The effectiveness of physical activity interventions on non-physiological symptoms of menopause: a systematic review and meta-analysis

IMPORTANCE: Women in the menopause transition (MT) commonly experience mood disturbances, anxiety, cognitive complaints, and reduced quality of life (QoL). Yet access to pharmacological or psychological treatments may be limited or unsuitable for some. Identifying and accessing non-pharmacological interventions is therefore an important clinical and public health priority. OBJECTIVE: To synthesize evidence from randomized controlled trials (RCT) evaluating the effectiveness of physical activity (PA) interventions for improving depression, anxiety, mood, cognition, stress, and QoL in women during the MT. EVIDENCE REVIEW: A systematic search of Medline, PsycINFO, Web of Science, Cochrane Library, and CINAHL was conducted from inception to April 2025. RCTs including women aged 40-65 years in peri and early postmenopause were eligible. PA interventions were compared with alternative PA or treatment as usual. Outcomes were pooled using random-effects meta-analysis, with subgroup analyses by menopausal stage (peri and early postmenopause) and intervention types (aerobic-based [ABI] and mind-body [MBI]). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. FINDINGS: Twelve RCTs involving 1,003 women were included. PA significantly improved depression (g=-1.37, 95% CI [-1.96 to -0.79], mood (g= 0.84, 95% CI [0.40-1.29]), psychological QoL (g=0.66, 95% CI [0.19-1.13]), and overall QoL (g=1.10, 95% CI [0.32-1.88]). Significant reductions in depression were found in both perimenopause (g=-1.57, 95% CI [-2.58 to -0.56]) and early postmenopause (g=-1.14, 95% CI [-1.48 to -0.79]), with other outcomes improving in early postmenopausal women. ABIs improved (g=-1.07, 95% CI [-1.35 to -0.78]), mood (g=1.05, 95% CI [0.52-1.58]), and overall QoL (g=1.41, 95% CI [0.12-2.69]), whereas MBIs improved psychological QoL (g=0.80, 95% CI [0.43-1.16]). Sensitivity analyses largely supported these findings. CONCLUSIONS AND RELEVANCE: PA may seem to improve depression, mood, and QoL in women in the MT. Both ABIs and MBIs may be beneficial, supporting the integration of PA into clinical care for menopausal women. Further high-quality trials with clearer menopause staging are needed to strengthen the evidence base.