Aerobic exercise training during pregnancy reduces depressive symptoms in nulliparous women: a randomised trial

Prevalence and risk factors of antenatal depression in the first trimester: A real-world cross-sectional study in a developed district in South China

BACKGROUND

Antenatal depression may result in adverse outcomes for both the mother and the offspring. However, few studies have focused on the screening of pregnant women at a higher risk for antenatal depression in the first trimester. The present study aimed to assess the effect of lifestyle and family relationships on antenatal depression in the first trimester in a large Chinese population.

METHODS

Cross-sectional population data were obtained from a real-world cross-sectional survey conducted in Shenzhen, China from 2020 to 2024. The data on sociodemographic characteristics, lifestyle, and family relationships were obtained using self-reported questionnaires. Antenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a score of ≥13 indicating the presence of probable antenatal depression. A binary logistic regression model was used to identify the risk factors of antenatal depression.

RESULTS

A total of 42,363 pregnant women in the first trimester were recruited in the cross-sectional survey, among whom 3107 (7.3 %) had probable antenatal depression. We found (1) age < 25 years, (2) low or moderate economic status, (3) smoking, (4) partner smoking, (5) alcohol use, (6) lack of physical exercise, (7) poor or moderate living environment, (8) low or moderate marital happiness, and (9) never talking about problems were associated with antenatal depression. However, level of education, employment status, partner alcohol use, and living alone were not significantly related to antenatal depression in the first trimester.

LIMITATIONS

The cross-sectional design and the use of self-report measures must be considered while interpreting the results.

CONCLUSIONS

This study suggested that the prevalence of antenatal depression in the first trimester was 7.3 %. Public health prevention efforts aimed at reducing the prevalence of antenatal depression are recommended. Early identification of women at a higher risk in early pregnancy is necessary for preventing antenatal depression and improving quality of life.

The Impact of Physical Activity on Depression, Anxiety, and Stress during Pregnancy in Saudi Arabia: A Cross-Sectional Study

Background and Objective: This study aimed to explore the impact of physical activity on depression, anxiety, and stress among pregnant women in the Jazan region of Saudi Arabia. Materials and Methods: A descriptive cross-sectional study was conducted among pregnant women attending randomly selected prenatal clinics in primary healthcare hospitals in Jazan, Saudi Arabia. The calculated sample size was 350. Data were collected conveniently through a semi-structured questionnaire covering demographic details, pregnancy-related characteristics, physical activity assessed using the Pregnancy Physical Activity Questionnaire (PPAQ), and mental health parameters evaluated by the Depression, Anxiety, and Stress Scale-21 (DASS-21). The statistical analyses included descriptive statistics and Wilcoxon and Kruskal-Wallis rank sum tests, with significance levels set at p < 0.05. Results: The study involved 406 pregnant females. Nearly a third (31%) had a family history of depression, anxiety, or distress. The prevalence of depression, anxiety, and stress was 62.6%, 68.7%, and 38.4%, respectively. The mean sedentary, light, moderate, vigorous, and total energy expenditures were 1.512, 24.35, 22.32, 4.84, and 53.02 metabolic equivalent tasks/day. Anxious females exhibited higher light activity (median 24, p = 0.033), while stressed ones showed higher light (median 25, p = 0.039), moderate (median 20, p < 0.001), and vigorous activity (median 3, p < 0.001). A significant association was observed between total energy expenditure and stress levels (p < 0.001). Conclusions: This study underscores the importance of physical activity in managing depression, anxiety, and stress among pregnant women in Jazan, Saudi Arabia. The findings suggest a need for tailored interventions to promote physical activity to improve mental well-being during pregnancy.

Effect of different physical activity interventions on perinatal depression: a systematic review and network meta-analysis

BACKGROUND

Perinatal depression can have profound impacts on both families and society. Exercise therapy is gradually becoming a widely used adjunct treatment for perinatal depression. Some studies have already focused on the relationship between physical activity and perinatal depression (PND). However, there is currently a lack of systematic and comprehensive evidence to address the crucial question of making optimal choices among different forms of physical activity. This study aims to compare and rank different physical activity intervention strategies and identify the most effective one for perinatal depression.

METHODS

Four databases, namely PubMed, Cochrane Library, Embase, and Web of Science, were searched for randomized controlled trials assessing the impact of physical activity interventions on perinatal depression. The search covered the period from the inception of the databases until May 2024. Two researchers independently conducted literature screening, data extraction, and quality assessment. Network meta-analysis was performed using Stata 15.1.

RESULTS

A total of 48 studies were included in the analysis. The results indicate that relaxation therapy has the most effective outcome in reducing perinatal depression (SUCRA = 99.4%). Following that is mind-body exercise (SUCRA = 80.6%). Traditional aerobics and aquatic sports were also effective interventions (SUCRA = 70.9% and 67.1%, respectively).

CONCLUSION

Our study suggests that integrated mental and physical (MAP) training such as relaxation therapy and mind-body exercise show better performance in reducing perinatal depression. Additionally, while exercise has proven to be effective, the challenge lies in finding ways to encourage people to maintain a consistent exercise routine.

TRIAL REGISTRATION

This study has been registered on PROSPERO (CRD 42,023,469,537).

Dose-Response Effects on LBP, Sleep, and Depression of Online Pre-Partum and Post-Partum Pilates-Based Programs

Purpose: Pilates-based programs can help pregnant women deal with the physical and psychological burden derived by major changes in their body. This study was designed to primarily test, in pregnant women, the dose-response and health effects of both pre-partum and post-partum, online Pilates-based program on weight control, low back pain (LBP) severity, sleep disturbances, mood and depression levels. Methods: A total of 136 pregnant women were screened for eligibility (low-risk pregnancy; aged 18-45 years; single pregnancy; 20-28-week gestational age, normal BMI). Participants completed an online Pilates-based program during pregnancy and after delivery, through an online platform guided by a Pilates, Yoga and Lagree certified instructor. Main outcomes (weight control, LBP disability, sleep quality, mood, and mental health) were assessed at baseline and at the completion of pre- and post-partum programs. Results: Regarding pre-partum, significant gains in weight were observed only in low- and intermediate-amount exercisers. Only high-amount exercisers did not display significant increase in LBP-related disability (+42.7%; p = .21) unlike low (+12.2%; p < .0001) and intermediate exercisers (+9.6%; p < .0001). Sleep disturbances increased significantly in low- (+24.3%; p = .005) but not in intermediate- (+4.6%; p = .50) and high-amount exercisers (-0.1%; p = .91). Regardless of the amount of exercise, depression scores improved in all groups. Following post-partum intervention (n = 40), only intermediate-amount exercisers showed significant reductions in sleep disturbances (-24.1%; p = .003) and depression (15.9%; p = .04). Conclusions: Approximately 270 min/week of an online Pilates-based program were needed to prevent LBP worsening, and sleep deterioration in pregnant women. A different pattern was outlined for those women resuming the Pilates-based intervention at post-partum, with 150 min/week emerging as the "dose" of exercise capable of inducing the largest improvements in LBP, sleep, and mood disturbances.

A socio-ecological model of factors influencing physical activity in pregnant women: a systematic review

Physical activity (PA) is safe for most pregnant women, improving both maternal fitness and birth outcomes. Despite evidence of benefits, most pregnant women eliminate or reduce PA during pregnancy. This systematic review aimed to analyze the factors affecting maternal PA during pregnancy with reference to a socio-ecological model. A systematic search of relevant published studies between 2001 and 2022 was conducted through PubMed, Scopus, Web of Science, Academic Search Ultimate, Medline, and SPORTDiscus with full text via the EBSCO platform. A total of 32 studies that met the inclusion criteria were reviewed. The findings revealed that various study designs can lead to different outcomes in terms of what is identified as a PA facilitator or barrier. The factors that positively influenced PA in pregnant women were: higher levels of education, knowledge, and skills, as well as access to mass media. Conversely, lower levels of education, lack of knowledge and skills, low income, pregnancy discomforts, limited time, safety concerns, and societal perceptions of PA in pregnancy acted as barriers. Additionally, family, colleagues/friends, and partners could either support or hinder PA. Factors affecting overall maternal PA were somewhat different from those affecting the moderate-to-vigorous intensity of PA. Pregnant women receive little organizational and policy support. There is an urgent need to provide accessible information and resource systems for pregnant women. Since most pregnant women are motivated to engage in PA and susceptible to family advice, interventions should not be limited only to pregnant women, but should involve a family member, especially partners. There is a need to take global, systemic actions to promote an active lifestyle in pregnancy. Addressing safety concerns related to PA during pregnancy should be a significant part of these promotional activities.

