Randomized trial examining the effect of exercise and wellness interventions on preventing postpartum depression and perceived stress

Abstract Background Approximately 13–19% of postpartum women experience postpartum depression and a majority report at least some stress during the postpartum phase. Traditional interventions such as psychotherapy and antidepressant medications are often not feasible or desirable. The purpose of this study was to examine two low cost, brief, accessible interventions designed to prevent postpartum depression and perceived stress among women at high risk. Methods Participants (n = 450) who were on average four weeks postpartum, had a history of depression before pregnancy, and exercised less than 60 min per week were randomly assigned to one of the following three conditions: (1) 6-month telephone-based exercise intervention; (2) 6-month telephone-based wellness/support intervention (e.g., healthy eating, sleep, and perceived stress); or (3) usual care. Results Overall, 2.4% of participants met criteria for depression at 6 months and 3.6% at 9 months with no differences between groups. At 6 months following randomization, median symptoms of depression were significantly lower among wellness participants compared to usual care participants (b = − 1.00, SE = 0.46, p = .03). Perceived stress at 6 months post-randomization was significantly lower among exercise vs. usual care participants (b = − 2.00, SE = .98, p = .04) and exercise vs. wellness participants (b = − 2.20, SE = 1.11, p = .04). Conclusions The wellness intervention was efficacious for preventing symptoms of depression; however, postpartum depression that met the diagnostic criteria was surprisingly low in all conditions among this at risk sample of postpartum women. Exercise interventions may have a protective effect on perceived stress among women at risk for postpartum depression. Practitioners should consider integrating exercise and wellness interventions into postpartum care. Trial registration Clinical Trials Number: NCT01883479 (06/21/2013).

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Comparative Efficacy of Seven Exercise interventions for Symptoms of depression in college students: a network of meta-analysis

10.21203/rs.2.13156/v1 ◽

2019 ◽

Author(s):

Shengyu Guo ◽

Fuying Li ◽

Yan Yang ◽

Ling Chen

Keyword(s):

College Students ◽

Depressive Symptoms ◽

Usual Care ◽

Tai Chi ◽

Exercise Intervention ◽

Meta Analysis ◽

Eligibility Criteria ◽

Exercise Interventions ◽

Symptoms Of Depression ◽

Depressed College Students

Abstract Background Depression among college students is common, exercise interventions are valued as one of the most widely prescribed interventions for depressed college students, however, it is especially difficult for university administrators to determine which exercise intervention is most effective, and efficacy of exercise interventions among depressed college students have not been evaluated. Objectives To systematically review and compare the efficacy of Seven Exercise interventions for Symptoms of depression in college students. Method A network of meta-analysis was conducted to fill the objectives. PubMed, Embase databases, and two Chinese language electronic databases WANFANG and CNKI were searched for the related articles. Eligibility criteria Randomized controlled trials comparing the efficacy of Seven Exercise interventions with usual care of college students with depression were included in the review. Main outcomes The Primary outcome of the present study were standardized mean difference(SMD) and the mean change of depressive symptoms. Results 14 trials were identified, including 2010 depressed college students. The result of direct meta-analysis of this review indicated exercise interventions overall had a significantly lower mean depression scores (SMD=-1.13) when compared with usual care. The result of NMA indicated when comparing with badminton intervention, yoga(SMD=-7.7, 95%CI -14 to -0.93) and tai chi (SMD=-9.4, 95%CI -16 to -2.7) can significantly decrease depression scores of the depressed college students. The rank of seven exercise interventions with respect to efficiently decrease symptom of depressed undergraduates was Tai chi > Yoga > Volleyball > Dance > Run> Basketball> Badminton, respectively. Conclusions Tai chi exhibited the highest probability that became the most efficacy intervention among the comparions, and Yoga showed the second most effectiveness to alleviate depressive symptoms of depressed college students, and dance ranks the third, followed by run, volleyball, basketball, badminton respectively.

