R E V I E W

ISSN 0120-0534

Volumen 58

* Corresponding author.

E-mail: katherine.soto@unab.cl

Nota. Código Postal 7591538, Santiago de Chile, Chile.

https://doi.org/10.14349/rlp.2026.v58.1 0120-0534/© 2026 Fundación Universitaria Konrad Lorenz. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/). Revista Latinoamericana de Psicología (2026) 58, e580177 https://doi.org/10.14349/rlp.2026.v58.1 https://revistalatinoamericanadepsicologia.konradlorenz.edu.co/ Physical exercise for perinatal mental health:

An umbrella review highlighting the prevalence of yoga over conventional forms of exercise Nuria Pérez-Romero a , Marco Antonio Contreras-Donoso b, Vicente Ignacio Jiménez-Reyes b, Alonso Muñoz-Zúñiga b, Constanza Catalina Reyes-Vera b, Katherine Soto-Schulz a,*

a Exercise and Rehabilitation Sciences Institute, Postgraduate, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Chile b Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Chile Received 22 August 2025; accepted 6 April 2026 Abstract | Objective: Perinatal mental health is a clinical and public health priority, given the high prevalence of anxiety, depression, and stress symptoms during pregnancy and postpartum. This umbrella review is aimed to synthesise the available evidence on the effects of physical exercise on perinatal mental health. Method: The review followed the PRIOR guidelines for umbrella reviews, and the protocol was registered in PROSPERO ID: CRD42024590807. Systematic searches were conducted in PubMed, Scopus, and Web of Science up to August 2025. The studies included were systematic reviews, with or without meta-analyses of randomised controlled trials, evaluating physical activity, exercise, or body-based inter­ ventions in pregnant or postpartum women, compared to non-intervention groups. Methodological quality was assessed using the AMSTAR-2 criteria, and study overlap was examined through the MOoR model. Results: Nineteen systematic reviews were included, covering a total of 26,065 participants. Yoga was the most frequently studied modality and con­ sistently showed beneficial effects in reducing anxiety symptoms. Other interventions, such as walking, aerobic exercise, or pelvic floor training, showed mixed or non-significant results. Limitations were identified, including poor application of the FITT framework and lack of standardisation. Conclusion: These findings suggest that mind-body interventions, particularly yoga, show more consistent associations, whereas the results for conventional forms of physical exercise are mixed. Moreover, they highlight the importance of integrating psychological components into care strategies, promoting a more holistic approach to maternal mental well-being, although research of higher methodological quality is needed to clarify the magnitude and robustness of these effects.

Keywords: Pregnancy, mental health, emotions, physical exercise, well-being © 2026 Fundación Universitaria Konrad Lorenz. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/ by-nc-nd/4.0/).

Ejercicio físico para la salud mental perinatal: una revisión de revisiones que destaca la importancia del yoga frente a otras modalidades Resumen | Objetivo: La salud mental perinatal representa una prioridad clínica y de salud pública, dada la alta prevalencia de síntomas de ansiedad, depresión y estrés durante el embarazo y el posparto. Esta revisión paraguas tuvo como objetivo sintetizar la evidencia disponible sobre los efectos del ejercicio físico en la salud mental perinatal. Método: Se siguieron las directrices PRIOR para revisiones paraguas y se registró el protocolo en PROSPERO ID: CRD42024590807. Se realizaron búsquedas sistemáticas en PubMed, Scopus y Web of Science hasta agosto de 2025. Se incluyeron revisiones sistemáticas,

2/15 N. Pérez-Romero et al.

The perinatal period is a stage of significant biopsy­ chosocial vulnerability, involving physical, emotional, and social changes that demand constant adaptation. These include physiological changes, shifting fami­ ly roles, and socioeconomic adjustments (Žutić, 2023), which can increase exposure to stressors and lead to anxiety and depression symptoms (Patel & Dev, 2023). Stress in this period is shaped by emotional, social, and environmental factors interacting with personal histo­ ry and coping abilities (Patel & Dev, 2023). Anxiety is marked by excessive worry and physical symptoms such as tachycardia or restlessness, while depression involves low mood, fatigue, and hopeless­ ness. Though often subclinical, symptoms are preva­ lent: anxiety affects 22.9% of pregnant women, peaking at 24.6% in the third trimester, and dropping to 15% postpartum. Diagnosed disorders occur in 9.9-15.2% of women (Dennis et al., 2017).

Common treatments include medication, coun­ selling, CBT, and telemedicine (Stentzel et al., 2023). Physical activity has emerged as a low-cost, accessi­ ble, preventive option. Defined as any musculoskele­ tal movement producing energy expenditure (World Health Organization, 2023), it ranges in intensity from light to vigorous. Exercise, structured and purposeful, includes modalities such as yoga, while sport refers to regulated physical activities. Studies show that exer­ cise, especially yoga and aerobic forms, can reduce peri­ natal anxiety and depression symptoms (Diprieto et al., 2019; Munns et al., 2024).

Several recent studies have partially explored the effects of physical activity on perinatal mental health. Matvienko-Sikar et al. (2023) focused on interventions for pregnant women with and without mental health risks. Villar-Alises et al. (2023) evaluated prenatal yoga interventions, reporting reductions in anxiety, depres­ sion, and stress. Diprieto et al. (2019) reviewed the bene­ fits of physical activity during pregnancy and postpar­ tum for both maternal and fetal health, while Chow et al. (2021) included exercise in their review on postpar­ tum depression.

However, no umbrella review has yet synthesised the available evidence on the effects of physical exer­ cise on perinatal mental health across both pregnancy con o sin metaanálisis de ensayos clínicos aleatorizados, que evaluaron intervenciones de actividad física, ejercicio o prác­ ticas corporales en mujeres embarazadas o puérperas, comparadas con grupos sin intervención. Se aplicaron los criterios AMSTAR-2 para evaluar la calidad metodológica y el modelo MOoR para analizar el solapamiento entre estudios prima­ rios. Resultados: Se incluyeron 19 revisiones sistemáticas, que en conjunto abarcaron a 26 065 participantes. El yoga fue la modalidad más estudiada y demostró efectos consistentes en la reducción de síntomas de ansiedad. Otras intervenciones, como caminatas, ejercicios aeróbicos o de fortalecimiento pélvico, mostraron resultados mixtos o poco significativos. Se identificaron limitaciones como la escasa aplicación del modelo FITT (frecuencia, intensidad, tiempo y tipo) y la falta de estandarización. Conclusión: Estos hallazgos sugieren que las intervenciones mente-cuerpo, en particular el yoga, mues­ tran asociaciones más consistentes, mientras que los resultados para las formas convencionales de ejercicio físico son heterogéneos. Además, subrayan la importancia de integrar componentes psicológicos en las estrategias de atención, pro­ moviendo un enfoque más holístico para el bienestar mental materno, aunque se requiere investigación de mayor calidad metodológica para esclarecer la magnitud y solidez de estos efectos. Palabras clave: Embarazo, salud mental, emociones, ejercicio físico, bienestar © 2026 Fundación Universitaria Konrad Lorenz. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/ by-nc-nd/4.0/).

and postpartum. Previous reviews have also lacked indepth analysis of intervention components using the FITT principles (frequency, intensity, time, type) and have not quantitatively examined effect sizes based on included meta-analyses. This type of synthesis is es­ sential to estimate the magnitude of exercise benefits and to identify which characteristics make interven­ tions more effective, offering valuable guidance for per­ inatal health professionals.