The impact of physical activity intervention on perinatal depression: A systematic review and meta-analysis

BACKGROUND

No meta-analysis has analyzed the effect of physical activity level, period of physical activity intervention, and duration of intervention, on perinatal depression. This study was to evaluate the impact of physical activity intensity, dose, period, and duration on perinatal depression.

METHODS

The literature was searched via the PubMed, Embase, Cochrane Library, and Web of Science databases. Weighted mean difference (WMD) or the risk ratio (RR) was used as the effect indicator, and the effect size was represented by the 95 % confidence interval (CI). Subgroup analysis based on the perinatal stage, physical activity intensity, physical activity equivalent, and intervention duration was performed.

RESULTS

Totally, 35 studies including 5084 women were included. Physical activity could reduce the incidence and severity of depression in perinatal women. Among depressed women with prenatal depression, low-intensity physical activity, with metabolic equivalents (METs)-min/week being <450, was associated with lower levels of depression. In the general population, the risk of postpartum depression was lower in the physical activity group when the duration of intervention was ≥12 weeks, being II, III stage, and ≥450 METs-min/week. Both low and moderate-intensity physical activity were beneficial to an improved depression severity among depressed women with postpartum depression, and moderate exercise intervention could decrease the risk of postpartum depression in general pregnant women.

LIMITATIONS

Different types of physical activities may affect the effectiveness of interventions.

CONCLUSION

Our study indicated physical activity specifically targeted at pregnant women could reduce depression risk and severity.

Physical exercise interventions for perinatal depression symptoms in women: A systematic review and meta-analysis

Background

The previous meta-analysis indicated that physical exercise could play a crucially therapeutic role in reducing perinatal depression symptoms in women. However, the efficacy varies across different exercise types, forms, intensities, and duration.

Aim

The purpose of this study was to review and evaluate the effects of different types, forms, intensities, and duration of exercise for improving perinatal depressive symptoms.

Design

A systematic review and meta-analysis.

Methods

Randomized controlled trials until December 2021 were searched from seven databases, including PubMed, EMBASE, Medline, CINAHL, Web of Science, Cochrane Library, and PsycINFO. The risk of bias in eligible trials was evaluated using the Cochrane Risk of Bias tool. When high heterogeneity was tested, we used random-effects models. A funnel plot was used to assess the publication bias. This review was performed under the PRISMA guidelines, Consensus on Exercise Reporting (CERT) checklist and Cochrane Handbook. The certainty of the body of evidence was assessed using the GRADE method.

Results

Of 1,573 records, 20 trials were identified in this study. The results of this review revealed that women with perinatal depression symptoms gained benefits from physical exercise [OR = 0.62, 95% CI (0.45, 0.86), P = 0.004; MD = -0.57, 95% CI (-0.83, -0.30), P < 0.0001]. Type of walking [SMD = -1.06, 95% CI (-1.92, -0.19), P < 0.00001], form of "Individual + group-based"exercise [SMD = -0.91, 95% CI (-0.80, -0.03), P = 0.04], intensity of ≥150 min per week [SMD = -0.84, 95% CI (-1.53, -0.15), P = 0.02], and ≥12 weeks duration [SMD = -0.53, 95% CI (-0.75, -0.31), P < 0.00001] seemed to generate more prominent improvement on perinatal depression symptoms.

Conclusion

Physical exercise showed a significant effect on reducing perinatal depressive symptoms. This meta-analysis provides an important update on exercise's efficacy in treating perinatal depression. Further higher quality and large-scale trials are needed to substantiate our findings.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022296230].

Prevalence and associated factors of perinatal depression among working pregnant women: a hospital-based cross-sectional study

Perinatal depression is a major public health problem having serious negative impacts on personal, family, and child developmental outcomes. This study aimed to determine the prevalence of major depressive disorder (MDD) and its associated factors in working pregnant women. This descriptive, cross-sectional study was performed on 389 working pregnant women enrolled from four Tunisian public maternity hospitals. Data collection tools were the sociodemographic, obstetric, family relationships, and work environment questionnaire, and the Center for Epidemiologic Studies Depression Scale (CES-D). The mean score of depression was 27.39 ± 6.97 and 76.1% of women had major depressive symptoms using cutoff points on the CES-D ≥ 23. Family income, diagnosis with a chronic illness, history of depression, and employment categories were associated with major depressive symptoms. In multivariate analyses, family income and work posture were significantly associated with MDD. These results suggest an increased burden of MDD during pregnancy in Tunisian women. Prevention, early detection, and interventions are needed to reduce the prevalence of perinatal depression.

Exercise, Mediterranean Diet Adherence or Both during Pregnancy to Prevent Postpartum Depression-GESTAFIT Trial Secondary Analyses

Targeting lifestyle behaviors during pregnancy is crucial to prevent the highly prevalent postpartum depression and its consequences. In these secondary analyses of an intervention trial to investigate the effects of concurrent exercise training on postpartum depression, we aimed to investigate the potential role of Mediterranean diet (MD) adherence on the exercise effects. A total of 85 pregnant women met the per-protocol criteria (exercise n = 46, control n = 39). The exercise program was delivered in 60 min sessions, 3 days/week, from the 17th gestational week until birth. Women's dietary habits were assessed with a food frequency questionnaire. The Mediterranean Food Pattern (an MD index) was derived from it to assess MD adherence. We used the Edinburgh Postnatal Depression Scale to assess postpartum depression. The postpartum depression score was not statistically different between control and exercise groups (p > 0.05). A higher consumption of fruits (β = -0.242, p = 0.022), lower intake of red meat and subproducts (β = 0.244, p = 0.020), and a greater MD adherence (β = -0.236, p = 0.027) were associated with lower levels of postpartum depression. Greater adherence to the MD during pregnancy was associated with fewer depressive symptoms and a lower risk of postpartum depression. Postnatal depression was not reduced by prenatal exercise. Promoting fruit consumption while controlling the intake of red meat during pregnancy might prevent postnatal depression.

"Conscious Nine Months": Exploring Regular Physical Activity amongst Pregnant Women-A Qualitative Study Protocol

Despite a clear and convincing evidence base and strong recommendations for pregnant women to maintain regular moderate physical activity throughout pregnancy, many of them reduce or discontinue exercise altogether. This is due to pregnancy-related difficulties and barriers. The aim of this protocol is to describe a qualitative research methodology for a study exploring the experiences of women who managed to achieve the recommended levels of physical activity throughout their pregnancy by regularly participating in a specially designed "Conscious nine months" exercise programme. A qualitative descriptive design will be used, including semi-structured in-depth literature-based interviews, together with thematic analysis. Consolidated criteria for reporting qualitative research (COREQ) guidelines will be used. In-depth individual interviews (60-90 min) with exercise programme participants, used together with a thematic analysis process, will allow for a better understanding and exploration of what enabled the participants to achieve such high adherence to the overall exercise programme. The chosen methodology offers a structured way for researchers to explore the experiences and factors that influence the ability of pregnant women to be physically active, enabling research into how pregnant women can be supported to remain active during this special, often challenging time in life.

Effects of physical exercise on blood pressure during pregnancy

Objective

Effect of physical exercise on pregnant women currently has become a hot topic in prenatal health care. In this study, A meta-analysis was conducted on account of Randomized Controlled Trial (RCT). It focused on evaluating the effect of physical exercise intervention on blood pressure so that could provide certain evidence for health care during pregnancy.

Methods

Results of relevant studies were retrieved from PubMed, Embase, Web of Science and the Cochrane Library, and all of these included studies were evaluated according to the Cochrane collaboration’s tool for assessing the risk of bias. Stata 15.1 was used for meta-analysis, and mean difference (MD) was used as statistic for pooled analysis. The effect values were combined by conventional meta-analysis and Bayesian meta-analysis respectively, and the consistency of pooled results was considered as well.

Results

A total of 18 RCT studies were included in the quantitative analysis. The conventional meta-analysis showed differences in blood pressure between intervention group and control group (P < 0.05). Systolic and diastolic blood pressures of intervention group were 3.19 mmHg (95% CI: -5.13, -1.25) and 2.14 mmHg (95% CI: -4.26, -0.03) lower than that of control group, respectively. Bayesian meta-analysis showed that both systolic and diastolic pressure among intervention group decreased by 3.34 mmHg (95% CrI: -5.15, -1.56) and 2.14 mmHg (95% CrI: -3.79, − 0.50), respectively. Subgroup analysis supported that as long as healthy pregnant women participated in exercises, their blood pressure could be slightly regulated, while hypertension susceptible pregnant women significantly lowered blood pressure.