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Risk Factors for Postpartum Depression During COVID-19 Pandemic: A Systematic Literature Review

Journal of Primary Care & Community Health ◽

10.1177/21501327211059348 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110593

Author(s):

Sadia Usmani ◽

Elona Greca ◽

Sana Javed ◽

Medha Sharath ◽

Zouina Sarfraz ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Literature Review ◽

Postpartum Depression ◽

Systematic Literature Review ◽

Adverse Outcomes ◽

Depression Symptoms ◽

Postpartum Women ◽

Negative Consequences ◽

Symptoms Of Depression

Introduction: The COVID-19 pandemic has had a devastating worldwide effect on mental health. Recent studies correlate the spreading of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with symptoms of depression, most prominent in postpartum women. Our systematic literature review scope is to identify the risk factors and predictors for postpartum depression (PPD) and describe the steps that should be taken to help postpartum women. This study will help clinicians, researchers, and policymakers to elucidate the predictors of PPD during this pandemic and prevent these adverse outcomes in future crises. Methods: We conducted a systematic search by employing databases PubMed, Google Scholar, Scopus, and Embase to identify articles published before March 2021. About 463 publications were generated during our search process and from those, 36 were reviewed, summarized, and synthesized. Studies qualified the criteria if they (1) utilized qualitative or quantitative design, (2) explored the risk factors for PPD, and (3) were written in English. Quality evaluation of each study was achieved by using criteria set by Lincoln and Guba. Results: Prevalence of depression symptoms ranged from 7% to 80.8% in postpartum women during the SARS-COV 2 pandemic. The risk factors for PPD were classified into 6 major categories: socio-demographic, psychological, pre-existing pathology, metabolic factors, previous events of miscarriage, and media misinformation. Conclusion: It is extremely vital to care for women’s mental health during pregnancy and after childbirth during these unprecedented times. This review urges the need to design adequate interventions for this vulnerable population to prevent negative consequences of PPD.

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Cost-Effectiveness Analysis from a Randomized Controlled Trial of Tailored Exercise Prescription for Women with Breast Cancer with 8-Year Follow-Up

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17228608 ◽

2020 ◽

Vol 17 (22) ◽

pp. 8608

Author(s):

Louisa G. Gordon ◽

Elizabeth G. Eakin ◽

Rosalind R. Spence ◽

Christopher Pyke ◽

John Bashford ◽

...

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Incremental Cost ◽

Usual Care ◽

Exercise Intervention ◽

Cost Effective ◽

Sensitivity Analyses ◽

Exercise Interventions ◽

Care Groups ◽

Life Years

Studies show conflicting results on whether exercise interventions to improve outcomes for women with breast cancer are cost-effective. We modelled the long-term cost-effectiveness of the Exercise for Health intervention compared with usual care. A lifetime Markov cohort model for women with early breast cancer was constructed taking a societal perspective. Data were obtained from trial, epidemiological, quality of life, and healthcare cost reports. Outcomes were calculated from 5000 Monte Carlo simulations, and one-way and probabilistic sensitivity analyses. Over the cohort’s remaining life, the incremental cost for the exercise versus usual care groups were $7409 and quality-adjusted life years (QALYs) gained were 0.35 resulting in an incremental cost per QALY ratio of AU$21,247 (95% Uncertainty Interval (UI): Dominant, AU$31,398). The likelihood that the exercise intervention was cost-effective at acceptable levels was 93.0%. The incremental cost per life year gained was AU$8894 (95% UI Dominant, AU$11,769) with a 99.4% probability of being cost effective. Findings were most sensitive to the probability of recurrence in the exercise and usual care groups, followed by the costs of out-of-pocket expenses and the model starting age. This exercise intervention for women after early-stage breast cancer is cost-effective and would be a sound investment of healthcare resources.

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Diet and exercise interventions for individuals at risk for type 2 diabetes: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2020-039532 ◽

2020 ◽

Vol 10 (11) ◽

pp. e039532

Author(s):

Megan MacPherson ◽

Kaela Cranston ◽

Sean Locke ◽

Mathew Vis-Dunbar ◽

Mary E Jung

Keyword(s):

