运动对绝经后妇女抑郁和焦虑的影响：随机对照试验的成对和网络荟萃分析。

BACKGROUND: Exercise has been identified as a promising non-pharmacological therapy for the management of depression, but there is still controversy over which type is most effective. We aimed to compare and rank the types of exercise that improve depression in postmenopausal women by quantifying information from randomized controlled trials (RCTs). METHODS: The PubMed, Web of Science, SPORTDiscus, CNKI, The Cochrane Library, PsycINFO, EMBASE, and CINAHL Plus databases were searched to identify articles published from inception to 1 March 2024 reporting RCTs that examined the effectiveness of exercise on depression in postmenopausal women. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for RCTs. The quality of the evidence for each comparison was graded using the online confidence in network meta-analysis tool (CINeMA). Standardized mean differences (SMDs) were calculated using the mean and standard deviation of pre-to-post intervention changes and then pooled using a random effects model in a pairwise meta-analysis using Review Manager 5.4. Then, a frequentist network meta-analysis was conducted using a random effects model was conducted to evaluate the efficacy of different exercise types using the network package of Stata 15. RESULTS: This study included 26 studies involving 2,170 participants. The pairwise meta-analysis revealed that exercise had a significant positive effect on depression in postmenopausal women (SMD = -0.71, 95% confidence interval [CI] = -0.94 to -0.48; I = 78%). The network meta-analysis revealed that mind-body exercise (SMD = -0.97, 95% CI = -1.28 to -0.67), aerobic exercise (SMD = -0.58, 95% CI = -0.88 to -0.27) and multicomponent exercise (SMD = -0.57, 95% CI = -1.15 to -0.002) significantly reduced depression compared to the control intervention. Mind-body exercise had the highest probability of being the most effective intervention. Exercise interventions also showed positive effects on anxiety. Most studies were judged to have some concerns regarding their risk of bias, and the confidence in evidence was often very low according to CINeMA. CONCLUSION: For postmenopausal women, there is very low to moderate quality evidence that exercise interventions are an effective antidepressant therapy, with mind-body exercise most likely being the optimal type. TRIAL REGISTRATION: This meta-analysis was prospectively registered with PROSPERO (registration number: CRD42024505425).

背景：运动已被确定为治疗抑郁症的一种有前途的非药物疗法，但哪种运动最有效仍存在争议。我们旨在通过量化随机对照试验（RCT）的信息来比较和排名改善绝经后妇女抑郁症的运动类型。

方法：检索 PubMed、Web of Science、SPORTDiscus、CNKI、The Cochrane Library、PsycINFO、EMBASE 和 CINAHL Plus 数据库，以确定从成立到 2024 年 3 月 1 日发表的报告 RCT 研究的文章，这些 RCT 研究检查了运动对绝经后妇女抑郁症的有效性。使用修订后的 Cochrane RCT 偏倚风险工具评估偏倚风险。使用在线置信度网络荟萃分析工具（CINeMA）对每项比较的证据质量进行分级。使用 Review Manager 5.4 中的预干预到后干预变化的平均值和标准差计算标准化均数差（SMD），然后使用随机效应模型进行汇总。然后，使用 Stata 15 的网络包进行似然网络荟萃分析，以使用随机效应模型评估不同运动类型的疗效。

结果：本研究纳入了 26 项研究，涉及 2170 名参与者。成对荟萃分析显示，运动对绝经后妇女的抑郁症有显著的积极影响（SMD=-0.71，95%置信区间[CI]=-0.94 至-0.48；I=78%）。网络荟萃分析显示，身心运动（SMD=-0.97，95%CI=-1.28 至-0.67）、有氧运动（SMD=-0.58，95%CI=-0.88 至-0.27）和多组分运动（SMD=-0.57，95%CI=-1.15 至-0.002）与对照组相比，显著降低了抑郁。身心运动最有可能是最有效的干预措施。运动干预也对焦虑有积极影响。根据 CINeMA，大多数研究被认为存在一些偏倚风险方面的问题，并且证据的可信度通常非常低。

结论：对于绝经后妇女，有非常低到中等质量的证据表明，运动干预是一种有效的抗抑郁治疗方法，身心运动最有可能是最佳类型。

试验注册：本荟萃分析已在 PROSPERO（注册号：CRD42024505425）进行前瞻性注册。