Conclusion

Exercise intervention during pregnancy is beneficial to lower or normalize blood pressure, and this research provides clues for follow-up studies.

The Main Changes in Pregnancy—Therapeutic Approach to Musculoskeletal Pain

Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, during this period, these changes precipitate the appearance of pain, musculoskeletal pain being the most common. Pregnant women should avoid treating musculoskeletal pain with medication and should choose alternative and complementary methods. Exercise along with rest is the basis for treating chronic musculoskeletal pain. Side effects of physical therapy are rare and, in addition, it is not contraindicated in pregnant women. The benefits of this type of treatment in combating pain far outweigh the risks, being an easy way to improve quality of life. The objective of this article is to discuss the management of musculoskeletal pain during pregnancy, to identify the main musculoskeletal pain encountered in pregnant women along with drug treatment, and to expose the beneficial effects of alternative and complementary methods in combating pain. Materials and Methods: A literature search was conducted using medical databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords “changes of pregnancy”, “musculoskeletal pain”, “pregnancy pain”, “pain management”, “pharmacological approach”, “alternative and complementary treatment” and specific sites. Information was collected from studies whose target population included pregnant women who complained of musculoskeletal pain during the 9 months of pregnancy; pregnant women with other pathologies that could increase their pain were not included in this review. Results: The articles related to the most common non-obstetric musculoskeletal pain in pregnancy along with pharmacological treatment options and alternative and complementary methods for musculoskeletal pain management during pregnancy were selected. Conclusions: The results were used to guide information towards the safest methods of therapy but also to raise awareness of the treatment criteria in order to compare the effectiveness of existing methods. Treatment must consider the implications for the mother and fetus, optimizing non-pharmacological therapeutic options.

Exercise and yoga during pregnancy and their impact on depression: a systematic literature review

It is well established that exercise can improve depressive symptoms in the general population; however, it is not clear if these benefits are also seen in pregnancy. This review aimed to synthesize the evidence that examines whether exercise during pregnancy impacts depressive and associated symptoms (e.g. anxiety) during the perinatal period. The review was conducted in accordance with PRISMA guidelines and reporting criteria; literature was searched using PubMed, Scopus and Web of Science database engines. Clinical trials published in English evaluating the effects of a defined exercise protocol during pregnancy on depressive and/or anxiety symptoms during the perinatal period were included. Studies without a control group were excluded. Risk of bias was conducted by Cochrane assessment to appraise the quality of the included studies. Twenty-seven articles, between 1994 and 2019, were included. Of these, only 5 specifically recruited women with depression (n = 334), which all assessed a yoga-based intervention; 4 of these studies showed a statistically significant improvement in depressive and/or anxiety symptoms in the intervention group compared to baseline; however, 2 of these studies also showed an improvement in the control group. The remaining 22 studies used various exercise interventions in pregnant women (n = 4808) with 20 studies reporting that exercise during pregnancy has the ability to improve depressive and/or anxiety measures in the perinatal period compared to either baseline or control. The evidence suggests that exercise of various types in pregnancy can reduce depressive and/or anxiety symptoms in the perinatal period in otherwise healthy women. Specifically in women with antenatal depression, the incorporation of yoga in pregnancy can improve depressive/anxiety symptoms in the perinatal period; however, this is based on a small number of studies, and it is not clear whether this is superior to non-exercise controls. Further studies are needed to determine the potential therapeutic effects of exercise of various types during pregnancy on symptoms of antenatal depression.

Influence of Different Exercise Types on Health-Related Quality-of-Life in Men With Depressive Disorder in South Korea

The aim of the study was to determine the influence of different exercise types on health-related quality of life (QOL) in men with depressive disorder (DD) in South (S) Korea. The data of 385 men aged 19 with DD were collected in S. Korea. The Euro Quality of Life 5 Dimensions (EQ-5D) index and Korea National Health and Nutrition Examination Survey (KNHANES) questionnaires were used to establish the purpose of this study. Furthermore, the complex sampling model was applied to investigate the influence of different exercise types on health-related QOL in participants. When reviewing the outcomes, the strength exercise and walking had significant influences on health-related QOL in men with DD in S. Korea. However, the flexibility exercise did not have a significant influence on them. Based on the results, strength exercise and walking were effective exercise types to increase levels of health-related QOL in men with DD in S. Korea.

Physical Activity and Its Relationship with Preterm Birth in the Presence of Depressive Symptomology

OBJECTIVE

To examine the relationship between physical activity (PA) and preterm birth (PTB) within the context of depressive symptoms (DS).

METHODS

Data are from the Life-course Influences of Fetal Environments (LIFE) Study, a cohort comprised of 1410 Black women, age 18-45 years who delivered a singleton in Metropolitan Detroit, MI. DS were measured with the Center for Epidemiologic Studies Depression Scale (CES-D); a score > 23 indicates severe DS. Traditional leisure time PA (LTPA) and non-LTPA during pregnancy (walking for a purpose, climbing stairs) were both measured. Modified Poisson regression models were used to estimate the association between PTB and PA. Effect modification by severe DS was assessed via stratification.

RESULTS

Approximately 16% of women had a PTB; 20% had CES-D scores > 23. Walking for a purpose was the most frequently reported type of PA (79%), followed by any LTPA (37.7%) and climbing stairs (13.5%). Compared with women who reported no PA, women who reported walking for a purpose (PR = 0.70, 95% CI 0.61, 1.10), partaking in LTPA (PR = 0.67, 95% CI 0.50, 0.90), or climbing stairs (PR = 0.61, 95% CI 0.45, 0.81) were less likely to have PTB. Results stratified by severe DS show the association between LTPA and PTB was more pronounced in women with severe DS, while the non-LTPA relationship with PTB was more heterogeneous.

CONCLUSIONS

Women who participated in traditional LTPA (any or walking only) and non-LTPA experienced improved birth outcomes. LTPA may buffer against PTB among pregnant Black women with severe DS as well as none or mild DS.

Exercise for perinatal depressive symptoms: A systematic review and meta-analysis of randomized controlled trials in perinatal health services

BACKGROUND

Exercise improves perinatal depressive (PD) symptoms, but reports call for more robust evidence. This systematic review and meta-analysis aimed at synthesizing evidence exclusively from randomized controlled trials (RCTs) examining the effects of exercise on PD symptoms in women recruited through perinatal health services.

METHODS

Nine e-databases and fifteen systematic reviews were searched for relevant RCTs. Exercise-specific tools extracted/coded data. A meta-analysis using a random effects model (Standardized Mean Difference [SMD]) investigated the effects of exercise on PD scores post-intervention.

RESULTS

From 285 records, 14 RCTs (2.025 participants) were considered eligible including two RCTs with clinically diagnosed PD women. Exercise showed a statistically significant, small, overall antidepressant effect (SMD = -0.21, 95% CI = -0.31, -0.11, p = 0.0001) with low/non-significant heterogeneity (Q = 17.82, I ² = 16%, p = 0.27). Only the fail-safe criterion recorded marginally significant publication bias, but trim-fill analysis added no study. Sensitivity analyses increased the overall effect in RCTs showing lower risk of bias or delivering ≥150 min/week moderate intensity aerobic exercise. Subgroup analyses revealed significant antidepressant effects for exercise across various settings, delivery formats, depressive symptoms severities and outcome measures used. Heterogeneity was low/non-significant in all analyses (I ² ≤ 50%). Hedges' g corrections did not influence the results.

LIMITATIONS

Study limitations include the small number of available trials and clinically diagnosed PD samples and the variety of exercise modalities.

CONCLUSIONS

Exercise improved PD symptoms, especially in RCTs with lower risk of bias or with ≥150 min/day moderate intensity aerobic exercise interventions. Findings are clinically useful but more RCTs for clinically diagnosed PD women are needed for firmer conclusions.

Poor reporting of physical activity and exercise interventions in youth mental health trials: A brief report

AIM

To describe the quality and completeness of the description and reporting of physical activity and exercise interventions delivered to young people to promote mental health or treat mental illness.

METHODS

We conducted a series of scoping reviews identifying 64 controlled trials of physical activity and exercise interventions delivered to young people. We extracted: intervention characteristics, personnel and delivery format, the intensity, duration, frequency and type of physical activity or exercise.