Type 2 Diabetes ◽

At Risk ◽

Scoping Review ◽

Diabetes Prevention ◽

Search Strategy ◽

Exercise Intervention ◽

Mode Of Delivery ◽

Exercise Interventions ◽

Diet And Exercise

IntroductionGlobal rates of type 2 diabetes (T2D) are on the rise and there is a need for both effective and replicable interventions to decrease this incidence. Systematic reviews highlight the efficacy of diet and exercise interventions in decreasing T2D risk; however, no review to date provides clear information regarding intervention details (eg, what is delivered, by whom, to whom, when, and mode of delivery). This paper outlines the protocol for a scoping review summarising intervention characteristics of diet and exercise programmes for individuals at risk for T2D. From the included studies and through the use of the Template for Intervention Description and Replication (TIDieR), the scoping review that results from this protocol paper will provide a narrative analysis of how diabetes prevention programmes are being reported and implemented.MethodsA comprehensive search strategy is outlined to identify studies within Medline, CINAHL, PsycINFO, EMBASE and SPORTDiscus. The search strategy will include terms relating to diet and exercise interventions and diabetes risk. To determine eligible studies, predefined inclusion and exclusion criteria will be used independently by two review authors. To be included, studies must be delivering a diet and/or exercise intervention among adults who have been identified as at risk for developing T2D with an outcome related to diabetes prevention. Data extraction of those studies that meet inclusion criteria will be guided by the TIDieR).Ethics and disseminationEthical approval is not required as this review will be using previously collected data. Review findings will be presented at scientific conferences and published in a peer-reviewed journal.

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Feasibility and Perception of Using Text Messages as an Adjunct Therapy for Low-Income, Minority Mothers With Postpartum Depression

JMIR Mental Health ◽

10.2196/mental.4074 ◽

2015 ◽

Vol 2 (1) ◽

pp. e4 ◽

Cited By ~ 39

Author(s):

Matthew A Broom ◽

Amy S Ladley ◽

Elizabeth A Rhyne ◽

Donna R Halloran

Keyword(s):

At Risk ◽

Postpartum Depression ◽

Low Income ◽

Text Messaging ◽

Negative Impact ◽

Low Cost ◽

Text Message ◽

Text Messages ◽

Adjunct Therapy ◽

Traditional Counseling

Background Postpartum depression (PPD) is the most common medical problem among new mothers that can have a negative impact on infant health. Traditional treatments are often difficult for low-income mothers to complete, particularly given the numerous barriers families face. Objective Among low-income, primarily racial, and ethnic minority mothers with postpartum depression, our aim was to evaluate (1) the feasibility of sending supportive text messages, and (2) the perception of receiving private, supportive text messages for postpartum depression. Methods Mothers found to be at risk for postpartum depression received supportive text messages four times weekly for 6 months in addition to receiving access to traditional counseling services based within an academic pediatric office. Feasibility was evaluated along with cellular and text messaging use, access, and perception of the message protocol. Perception of the message protocol was evaluated at study completion via a Likert scale questionnaire and open-ended qualitative survey. Results In total, 4158/4790 (86.81%) text messages were successfully delivered to 54 mothers over a 6-month period at a low cost (US $777.60). Among the 96 scripted messages, 37 unique messages (38.54%) allowed for a response. Of all sent messages that allowed for responses, 7.30% (118/1616) were responded to, and 66.1% of those responses requested a call back; 46% (25/54) of mothers responded at least once to a text message. Mothers felt that messages were easily received and read (25/28, 89%) and relevant to them personally (23/28, 82%). Most shared texts with others (21/28, 75%). Conclusions Text messaging is feasible, well-accepted, and may serve as a simple, inexpensive adjunct therapy well-suited to cross socioeconomic boundaries and provide private support for at-risk mothers suffering from postpartum depression.

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Mother’s Milk, Mother’s Tears: Breastfeeding With Postpartum Depression

Clinical Lactation ◽

10.1891/2158-0782.5.1.9 ◽

2014 ◽

Vol 5 (1) ◽

pp. 9-15 ◽

Cited By ~ 2

Author(s):

Tonia Olson ◽

Lorraine Holtslander ◽

Angela Bowen

Keyword(s):

At Risk ◽

Postpartum Depression ◽

Lived Experience ◽

Early Identification ◽

Healthcare Professionals ◽

Recent Literature ◽

Phenomenological Approach ◽

Symptoms Of Depression ◽

Mother's Milk ◽

Insight Into

Recent literature suggests that when breastfeeding goes well, it may protect mothers from the deleterious effects of postpartum depression. Using a phenomenological approach, the objective of this research was to provide insight into the lived experience of breastfeeding in mothers with postpartum depression. Two major themes emerged from the participants’ perceptions of breastfeeding with postpartum depression: (a) Breastfeeding in the Dark: Despite difficulties associated with establishing and maintaining the breastfeeding relationship, breastfeeding through depression meant bonding with baby and maintaining a semblance of control; (b) Breastfeeding Under Wraps: Mothers perceived a lack of support to breastfeed their babies and delayed seeking support for their symptoms of depression out of fear of being stigmatized. This study underscores the need for heightened awareness regarding perinatal and postnatal screening for depression. The early identification of women at risk for postpartum depression will offer healthcare professionals the capacity to engage women and their families in a participatory manner to work through natural challenges associated with establishing and maintaining the breastfeeding relationship.

