Effects of different exercise types on body image in females: a systematic review and network meta-analysis

Background Negative body image is prevalent among women and is linked to emotional disorders, low self-esteem, and reduced quality of life. Exercise is an accessible non-pharmacological strategy that may improve body image, but the comparative effectiveness of different modalities remains unclear. Methods PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to May 2026. Randomized controlled trials (RCTs) of exercise interventions lasting at least 4 weeks were included. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment using the Cochrane Risk of Bias 2 (RoB 2) tool. A frequentist random-effects network meta-analysis was performed, with effects expressed as standardized mean differences (SMDs) and interventions ranked using P-scores. Results Twenty-three trials involving 1,914 female participants and seven network nodes were included. Aerobic exercise, dance, and multimodal exercise significantly improved body image relative to usual care. Resistance training showed a favorable but imprecise effect, whereas mind–body exercise and behavioral intervention did not differ significantly from usual care. Aerobic exercise had the highest P-score, but confidence intervals for the leading interventions overlapped substantially and most active-treatment comparisons were not statistically significant. Network heterogeneity was moderate (I 2 = 59%). Publication-bias assessments were discordant, and publication bias could not be excluded. Conclusion Exercise appears to be a useful strategy for improving body image in women. Aerobic exercise and dance showed the most consistent evidence of benefit, while multimodal exercise also showed beneficial effects. However, the available evidence does not establish clear superiority of any single modality. Exercise selection should therefore consider the comparative evidence together with participant preferences, feasibility, accessibility, and the implementation setting. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261359034 , identifier (CRD420261359034).