RESULTS

There was limited reporting of intervention details across studies; 52% did not provide information to confidently assess intervention intensity, 29% did not state who delivered the intervention, and 44% did not specify the intervention delivery format.

CONCLUSIONS

We recommend that authors adhere to the CONSORT reporting requirements and its intervention reporting extensions, (a) the Template for Intervention Description and Replication, (b) Consensus for Exercise Reporting Template and (c) as part of this, detail the frequency, intensity, time and type of physical activity recommendations and prescriptions. Without this, future trials are unable to replicate and extend previous work to support or disconfirm existing knowledge, leading to research waste and diminishing translation and implementation potential.

Development of an exercise attitude scale in Turkish for pregnant women: validity and reliability

This study, conducted between October 2018 and May 2019, aimed to develop an Exercise Attitude Scale in Turkish (EAS-Turkish) for pregnant women and to determine its validity and reliability. The scale was prepared in Turkish to comprehensively measure pregnant women's exercise attitudes. Then, it administered in 253 pregnant women, who were native speakers of Turkish and older than 18 years, in the Obstetrics Polyclinic at Ataturk Training and Research Hospital, Ankara, Turkey. Validity with exploratory and confirmatory factor analysis and reliability with test-retest and internal consistency methods were tested. The 37-item scale was found to be 2-dimensional (knowledge and benefit; barrier). All indexes of the goodness of fit (χ2/df = 2.0, Comparative Fit Index = 0.90, Goodness-of-fit Index = 0.85, Root Mean Square Error of Approximation = 0.06) indicated that the fit between the model and the sample data was acceptable. The item-total score correlations varied between r = 0.22 and 0.60. The Cronbach alpha coefficients were found as 0.90 for the whole scale, 0.91 for the knowledge and benefit sub-dimension, and 0.87 for the barrier sub-dimension. In the test-retest analysis conducted with 41 pregnant women, the reliability coefficients were detected as 0.93 for the whole scale and 0.84 for each sub-dimension. The EAS-Turkish for pregnant women was found to be a valid and reliable tool.

The effect of music, massage, yoga and exercise on antenatal depression: A meta-analysis

BACKGROUND

Prenatal depression affects 20.7 percent of women worldwide, which was associated with preterm birth, low birth weight and Apgar score, as well as cognitive, emotional and behavioral development disorders. We conducted a systematic review and meta-analysis to retrieve the latest and best evidence about music, massage, yoga and exercise in the prevention and treatment of prenatal depression, and to preliminarily compare the four methods to explore the most effective means. We also compared different types of yoga and music, in order to find the most effective type of intervention.

METHODS

A comprehensive literature search was carried out through six databases on randomized controlled trials (RCTs). Effects were summarized by a random effects model using mean differences with 95% confidence intervals. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

This research found low to very low evidence that yoga, exercise, music and massage could reduce antenatal depression. Among them, music may be the most effective intervention, and integrated yoga other than simple yoga would improve prenatal depression. The effect of Chinese Medicine Five Element Music may be better than ordinary music.

CONCLUSION

It is important to support prenatal depression patients to make informed decisions about their behavior therapy.

Multidimensional analyses of the effect of exercise on women with depression: A meta-analysis

BACKGROUND

The proportion of women is higher than men in depression. This is mainly due to women's physiological regulation is different from men, especially in puberty, menstruation, pregnancy, menopause, among others. Therefore, treating depressive women is still a health challenge. Besides, recent studies of exercise therapy have a more outstanding performance in treating depression, especially in contrast to drug therapy and psychotherapy. Its main advantages are convenience, quickness, no side effects, real-time, and long-term effectiveness.

OBJECTIVE

The aim of this study was to systematically review the clinical efficacy of exercise on women with depressive symptoms.

METHODS

Searching PubMed, The Cochrane Library, and Embase databases to collect randomized controlled trials about exercise in the treatment of depressive women. After literature screening, data extraction, and literature quality evaluation, the meta-analysis of acquirement data was performed with RevMan5.3 software.

RESULTS

A total of 2294 patients were included in 25 different articles totally. Meta-analysis shows that compared with the control group, exercise could relieve female depression (standard mean difference [95% confidence interval, CI] = -0.64 [-0.89 to -0.39], Z = 4.99, P < .001). Subgroup analysis shows that different types of exercise have significant effects in improving depression symptoms. Exercise therapy has better effect on depressive patients induced by physiology or disease than ordinary depressive patients.

CONCLUSION

Exercise can significantly improve depressive symptoms in women.

Depressive symptoms postpartum is associated with physical activity level the year prior to giving birth - A retrospective observational study

OBJECTIVES

To examine physical activity level prior to pregnancy, during pregnancy and postpartum and investigate the association with depressive symptoms postpartum among women in Sweden.

STUDY DESIGN

Retrospective observational study including 532 women on self-assessment of physical activity level before pregnancy, during pregnancy and postpartum, depressive symptoms postpartum as well as stressful life events in the past two years.

MAIN OUTCOME MEASURES

Level and change of physical activity before pregnancy, during pregnancy and postpartum and depressive symptoms postpartum.

RESULTS

Almost two-thirds of the women in the study reported that they were inactive or performed light physical activity (62.9%; n = 331) in the year prior to giving birth. Women with a sedentary lifestyle or performing light physical activity level reported depressive symptoms postpartum to a greater extent than active women.

CONCLUSIONS

A higher level of physical activity during pregnancy was associated with a lower level of depressive symptoms postpartum. Physical activity is a contributing factor to promote a healthier lifestyle and can contribute to improve mental health for pregnant women, newly become mothers and their children.

Exercise During Pregnancy and Prenatal Depression: A Systematic Review and Meta-Analysis

Background: Prenatal depression is associated with an increased risk of physical, physiological, cardiovascular, and psychological diseases for mothers and future newborns. Prenatal depression and depressive symptoms could have negative effects on the cognitive, emotional, social, and behavioral development of children. Objective: This study aimed to examine the influence of exercise during pregnancy on the prevalence of prenatal depression and depressive symptoms in the scientific literature. Data Sources: A search was carried out examining different online databases up to November 2020. Methods of Study Selection: A systematic review with random effects meta-analysis was performed. Only randomized controlled trials published in English or Spanish with pregnant populations and interventions with exercise programs carried out during pregnancy were included. The scores obtained by the tools that measured the emotional state and depressive symptoms as well as the number and percentage of depressed women of the study groups were analyzed. Tabulation, Integration, and Results: We analyzed 15 studies and found a negative association between moderate exercise during pregnancy and prenatal depression (ES = -0.36, 95% CI = -0.58, -13, I 2 = 80.2%, Pheterogeneity = 0.001). In addition, the studies also showed that women who were inactive during pregnancy had a 16% higher probability of suffering prenatal depression [RR = 0.84 (95% IC = 0.74, 0.96) I 2 = 61.9%, Pheterogeneity = 0.010]. Conclusion: Supervised exercise during pregnancy may be useful for the prevention and reduction of prenatal depression and depressive symptoms. Systematic Review Registration: Registered in PROSPERO (Registration No. CRD42020164819).

Level of exercise and physical activity among pregnant women in Saudi Arabia: A systematic review

The current study aimed to clarify the health benefits of physical activity on the mother and fetus in the Saudi women population. Besides, it is intended to provide recommendation based on the literature and results of studies from Saudi Arabia for exercise in pregnancy to improve the general health of women in Saudi Arabia. Prenatal physical exercise enhances physical and mental health of pregnant women. It can also reduce the risk of multiple pregnancy-related complications such as; lower back pain, fluid retention and risk of gestational diabetes. All these factors can affect fetal development and life later. Multiple studies showed that prenatal exercise could reduce the risk of fetal macrosomia with no effect on other perinatal or postnatal complications. The study followed the systematic literature review approach where it included multiple medical search Databases using PICOS eligibility criteria up to January 2019. The review was based on the following keywords: pregnancy, gestational, or prenatal) and (physical exercise, exercise, or physical activity. There are only two studies that dealt with physical exercises among Saudi women. The results indicated a relation between prenatal physical exercise on improving or decreasing risks on the mother and child during pregnancy.