The aim of this study was to synthesise previous re­ views on the effect of physical exercise on symptoms of stress, anxiety and depression in pregnant and post­ partum women. In addition to evaluating the effect of physical exercise on this symptomatology, to detail the types of physical exercise and to analyse the optimal dosage, something that other previous studies did not specify.

Method An umbrella review was conducted in line with the PRIOR guidelines (Gates et al., 2022) and the Cochrane Handbook recommendations (Higgins et al., 2024). The protocol was registered in PROSPERO: CRD42024590807. Data sources and search strategies A systematic search was performed on 07/08/2024 in PubMed, Web of Science, and Scopus using MeSH terms and synonyms for pregnancy, physical activity, and mental health, combined with Boolean operators and then updated in 07/08/2025. Full search strategies are detailed in Table 1.

Eligibility criteria PICOS strategy (population, intervention, comparator, outcome and study type) was used (Table 2). In addition, overlap was considered, as explained below. Study selection Four authors divided into two groups (M. A. C.-D. and V.

I. J.-R.; A. M.-Z. and C. C. R.-V.) read the title, abstract and

full text in parallel and they compared the results. Con­

3/15 Physical exercise for perinatal mental health: An umbrella review highlighting the prevalence of yoga over conventional flicts encountered were resolved by a fifth author (N. P.- R.) and reviewed by a sixth author (K. S.-S.). Table 1. Search strategies according to database Database Search strategy

PUBMED

(((((((pregnant[Title/Abstract]) OR (pregnancy[­ Title/Abstract])) OR (Postnatal[Title/Abstract])) OR (Prenatal[Title/Abstract])) OR (Postpartum[­ Title/Abstract])) OR (gestation[Title/Abstract])) AND (((((((“physical exercise”[Title/Abstract]) OR (strength[Title/Abstract])) OR (“physical ac­ tivity”[Title/Abstract])) OR (Yoga[Title/ Abstract])) OR (aerobic[Title/Abstract])) OR (training[Title/Abstract])) OR (walking[Title/ Abstract]))) AND ((((((((“mental health”[Title/Ab­ stract]) OR (“mental hygiene”[Title/Abstract])) OR (depression[Title/Abstract])) OR (anxiety[Ti­ tle/Abstract])) OR (emotion[Title/Abstract])) OR (stress[Title/Abstract])) OR (“wellbeing”[Title/ Abstract])) OR (wellness[Title/Abstract])) Fil­ ters: Meta-Analysis, Network Meta-Analysis, Review, Systematic Review

WOS

#1:

AB=(Pregnant); #2:

AB=(Pregnancy); #3: AB=(Postnatal); #4: AB=(Prenatal); #5: AB=(Postpartum); #6: AB=(Gestation); #7: #1 OR #2 OR #3 OR #4 OR #5 OR #6; #8: AB=(“­ Physical exercise”); #9: AB=(Strength); #10: AB=(“Physical activity”); #11:

AB=(Yoga); #12: AB=(aerobic); #13: AB=(Training); #14: AB=(Walking); #15: #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14; #16: AB=(“Mental health”); #17: AB=(“Mental hygiene”); #18: AB=(Depres­ sion); #19: AB=(Anxiety); #20: AB=(Emotion); #21: AB=(Stress); #22: AB=(“Well being”); #23: AB=(Wellness); #24: #16 OR #17 OR #18 OR #19

OR #20 OR #21 OR #22 OR #23; #25: #7 AND #15

AND #24; #26: #7 AND #15 AND #24 and Re­ view Article (Document Types)

SCOPUS

( ( ABS ( pregnant ) ) OR ( ABS ( pregnancy ) ) OR ( ABS ( prenatal ) ) OR ( ABS ( postpartum ) ) OR ( ABS ( postnatal ) ) OR ( ABS ( gestation ) ) ) AND ( ( ABS ( “Physical exercise” ) ) OR ( ABS ( strength ) ) OR ( ABS ( “Physical activity” ) ) OR ( ABS ( yoga ) ) OR ( ABS ( aerobic ) ) OR ( ABS ( training ) ) OR ( ABS ( walking ) ) ) AND ( ( ABS ( “Mental health” ) ) OR ( ABS ( “Mental hygiene” ) ) OR ( ABS ( depression ) ) OR ( ABS ( anxiety ) ) OR ( ABS ( emotion ) ) OR ( ABS ( stress ) ) OR ( ABS ( “Well being” ) ) OR ( ABS ( wellness ) ) ) AND ( LIMIT-TO ( DOCTYPE , “re” ) ) Data extraction The articles were independently reviewed in full by the research team and then compared (M. A. C.-D. and V. I. J.-R.; A. M.-Z. and C. C. R.-V.). All extracted data were re­ viewed by a fifth author (N. P.-R.) and subsequently by a sixth author (K. S.-S.). A Microsoft 365 Excel spread­ sheet was used to record study characteristics (num­ ber of primary studies, databases), sample details (size, pregnancy stage, age), and intervention parameters (duration, frequency, intensity, type). Mental health variables, assessment instruments, and outcomes for stress, anxiety, and depression were also extracted. For meta-analyses, confidence intervals (CI), heterogeneity (I²), standardised mean differences (SMD), and p-values were recorded. For non-meta-analytic reviews, out­ comes were classified based on the number of primary studies and reported group improvements. Table 2. Eligibility criteria based on PICOS methodology Picos Inclusion criteria Exclusion criteria P Pregnant and post-pregnancy wo­ men 6-52 weeks after delivery (Kumarasin­ ghe et al., 2024).

Pregnant women with chronic illnesses.

I Physical activity pro­ grammes, physical exercise or sport that include more than one session.

Interventions that do not detail what they did or that were not program­ med, such as, for example, a prescription to reduce sedentary lifestyle.

C Failure to carry out a physical activity, exercise or sport programme.

Groups that the study calls “control” but actua­ lly do some type of sche­ duled physical activity.

O Symptoms of anxiety, stress and depression.

Non-validated instruments.

S Systematic Reviews with or without Me­ ta-analyses of rando­ mised clinical trials.

Non pre-post interven­ tion results, such as con­ ference abstracts.

Risk of bias The risk of bias of the included reviews was assessed us­ ing AMSTAR-2 (A Measurement Tool to Assess System­ atic Reviews, Shea et al., 2017). Two groups of authors (M. A. C.-D. and V. I. J.-R.; A. M.-Z. and C. C. R.-V.) conducted independent parallel assessments, which were later re­ viewed by two additional authors (N. P.-R. and K. S.-S.). AMSTAR-2 includes 16 items, of which 7 are considered critical domains. Each item is rated as yes, partially yes, or no. Based on the number and type of weakness­ es, overall confidence in the results of each review was classified as high, moderate, low, or critically low. Overlap To address overlap among primary studies included in multiple reviews, we applied the MOoR Framework. When reviews shared all their primary studies, we re­ tained only one, prioritising meta-analyses, analyses disaggregated by exercise type, and those with the largest number of studies. Full-text review allowed ex­ traction of unique data without duplicating quantita­ tive results. No studies were excluded due to risk of bias. We calculated the Corrected Covered Area (CCA) using a citation matrix, categorising overlap as slight (0-5%), moderate (6-10%), high (11-15%), or very high (> 15%). In systematic reviews, only non-redundant results were extracted for reporting, and marked visually without contributing to CCA totals.

4/15 N. Pérez-Romero et al.

