The Role of Exercise in Treating Postpartum Depression: A Review of the Literature

Amanda J. Daley, PhD, C. Psychol; Christine MacArthur, PhD; Heather Winter, MD, MROG, FFPH

Disclosures

J Midwifery Womens Health. 2007;52(1):56-62. 

In This Article

Exercise Interventions in Depressed Populations

There is growing recognition and acceptance of exercise as a useful treatment option for depression among general populations. In a recent systematic review and metaregression analysis of RCTs, Lawlor and Hopker[15] concluded that exercise may be efficacious in reducing symptoms of depression (standardised mean difference in effect size, -1.1; 95% CI: -1.5 - -0.6), although the authors expressed concerns about the quality and small sample size of many studies and the inclusion of individuals without clinical levels of depression. Another meta-analysis[16] excluded studies that did not target clinical levels of depression, were not published in peer-reviewed journals, or did nor provide a non-active comparison group. Results from this meta-analysis of 11 treatment studies of individuals with depression yielded a very large combined effect size (Cohen's d = 1.42; 95% CI: 0.92-1.93), providing convincing statistical evidence to support the use of exercise for the treatment of clinically significant depression.

Furthermore, mean drop out rate for the exercise interventions in this meta-analysis (based on data from 8/11 studies) was approximately 20%, which is similar or better than for antidepressant treatments for depression, which have reported discontinuation rates of between 21% and 31%, depending on the type of drug.[17] This systematic review did not assess the quality of the studies included in the review, and whilst the authors report a large effect size, it is difficult to know what this finding translates to in clinical terms.

The UK National Institute for Clinical Excellence (NICE)[18] guidelines for treating depression recommend that patients be advised about the benefits of exercise. The "At Least Five a Week" report of the United Kingdom Chief Medical Officer[19] also concluded that exercise participation can promote mental health and feelings of well-being. It seems plausible that regular exercise may also have a positive effect in the management of depression, specifically in postpartum women.

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