Important Update: Exercise & Postpartum Depression

Important Update: Exercise & Postpartum Depression

A new study published this month in Birth1 showed that exercise can, indeed, help to reduce postpartum depression (PPD). We have suspected this for quite some time (since about 1990, to be exact), and this meta-analysis study helped to strengthen the hypothesis.

If you’re experiencing PPD or you think you may be, don’t take this as a license to self-treat. You really need to talk to your doctor about your symptoms so that she can develop a treatment program that’s best for you. If you’d like, using the information from this study, you can ask your doctor if adding an exercise program may beneficial for you.

In a meta-analysis, researchers analyze data and results from several studies that meet their inclusion criteria. Meta-analysis studies are cool because they’re able to use data and results from existing studies to compare groups that weren’t directly compared in the individual studies, and they’re able to use data from more subjects than any single study they analyzed.

For example, in previous studies, researchers explored the effects of exercise vs. no exercise on depressive markers like feelings of sadness, worry, sleep disruption, etc. in women with a diagnosis of PPD. Separately, other researchers have studied the effects of exercise on depressive markers in postpartum women with no diagnosis of PPD.

By pulling out the raw data from those studies and analyzing data from multiple studies, the researchers were able to compare the effects of exercise on depressive symptoms in new moms with PPD versus new moms without PPD. Now we can tell whether exercise just helps new moms feel better the same amount (whether they’re depressed or not) or if it helps new moms with PPD feel better in particular, more than new moms who are not depressed. And guess what? It does!

This meta-analysis included 12 studies (and 932 moms) from around the world, including the US, Canada, Iran, China, the UK, Taiwan, and Australia. The exercises in these studies included a wide variety: light stretching and breathing exercises, cardiovascular exercises, strength plus cardio, Pilates, and yoga. Exercise frequency and intensity varied from study to study, but overall the new moms exercised under supervision anywhere from 1-5 days per week (often plus more days on their own at home) with an intensity that ranged from low to high and everything in between.1

Before this study, here’s what we already knew about exercise and PPD:
  • Between 3 and 15% of new moms experience a major depressive event during pregnancy or in the first year after pregnancy.1
  • Between 11-15% of new moms experience mild PPD, and between 17-23% experience moderate to severe PPD.2
  • If you experience PPD, you’re twice as likely to experience another bout of depression within the next 5 years.1
  • PPD can negatively impact mom’s interaction with baby.1
  • Exercise decreases depression symptoms in folks in the general population who are experiencing depression.3
  • Exercise can help prevent PPD.4
  • Exercise can improve mood, quality of life, and self-esteem among new moms.4-6
  • The American College of Obstetrics and Gynaecology (ACOG) recommends 30 minutes of moderate activity on most, if not all, days of the week. That includes all adults- pregnant, postpartum, men, women – everybody.1*
Here’s what this study adds to what we know about exercise and PPD:1
  • Exercise can be more effective for the treatment of PPD than many traditional treatments like home visits, mom-to-mom telephone call support, and one-on-one psychotherapy.
  • So long as you’re meeting the ACOG recommendations to do moderate activity for 30 minutes most days of the week, it doesn’t matter what type of exercise you do or for what frequency or intensity – they are all equally beneficial for reducing PPD.
  • When comparing new moms with PPD to new moms without PPD, the effect of exercise for lowering depressive markers like sadness, worry, and sleep disruption is significantly amplified in new moms with postpartum depression (it helps new moms with PPD extra).**

The authors did mention there’s an important unanswered question: How to dose exercise based upon the severity of symptoms – we don’t yet know what dose of exercise to prescribe based upon how severe the depression is, or if the severity even effects the dosage.1

Research always sets the stage for more questions, but this is a great step forward for creating a clearer picture of treatment options for PPD. I wrote it before, but it’s so important that I’ll write it again: if you suspect you may be experiencing PPD, even if something just doesn’t feel “right,” (for example, if you feel like this should be such a wonderful, happy time, but deep down it’s just… not), discuss it immediately with your doctor. You can also visit www.postpartum.net for more information, including how to get help. If at any point you think you may harm yourself or your baby, go straight to the emergency room or call 911. In no way is this post meant to substitute for an interaction with a medical provider, but you can take this information with you when you discuss your symptoms with your doctor to find out if an exercise program might be beneficial for your particular situation.

*Moderate activity = activities like walking or slow biking. Activities like running, hiking uphill or biking > 10mph are considered vigorous.

**The effect size of exercise for reducing depressive symptoms in new moms with PPD is .67, and the effect size for reducing symptoms in new moms without PPD is .29. If you don’t have a statistics book and a calculator handy, that means that if we’re looking at a group of new moms who all have postpartum depression, the average depressed new mom who was exercising would have fewer depressive symptoms than about 75% of those who were not exercising. If we’re looking at a group of new moms, none of whom have postpartum depression, the average new mom who was exercising would have fewer depressive symptoms than about 61% of those who were not exercising.

 

References:

  1. Poyatos León R, García Hermoso A, Sanabria Martínez G, Álvarez Bueno C, Cavero Redondo I, Martínez Vizcaíno V. Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomized controlled trials. Birth. June 2017.
  2. Mayberry LJ, Horowitz JA, Declercq E. Depression Symptom Prevalence and Demographic Risk Factors Among U.S. Women During the First 2 Years Postpartum. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2007;36(6):542-549.
  3. Meyer DL. Effect of Postpartum Exercise on Mothers and their Offspring: A Review of the Literature. Obes Res. 2002;10(8):841-853.
  4. Larson-Meyer E. The effects of regular postpartum exercise on mother and child: review article. Int SportMed J. 2003;4(6):1-14.
  5. Haruna M, Watanabe E, Matsuzaki M, Ota E. The effects of an exercise program on health-related quality of life in postpartum mothers: A randomized controlled trial. Health. 2013;5(3):432-439. doi:10.4236/health.2013.53058.
  6. Norman E, Sherburn M, Osborne RH. An Exercise and Education Program Improves Well-Being of New Mothers: A Randomized Controlled Trial. Phys Ther. 2010;90(3):348-355.

 

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