Effects of exercise interventions on depressive symptoms in perimenopausal women in China: a systematic review and meta-analysis

Objective Perimenopausal women are at increased risk of depressive symptoms due to hormonal and psychosocial changes, while evidence regarding the effectiveness of exercise interventions in Chinese populations remains limited and inconsistent. This study aimed to systematically evaluate the effects of exercise interventions on depressive symptoms in Chinese perimenopausal women and to provide evidence for non-pharmacological intervention strategies. Methods This systematic review and meta-analysis was reported in accordance with the PRISMA guidelines and conducted based on the PICOS framework. Web of Science, PubMed, Cochrane Library, CNKI, Wanfang, and VIP databases were searched from inception to December 2025. Randomized controlled trials investigating exercise interventions in Chinese perimenopausal women were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane risk-of-bias tool. Meta-analysis was conducted using Stata 16.0 with standardized mean differences (SMDs) and 95% confidence intervals (CIs). Random-effects models, subgroup analyses, sensitivity analyses were performed to explore heterogeneity. Results A total of 19 studies comprising 21 randomized controlled trials involving 1,398 Chinese perimenopausal women were included. Compared with control conditions, exercise interventions significantly reduced depressive symptoms (SMD = −1.37, 95% CI: −2.06 to −0.69, p < 0.001), although substantial heterogeneity was observed (I 2 = 97.14%). Sensitivity analyses indicated that the pooled results were relatively stable after sequential exclusion of individual studies. Begg’s and Egger’s tests suggested potential publication bias ( p < 0.05); however, trim-and-fill analysis showed that the overall pooled effect remained statistically significant. Subgroup analyses suggested that exercise interventions with different session durations, frequencies, intensities, and intervention periods were associated with improvements in depressive symptoms, although substantial heterogeneity remained across subgroups. Conclusion Exercise interventions may effectively alleviate depressive symptoms in Chinese perimenopausal women and represent a feasible non-pharmacological strategy for mental health management. However, given the substantial heterogeneity and potential publication bias among included studies, the findings should be interpreted cautiously. Further high-quality randomized controlled trials with standardized intervention protocols and long-term follow-up are needed to determine the optimal exercise prescription for this population. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251271853 , identifier CRD420251271853.