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

The Potential Value of Exercise in the Management of Postpartum Depression

Antidepressants have been reported to be effective in treating postpartum depression in one small trial,[38,39] and there is good evidence of their benefit within the general population of persons who are depressed,[40] although some reluctance to take such medication among postpartum women has been reported.[39,41] Numerous small trials of different psychological therapies and counselling based interventions have consistently shown these to be effective treatments for postpartum depression,[38,42] but their availability is often limited.

In contrast, exercise has minimal associated side effects and is less reliant upon external factors, such as the availability of a therapist. There are additional potential benefits, because exercise interventions can improve a mother's physical and psychological health simultaneously, making it potentially a cost-effective self-care adjunctive treatment.[43] Engaging in exercise does not carry a stigma and can be done outside the standard medical setting. The costs associated with exercise are usually low.

Maternal body weight and postpartum weight have been found to be important predictors of psychological well-being following birth.[44,45] After giving birth, many mothers have excess weight and decreased fitness levels.[28,46] Exercise is a proven method for weight loss and for cardiovascular health gains.[19] Studies of pregnant and postpartum women have indicated high risk for inactivity and reductions in previously established levels of activity;[47,48,49] thus, the promotion of exercise after birth may help to improve physical activity levels of women throughout the life course.

While evidence suggests that exercise can have many health benefits,[28] initiation of an active lifestyle may not be an easy task for women in the postpartum period, and is likely to be even more difficult for those who are depressed. Women with postpartum depression who are asked to do too many things to manage their symptoms/disease may find it difficult to implement any of the changes, leading to further developments of feelings of inadequacy. Other possible barriers for postpartum women include having to care for the newborn and possibly other children, which compromises their time, and increases the costs associated with exercise.[25] Once a mother makes a decision to exercise, her ability to do so might be complicated further by pragmatics, such as breastfeeding, and some women are concerned about the potential negative effects of exercise on their breastfeeding outcomes.[50] Exercise as an intervention may not be suitable for some women, such as those recovering from a recent physically difficult birth or those experiencing more severe forms of postpartum depression or postpartum psychosis. Individuals experiencing mental ill-health can often be lacking in motivation and are socially isolated so it may be difficult for these women to seek out opportunities to exercise in their communities.

Many types of exercise could be beneficial for postpartum women, but pram walking may be the most viable and adherence to pram walking interventions in the previous small trials[20,22] was relatively high (66%-75%), although this was in optimal climate conditions. New mothers generally have endorsed the community pram walking group concept as good idea.[25] Other research[48] has found that new mothers cite lack of support from a spouse/partner and parenting issues as particular barriers to physical activity, with facilitators being social support for exercise and availability of childcare. With these comments in mind, pram walking is an activity that can be integrated into women's lives relatively easily, can be fitted in around the demands of the baby, and includes the baby so no additional childcare is required. More information on appropriate alternatives is needed.

If exercise is found to be an effective treatment for women with postpartum depression, the challenge for health professionals may then be to motivate mothers who are depressed to engage in a physically active lifestyle. Leaders of postpartum depression support groups could introduce pram walks and/or exercise classes into their sessions; this may also prove to a useful source of motivation for mothers in terms of peer support. Such schemes have been evaluated[24,29] as being successful in getting depressed mothers and mothers with young children active in their communities. It might be that health organizations could consider developing information packs for local providers to promote pram-walking groups. As an example of this, as part of the Australian "Stroll Your Way to Well-Being" programme,[25,26,27] kits were developed and distributed to facilitate the set-up of postpartum community walking groups. The effectiveness of this was assessed showing that about one quarter of information kit recipients established a pram walking group.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....