Effectiveness of different types of exercise therapy in improving post-stroke depression: a systematic review and network meta-analysis

Objective To systematically evaluate the effects of exercise therapies such as aerobic exercise (CAE), Tai Chi (TC), Baduanjin (BDJ), resistance training (RE), Wuqinxi (WQX), yoga (YG), and rehabilitation training (RT) on depressive symptoms, daily living abilities, motor function, and balance function in patients with post-stroke depression (PSD). A network meta-analysis method was employed to compare the relative efficacy of various interventions, providing high-quality evidence-based medical data for clinical selection of optimal intervention strategies. Methods We conducted systematic searches in China National Knowledge Infrastructure, Wanfang Data, VIP Information, Chinese Biomedical Literature Database, PubMed, Embase, Cochrane Library, and Web of Science, with the search period concluding on April 5, 2026. Randomized controlled trials (RCTs) evaluating exercise therapy interventions for PSD were included. Two investigators independently performed screening, data extraction, and RoB 2.0 bias risk assessment. A network meta-analysis was performed using Stata 17.0 under the frequency framework, with continuous outcomes expressed as mean difference (MD) and 95% confidence interval (CI), and ranked by SUCRA. Results A total of 33 RCTs ( n = 2,339) were included, comparing seven types of interventions: CAE, TC, BDJ, RE, WQX, YG, and RT. The network meta-analysis revealed that compared with the control group, RT [MD = −8.45, 95% CI (−11.59, −5.31)], WQX [MD = −5.55, 95% CI (−11.00, −0.10)], BDJ [MD = −3.41, 95% CI (−6.24, −0.58)], and TC [MD = −3.02, 95% CI (−5.32, −0.71)] significantly reduced the Hamilton Depression Rating Scale (HAMD) scores; CAE [MD = −12.48, 95% CI (−17.79, −7.17)] significantly decreased Self-Rating Depression Scale (SDS) scores; RT[MD = 9.47, 95% CI (2.39, 16.55)] demonstrated the largest effect size in improving the Barthel Index (BI) scores; RE (SUCRA = 96.7%) was the most effective intervention for improving the Fugl-Meyer Assessment (FMA) scores; BDJ [MD = 8.20, 95% CI (2.73, 13.67)] significantly enhanced the Berg Balance Scale (BBS) levels. HAMD and SDS were used to assess patients’ depressive status, BI to evaluate daily living abilities, FMA to assess motor function, and BBS to evaluate balance function. Conclusion Exercise therapy can serve as an effective adjunctive intervention in the comprehensive management of PSD, demonstrating potential benefits in alleviating depressive symptoms and improving certain functional outcomes. The efficacy of different exercise modalities varies across outcome dimensions: RT shows superior performance in improving HAMD scores and BI, CAE exhibits greater advantages in enhancing SDS scores, RE ranks highest in promoting FMA improvement, and BDJ demonstrates optimal efficacy in improving BBS scores. Given the overall limited methodological quality of included studies, small sample sizes for some outcomes, relatively sparse evidence networks, and short follow-up durations in most studies, these findings require further validation through high-quality, large-sample, long-term randomized controlled trials. Systematic review registration CRD420261333356.