Effects of Different Types of Physical Activity on Health-Related Quality-of-Life in Korean Women with Depressive Disorder

Depressive disorder is a frequent psychological illness and causes community health problems for many women. It was found that the health-related quality of life (HRQoL) score of many women was altered due to mental and physical problems. Physical activity (PA) might effectively improve the responses of the HRQoL of women with depressive disorder. Therefore, the study aimed to identify the effects of different types of PA (e.g., walking, strength exercise, flexibility exercise) on the responses of the HRQoL of Korean women with depressive disorder. A sample of 1315 Korean women aged 19 or older with a depressive disorder was accumulated. The Korea National Health and Nutrition Examination Survey (KNHANES) and Euro Quality of Life-5 Dimensions (EQ-5D index score) were used. The characteristics of the participants were analyzed by the complex sample in frequency analysis. Furthermore, the complex sample general linear model was used to determine the effects of different types of PA on the HRQoL of Korean women with depressive disorder. In the results, there was a statistically significant difference between the groups who participated for one to two days, who participated for three to four days, and who did not participate in walking at all. In the flexibility exercise, there was a statistically significant difference in the group who participated for three to four days from the group who did not participate at all. However, there was no statistically significant difference in the strength exercise. In conclusion, the walking and flexibility exercises were effective physical activities (PAs) to improve the responses to the HRQoL of Korean women with depressive disorder.

Low-intensity physical activity may protect pregnant women against spontaneous preterm labour: a prospective case-control study

The innate immune system plays a significant role in onset of parturition. Maternal antenatal physical activity can influence immune function and timing of labour. We examined physical activity patterns and concentration of 19 cytokines at 16 and 27 weeks gestational age (GA), in peripheral plasma of 28 asymptomatic women who later had spontaneous preterm labour (SPTL, <37 weeks GA) and 52 women who later delivered at term (TL; ≥37 weeks GA). This nested case-control study used data from the Ontario Birth Study cohort. Exercise was assessed using the International Physical Activity Questionnaire, and cytokines were analyzed using Luminex assays. There was no significant difference in exercise patterns between SPTL and TL subjects. Plasma concentration of interleukin (IL)-10 was significantly higher in SPTL women at 16 and 27 weeks, while tumour necrosis factor alpha (TNF-α), IL-8, and monocyte chemoattractant protein (MCP)-1 concentrations were increased at 27 weeks GA (p < 0.05). Concentration of IL-10 was negatively correlated with the amount of reported walking (ρ = −0.264, p = 0.03). Women should be encouraged to partake in low-intensity exercise throughout pregnancy, as it may confer a protective effect against SPTL through IL-10–mediated pathways. Additionally, plasma cytokine analysis at 27 weeks GA may be useful for predicting SPTL in asymptomatic women.

Novelty: In women that delivered preterm, plasma levels of anti-inflammatory cytokine IL-10 were significantly elevated at 16 and 27 weeks of gestation. Plasma levels of IL-10 were negatively correlated with the amount of reported walking. Concentration of IL-8, MCP-1 and TNF-α were increased in plasma of asymptomatic women that subsequently deliver preterm.

Physical activity and prenatal depression: going beyond statistical significance by assessing the impact of reliable and clinical significant change

BACKGROUND

Previous literature supports exercise as a preventative agent for prenatal depression; however, treatment effects for women at risk for prenatal depression remain unexplored. The purpose of the study was to examine whether exercise can lower depressive symptoms among women who began pregnancy at risk for depression using both a statistical significance and reliable and clinically significant change criteria.

METHODS

This study is a secondary analysis of two randomized controlled trials that followed the same exercise protocol. Pregnant women were allocated to an exercise intervention group (IG) or control group (CG). All participants completed the Center for Epidemiological Depression (CES-D) scale at gestational week 9-16 and 36-38. Women with a baseline score ⩾16 were included. A clinically reliable cut-off was calculated as a 7-point change in scores from pre- to post-intervention.

RESULTS

Thirty-six women in the IG and 25 women in the CG scored ⩾16 on the CES-D at baseline. At week 36-38 the IG had a statistically significant lower CES-D score (14.4 ± 8.6) than the CG (19.4 ± 11.1; p < 0.05). Twenty-two women in the IG (61%) had a clinically reliable decrease in their post-intervention score compared to eight women in the CG (32%; p < 0.05). Among the women who met the reliable change criteria, 18 (81%) in the IG and 7 (88%) in the CG had a score <16 post-intervention, with no difference between groups (p > 0.05).

CONCLUSIONS

A structured exercise program might be a useful treatment option for women at risk for prenatal depression.

Exercise routine change is associated with prenatal depression scores during the COVID-19 pandemic among pregnant women across the United States

BACKGROUND

The COVID-19 pandemic has negatively affected physical and mental health worldwide. Pregnant women already exhibit an elevated risk for depression compared to the general public, a pattern expected to be exacerbated by the pandemic. Certain lifestyle factors, including moderate exercise, may help support mental health during pregnancy, but it is unclear how the pandemic may impact these associations across different locations. Here, we test whether: (i) reported exercise routine alterations during the pandemic are associated with depression scores; and, (ii) the likelihood of reporting pandemic-related exercise changes varies between women living in metro areas and those in non-metro areas.

METHODS

This cross-sectional study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant women in the United States. Participants were recruited April-June 2020 (n = 1,856). Linear regression analyses assessed whether reported COVID-19-related exercise change was associated with depression score as measured by the Edinburgh Postnatal Depression Survey. Logistic regression analyses tested whether a participant's Rural-Urban Continuum Code classification of "metro" was linked with higher odds of reporting exercise changes compared to a "non-metro" classification.

RESULTS

Women who reported exercise changes during the pandemic exhibited significantly higher depression scores compared to those reporting no changes. Moreover, individuals living in metro areas of all sizes were significantly more likely to report exercise changes compared to women living in non-metro areas.

CONCLUSIONS

These results suggest that the ability to maintain an exercise routine during the pandemic may help support maternal mental health. It may therefore be prudent for providers to explicitly ask patients how the pandemic has impacted their exercise routines and consider altered exercise routines a potential risk factor for depression. An effort should also be made to recommend exercises that are tailored to individual space restrictions and physical health.

Designing an intervention program over the effects of Pilates on pregnancy outcomes among the pregnant women: A protocol study

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Pilates exercise intervention program reduces maternal and neonatal outcomes.

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This intervention program improving postpartum depression and back pain.

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Strategies of this program is as a framework to improve reproductive health.

Background

Pregnancy is a pleasure for most women, it is often considered as a stressful period with physiological, anatomical, biochemical, and psychological changes. Pilates exercise improved quality of life in women. Therefore, the present study targeted at designing an intervention program over the effects of Pilates on pregnancy outcomes among the pregnant women.

Methods

In this protocol, a clinical intervention will be designed in three phases. In the first phase of the study, a researcher-made checklist will be used to evaluate the pregnancy and neonatal outcomes based on the literature review. In the second phase, an intervention program of Pilates exercise will be conducted according to different studies and viewpoints of a panel of reproductive health and physical activity specialists. The exercises will include two sessions of 30 minutes per week for 12 weeks conducted under the supervision of a qualified trainer. The third phase of the intervention will include the pre-test and post-test using a standard questionnaire and a researcher-made checklist for the two intervention groups and one control group.

Discussions

The present study provides useful data regarding the design of a Pilates exercise intervention program for pregnant women with the aim of influencing pregnancy and neonatal outcomes, reducing depression, low back pain and improving maternal mental health. It can also reduce their medical and treatment costs. The strategies of this program could be important and cost effective, and therefore we hope that the success of such a program is a step forward in improving reproductive health status.

Knowledge, attitude, and practices on exercise among pregnant females attending Al-Wazarat Health Center, Riyadh, Saudi Arabia

BACKGROUND

The consequences of physical inactivity during pregnancy are one of the major problems among pregnant women in Saudi. To explore the pattern of exercise and to know the beliefs and reasons for not doing physical activity (PA) emphasized the need for conducting this study. This study aimed to improve the level of knowledge and practice of PA among women during pregnancy.

METHODS

A cross-sectional study was performed using quota sampling.

RESULTS

41.62% of pregnant women had high level of physical activity (PA) awareness and practice and 58.37% had a low level of awareness and practice. Statistical difference was found between the two groups in terms of parity, education level, work status, and family income. Pregnant women preferred walking as exercise. They are aware about PA benefits during pregnancy, but perceived that tiredness was the greatest barrier for physical activity.

CONCLUSION

This study recommends conducting well-designed intervention sessions to promote PA awareness and practice among pregnant women, especially those with low education, low income, and low number of children.