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Rationale, design, and challenges with implementing a clinical intervention to teach appropriate gestational weight gain (TAGG): Protocol of a Randomized controlled trial (Preprint)

10.2196/preprints.17484 ◽

2019 ◽

Author(s):

Awathif Mackeen ◽

Danielle Downs ◽

Vonda Hetherington ◽

Shawnee Lutcher ◽

Jacob Mowery ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Weight Gain ◽

Gestational Diabetes ◽

Usual Care ◽

Gestational Weight Gain ◽

Perceived Stress ◽

Controlled Trial ◽

Household Food Security ◽

Gestational Weight ◽

Randomized Controlled

BACKGROUND Excessive gestational weight gain (GWG) has public health implications including preterm birth, preeclampsia, gestational diabetes, and cesarean delivery. In an effort to mitigate adverse consequences of excessive GWG, this study tests a health intervention that includes enhancements to improve knowledge and awareness of appropriate GWG, and patient-centered nutritional counseling to promote appropriate GWG. OBJECTIVE The primary objective of the study was to increase the proportion of women who are managing their GWG as recommended by the IOM.4,5 METHODS This randomized controlled trial was conducted at Geisinger in Pennsylvania where excessive GWG is common among women with pre-conception obesity. Eligible, consenting participants with pre-pregnancy body mass index >30.0 kg/m2 were randomized (1:1) to: 1) Usual Care: usual written educational materials and counseling by an obstetric care provider or 2) Enhanced Care: Usual Care plus a) a personalized letter from a physician detailing appropriate GWG, b) exposure to individualized GWG chart in the electronic health record via the patient portal, and c) a consult with a Registered Dietitian Nutritionist and follow-up via tele-health counseling (10-20 mins/1-2 weeks) for the duration of the pregnancy. RESULTS The primary outcome was the proportion of women that gain less than 20 pounds over the course of the pregnancy. Secondary outcomes include knowledge, expectations, and attitude about pregnancy weight gain; increased self-efficacy for ability to eat healthy and being physically active to manage weight; and eating behavior. Potential moderators that will be explored include sleep, perceived stress, perceived involvement in care, and household food security. Data collection has been completed as of November 2019. CONCLUSIONS As GWG care was initiated for mothers with pre-pregnancy BMI >30 kg/m2 within the first and second trimesters, the intervention may have the additional benefit of reducing other adverse pregnancy outcomes including the incidence of gestational diabetes due to healthier rates of GWG. In addition to assessing appropriate GWG, this project will assess eating habits, physical activity, GWG attitudes, sleep quality, and psychological measures, all of which are associated with GWG. Exploratory mediators including perceived stress and food insecurity will also be evaluated. CLINICALTRIAL ClinicalTrials.gov NCT02963428

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Remote interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review and meta-analysis

BMC Cancer ◽

10.1186/s12885-021-07989-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Saïd Ibeggazene ◽

Rebecca Turner ◽

Derek Rosario ◽

Liam Bourke

Keyword(s):

Systematic Review ◽

Exercise Intervention ◽

Meta Analysis ◽

Exercise Interventions ◽

Exercise Behaviour ◽

Cancer Services ◽

The Social ◽

Intervention Adherence ◽

Randomised Controlled ◽

Exercise Guidelines

Abstract Background The COVID-19 pandemic has forced many cancer services to consider a transition to a remote format of delivery that is largely untested. Accordingly, we sought to perform a systematic review of the effects of remotely delivered interventions to improve exercise behaviour in sedentary adults living with and beyond cancer. Methods Eligible studies were randomised controlled trials comparing a remotely delivered exercise intervention to a usual care comparison in sedentary people over 18 years old with a primary cancer diagnosis. Nine electronic databases were searched from inception to November 2020. Results The review included three trials, totalling 186 participants. Two of the included trials incorporated prescriptions that meet current aerobic exercise recommendations, one of which also meets the guidelines for resistance exercise. No trials reported an intervention adherence of 75% or more for a set prescription that meets current exercise guidelines. Conclusion There is little evidence suggesting that remote exercise interventions promote exercise behaviours or improve physical function in sedentary adults living with and beyond cancer. The development and evaluation of novel remote exercise interventions is needed to establish their usefulness for clinical practice. Given the social response to the COVID-19 pandemic, further research in this area is urgently needed.

