Optimal doses of different exercise types for improving depressive symptoms in climacteric women: a systematic review and network meta-analysis

Background: Depression in climacteric women-defined as females transitioning from perimenopause to postmenopause (perimenopause: declining ovarian function with fluctuating and decreasing estrogen levels; postmenopause: cessation of menstruation for ≥12 months with persistently low estrogen levels)-impairs quality of life and burdens families and healthcare systems. Exercise, a proven non-pharmacological intervention for menopausal depression, has been understudied for "optimal dosage across exercise types"-previous research either focused on activity-depression associations or ignored dosage when selecting exercise types. This systematic review and network meta-analysis addresses this gap by comparing optimal doses of four exercises (aerobic, multi-mode, stretching, and mind-body) to establish an evidence-based "exercise type-dose" hierarchy for clinical practice. Methods: We systematically searched PubMed, Cochrane Library, Embase, and Web of Science (inception to September 2025) for randomized controlled trials (RCTs) on exercise for climacteric women's depression. Two researchers independently screened studies, extracted data, and assessed quality via Cochrane RoB2. Bayesian network meta-regression (MBNMA, R software) modeled dose-response relationships, and SUCRA ranked intervention efficacy to identify optimal doses. Results: Twenty-three RCTs were included. The most favorable ranges observed in available RCTs appear to be: aerobic exercise (600-1,100 MET-min/week, slight saturation); multi-mode exercise (1000-1,500 MET-min/week); stretching exercise (900-1,200 MET-min/week, U-shaped curve); mind-body exercise (1000-1,500 MET-min/week, limited data >1,500 MET-min/week). Three sessions/week and 12-week intervention aligned with these most favorable ranges. Conclusion: Aerobic (600-1,100 MET-min/week), multi-mode (1000-1,500 MET-min/week), and stretching (900-1,200 MET-min/week) exercises are most effective for alleviating climacteric depression. Clinicians should prioritize aerobic exercise; multi-mode exercise may improve adherence for those seeking variety. Key challenges include supplementing high-dose mind-body exercise data (>1,500 MET-min/week) and supporting long-term adherence amid menopausal physiological changes. Systematic review registration: This study has been registered on PROSPERO (CRD420251162965).