Synthesis of data from reviews Data were synthesised narratively and grouped by out­ come (stress, anxiety, and depression). Effect sizes were compared across studies to explore potential sources of variation. In the absence of reported thresholds, Co­ hen’s (1992) criteria were used to interpret the magni­ tude of effects: small (d = 0.20), medium (d = 0.50), and large (d = 0.80).

Sensitivity analysis and publication bias An additional qualitative sensitivity analysis that had not been specified in the registered protocol was per­ formed, separating into Conventional Physical Exercise and mind–body practices. It was examined how the re­ views evaluated and addressed publication bias (Ciria et al., 2023).

Results Study selection From 2,230 initial records, 1,084 duplicates were re­ moved and 1,106 studies were excluded by title and ab­ stract (Figure 1). Of the remaining 40, 21 were excluded after full-text review (Supplementary Material A). Figure 1. PRISMA flow diagram of selected studies Records screened (n = 1146)

Reports sought for retrieval (n = 40)

Reports assessed for eligibility

(n = 40) Studies included in review

(n = 19) Reports of included studies (n = 19)

Identification of studies via databases and registers

Identification Screening

Included Records identified from*:

Databases (n = 3)

Registers (n = 2230)

Scopus (n = 756)

WOS (n = 660)

Pubmed (n = 814) Records removed before screening:

Duplicate records removed

(n = 1084)

Records marked as ineligible by

automation tools (n = 0)

Records removed for other

reasons (n = 0) Records excluded by title and abstract (n = 1106) Reports not retrieved (n = 0) Reports excluded:

Wrong design (n = 3)

Wrong intervention (n = 1)

Unable to recover (n = 1)

Wrong analysis (n = 1)

Overlap (n = 15)

5/15 Physical exercise for perinatal mental health: An umbrella review highlighting the prevalence of yoga over conventional Study characteristics The 19 reviews, published between 2015 and 2025, used

1 to 9 databases with searches conducted between 2014

and 2024 (one study did not report it; Table 3). They in­ cluded 238 RCTs with 26,065 participants: 12,463 in ex­ perimental groups and 12,628 in control groups, although three reviews did not report full group sizes (Kwon et al., 2020; Pritchett et al., 2017; Wang et al., 2022; Zeng et al., 2025). Participants ranged from 14 to over 40 years of age, but ten studies did not specify this. The stage of pregnancy varied from eight reviews focused on preg­ nancy (10-37 weeks or unspecified), five on postpartum (up to 50 weeks), and three that included both of them. Results were grouped according to effects on stress, anxiety and depression.

Stress Five studies assessed stress: four found significant im­ provements with yoga versus control, one with a large effect size. One review measured salivary cortisol and the others perceived stress. Another study showed ben­ efits from aerobic exercise. Sessions varied widely and none reported exercise intensity (Table 4). Anxiety Three studies showed improvements in anxiety with yoga compared to control groups; two reported a large effect size, two realised a network meta-analysis, and two were reviews. Additionally, physical activity com­ bined with sleep hygiene and gymnastics was found to reduce anxiety according to reviews. Pelvic floor exer­ cises, walking, aerobics, and stretching did not show significant differences. Only two studies reported the intensity of the interventions (Table 5). As for the me­ ta-analysis network, it found no evidence that any in­ tervention is clearly better at preventing prenatal anx­ iety. Pilates obtained the highest SUCRA score (73.1%), a value that indicates the probability that an interven­ Table 3. Study characteristics First search number/RCT Database/Last search year Stage of pregnancy (weeks) Age Sample Chan et al. (2019) 29/2 6/2018 Pregnant (18-24) N. R.

310; EG = 155, CG = 155 Corrigan et al. (2022) 879/25 9/2021 Pregnant (12-37) N. R.

1892; EG = 953, CG = 939 Daley et al. (2015) 919/6 8/2014 Pregnant (16)

14-38

406; EG = 160, CG = 188 Deprato et al. (2024) 61385/25 8/2024 Postpartum N.R.

2949; EG = 1471, CG = 1478 Jarbou and Newell

(2022)

2394/9 3/2019 Pregnant (10-32)

14-40

2399; EG = 1216, CG = 1183 Ji et al. (2024) 1056/48 8/2022 Pregnancy/postpartum N. R.

5171; EG = 2487, CG = 2684 Kwon et al. (2020) 177/1 4/2018 Pregnant (16) N.R.

94; EG = N.R., CG = N.R.

Kołomańska-Boguc­ ka and Mazur-Bialy,

(2019)

16/1 1/2018 Pregnant (16-22) N. R.

60; EG = 30, CG = 30 Mai et al. (2023) 4596/16 9/2022 Postpartum (<12)

23 >35

2233; EG = 1124, CG = 1109 Mérida-Tellez et al.

(2025)

88/2 4/2024 Pregnant N.R.

89; EG = 34, CG = 55 Munns et al. (2024) 426/1 6/2022 Postpartum (8-50) N.R.

32; EG = 16, CG = 16 Paz Fernández et al.

(2021)

430/4 3/2020 Pregnancy/postpartum

18-35

616; EG = 339, CG = 277 Pritchett et al. (2017) 9340/5 9/2016 Postpartum (<12) N. R.

1734; EG = N. R., CG = N.R.

Sánchez-Polán et al.

(2021)

597/10 2/2021 Pregnancy/postpartum N.R.

786; EG = 396, CG = 390 Wang et al. (2022) 2612/12 3/2021 Pregnant with-without depression N. R.

594; EG = N. R., CG = N.R.

Wang et al. (2024) 1076/12 5/2023 Postpartum

20-35

1260; EG = 532, CG = 728 Wu et al. (2025) 12063/13 8/2024 Pregnant

26-39

2457; EG = 1216, CG = 1241 Xu et al. (2023) 5905/26 5/N.R.

Pregnancy/postpartum

25-37

2884; EG = 1334, CG = 1550 Zeng et al. (2025) 12412/20 4/2024 Pregnant

23-32

1089; EG = N.R.; CG = N.R.

Note. CG = control group; EG = experimental group; N.R. = not reported.

6/15 N. Pérez-Romero et al. Table 4. Intervention characteristics and results for stress Study Type of physical exercise (n) Control Group (n) Session length (minutes) Frequency (times per week) Intensity Time weeks Intervention (instru­ ment): results Corrigan et al.

(2022)

Yoga (lectures, brea­ thing exercises, deep relaxation, medi­ tation, Hatha yoga, postures, guided imagery) Routine Physi­ cal activity (1), Standard ante­ natal care (3)

50-120

1-3

N. R.

4-16 (36-92

sessions) *Yoga (N.R. perceived stress): SMD = –1.22; CI = 95% [–1.66, –0.79]; I² = 70%, p = 0.02 Jarbou and Newell

(2022)

Yoga (1) Routine antena­ tal care (1)

40-45

2

N.R.

8

Yoga (PPHAS): diffe­ rences in intra and intergroup, exercise reduced stress and pre-post in both Kwon et al.

(2019)

Yoga (1) Standard prena­ tal treatment (1)

75

2

N.R.

20

Yoga (salivary cor­ tisol): lower cortisol than control pre-post in short term but no differences in long term Munns et al. (2024) Dru yoga Hatha (1)

WLC (1)

N.R.

N.R.

N.R.

4

Yoga (PSS): significant differences between groups, yoga reduces stress.