Effects of Physical Activity on the Stress and Suicidal Ideation in Korean Adult Women with Depressive Disorder

Depressive disorder is common in many adult women in the world. It was found that depressive disorder was related to stress and suicidal ideation in Korean adult women with depressive disorder. Physical activities were effective to solve this mental disorder. Thus, the purpose of the study was to investigate the effects of physical activity (PA) on the stress and suicidal ideation of Korean adult women with depressive disorder. A sample of 1315 Korean adult women who have depressive disorder was collected, and the Korea National Health and Nutrition Examination Survey (KNHANES) was used to determine this purpose of the study. The complex samples in frequency analysis were used to identify the characteristics of the participants. The logistic regression in the complex sample design was conducted to investigate the effects of PA on the stress and suicidal ideation in Korean adult women with depressive disorder. The effects of flexibility exercise on the stress in Korean adult women with depressive disorder showed the odds ratio (OR) value of 1.434 (OR = 1.434, 95% CI = 1.043–1.973, p < 0.05). The effects of flexibility exercise on the suicidal ideation in Korean adult women with depressive disorder presented the OR value of 0.682 (OR = 0.682, 95% CI = 0.496–0.937, p < 0.05). Based on the results, the participants who did flexibility exercises were likely to have less stress and suicidal ideation than the Korean adult women with depressive disorder who did not participate in flexibility exercise. In conclusion, the flexibility exercise has played an important role in reducing and preventing stress and suicidal ideation in Korean adult women with depressive disorder.

Preventing postpartum depressive symptoms using an educational video on infant crying: A cluster randomized controlled trial

BACKGROUND

The aim of this study was to examine the impact of watching an educational video on infant crying within 1 week of age after delivery at maternity wards to reduce the prevalence of postpartum depressive symptoms at 1 month after giving birth.

METHODS

The study design was a cluster randomized controlled trial. The intervention hospitals were randomly assigned, stratified by area and function of the hospital. Participants included 47 obstetrics hospitals or clinics out of 150 hospitals or clinics in Osaka Prefecture, Japan. In total, 44 hospitals or clinics completed the trial and 2,601 (intervention group = 1,040, control group = 1,561) caregivers responded to the questionnaire on postpartum depression (response rate: 55.1%). Mothers in the intervention group watched an educational video, within 1 week of age, during hospitalization at maternity wards. Primary outcome in this study was postpartum depression assessed by the Edinburgh Postnatal Depression Scale as 9+ and assessed via questionnaire at a 1-month health checkup.

RESULTS

In the intervention group, 142 (13.7%) mothers reported postpartum depression compared to 250 (16.0%) in the control group. Intention-to-treat analysis showed no significant difference in the prevalence of postpartum depression between the groups. However, among young mothers (<25 years), the analysis showed a 67.0% reduction in postpartum depression (odds ratio: 0.33, 95% CI: 0.15-0.72).

CONCLUSIONS

Watching an educational video on infant crying within 1 week after delivery at maternity wards did not reduce postpartum depression at 1 month after giving birth, but it was effective for young mothers aged <25 years.

Physical activity and associated factors among pregnant women in Ethiopia: facility-based cross-sectional study

BACKGROUND

Regular physical activity (PA) has health benefits, including reducing the risk of complications during pregnancy. In Ethiopia, little is known about PA status and its determinants among pregnant women. The purpose of this study was to assess PA status and associated factors among pregnant women attending antenatal care at public and private health facilities in Mekelle, Ethiopia.

METHODS

A facility-based cross-sectional study was conducted. Data was collected from 299 pregnant women using a structured questionnaire. Study participants were selected using a simple random sampling technique. A binary logistic regression was modeled to investigate the statistical significance of independent variables with PA status during pregnancy. Factors associated with PA status were estimated using adjusted odds ratios with 95% confidence intervals and statistical significance was declared at p-value < 0.05.

RESULTS

79.3% of the study participants were classified as sedentary. The age group of 26-35 years (AOR: 2.69, 95% CI: 1.07-6.78), attending non-formal education (AOR: 13.50, 95% CI: 2.65-68.91), and women who did not work outside the home (AOR: 5.23, 95% CI: 1.34-20.38) were significantly associated with a higher risk of sedentary activity status. Pregnant women who were married (AOR: 0.26, 95% CI: 0.09-0.73), had two children (AOR: 0.13, 95% CI: 0.03-0.59), traveled an hour or more to health facilities (AOR: 0.31, 95% CI: 0.11-0.89) were protected from being sedentary.

CONCLUSION

Sedentary PA status was highly prevalent during pregnancy. Pregnant women in the age group of 26-35 years, with a non-formal education, and women who did not work outside the home had a greater risk of reporting being sedentary. Those who were married, had two children, and traveled an hour or more to health facilities were less likely to be sedentary. Stakeholders (Tigrai regional health bureau, Mekelle University, local NGOs working with pregnant women and societies at large) should give higher emphasis on designing appropriate strategies including educational interventions to overcome barriers to PA during pregnancy.

How Depressive Symptoms among African American Women Relate to Measures of Social Disorder in Her Childhood and Pregnancy Neighborhood

Pregnant African American women who report higher levels of social disorder (e.g., vacant housing, drug dealing) in their neighborhoods also report higher levels of depressive symptoms. The effects of social disorder in the neighborhood during childhood on depressive symptoms during pregnancy are not known. Also unknown is the interaction between social disorders in the neighborhood during childhood and during pregnancy regarding depressive symptoms during pregnancy. The purpose of this study was to examine whether higher levels of social disorder in the neighborhood during pregnancy buffered the association of social disorder in the neighborhood during childhood (at age 10 as reference) with depressive symptoms during pregnancy among African American women. We conducted a secondary data analysis of 1383 African American women from the Life-course Influences on Fetal Environments (LIFE) Study (Detroit, Michigan, 2009-2011). Women were interviewed in the hospital 24-72 h after the births. The Center for Epidemiological Studies-Depression (CES-D) scale measured depressive symptoms. Scales measuring social disorder in the neighborhood both during childhood and during pregnancy were also included in the interviews. Women with CES-D scores ≥ 16 were younger, were more likely to be single, and had lower levels of education and household income compared with women with CES-D < 16. There was a significant association between women who report social disorder in their neighborhoods during childhood and depressive symptoms during pregnancy. This effect was moderated by measures of social disorder in the neighborhood during pregnancy (p = .037). Women who reported both low levels of social disorder in their neighborhoods during childhood and during pregnancy had the lowest CES-D scores after controlling for maternal age, marital status, years of education, and family income. The model had a good fit to the data (χ²₍₆₎ = 6.36, p = .38). Health care providers should inquire about neighborhood conditions during childhood and during pregnancy and provide referrals for appropriate professional and community support for women who report social disorder in their neighborhoods and depressive symptoms.

Physical activity and exercise in youth mental health promotion: a scoping review

BACKGROUND/AIM

This scoping review examined the breadth and outcomes of controlled trials testing the effect of physical activity and exercise interventions across all mental health outcomes for mental health promotion and indicated prevention studies in young people.

METHODS

The literature search was conducted using 'Evidence Finder'.

RESULTS

Thirty publications were included. Available evidence suggested that interventions of varying intensity may lead to a reduction in depression symptoms and that moderate-to-vigorous-intensity and light-intensity interventions may reduce anxiety symptoms. Effects of physical activity/exercise interventions on additional mental health outcomes were also shown; however, the number of studies was small, indicating a limited evidence base. Robust research regarding the effects of physical activity/exercise on mental health promotion and as an indicated prevention strategy in young people is lacking.

CONCLUSION

The available evidence suggests that physical activity/exercise is a promising mental health promotion and early intervention strategy and warrants further investigation.

Effects of a lifestyle intervention in routine care on prenatal physical activity - findings from the cluster-randomised GeliS trial

BACKGROUND

Excessive gestational weight gain (GWG) is associated with an increased risk of pregnancy and obstetric complications. The "healthy living in pregnancy" (GeliS) study was performed in a routine care setting with the aim of limiting excessive GWG. The purpose of this secondary analysis is to evaluate the effect of the intervention on physical activity (PA) behaviour and to assess the impact of PA intensities on GWG.

METHODS

The cluster-randomised, multicentre GeliS trial was performed in a routine care setting alongside scheduled prenatal visits. Pregnant women with a pre-pregnancy BMI between 18.5 and 40.0 kg/m2 were either assigned to the control group receiving usual care or to the intervention group. Participants in the intervention group attended three antenatal counselling sessions on diet and PA and one additional postpartum session. Data on PA behaviour were collected twice, before the end of the 12th (baseline) and after the 29th week of gestation using the Pregnancy Physical Activity Questionnaire.

