, Web of Science, Scopus, and the Cochrane Library for studies published between 2000 and 2024. Study quality, risk of bias, and heterogeneity were assessed before synthesizing the results using a random-effects model. Results: Nine RCTs met the inclusion criteria. Exercise significantly reduced depressive symptoms (SMD = -0.47; 95% CI = -0.86 to -0.08; p = 0.02) despite high heterogeneity (I2 = 88%). Subgroup analyses showed stronger effects during pregnancy (SMD = -0.77; 95% CI = -1.40 to -0.15) than in the postpartum period (SMD = -0.05; 95% CI = -0.31 to 0.22). Conclusion: Exercise effectively reduces perinatal depressive symptoms and represents a valuable public health intervention. Longer follow-up periods (?6 months) are needed to confirm the durability of benefits and to evaluate maternal and child outcomes. Future high-quality RCTs with standardized exercise protocols (?150 min/week of moderate activity) will be essential to translate this evidence into actionable public health and clinical guidelines. © © 2025 Fuenzalida, Droppelmann, Mahecha and Feijoo.