Paz Fer­ nández et al. (2021) Aerobics (1) Basic postpar­ tum informa­ tion (1)

90

3

N.R.

4-12

Aerobics (PSS): diffe­ rences intergroup, exercise reduced stress

* In favour of the intervention group; TAU = Treatment as usual; N. R. = not reported; PPHAS = Psychosocial Health Assessment Scale;

PSS = Perceived Stress Scale; SMD = Standard Median Deviation. Table 5. Intervention characteristics and results for anxiety Study Type of physical exercise (n) Control Group (n) Session length (minutes) Frequency (times per week) Intensity Time (weeks) Intervention (instrument):

results Chan et al.

(2019)

Nonaerobic exer­ cises of contrac­ ting pelvic floor, counselling and home-based exer­ cises of stretching and relaxation (1) Educational ses­ sions (1)

50

N.R.

N.R.

N.R.

Pelvic floor (N. R.): Non-significant differen­ ces between groups Jarbou and Newell

(2022)

Yoga (2), walking (1), aerobics (1) and gymnastics (1) Routine ante­ natal care (2), control (2) and childbirth educa­ tional classes (1)

30-120

2 - >3

N.R.

8-12

Yoga (PPHAS, UMACL): di­ fferences in intra and in­ tergroup, exercise reduced anxiety and pre-post in both in both studies; wal­ king (POMS): non-signifi­ cant differences between groups or intragroup; ae­ robics (PGWBI): non-signi­ ficant differences between groups; and gymnastics (ESS): differences between groups, exercise reduced anxiety, no differences pre-post exercise (Continued)

7/15 Physical exercise for perinatal mental health: An umbrella review highlighting the prevalence of yoga over conventional tion is the most effective based on a comparison of all treatments. Most of the effects came from direct com­ parisons with control groups, and there were few indi­ rect comparisons between interventions. Depression Seven meta-analyses showed a reduction in depres­ sive symptoms, mostly with small effect sizes and three Study Type of physical exercise (n) Control Group (n) Session length (minutes) Frequency (times per week) Intensity Time (weeks) Intervention (instrument):

results Mérida- Tellez et al.

(2025)

Pilates (2) Childbirth trai­ ning (1), control group (2)

55-90

2

Moderate

8-12

Pilates (STAI, HADS-A):

Pilates exercises were less anxious than the other groups (p < .05). *Decrease from 38.5% to 0% (p = .09) Paz Fernández et al. (2021) Physical exercise and stretching (1) and physical acti­ vity and exercise with accompan­ ying sleep hygiene and various care

(2)

Routine cares (2)

30-90

3-4

N.R.

8-24

Physical exercise and stretching (Spilberg): no significant differences; and physical activity and exercise with accompan­ ying sleep hygiene and varied care (Spilberg):

significant differences with both groups inclu­ ding exercise vs. control, but greater improvements when the sexual problems of the couple are treated instead of only the wo­ man’s problem.

Sán­ chez-Polán et al. (2021) Yoga (7), yoga and others like Pilates (1), Tai-chi (1) and Qi-exercises (1) No participation in exercise (10)

20-90

1-7

Moderate

2-16

*Mindbody exercises (STAI-T, STAI-T): z = -2.62, p < 0.01; ES = -0.46, 95% CI = -0.80, -12, I2 = 84%, Phet­ erogeneity = 0.001.

Wang et al.

(2022)

Yoga Usual perinatal treatment (4), social support (1), the same training classes unless yoga (1)

20-75

N. R.

N. R.

8-16

*Yoga (POMS, HADS, STAI):

SMD = –4.75; CI = 95% [–8.3,

–1.19]; I² = 73.8%, p = 0.002 Wu et al.

(2025)

Exercise (2), exer­ cise + education (1), yoga (4), Pilates (1) No treatment (4), Usual care (4) N. R.

N. R.

N. R.

8-16

The NMA indicated that there is no evidence to suggest that any one intervention is superior to others in preventing prenatal anxiety (POMS,

PGWBI, S-AI, STAI, DASS-

42, HADS-A).

SUCRA = Pilates 73.1% Zeng et al.

(2025)

Physical exer­ cise: supervised exercise sessions and pelvic floor muscle exercise (1), regular exercise programme (1); Mind-body exerci­ ses: Online Pilates (1), prenatal yoga (8), Tai chi/yoga treatment (1), Qi Exercise (1) Standard ante­ natal care (2), routine antenatal care (2), TAU (6), no yoga practice (1), Social support

(1) Massage the­

rapy (1)

20-90

1-5

N.R.

6-12

Physical exercise: NMA shows effects mainly from direct comparisons vs control; no direct links to other interventions.

Mind–body exercise: NMA includes mostly control comparisons with mini­ mal indirect connections.

HADS = Hospital Anxiety and Depression Scale; * In favour of the intervention group; NMA = Network Meta-Analysis; N. R. = not reported; POMS = Profile of Mood States; STAI = State-Trait Anxiety Inventory; SMD = Standard Median Deviation; SUCRA = surface under the cumulative ranking curve; TAU = Treatment as usual.

8/15 N. Pérez-Romero et al.

with a large effect size. Yoga showed improvements in five meta-analyses and one review. Benefits were also observed with stroller walking, aquatic sports, walk­ ing, and physical activity combined with care inter­ ventions. Pilates showed no differences in one review (only one primary study analysed). Results for strength and aerobic exercises were mixed (Table 6). In the me­ ta-analysis network, yoga showed a high SUCRA rating (89.1%), indicating a high probability of being one of the most effective interventions. Physical exercise had few indirect connections, which limited the accuracy of its estimate, while mind-body interventions had multiple indirect connections.

Sensitivity analysis For stress, only one review assessed non–mind–body physical exercise (aerobic exercise), which reported Table 6. Intervention characteristics and results for depression Study Type of physical exercise (n) Control group (n) Session length (minutes) Frequency (times per week) Intensity Time (weeks) Intervention (instrument):

results Chan et al.

(2019)

Supervised aero­ bic dance (1)

TAU (1)

60

2

N.R.

12

Aerobic dance (WHO­ QOL-BREF and SF-36):

non-significant re­ sults between groups Daley et al.

(2015)

Yoga (5), aerobics

(1)

Control (6), massa­ ge (1)

20-120

1-3

N. R.

8-32

*All (CES-D, EPDS):

SMD = –0.46; CI = 95%

[–0.87, –0.05]; I² = 68%, p = 0.004 Deprato et al.

(2024)

Exercise (19), exer­ cise + co-interven­ tion (6) Control group (25)

15-90

1-5

N.R.

N.R.

*Exercise (N.R.): SMD = –0.52; CI = 95% [–0.80, –0.24]; I² = 86%, p < .001; *Exer­ cise + co-intervention

(N.R.): SMD = –0.20; CI

= 95% [–0.42, –0.01]; I² = 60%, p = 0.03 Jarbou and Newell (2022) Aerobics (3), wal­ king (2), Pilates/ yoga (1) Routine antenatal care (2), control (3), childbirth educa­ tional classes (1), relaxation (1)

30-65

2 - >3

N.R.

6-12

Aerobics (PGWBI, CES-D, EPDS): non-sig­ nificant results between groups in the three studies; walking (BDI-II, POMS): differences intergroup, exercise reduced depression in the both studies, one of them shows differences at the end of gestational process but no after 6 month; Pilates/yoga (POMS): exercise and relaxation separated reduces depression, control group no di­ fferences pre-post Ji et al. (2024) Aerobics (15), aerobics plus resistance (6), yoga (19), movement in water (2), prenatal exercises (2), gym­ nastics (2), stroller walk (2) Daily activities (8), non-intervention (10), routine care (20), general educa­ tion (1), conventio­ nal treatment (1), standard care (8) N. R.

