The effectiveness of exercise as a treatment for postnatal depression: study protocol

Systematic review of lifestyle interventions to improve weight, physical activity and diet among people with a mental health condition

BACKGROUND

People with a mental health condition experience an elevated risk of chronic disease and greater prevalence of health and behaviours. Lifestyle interventions aim to reduce this risk by modifying health behaviours such as physical activity and diet. Previous reviews exploring the efficacy of such interventions for this group have typically limited inclusion to individuals with severe mental illness (SMI), with a focus of impact on weight. This review assessed the efficacy of lifestyle interventions delivered in community or outpatient settings to people with any mental health condition, on weight, physical activity and diet.

METHODS

Eligible studies were randomised or cluster-randomised controlled trials published between January 1999 and February 2019 aiming to improve weight, physical activity or diet, for people with any mental health condition. Two reviewers independently completed study screening, data extraction and assessment of methodological quality. Primary outcome measures were weight, physical activity and diet. Secondary outcome measures were body mass index (BMI), waist circumference, sedentary behaviour and mental health. Where possible, meta-analyses were conducted. Narrative synthesis using vote counting based on direction of effect was used where studies were not amenable to meta-analysis.

RESULTS

Fifty-seven studies were included (49 SMI only), with 46 contributing to meta-analyses. Meta-analyses revealed significant (< 0.05) effect of interventions on mean weight loss (-1.42 kg), achieving 5% weight loss (OR 2.48), weight maintenance (-2.05 kg), physical activity (IPAQ MET minutes: 226.82) and daily vegetable serves (0.51), but not on fruit serves (0.01). Significant effects were also seen for secondary outcomes of BMI (-0.48 units) and waist circumference (-0.87cm), but not mental health (depression: SMD -0.03; anxiety: SMD -0.49; severity of psychological symptoms: SMD 0.72). Studies reporting sedentary behaviour were not able to be meta-analysed. Most trials had high risk of bias, quality of evidence for weight and physical activity were moderate, while quality of evidence for diet was low.

CONCLUSION

Lifestyle interventions delivered to people with a mental health condition made statistically significant improvements to weight, BMI, waist circumference, vegetable serves and physical activity. Further high-quality trials with greater consistency in measurement and reporting of outcomes are needed to better understand the impact of lifestyle interventions on physical activity, diet, sedentary behaviour and mental health and to understand impact on subgroups.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019137197.

Effects of Exercise during Pregnancy on Postpartum Depression: A Systematic Review of Meta-Analyses

Simple Summary

Postpartum depression (PPD) is a public health problem. Exercise is a nonpharmacologic alternative to deal with PPD. This study conducted a systematic review of previous meta-analyses and an exploratory pooled analysis regarding the effects of exercise on depressive symptoms among women during the postpartum period. We searched for previous meta-analyses of experimental studies. Of the 52 records selected, we included five in the analyses, because they were focused on PPD. From the results, it was clear that exercise had a significant but small effect on depressive symptoms. This study shows that exercise is effective in reducing PPD symptoms.

Abstract

Postpartum depression (PPD) is a public health issue. Exercise is a nonpharmacologic alternative to deal with PPD. This study conducted a systematic review of previous meta-analyses and an exploratory pooled analysis regarding the effects of exercise on depressive symptoms among women during the postpartum period. We searched for previous meta-analyses of randomised controlled trials on PubMed, Web of Science and Scopus, date of inception to 31 May 2021. The methodological quality was assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) instrument. We pooled the standardised mean differences from the selected studies. Of the 52 records screened, five were included. The results revealed a significant moderate effect of exercise on depressive symptoms among women during the postpartum period (SMD = −0.53; 95% CI: −0.80 to −0.27, p < 0.001). The pooled effect of the five meta-analyses established that exercise had a significant, small effect on depressive symptoms (SMD = −0.41; 95% CI: −0.50 to −0.32, p < 0.001). Our study indicates that exercise is effective in reducing PPD symptoms. Compared with traditional control approaches (psychosocial and psychological interventions), exercise seems have a superior effect on PPD symptoms. The implications of the present synthesis of past meta-analytical findings to guide health policies and research are discussed.

Development and Validation of a Survey to Evaluate Mental Health Knowledge: The Case of Indonesian Pregnant Women

BACKGROUND: Internationally, many instruments have been designed to evaluate mental health knowledge; however, in pregnant women is very limited. AIM: Therefore, this study aimed to develop and validate a survey to measure the mental health knowledge of pregnant women. METHODS: In this cross-sectional study, 13 midwives attended the FGD and 10 pregnant women were invited for in-depth interviews to develop an item pool. The content validity was carried out by a panel of 6 experts. The face validity was performed with 5 pregnant women. Next, the construct validity test involved 150 pregnant women who were selected by stratified sampling from 13 public health centers in Surakarta, Indonesia. Analyses were conducted to check content validity, face validity, construct validity, internal consistency reliability, difficulty index, and exploratory factor analysis. RESULTS: A final 20-item Mental Health Knowledge Scale (MHKS) has a content validity index of 0.97 and a correlation value per item greater than the r-table (i.e., 0.1603). In addition, the MHKS has a Kuder–Richardson 20 reliability coefficient of 0.717. Furthermore, the difficulty index ranged from 0.39 to 0.82 which was considered in the good and acceptable category. Construct validity was confirmed using exploratory factor analysis KMO = 0.713, Bartlett’s test p < 0.001. CONCLUSION: Based on the findings, the final version of the MHKS was considered a valid and reliable tool. The instrument can be applied to measure the understanding of pregnant women about pregnancy depression. Further studies require adjustment items to other participants regarding mental health knowledge.