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Postpartum depression symptoms in survey-based research: a structural equation analysis

BMC Public Health ◽

10.1186/s12889-020-09999-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Che Wan Jasimah Bt Wan Mohamed Radzi ◽

Hashem Salarzadeh Jenatabadi ◽

Nadia Samsudin

Keyword(s):

Postpartum Depression ◽

Latent Variable ◽

Structural Equation ◽

Depression Scale ◽

Public Health Problem ◽

Equation Modeling ◽

Depression Symptoms ◽

Postpartum Women ◽

Unhealthy Food ◽

High Level

Abstract Background Since the last decade, postpartum depression (PPD) has been recognized as a significant public health problem, and several factors have been linked to PPD. Mothers at risk are rarely undetected and underdiagnosed. Our study aims to determine the factors leading to symptoms of depression using Structural Equation Modeling (SEM) analysis. In this research, we introduced a new framework for postpartum depression modeling for women. Methods We structured the model of this research to take into consideration the Malaysian culture in particular. A total of 387 postpartum women have completed the questionnaire. The symptoms of postpartum depression were examined using the Edinburgh Postnatal Depression Scale (EPDS), and they act as a dependent variable in this research model. Results Four hundred fifty mothers were invited to participate in this research. 86% of the total distributed questionnaire received feedback. The majority of 79.6% of respondents were having depression symptoms. The highest coefficients of factor loading analysis obtained in every latent variable indicator were income (β = 0.77), screen time (β = 0.83), chips (β = 0.85), and anxiety (β = 0.88). Lifestyle, unhealthy food, and BMI variables were directly affected by the dependent variable. Based on the output, respondents with a high level of depression symptoms tended to consume more unhealthy food and had a high level of body mass indexes (BMI). The highest significant impact on depression level among postpartum women was unhealthy food consumption. Based on our model, the findings indicated that 76% of the variances stemmed from a variety of factors: socio-demographics, lifestyle, healthy food, unhealthy food, and BMI. The strength of the exogenous and endogenous variables in this research framework is strong. Conclusion The prevalence of postpartum women with depression symptoms in this study is considerably high. It is, therefore, imperative that postpartum women seek medical help to prevent postpartum depressive symptoms from worsening.

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Effects of Exercise Interventions on Weight, Body Mass Index, Lean Body Mass and Accumulated Visceral Fat in Overweight and Obese Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052635 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2635

Author(s):

Hyun Suk Lee ◽

Junga Lee

Keyword(s):

Body Mass Index ◽

Randomized Controlled Trials ◽

Lean Body Mass ◽

Body Mass ◽

Visceral Fat ◽

Exercise Intervention ◽

Meta Analysis ◽

Controlled Trials ◽

Exercise Interventions ◽

Randomized Controlled

(1) Background: Exercise interventions for overweight and obese individuals help reduce accumulated visceral fat, which is an indicator of cardiometabolic risk, but the effectiveness of these interventions is controversial. The purpose of this meta-analysis was to investigate the effectiveness of exercise interventions in overweight and obese individuals in order to reduce weight, body mass index (BMI), and accumulated visceral fat, and increase lean body mass. (2) Methods: Databases were used to select eligible studies for this meta-analysis. Randomized controlled trials with control and experimental groups were included. The degrees of effectiveness of the exercise interventions were computed to assess the benefits on reducing weight, BMI, and accumulated visceral fat, and increasing lean body mass. (3) Results: Sixteen studies were included in this meta-analysis. Participation in exercise interventions reduced weight (d = −0.58 (95% confidence interval (CI), −0.84–−0.31; p < 0.001; k = 9)), BMI (d = −0.50 (95% CI, −0.78–−0.21; p < 0.001; k = 7)), and accumulated visceral fat (d = −1.08 (95% CI, −1.60–−0.57; p < 0.001; k = 5)), but did not significantly increase lean body mass (d = 0.26 (95% CI, −0.11–0.63; p = 0.17; k = 6)). The average exercise intervention for overweight and obese individuals was of moderate to vigorous intensity, 4 times per week, 50 min per session, and 22 weeks duration. (4) Conclusions: Participating in exercise interventions has favorable effects on weight, BMI, and accumulated visceral fat. Further studies considering different modalities, intensities, durations, and measurements of fatness need to be conducted.

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