N. R.

N. R.

N. R.

*All (EPDS, CES-D,

SCL-90, SAS, HAMA,

PHQ-9, STAI, BDI,

HDRS): SMD = –0.71;

CI = 95% [–0.89, –0.52]; I² = 89%, p <

0.001

(Continued)

9/15 Physical exercise for perinatal mental health: An umbrella review highlighting the prevalence of yoga over conventional Study Type of physical exercise (n) Control group (n) Session length (minutes) Frequency (times per week) Intensity Time (weeks) Intervention (instrument):

results Kołomańska- Bogucka and Mazur-Bialy,

(2019)

Resistance (1) Non exercise (1) N.R.

N.R.

N.R.

N.R.

Resistance (CES-D):

non-significant re­ sults between groups Mai et al.

(2023)

Yoga (4), dance gymnastics (3), aerobic exercise (6), water sport

(2) and strength

exercise (1) Routine care, psy­ chological care and health education and did not prac­ tice any form of exercise (N.R.)

<30 >60 < or > 3 N.R.

N.R.

*All (N.R.): SMD = –1.31; CI = 95% [–1.40, –1.21]; I² = 97%, p <

0.001. Yoga (SMD =

–1.34, 95% CI = –1.59, –1.09), aerobics (SMD = –1.78, 95% CI = –1.94 to –1.63), and dance gymnastics (SMD = –1.34, 95% CI = –1.54 to –1.15) had statistically significant effect on depression (p < 0.001).

Water sports (SMD = –0.03, 95% CI = –0.34 to 0.28) and strength exercise (SMD = –0.24, 95% CI = –0.58 to 0.10), p > 0.05.

Mérida-Tellez et al. (2025) Pilates (1) Control group (1)

55

2 t/w

N.R.

12

Pilates (HADS-D): no differences.

Paz Fernán­ dez et al.

(2021)

Aerobics (2), phy­ sical exercise and stretching (1) and physical activity and exercise with accompanying sleep hygiene and various care (2).

Routine care (2), basic postpartum information (1), medical and nutri­ tional counselling

(1)

30-90

3-4

N.R.

8-40

Aerobic exercise (EDCEE): significant differences improve exercise; physical exercise and stret­ ching (EDPE): no sig­ nificant differences; and physical activity and exercise with accompanying sleep hygiene and various care (EDPE): signifi­ cant differences, be­ ing greater in the two groups that include exercise vs. control, but greater impro­ vements when the sexual problems of the couple are treated instead of only the woman’s problem.

Pritchett et al.

(2017)

Pram walking (2), exercise counse­ lling (7), home-ba­ sed walking (1), group exercise (3) Phone support (3), usual care (6), education (2), N.R.

(1), discussion (1) N.R.

N.R.

N.R.

4-24

*All (EPDS, DASS,

HAM-D, CES-D, SCID-1,

PHQ-9): SMD = –0.44;

CI = 95% [–0.75, –0.12]; I² = 85%, p < 0.001 Wang et al.

(2022)

Yoga Aerobics (1), usual perinatal treat­ ment (6), self before and after comparison (3), social support (1), nonintervention (1)

20-120

N. R.

N. R.

8-16

*Yoga (CES-D, QIDS,

EPDS, HDRS, WDEQ,

POMS, HADS): SMD =

–2.31; CI = 95% [–3.67, –0.96]; I² = 34.8%, p =

0.139

(Continued)

10/15 N. Pérez-Romero et al.

Study Type of physical exercise (n) Control group (n) Session length (minutes) Frequency (times per week) Intensity Time (weeks) Intervention (instrument):

results Wang et al.

(2024)

Pram walking (4), common yoga (3), supervised mixed exercise included aerobic, strength, stretching and pregnancy-speci­ fic exercises (5) TAU/no therapy N. R.

1-7

60%-70%

HR

4-24

*Pram walking (EPDS and HDRS): SMD = –0.91; CI = 95% [–1.47, –0.36]; I² = 49%, p = 0.12; *Yoga: SMD = –0.67; CI = 95% [–0.98, –0.36]; I² = 4%, p = 0.35; *Mixed exercise:

SMD = –0.77; CI = 95%

[–1.47, –0.07]; I² = 94%, p < 0.01 Wu et al.

(2025)

Exercise (4), exer­ cise + education (1), yoga (3), Pilates

(2)

No treatment (4), Usual care (5), edu­ cation (1) N. R.

N. R.

N. R.

8-12

*Yoga-usual care

(EPDS, CES-D, DASS-

42): SMD = -2.72; CI

= 95% [-4.39, 1.05]; *Yoga-no interven­ tion (CES-D, HADS-D,

EPDS): SMD = -2.20; CI

= 95% [-4.13, 0.26] SUCRA = yoga 89.1% Xu et al. (2023) Dance (3), rising walking (1), yoga (4), body sha­ pe exercise (1), aerobic gymnas­ tics (1), aerobic exercise classes (4), walking and stretching (1), stroller wal­ king (3), jogging (2), walking (1), walking cycling (1), stretching (2), exercise ball (1) and swimming (1) Standard care (26)

20-60

2-6

Low-high

4-24

*All (N.R.): SMD = –1.91; CI = 95% [–2.58, –1.21]; I² = 85%, p <

0.001

Zeng et al.

(2025)

Physical exercise:

High-intensity interval training (1), combined exer­ cise (1), Supervised physical conditio­ ning programme (1); and mind-body exercise: online Pilates (1), Gesta­ tional Yoga (10), Tai chi/yoga (1), Qi exercise (1) Standard antena­ tal care (1), TAU (7), Educational programme (1), Routine prenatal health care (3), no yoga practice (1), Mom-baby well­ ness workshop (1), Social support (1), Parenting educa­ tion sessions (1), Massage therapy

(1)

20-90

1-5

N.R.

6-12

Physical exercise: In the NMA, it showed few indirect connec­ tions, limiting the precision of the effect estimate compared to other interventions.

Mind–Body: In the NMA, it presen­ ted multiple indi­ rect connections, strengthening the effect estimate and comparability.

BDI = Beck Depression Inventory; CES-D = Centre for Epidemiologic Studies Depression Scale; DASS = Depression Anxiety Stress Scales; EDCEE = Exercise and Depression Cognitive Behavioural Therapy; EPDS = Edinburgh Postnatal Depression Scale; HADS = Hospital Anxiety and Depression Scale; HAM-D = Hamilton Depression Rating Scale; HAMA = Hamilton Anxiety Rating Scale; HDRS = Hamilton Depression Rating Scale; I² = heterogeneity index; * In favour of the intervention group; NMA = Network Meta-Analysis; N. R. = not reported; POMS = Profile of Mood States; PHQ-9 = Patient Health Questionnaire-9; PGWBI = Psychological General Well- Being Index; SAS = Self-Rating Anxiety Scale; SCL-90 = Symptom Checklist-90; SF-36 = Short Form 36; SMD = Standard Median Deviation; STAI = State-Trait Anxiety Inventory; SUCRA = surface under the cumulative ranking curve; TAU = Treatment as usual; WHOQOL-BREF = World Health Organization Quality of Life.