Physical activity in working mothers: Running low impacts quality of life

Objectives:

The transition to motherhood is associated with declines in physical activity in women. Working mothers may be particularly at-risk for low levels of physical activity, since they have to balance the competing interests of work and family life, and exercise often takes a backseat to more seemingly pressing concerns. The potential benefits working mothers can experience from physical activity are numerous. The objectives of this study were to evaluate the percentage of working mothers from the United States who met the World Health Organization’s and the American College of Sports Medicine’s recommended guidelines for weekly physical activity and investigate the associations between physical activity, quality of life, and self-rated work productivity in this sample of working mothers.

Methods:

Participants were 334 working mothers from the United States (mean age = 35.00 years; standard deviation (SD) = 5.85; 77.8% White) recruited from a Qualtrics research panel. To be eligible to participate in the study, a woman had to be 18 years or older with at least one child aged 5 years or younger, work at least 30 h per week at a job, live with her child(ren) at least 50% of the time, and have a minimum of a bachelor’s degree. Participants completed the Godin leisure time exercise questionnaire, the World Health Organization—five well-being index, a single-item indicator of self-rated work productivity, and a demographic questionnaire.

Results:

Of the working mothers in the sample, 45.5% met the recommended guidelines of at least 150 min of moderate exercise in the past week. Approximately 39% of working mothers reported engaging in no 30-min bouts of strenuous exercise in the past week. Non-white working mothers, working mothers with a higher singular annual income, and working mothers who obtained a higher educational level were more likely to meet the recommended guidelines for physical activity in the past week. Meeting the recommended physical activity guidelines in the past week was associated with better quality of life (r = 0.39; p < 0.001) and self-rated work productivity (r = 0.13; p < 0.05). Only the association between physical activity and quality of life remained significant in a multivariate analysis (standardized beta coefficient = 0.33; p < 0.001) after controlling for race/ethnicity, maternal singular annual income, and maternal highest level of education.

Conclusion:

Our findings highlight that working mothers in the United States are a group at risk for low levels of physical activity. Given the great benefits that these women do experience as a function of getting exercise, it is critically important we pay more attention to how individual, organizational, and societal-level interventions might assist them in attaining target levels of physical activity.

Innovations in the Treatment of Perinatal Depression: the Role of Yoga and Physical Activity Interventions During Pregnancy and Postpartum

PURPOSE OF REVIEW

We review evidence for physical activity and yoga as interventions for depressed pregnant and postpartum women.

RECENT FINDINGS

Results from existing trials have generally indicated that physical activity and yoga interventions are acceptable to women during the perinatal period, and that these interventions can be effective in reducing depression. However, some studies have not found significant differences between intervention and control conditions. In addition, symptom improvements were not always maintained. The available research on physical activity and yoga as interventions for perinatal depression is encouraging with regard to feasibility, acceptability, patient safety, and preliminary efficacy. These interventions have the ability to reach a large number of women who may not engage in traditional treatment. Additional high quality, rigorous, randomized controlled trials are needed. Future research is also needed to examine the optimal dose of these interventions and how to best increase sustained engagement.

Evaluation of the Health-related Behaviour of Pregnant Women from Warsaw, Poland

BACKGROUND

Pregnancy is a period of time when women tend to suffer from the weakening of their psychophysical fitness. This research evaluated several selected elements of the lifestyle of pregnant women compared to those of non-pregnant women.

METHODS

Overall, 482 women attended to the Childbirth School in Gynecological-Obstetric Hospital "Inflancka" in Warsaw, Poland, in the years 2011-2013; Group 1 contained 214 pregnant, and Group 2 contained 268 non-pregnant completed a survey inquiry. The research tool applied was Juczyński's "Inventory of Health Behaviour" (Inwentarz Zachowań Zdrowotnych). In this tool, the author evaluates health behaviors through four separate categories: dietary habits, prophylactic behaviors, mental attitude, and health behaviors. The differences between the data were defined through the Student's t-test for independent groups, with a minimal level of significance set at P ≤ 0.05.

RESULTS

Pregnant women take care of following a healthy lifestyle. The general health behaviour index figure was significantly higher in Group 1 as compared with the Group 2 (P<0.001). A higher level (P<0.001) of healthy behaviour was typical of physically-active individuals, regardless of their Group (1 & 2).

CONCLUSION

Pregnancy might cause women to increase their interest in matters of their own health and adopt a healthier lifestyle. Physical activity can influence other health-related practices.

