Exercise-based interventions for depression in women with polycystic ovary syndrome: a systematic review and meta-analysis

Background: Depressive symptoms are highly prevalent among women with polycystic ovary syndrome (PCOS), with previous studies suggesting a substantially elevated burden of depression and depressive symptoms in this population compared with women without PCOS, exacerbating the metabolic and reproductive burden of the disorder. Although exercise is recommended as a core component of PCOS management, its specific effects on depressive outcomes in this population remain unclear because evidence from randomised controlled trials has not been comprehensively and quantitatively synthesised. Objective: To evaluate the efficacy of exercise interventions in reducing depressive symptoms among women with PCOS and to explore whether intervention characteristics may moderate treatment effects. Methods: A systematic review and meta-analysis of randomised controlled trials was conducted. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random- or fixed-effects model as appropriate. Pre-specified subgroup analyses examined exercise type, intervention format, weekly frequency, and programme duration. But were considered exploratory because of the limited number of included studies, Sensitivity analyses and publication bias assessments were performed. Results: Seven trials met the inclusion criteria. Exercise interventions significantly reduced depressive symptoms compared with controls (SMD = -0.75, 95% CI -0.96 to -0.55). In exploratory subgroup analyses, resistance exercise and interventions with higher weekly frequency or longer duration showed numerically larger effect estimates; however, between-subgroup differences were not statistically significant. Sensitivity analyses showed that the pooled effect estimate was not materially altered by sequential study removal, and no significant publication bias was detected. Conclusion: Structured exercise may be a promising non-pharmacological strategy for reducing depressive symptoms in women with PCOS. However, the findings should be interpreted cautiously in light of the small number of trials and limited sample sizes. Further high-quality trials are required to determine optimal exercise prescriptions and long-term psychological benefits. Systematic review registration: The protocol was registered on https://www.crd.york.ac.uk/PROSPERO/view/CRD42022375480 (CRD420261285288).