11/15 Physical exercise for perinatal mental health: An umbrella review highlighting the prevalence of yoga over conventional reductions in perceived stress compared with control conditions. However, most of the available evidence was based on yoga interventions. For anxiety, findings were inconsistent when yoga interventions were exclud­ ed. Walking, pelvic floor exercises, and aerobic exer­ cise generally showed non-significant results, whereas some combined interventions (e.g., exercise plus sleep hygiene) showed improvements. For depression, benefi­ cial effects were still observed in several studies exam­ ining conventional physical exercise although results remained heterogeneous (Table 7).

Risk of bias assessment Figure 2 shows that all studies presented a risk of bias in more than three domains except Zeng et al. 2025. The domain with the lowest risk was D1 (inclusion of PICO components). The domains with the highest risk were D3, D7, and D10, due to lack of justification for study de­ sign, absence of a list of excluded studies, and missing funding information. Domains D11 and D12 lacked ex­ planations for separate analyses, and D13 did not ex­ clude low-quality studies. These shortcomings justify the high-risk ratings assigned in each domain (Figure 3). Overlap The overlap matrix is presented in Supplementary Ma­ terial B, which contains an Excel sheet with 20 columns representing the included reviews, 115 rows for each of the primary studies, and 244 marked cells (x) represent­ ing the total number of primary studies, including du­ plicates. Using the formula described in the methodolo­ gy section, the overlap yielded a corrected covered area of 5.9%, which is considered a moderate overlap (6-10%). Publication bias Only 7 of the 19 included studies conducted some formal analysis (Supplementary Material C). They used funnel plots, and four of them supplemented with statistical Table 7. Differences between conventional and mind-body exercises Outcome Conventional physical exercise Mind-body exercise Conclusion Stress Only 1 study (aerobics) reported significant benefits.

4/5 studies (Yoga) reported significant improvements.

Mind-body Anxiety Walking, aerobics, and pelvic floor exercises showed non-significant differences.

Significant effects for Yoga and Pilates. Mind-body Depression Positive results for walking/stroller walking, but mixed or non-significant for strength and aerobic dance.

Yoga showed improvements in 5 MAs and 1 review.

Mind-body Figure 2. AMSTAR 2 risk of bias assessment per study Note. Red = not on AMSTAR-2 (high risk); yellow = possible yes AMSTAR-2 (unclear); green = yes in AMSTAR-2 (low risk); Blue = no meta-analysis.

12/15 N. Pérez-Romero et al.

tests such as the Begg and Egger tests. Overall, the re­ sults suggest a low risk of publication bias. Discussion The objective was to synthesise previous reviews re­ garding the effect of physical exercise on stress, anxiety, and depressive symptoms in pregnant and postpartum women, with a specific focus on identifying exercise types and analysing optimal dosing parameters. Yoga as the most relevant and studied intervention The results indicate that yoga is the most studied in­ tervention and yields the greatest benefits for mental health. Furthermore, in one network meta-analysis, yoga obtained one of the highest SUCRA values (89.1%), reflecting a high probability of being among the most effective interventions. Its effectiveness may stem from the fact that, in addition to being a form of phys­ ical exercise, yoga incorporates meditation and breath control. These elements may influence the hypotha­ lamic-pituitary-adrenal (HPA) axis and the produc­ tion of cortisol and ACTH, thereby reducing stress and anxiety (Viswanathan et al., 2021). Pranayama (breath regulation) modulates the sympathetic nervous sys­ tem and enhances parasympathetic activity (Magnon et al., 2021) which is particularly relevant since anxiety is associated with sympathetic hyperactivation leading to increased respiratory rate and reduced breathing depth. However, more longitudinal studies are needed to confirm these effects.

Figure 3. Assessment of the risk of bias according to percentages of each article in AMSTAR item 2

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

D1 D2 D3 D4 D5 D6 D7 D8 D9 D10 D11 D12 D13 D14 D16 Overall D15 Note. Red = high risk; yellow = unclear; green = low risk; Blue = no meta-analysis. Other forms of exercise with positive results While yoga was the most consistently effective inter­ vention, other physical activities—such as aerobic exer­ cise, supportive care-based programmes, gymnastics, stroller walking, regular walking, and swimming— showed benefits in at least one outcome. Notably, in one network meta-analysis, Pilates obtained the highest SUCRA value (73.1%) for anxiety, suggesting a compar­ atively high probability of being effective. Aerobic ex­ ercise was linked to reduced stress, possibly through endorphin release, improved brain oxygenation, and cortisol regulation (Smith & Merwin, 2021). Combining physical activity with sleep hygiene and complemen­ tary care improved anxiety and depression, likely via cortisol modulation and sleep restoration (De Nys et al., 2022), enhancing self-esteem and self-perception (Wang et al., 2022). Gymnastics reduced anxiety by fos­ tering body awareness and social connection (Wang et al., 2022). Stroller walking, aquatic sports, and walking were associated with lower depressive symptoms, po­ tentially due to natural settings, mood restoration, or placebo effects (Antonelli et al., 2019), while also sup­ porting time management and maternal well-being. Interventions without significant effects Some interventions, such as pelvic floor exercises, walking, traditional aerobics, stretching, and strength training did not show significant differences compared to control groups in reducing anxiety or depression, and Pilates also did not show significant effects for de­ pression. In the case of stretching, studies consistently failed to find significant effects. For Pilates, this result

13/15 Physical exercise for perinatal mental health: An umbrella review highlighting the prevalence of yoga over conventional is based on only one primary study retrieved in the re­ view, which limits the strength of the conclusion. These results may reflect methodological limitations or a lack of sensitivity in outcome measures. It is also important to consider not only the type of exercise, but also its in­ tensity and duration, as not all physical activity yields mental health benefits (Chekroud et al., 2018). Conventional exercise versus mind-body exercises The results suggest that the benefits attributed to phys­ ical exercise on mental health during the perinatal pe­ riod are not consistent across different types of exercise but rather depend largely on the inclusion of mind– body practices, particularly yoga. When these inter­ ventions are excluded, the effects on stress and anxiety decrease or become inconsistent, while some benefits of conventional exercise persist for depression, albeit with high heterogeneity. This indicates that specific compo­ nents of mind–body practices, such as breath regula­ tion, relaxation, and mindfulness, may play a key role in improving emotional symptoms, beyond the effect of physical movement alone.