Exercise as an adjunct treatment for postpartum depression for women living in an inner city-A pilot study

To examine the effectiveness of exercise in the management of postpartum depression (PPD), women living in an inner city, who were diagnosed using the Structured Clinical Interview for DSM-IV (Perinatal Version; SCID-PN), were randomly assigned to an exercise group (N = 12) or control group (N = 12). A focus group was carried out to explore women's views of the trial. There were no significant differences between the two groups for the SCID-PN. Although women who had engaged in the exercise viewed it positively (based on focus group data), low adherence to exercise meant that significant improvements in PPD were not found.

The Effect of the More Active MuMs in Stirling Trial on Body Composition and Psychological Well-Being among Postnatal Women

Introduction. Physical activity is important for health and well-being; however, rates of postnatal physical activity can be low. This paper reports the secondary outcomes of a trial aimed at increasing physical activity among postnatal women. Methods. More Active MuMs in Stirling (MAMMiS) was a randomised controlled trial testing the effect of physical activity consultation and pram walking group intervention among inactive postnatal women. Data were collected on postnatal weight, body composition, general well-being, and fatigue. Participants were also interviewed regarding motivations and perceived benefits of participating in the trial. Results. There was no significant effect of the intervention on any weight/body composition outcome or on general well-being at three or six months of follow-up. There was a significant but inconsistent difference in fatigue between groups. Qualitative data highlighted a number of perceived benefits to weight, body composition, and particularly well-being (including improved fatigue) which were not borne out by objective data. Discussion. The MAMMiS study found no impact of the physical activity intervention on body composition and psychological well-being and indicates that further research is required to identify successful approaches to increase physical activity and improve health and well-being among postnatal women.

A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial

BACKGROUND

Postnatal depression affects about 10-15% of women in the year after giving birth. Many women and healthcare professionals would like an effective and accessible non-pharmacological treatment for postnatal depression.

METHOD

Women who fulfilled the International Classification of Diseases (ICD)-10 criteria for major depression in the first 6 months postnatally were randomized to receive usual care plus a facilitated exercise intervention or usual care only. The intervention involved two face-to-face consultations and two telephone support calls with a physical activity facilitator over 6 months to support participants to engage in regular exercise. The primary outcome was symptoms of depression using the Edinburgh Postnatal Depression Scale (EPDS) at 6 months post-randomization. Secondary outcomes included EPDS score as a binary variable (recovered and improved) at 6 and 12 months post-randomization.

RESULTS

A total of 146 women were potentially eligible and 94 were randomized. Of these, 34% reported thoughts of self-harming at baseline. After adjusting for baseline EPDS, analyses revealed a -2.04 mean difference in EPDS score, favouring the exercise group [95% confidence interval (CI) -4.11 to 0.03, p = 0.05]. When also adjusting for pre-specified demographic variables the effect was larger and statistically significant (mean difference = -2.26, 95% CI -4.36 to -0.16, p = 0.03). Based on EPDS score a larger proportion of the intervention group was recovered (46.5% v. 23.8%, p = 0.03) compared with usual care at 6 months follow-up.

CONCLUSIONS

This trial shows that an exercise intervention that involved encouragement to exercise and to seek out social support to exercise may be an effective treatment for women with postnatal depression, including those with thoughts of self-harming.

Depression and Exercise: A Clinical Review and Management Guideline

CONTEXT

There is an increasing interest to detect how exercise affects depression symptoms. Although recent findings confirm the positive effect of exercise on depression, there is no clear guideline regarding advice on exercise for patients with depression. The following review aims at presenting the contemporary literature regarding the nature of depression, exercise, the underlying mechanisms and the management of an exercise program in individuals with depression.

EVIDENCE ACQUISITION

We searched electronic databases including Cochrane Library, PubMed, ISI web of knowledge and PsychInfo (from January 2000 to October 2014). We reviewed the systematic reviews, meta-analyses, and large-scale randomized control trials on effects of exercise on depression.

RESULTS

Recent evidence has emerged on characteristics of effective exercise programs and those patients with depression that will most benefit from the exercise programs. However due to the methodological weaknesses and inconsistencies of studies, conclusions must be made with caution.

CONCLUSIONS

We have provided a number of recommendations for clinicians and researchers who plan to use exercise protocols in depression.

Antenatal and postnatal depression: A public health perspective

Depression is widely prevalent among women in the child-bearing age, especially during the antenatal and postnatal period. Globally, post-partum depression has been reported in almost 10% to 20% of mothers, and it can start from the moment of birth, or may result from depression evolving continuously since pregnancy. The presence of depression among women has gained a lot of attention not only because of the rising incidence or worldwide distribution, but also because of the serious negative impact on personal, family and child developmental outcomes. Realizing the importance of maternal depression on different aspects-personal, child, and familial life, there is a crucial need to design a comprehensive public health policy (including a mental health strategy), to ensure that universal psychosocial assessment in perinatal women is undertaken within the primary health care system. To conclude, depression during pregnancy and in the postnatal period is a serious public health issue, which essentially requires continuous health sector support to eventually benefit not only the woman, but also the family, the community, and health care professionals.