RESULTS

PA data were available for 1061 (93%) participants in the intervention and 1040 (93%) in the control group. Women in the intervention group reported significant improvements in the levels of total PA (p < 0.001), total PA of light intensity and above (p < 0.001), moderate-intensity (p = 0.024) and vigorous-intensity activities (p = 0.002) as well as sport activities (p < 0.001) in late pregnancy compared to the control group. The proportion of women meeting the international PA recommendations in late pregnancy was significantly higher in the intervention (64%) versus the control group (49%, p < 0.001). Activities of light-intensity and above (p = 0.006), light-intensity (p = 0.002) and vigorous-intensity (p = 0.014) in late pregnancy were inversely associated with total GWG.

CONCLUSION

We found significant evidence of improvements in the PA pattern of pregnant women receiving lifestyle counselling within the framework of routine care. Most PA intensities were inversely associated with total GWG which indicates that PA across different intensities should be promoted.

TRIAL REGISTRATION

NCT01958307, ClinicalTrials.gov, retrospectively registered 9 October, 2013.

Examination of the Myokine Response in Pregnant and Non-pregnant Women Following an Acute Bout of Moderate-Intensity Walking

Background

It is recommended that women accumulate 150-min of weekly moderate-intensity physical activity (MPA) when pregnant. Engaging in regular physical activity (PA) confers many health benefits to both the mother and the fetus. However, the molecular mechanisms by which these health benefits are bestowed are not well understood. One potential factor that may be contributing to the observed benefits is myokines, which are small peptides secreted by skeletal muscles. In the non-pregnant population, myokines are believed to be involved in the molecular mechanisms resulting from PA. The objective of this study was to characterize and compare the myokine profile of pregnant and non-pregnant women, after an acute bout of MPA.

Methods

Pregnant (n = 13) and non-pregnant (n = 17) women were recruited from the Ottawa region to undergo a treadmill walking session at moderate-intensity (40–60% heart rate reserve). Pre- and post-exercise serum samples were taken, and a set of 15 myokines were analyzed although only 10 were detected. IL-6 was analyzed using a high-sensitivity assay, while FGF21, EPO, BDNF, Fractalkine, IL-15, SPARC, FABP-3, FSTL-1, and oncostatin were analyzed using various multiplex assays.

Results

The pregnant and non-pregnant groups did not differ in terms of age, height, non/pre-pregnancy weight, BMI, and resting heart rate. Baseline levels of EPO and oncostatin were higher in the pregnant group while FGF21 was higher in the non-pregnant group. Circulating levels of three myokines, FGF21, EPO, and IL-15 significantly increased in response to the acute exercise in the pregnant group. Non-pregnant women exhibited an increase in three myokines, FABP-3, FSTL-1, and oncostatin, while one myokine, EPO, decreased post-exercise. SPARC, fractalkine and BDNF were shown to increase post-exercise regardless of pregnancy status while the response for BDNF was more pronounced in the non-pregnant group.

Conclusion

This is the first study examining myokine response following an acute bout of PA in pregnancy. Moderate intensity PA, which is recommended during pregnancy, elicited an increase in four myokines post-compared to pre-exercise in the pregnant group. Further research is warranted to understand the role of myokines in pregnancy.

Physical Activity and Depressive Disorders in Pregnant Women-A Systematic Review

Background and Objectives: Pregnancy is a unique period in the life of every woman. The lifestyle of a pregnant woman has a significant impact on her and her child's health. Regular physical activity is one of the elements that help maintain normal mental and physical well-being. In pregnant women who regularly have moderate physical activity, there is a lower risk of developing obesity and overweight. Physical exercises have an impact on maintaining proper muscular tonus, reduce pain and prepare for the exertion during labour. Based on the available literature, the aim of this study was to present the impact of physical activity on depressive disorders in pregnant women. Materials and Methods: A review of the literature was carried out in the Medline PubMed database. The basic search terms were: "pregnancy" AND "physical activity AND depression". The work included only English-language publications published in the years 2000-2018. Results: A total of 408 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 354 articles were rejected, and 54 articles were fully read, of which five were rejected due to lack of access to the full version. Finally, 17 references were included in the review. Conclusions: Physical activity, at least once a week, significantly reduces the symptoms of depression in pregnant women and may be an important factor in the prevention of depression in this period.

Effectiveness of Physical Activity Interventions on Pregnancy-Related Outcomes among Pregnant Women: A Systematic Review

Regular physical activity has been demonstrated to contribute to physical and psychological health. Nevertheless, pregnant women generally exhibit low levels of physical activity. Implementation of interventions that enhance the self-efficacy of pregnant women on increasing physical activity is required. This paper provides an in-depth review of studies reporting the effect of various physical activity interventions dedicated for pregnant women on pregnancy-related issues, including gestational weight gain, pain and depression, physical activity level, and quality of life among these individuals. Five databases were used in searching the literature. Findings of the included studies were presented narratively, and appraisal of their methodological quality was conducted using the quality assessment tool developed by Effective Public Health Practice Project. Review findings demonstrated that physical activity interventions are effective in enhancing physical activity levels of pregnant women. Further, they are potentially useful in alleviating pregnancy-related pain and psychological symptoms, reducing gestational weight gain, and increasing self-efficacy in enhancing physical activity levels among these individuals. Nevertheless, inconsistencies in findings between studies hamper the drawing of firm conclusions on these latter outcomes. Overall, studies demonstrated a positive effect of physical activity interventions on the well-being and physical and psychological health of pregnant women.

Efficacy of Regular Exercise During Pregnancy on the Prevention of Postpartum Depression: The PAMELA Randomized Clinical Trial

IMPORTANCE

Interventions to reduce postpartum depression have mainly focused on enhancing screening to increase treatment rates among women. Preventive approaches are timely from a population health perspective, particularly in low- and middle-income countries where access to mental health services is limited.

OBJECTIVE

To assess the efficacy of regular exercise during pregnancy on the prevention of postpartum depression.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial examines a prespecified secondary outcome of the Physical Activity for Mothers Enrolled in Longitudinal Analysis (PAMELA) Study, a parallel-group, randomized clinical trial. This trial was nested in the 2015 Pelotas (Brazil) Birth Cohort Study. Between August 27, 2014, and March 14, 2016, pregnant women between 16 and 20 weeks of gestation with no contraindications to exercise were randomized 1:2 to the intervention group or control group via computer-generated randomization using a block size of 9. Data were analyzed from March 7 to May 2, 2018.

INTERVENTIONS

Participants assigned to the intervention were engaged in a 16-week supervised exercise program including aerobic and resistance training delivered in 60-minute sessions 3 times per week.

MAIN OUTCOMES AND MEASURES

Postpartum depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale 3 months after birth. A score of 12 or greater was defined as screening positive for postpartum depression. Primary analysis was performed on a complete case basis (90% of participants who had the primary end point ascertained).

RESULTS

A total of 639 participants (mean [SD] age, 27.1 [5.1] years; mean gestational age, 16.5 [1.5] weeks) were randomly assigned to the intervention group (n = 213) or control group (n = 426). Compliance with the protocol, defined as having engaged in at least 70% of exercise sessions, was low (40.4%). There was no significant difference in mean (SD) scores for postpartum depression between the intervention group (4.8 [3.7]) and the control group (5.4 [4.1]) (mean difference, -0.6; 95% CI, -1.3 to 0.1). There was also no significant difference in rates of postpartum depression between the intervention group (12 of 192 [6.3%]) and the control group (36 of 387 [9.3%]) (odds ratio, 0.65; 95% CI, 0.33-1.28). Instrumental variable analysis indicated that noncompliance may have attenuated the effect estimates obtained in the primary analysis.

CONCLUSIONS AND RELEVANCE

Moderate-intensity exercise during pregnancy did not lead to significant reductions in postpartum depression. However, noncompliance to the intervention protocol was substantial and may have led to underestimations of the possible benefits of exercise. The point estimates for this study are in the same direction as the previous randomized clinical trial on this topic. Future studies on how to promote regular exercise during pregnancy to improve compliance, particularly targeting young and less educated women, are warranted before further trials are undertaken.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02148965.

Effects of physical activity during pregnancy on preterm delivery and mode of delivery: The Japan Environment and Children's Study, birth cohort study

Background

The aim of this study was to examine how physical activity (PA) before and during pregnancy influences pregnancy outcomes, particularly preterm delivery and mode of delivery.