Limitations and future research Conclusions are limited by the wide variability of inter­ vention parameters which makes it difficult to stand­ ardise and define the parameters of FIIT (frequency, in­ tensity, time and type). Some studies (Carter et al., 2019; Xu et al., 2023) found greater effects in shorter interven­ tions (SMD = –1.72) than in longer ones (SMD = –0.52), possibly due to lower postpartum adherence, which could be influencing the findings. The high risk of bias in the studies also limits the conclusions. The findings also highlight the need to adhere to the PRISMA guide­ lines and to present the characteristics of the interven­ tions and results clearly. Nevertheless, some domains were consistently rated as low because the required in­ formation was not reported. As AMSTAR-2 does not al­ low an “uncertain” option for some specific items, these were scored as “no” (e.g., full exclusion lists and funding sources of included studies). Furthermore, the available evidence does not allow analysis of potential cultural influences on the effectiveness or acceptability of ex­ ercise interventions during the perinatal period. Ad­ ditionally, the possibility of publication bias should be considered, as studies reporting the positive effects of exercise interventions are more likely to be published than those with null findings. Exploring this represents an important avenue for future research. Conclusion Yoga is emerging as the most studied and effective in­ tervention for anxiety in pregnant and postpartum women, likely due to its combination of physical exer­ cise with mindfulness and breath regulation. Aerobic and strength exercises benefit depression, while stress remains underexplored, however, when convention­ al exercise and mind–body modalities are examined separately, mind–body interventions appear to demon­ strate comparatively stronger effects. This review high­ lights the importance of exercise in optimising treat­ ment outcomes and reinforcing preventive strategies. These findings also emphasise the importance of incor­ porating mental components into exercise programmes to maximise psychological benefits. However, method­ ological shortcomings, inconsistent reporting, and a lack of conclusive FIIT evidence limit the formulation of recommendations. Future research should systemat­ ically apply and clearly communicate FITT parameters, publication bias and intervention description. Author contributions The research idea and scope were initially proposed by Marco Antonio Contreras-Donoso, Vicente Ignacio Jiménez-Reyes, Alonso Muñoz-Zúñiga, and Constanza Catalina Reyes-Vera. All authors participated in the de­ sign of the review protocol, as well as in the systematic search, screening, and analysis of the included studies. Nuria Pérez-Romero and Katherine Soto-Schulz con­ tributed throughout all phases of the review process and were primarily responsible for the methodolog­ ical refinement and final revision of the manuscript. This article originated from a final undergraduate re­ search project in Kinesiology at Universidad Andrés Bello which was later substantially revised, expanded, and methodologically strengthened: Contreras Donoso, M. A., Jiménez Reyes, V. I., Muñoz Zúñiga, A. E., & Reyes Vera, C. C. (2024). Efecto del ejercicio físico en la salud mental de mujeres embarazadas y postparto: Umbrella review [Tesis de licenciatura, Universidad Andrés Bel­ lo, Facultad de Ciencias de la Rehabilitación]. Santiago, Chile.

Conflict of interest The authors declare no conflicts of interest. Funding This research received no external funding. Supplementary Material Supplementary material related to this article is availa­ ble online at https://doi.org/10.14349/rlp.2026.v58.1 References Antonelli, M., Barbieri, G., & Donelli, D. (2019). Effects of forest bathing (shinrin-yoku) on levels of cortisol as a stress bio­ marker: A systematic review and meta-analysis. Interna­ tional Journal of Biometeorology, 63(8), 1117-1134. https://doi. org/10.1007/s00484-019-01717-x Carter, T., Bastounis, A., Guo, B., & Jane Morrell, C. (2019). The ef­ fectiveness of exercise-based interventions for preventing or treating postpartum depression: A systematic review and meta-analysis. Archives of Women’s Mental Health, 22(1), 37-53. https://doi.org/10.1007/s00737-018-0869-3 Chan, C. W. H., Au Yeung, E., & Law, B. M. H. (2019). Effectiveness of physical activity interventions on pregnancy-related outcomes among pregnant women: A systematic review. International Journal of Environmental Research and Public Health, 16(10), 1840. https://doi.org/10.3390/ijerph16101840

14/15 N. Pérez-Romero et al.

Chekroud, S. R., Gueorguieva, R., Zheutlin, A. B., Paulus, M., Krumholz, H. M., Krystal, J. H., & Chekroud, A. M. (2018). As­ sociation between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: A cross-sectional study. The Lancet Psychiatry, 5(9), 739-746. https://doi.org/10.1016/S2215-0366(18)30227-X Chow, R., Huang, E., Li, A., Li, S., Fu, S. Y., Son, J. S., & Foster, W. G. (2021). Appraisal of systematic reviews on interventions for postpartum depression: Systematic review. BMC Preg­ nancy and Childbirth, 21(1), 18. https://doi.org/10.1186/s12884-

020-03496-5

Ciria, L. F., Román-Caballero, R., Vadillo, M. A., Holgado, D., Luque-Casado, A., Perakakis, P., & Sanabria, D. (2023). An umbrella review of randomized control trials on the ef­ fects of physical exercise on cognition. Nature Human Be­ haviour, 7(6), 928-941. https://doi.org/10.1038/s41562-023-

01554-4

Cohen, J. (1992). Statistical power analysis. Current Direc­ tions in Psychological Science, 1(3), 98-101. https://doi. org/10.1111/1467-8721.ep10768783 Corrigan, L., Moran, P., McGrath, N., Eustace-Cook, J., & Daly, D. (2022). The characteristics and effectiveness of pregnancy yoga interventions: A systematic review and meta-anal­ ysis. BMC Pregnancy and Childbirth, 22(1), 250. https://doi. org/10.1186/s12884-022-04474-9 Daley, A., Foster, L., Long, G., Palmer, C., Robinson, O., Walmsley, H., & Ward, R. (2015). The effectiveness of exercise for the prevention and treatment of antenatal depression: Sys­ tematic review with meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 122(1), 57-62. https://doi. org/10.1111/1471-0528.12909 De Nys, L., Anderson, K., Ofosu, E. F., Ryde, G. C., Connelly, J., & Whittaker, A. C. (2022). The effects of physical activity on cortisol and sleep: A systematic review and meta-anal­ ysis. Psychoneuroendocrinology, 143, 105843. https://doi. org/10.1016/j.psyneuen.2022.105843 Dennis, C.-L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. British Journal of Psychiatry, 210(5), 315-323. https://doi.org/10.1192/bjp.bp.116.187179 Deprato, A., Ruchat, S.-M., Ali, M. U., Cai, C., Forte, M., Gierc, M., Meyer, S., Sjwed, T. N., Shirazi, S., Matenchuk, B. A., Jones, P. A. T., Sivak, A., & Davenport, M. H. (2024). Impact of post­ partum physical activity on maternal depression and anx­ iety: A systematic review and meta-analysis. British Jour­ nal of Sports Medicine. 59, 550-561. https://doi.org/10.1136/ bjsports-2024-108478 Diprieto, L., Evenson, K. R., Bloodgood, B., Sprow, K., Troiano, R. P., Pierce, K. L., Vaux-Bjerke, A., & Powell, K. E. (2019). Benefits of physical activity during pregnancy and postpartum: An Umbrella review. Medicine & Science in Sports & Exercise, 51(6), 1292-1302. https://doi.org/10.1249/

MSS.0000000000001941

Gates, M., Gates, A., Pieper, D., Fernandes, R. M., Tricco, A. C., Moher, D., Brennan, S. E., Li, T., Pollock, M., Lunny, C., Sepúlveda, D., McKenzie, J. E., Scott, S. D., Robinson, K. A., Matthias, K., Bougioukas, K. I., Fusar-Poli, P., Whiting, P., Moss, S. J., & Hartling, L. (2022). Reporting guideline for overviews of reviews of healthcare interventions: Devel­ opment of the PRIOR statement. BMJ, 378, e070849. https:// doi.org/10.1136/bmj-2022-070849 Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (2024). Cochrane Handbook for Sys­ tematic Reviews of Interventions Version 6.5. https://training. cochrane.org/handbook/current Jarbou, N. S., & Newell, K. A. (2022). Exercise and yoga during pregnancy and their impact on depression: A systematic literature review. Archives of Women’s Mental Health, 25(3), 539-559. https://doi.org/10.1007/s00737-021-01189-2 Ji, M., Li, R., & Xu, Y. (2024). Meta-analysis of the effect of differ­ ent exercise modalities in the prevention and treatment of perinatal depression. Journal of Affective Disorders, 350, 442-