Methods

This study was based on the Japan Environment and Children’s Study. A total of 92,796 pregnant women who gave birth to live singleton babies were included. Information on mean PA per week during pregnancy was extracted from the responses to questionnaires completed by women during the second and third trimesters of pregnancy. Information on PA before pregnancy was obtained from questionnaires answered based on recall at participation. The level of PA was stratified into the following quartiles for categorical analysis: Very low, Low, Medium, and High. Pregnancy outcomes, gestational age at delivery (whether preterm delivery or not), and mode of delivery (spontaneous, instrumental, or caesarean delivery) were compared between the different groups adjusted for multiple covariates.

Results

With respect to PA during pregnancy, the risk of preterm delivery and instrumental delivery increased significantly in the Very low group compared to that in the Medium group (odds ratios [OR] 1.16, 95% confidence interval [CI], 1.05–1.29; OR 1.12, 95% CI, 1.03–1.22, respectively). Moreover, the risks of caesarean delivery in the Low group and instrumental delivery in the High group were significantly higher than the risks in the Medium group (OR 1.07, 95% CI, 1.00–1.15; OR 1.12, 95% CI, 1.02–1.22, respectively). In contrast, with respect to PA before pregnancy, there were no statistically significant differences when the other groups were compared to the Medium group.

Conclusions

Pre-pregnancy PA has no negative effects on preterm birth and caesarean delivery. In contrast, both may be affected by PA during pregnancy because a low level of PA appears to slightly increase the risk of preterm delivery and operative delivery (caesarean and instrumental).

Effect of stress management training on depression, stress and coping strategies in pregnant women: a randomised controlled trial

INTRODUCTION

Pregnancy is a period of important biological and psychosocial changes and a period that carries high risk of experiencing anxiety and stress. It is important to reduce the depression and stress that is experienced in this period or to reduce the severity of the stress and to increase the stress coping power of the pregnant women. The research was conducted to examine the effect of stress management training on pregnant women's depression, stress and methods for coping with stress.

METHODS

Randomised controlled study of 202 pregnant women (experimental group: 103; control group: 99). The experimental group received stress management training and standard care; the control group received standard care. Data were collected using a Personal Information Form, the Beck Depression Inventory (BDI), Perceived Stress Scale (PSS) and ways of coping inventory (WCI).

RESULTS

Both groups showed a decrease in average BDI score during the study; the decrease was greater in the experimental group (p < 0.05). In the two assessments carried out after training the experimental group had lower average PSS scores than the control group (p < 0.05). At the second and third assessments the experimental group had higher scores than the control group on the self-confident approach and search for social support approach WCI subscales (ps < 0.05).

DISCUSSION

The average BDI and PSS scores of pregnant women in the experimental group decreased after training in coping with stress. Their scores on the self-confident approach, optimistic approach and search for social support WCI subscales increased. Stress management training is an effective method of encouraging pregnant women to take a positive approach to coping with stress.

Physical activity and depressive symptoms during pregnancy among Latina women: a prospective cohort study

BACKGROUND

Latina women are at increased risk for antenatal depressive disorders, which are common during pregnancy and are associated with elevated risk for poor maternal health and birth outcomes. Physical activity is a potential mechanism to reduce the likelihood of depressive symptoms. The purpose of the study was to assess whether total and domain-specific physical activity in early pregnancy reduced risk for elevated antenatal depressive symptoms in mid-late pregnancy in a population of Latina women at high-risk for depression.

METHODS

Data from 820 Latina participants in the prospective cohort study Proyecto Buena Salud was examined using multivariable logistic regression. Total, moderate/vigorous, and domain-specific physical activity (household/caregiving, occupational, sports/exercise, transportation) were assessed using the Pregnancy Physical Activity Questionnaire. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms and identify women with elevated symptoms indicative of at least probable minor depression and probable major depression.

RESULTS

A total of 25.9% of participants experienced at least probable minor depression and 19.1% probable major depression in mid-late pregnancy. After adjusting for important risk factors, no significant associations were observed between total physical activity (4th Quartile vs.1st Quartile OR = 1.02, 95% CI = 0.61, 1.71; p-trend = 0.62) or meeting exercise guidelines in pregnancy (OR = 0.96, 95% CI = 0.65, 1.41) and at least probable minor depression; similarly, associations were not observed between these measures and probable major depression. There was a suggestion of increased risk of probable major depression with high levels of household/caregiving activity (4th Quartile vs 1st Quartile OR = 1.51, 95% CI = 0.93, 2.46), but this was attenuated and remained not statistically significant after adjustment. When we repeated the analysis among women who did not have elevated depressive symptoms in early pregnancy (n = 596), findings were unchanged, though a nonsignificant protective effect was observed for sport/exercise activity and probable major depression in fully adjusted analysis (OR = 0.63, 95% CI = 0.30, 1.33).

CONCLUSION

Among Latina women at high-risk for antenatal depression, early pregnancy physical activity was not associated with elevated depressive symptoms in mid-to-late pregnancy.

Physical exercise programme during pregnancy decreases perinatal depression risk: a randomised controlled trial

Introduction

The incidence of depression is high during the perinatal period. This mood disorder can have a significant impact on the mother, the child and the family.

Objective

To examine the effect of an exercise programme during pregnancy on the risk of perinatal depression.

Methods

Healthy women who were <16 weeks pregnant were randomly assigned to two different groups. Women in the intervention group participated in a 60 min exercise programme throughout pregnancy, 3 days per week, which was conducted from October 2014 to December 2016. The Center for Epidemiological Studies-Depression Scale was used to measure the risk of depression at the beginning of the study (12–16 weeks), at gestational week 38 and at 6 weeks postpartum.

Results

One hundred and twenty-four pregnant women were allocated to either the intervention (IG=70) or the control (CG=54) group. No differences were found in the percentage of depressed women at baseline (20% vs 18.5%) (χ2=0.043; p=0.836). A smaller percentage of depressed women were identified in the IG compared with the CG at 38 gestational weeks (18.6% vs 35.6%) (χ2=4.190; p=0.041) and at 6 weeks postpartum (14.5% vs 29.8%) (χ2=3.985; p=0.046) using the per-protocol analysis. No significant differences were found using the intention-to-treat analyses, except in the multiple imputation analysis at week 38 (18.6% vs 34.4%) (χ2=4.085; p=0.049).

Conclusion

An exercise programme performed during pregnancy may reduce the prevalence of depression in late pregnancy and postpartum.

Trial registration number

NCT02420288; Results.

The association of exercise during pregnancy with trimester-specific and postpartum quality of life and depressive symptoms in a cohort of healthy pregnant women

Few published studies have examined the relationship between exercise during pregnancy, quality of life (QOL), and postpartum depressive symptoms in healthy pregnant women. A prospective cohort of 578 healthy pregnant women were followed during their pregnancy through 6 months postpartum. Levels of self-reported exercise and QOL before, during, and following pregnancy were assessed using standardized questionnaires during each trimester of pregnancy and 6 months postpartum. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 28 weeks gestation and 6 weeks postpartum. Participants were classified as having "sufficient exercise" if they achieved at least 150 min of exercise per week. Sufficient exercisers reported significantly higher ratings on most domains of QOL during each trimester of pregnancy and in the postpartum follow-up, compared with insufficient exercisers. There were no significant between-group differences in depressive symptoms. In examining the impact of exercise during each trimester, active women who became sedentary during their third trimester demonstrated a decline in their QOL. Achieving recommended levels of exercise during pregnancy was associated with higher QOL during pregnancy and the postpartum in healthy pregnant women. Decreasing the amount of exercise during pregnancy was associated with reduced QOL. These results suggest that it may be important for health care professionals to counsel healthy pregnant women about both the benefits of being physically active during pregnancy, and to provide guidance on how to remain physically active during a healthy pregnancy.

Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review

QUESTION

What are the attitudes, barriers and enablers to physical activity perceived by pregnant women?

DESIGN

In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework.

PARTICIPANTS

Pregnant women.

INTERVENTION

Not applicable.

OUTCOME MEASURES

Attitudes and perceived barriers and enablers to physical activity during pregnancy.

RESULTS

Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity.

CONCLUSION

Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women's positive attitudes into increased physical activity participation.

REGISTRATION

PROSPERO CRD42016037643. [Harrison AL, Taylor NF, Shields N, Frawley HC (2018) Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of Physiotherapy 64: 24-32].