451. https://doi.org/10.1016/j.jad.2024.01.076

Kołomańska-Bogucka, D., & Mazur-Bialy, A. I. (2019). Phys­ ical activity and the occurrence of postnatal depres­ sion—A systematic review. Medicina, 55(9), 560. https://doi. org/10.3390/medicina55090560 Kumarasinghe, M., Herath, M. P., Hills, A. P., & Ahuja, K. D. K. (2024). Postpartum versus postnatal period: Do the name and duration matter? Plos One, 19(4), e0300118. https://doi. org/10.1371/journal.pone.0300118 Kwon, R., Kasper, K., London, S., & Haas, D. M. (2020). A system­ atic review: The effects of yoga on pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 250, 171-177. https://doi.org/10.1016/j.ejogrb.2020.03.044 Magnon, V., Dutheil, F., & Vallet, G. T. (2021). Benefits from one session of deep and slow breathing on vagal tone and anx­ iety in young and older adults. Scientific Reports, 11(1), 19267. https://doi.org/10.1038/s41598-021-98736-9 Mai, S., Liu, Y., He, H., & Yan, X. (2023). The effects of different exercise programs on the prevention of perinatal depres­ sion: A systematic review and meta-analysis. Clinical and Experimental Obstetrics & Gynecology, 50(1), 9. https://doi. org/10.31083/j.ceog5001009 Matvienko-Sikar, K., Redsell, S., & Flannery, C. (2023). Effects of maternal stress and/or anxiety interventions in the first

1000 days: Systematic review of reviews. Journal of Repro­

ductive and Infant Psychology, 41(2), 114-151. https://doi.org/1 0.1080/02646838.2021.1976400 Mérida-Téllez, J. M., Vázquez-Lara, J. M., Fernández-Carrasco, F. J., Gómez-Salgado, J., Macías-Toronjo, I., Muñoz-Vela, F. J., Fagundo-Rivera, J., Palomo-Gómez, R., & Rodríguez- Díaz, L. (2025). Effects of Pilates on the quality of life of pregnant women during pregnancy: A systematic re­ view. Medicine, 104(17), e41967. https://doi.org/10.1097/ MD.0000000000041967 Munns, L., Spark, N., Crossland, A., & Preston, C. (2024). The effects of yoga-based interventions on postnatal mental health and well-being: A systematic review. Heliyon, 10(3), e25455. https://doi.org/10.1016/j.heliyon.2024.e25455 Patel, I., & Dev, A. (2023). What is prenatal stress? A scoping review of how prenatal stress is defined and measured within the context of food insecurity, housing instability, and immigration in the United States. Women’s Health, 19. https://doi.org/10.1177/17455057231191091 Paz Fernández, N., González González, Y., Calvete, A. A., & Da Cuña Carrera, I. (2021). Efectos del ejercicio en la depresión durante el embarazo y el posparto. Una revisión sistemá­ tica. Clínica e Investigación en Ginecología y Obstetricia, 48(4),

100683. https://doi.org/10.1016/j.gine.2021.100683

Pritchett, R. V., Daley, A. J., & Jolly, K. (2017). Does aerobic ex­ ercise reduce postpartum depressive symptoms? A sys­ tematic review and meta-analysis. British Journal of Gen­ eral Practice, 67(663), e684-e691. https://doi.org/10.3399/ bjgp17X692525 Sánchez-Polán, M., Silva-Jose, C., Franco, E., Nagpal, T. S., Gil- Ares, J., Lili, Q., Barakat, R., & Refoyo, I. (2021). Prenatal anxiety and exercise. Systematic review and meta-anal­ ysis. Journal of Clinical Medicine, 10(23), 5501. https://doi. org/10.3390/jcm10235501 Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Mo­ ran, J., Moher, D., Tugwell, P., Welch, V., Kristjansson, E., & Henry, D. A. (2017). AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-ran­

15/15 Physical exercise for perinatal mental health: An umbrella review highlighting the prevalence of yoga over conventional domised studies of healthcare interventions, or both. BMJ, 358, j4008. https://doi.org/10.1136/bmj.j4008 Smith, P. J., & Merwin, R. M. (2021). The role of exercise in management of mental health disorders: An integrative review. Annual Review of Medicine, 72(1), 45-62. https://doi. org/10.1146/annurev-med-060619-022943 Stentzel, U., Grabe, H. J., Schmidt, S., Tomczyk, S., van den Berg, N., & Beyer, A. (2023). Mental health-related telemedicine interventions for pregnant women and new mothers: A systematic literature review. BMC Psychiatry, 23(1), 292. https://doi.org/10.1186/s12888-023-04790-0 Villar-Alises, O., Martinez-Miranda, P., & Martinez-Calderon, J. (2023). Prenatal yoga-based interventions may improve mental health during pregnancy: An overview of sys­ tematic reviews with meta-analysis. International Jour­ nal of Environmental Research and Public Health, 20(2), 1556. https://doi.org/10.3390/ijerph20021556 Viswanathan, V., Sivakumar, S., Sai Prathiba, A., Devarajan, A., George, L., & Kumpatla, S. (2021). Effect of yoga intervention on biochemical, oxidative stress markers, inflammatory markers and sleep quality among subjects with type 2 di­ abetes in South India: Results from the SATYAM project. Diabetes Research and Clinical Practice, 172, 108644. https:// doi.org/10.1016/j.diabres.2020.108644 Wang, G., Liang, C., & Sun, G. (2022). Yoga’s therapeutic effect on perinatal depression: A systematic review and meta-anal­ ysis. Psychiatria Danubina, 34(2), 195-204. Wang, J., Carru, C., Sedda, S., Fiori, P. L., Li, Z., & Chen, Z. (2024). Comparative impact of exercise-based interventions for postpartum depression: A Bayesian network meta-anal­ ysis. International Journal of Gynecology & Obstetrics, 165(1), 67-75. https://doi.org/10.1002/ijgo.15091 World Health Organisation. (2023). Informe sobre la situación mundial de la actividad física 2022. https://iris.who.int/han­ dle/10665/366042 Wu, Y., Wang, H., Hui, X., Qian, Z., Wang, M., E, F., Xu, M., Zhou, L., Deng, X., Li, X., & Yang, K. (2025). Efficacy of non-pharma­ cological interventions for the prevention of antenatal de­ pression: A systematic review and network meta-analysis. Neuroscience and Biobehavioral Reviews, 172, 106088. https:// doi.org/10.1016/j.neubiorev.2025.106088 Xu, H., Liu, R., Wang, X., & Yang, J. (2023). Effectiveness of aer­ obic exercise in the prevention and treatment of postpar­ tum depression: Meta-analysis and network meta-anal­ ysis. Plos One, 18(11), e0287650. https://doi.org/10.1371/ journal.pone.0287650 Zeng, G., Niu, J., Zhu, K., Li, F., Li, L., Gao, K., Zhuang, Y., Zhang, B., Han, X., Ye, G., Gao, Z., & Li, H. (2025). Effects of non-pharma­ cological interventions on depressive and anxiety symp­ toms in pregnant women: A systematic review and net­ work meta-analysis. eClinicalMedicine, 79, 103011. https:// doi.org/10.1016/j.eclinm.2024.103011 Žutić, M. (2023). Biopsychosocial models of peripartum depres­ sion: A narrative review. Clínica y Salud, 34(2), 91-99. https:// doi.org/10.5093/clysa2023a16