A CLINICAL STUDY TO EVALUATE THE IMPACT OF EXERCISE ON POSTPARTUM DEPRESSION AND STRESS IN PREGNANT WOMEN

Introduction: Pregnancy and postpartum periods are considered as the most sensitive period in women’s lives. This period is also important psychologically and socially in addition to its physical importance. Postpartum depression is one of the most common psychological disorders that are resistant and serious which affects pregnant women. The purpose of this study was to investigate the effects of exercise training on postpartum anxiety and depression in pregnant women who referred to Ganga ram hospital Lahore. Material and Method: This research is a clinical trial study conducted on 102 pregnant women (51 in case group and 51 in control group). The instruments used included Edinburgh Postpartum Depression Scale and Spielberger State-Trait Anxiety Inventory. To analyse the data, T-test was used to compare the groups and the pair was used to compare the effects of the training before and after the study. Results: The demographic characteristics between the two groups were not significantly different from each other. After exercise trainings, the study group showed a significant decrease in postpartum depression (p = 0.02). Also, obvious anxiety decreased significantly from 49.55 ± 4.28 to 47.46 (P <0.0001); the hidden anxiety was also decreased from 50.21 ± 4.34 to 47.46 ± 3.57 (p = 0.001). Conclusion: The results of 8 weeks of aerobic exercises showed an impact and decreasing effect on the levels of depression and anxiety and stress in postpartum women. Therefore, care providers of pregnant women should consider exercise as a promotion of mental and psychological health of women. Correponding Author: Dr. Abdul Rafay, Medical Officer at Rural dispensary Rohra, Sheikhupura E-mail:rafay.rav@hotmail.com Please cite this article in press Abdul Rafay et al., A Clinical Study to Evaluate the Impact of Exercise on Postpartum Depression and Stress in Pregnant Women. , Indo Am. J. P. Sci, 2018; 05(12). QR code IAJPS 2018, 05 (12), 16691-16695 Abdul Rafay et al ISSN 2349-7750 w w w . i a j p s . c o m Page 16692 INTRODUCTION: According to WHO report, mood disorders will be the second leading cause of disability worldwide by 2020 (1). Mood disorders are commonly observed in the postpartum period (2). Postpartum depression is a major public health problem and it is the most common problem for women in childbearing age. Women in their reproductive age are at high risk for depression. This disorder occurs more often during postpartum period than any other time (4). Postpartum depression is a disorder characterized by symptoms such as severe loneliness, irritability, fear, lack of confidence, changes in feelings, guilty feelings, decreased concentration, and in severe cases is accompanied with suicidal thoughts (5). Approximately 13% of women experience postpartum depression (6). Some studies have highlighted the prevalence of this disorder in the world as high as 33%. According to studies conducted in our country, the frequency of postpartum depression has been reported to be 42.13% (7). In postpartum depression, there is a risk of injury to the mother and the baby (8). In developing countries, pregnancy and childbirth are among the main causes of death, illness and disability in women of reproductive age (9, 10). This period is associated with changes in psychological needs such as increased anxiety and depression and physical changes such as weight gain and outflow of the heart (1). Lack of knowledge and fear causes pregnant mothers to become anxious and this anxiety and fear are transmitted to the brain and causes an increase in stress hormones secretion in the mother (11). Stressing events significantly increases the prevalence of postpartum depression (12). Today, exercise and physical activity are considered not only as leisure time, but also as an indispensable necessity for health and well-being (13). Considering women’s sports and exercise as a major part of society are essential along with their conditions and physiological needs (14). Research on the physiological response of the body to exercise trainings suggests that healthy pregnant mothers can cause adaptation between sport activities with their physiological and foetal needs (15). Also, exercise is one of the ways to reduce the adverse effects of pregnancy such as insomnia, fatigue, excessive weight gain, back and lower back pain, pelvic pain, constipation, inability to control urine, increased blood pressure, gestational diabetes, depression and anxiety (16). Several studies inside the country and abroad have shown that exercise can reduce the intensity of anxiety and, after stopping exercise, anxiety reappears. According to the results by Isard, regular exercise reduces anxiety and, once the exercise is stopped, symptoms of anxiety reappear (17). DeLorenz et al. have examined the long-term effects of aerobic exercises on anxiety, depression, and emotional states in their study. Their research showed that there is a correlation between the improvement of physical fitness of participants in aerobic exercises and reduction of anxiety (18). There is still no comprehensive and precise understanding of the effects of exercise with different intensities and different times during pregnancy on the mother and the foetus, and on the other hand, the researches show contradictory results (19). The current study aims to investigate the effects of exercise training on postpartum anxiety and depression in pregnant women who referred to women's clinic. MATERIAL AND METHOD: This study was a clinical trial study conducted on 102 women (an intervention group and a control group) who had childbirth and who were referred to gynaecological clinic for postpartum care. According to Edinburgh questionnaire, women who were diagnosed with depression and had the inclusion criteria entered the study. These individuals had randomly divided into two study and control groups. The members of the study group entered the training stages, but the control group had been evaluated only in the final stage of the study along with the case group. All mothers in the case group received training at the first session, so that they could practice the exercises correctly and completely. Classes lasted for 8 weeks with 2 sessions per week and each session was 30 minutes. In each class 10 to 12 pregnant mothers had participated and classes conducted in 5 courses. The training program included 5 minutes of general warm-up, stretching; walking slowly for a maximum of 5 minutes, or 10 times and 5 minutes of rehearsed exercises similar to initial warp-ups for cooling down. These exercises included 10 types of exercise that promotes muscle strength and flexibility. Questionnaire No. 1 contains demographic characteristics and questionnaire No. 2, Spielberg revaluates hidden and obvious anxiety and questionnaire No. 3, the Beck Depression Inventory, had been completed before and after the intervention and under the opinions of experts and recorded for both groups. To measure anxiety, Spielberger questionnaire was used. Hidden and obvious anxiety questionnaire, which has been standardized and used on general population many times, has an acceptable validity; it’s evaluated based on4-point Likert scale from a general score of 20 to 80. In this questionnaire, score of 20-44 show mild anxiety, scores of 43-53 show moderate anxiety and scores >53 show severe anxiety (20). IAJPS 2018, 05 (12), 16691-16695 Abdul Rafay et al ISSN 2349-7750 w w w . i a j p s . c o m Page 16693 The second part included a standard depression questionnaire of Edinburgh; based on this questionnaire, participants are divided into two groups of depressed (EPAD ≤12) and nondepressed (EPDS > 12). This questionnaire was first arranged by Cox et al. In 1987 and it is a valid and reliable questionnaire [21, 22, 23]. STATISTICAL ANALYSIS The findings were analysed by statistical software. Descriptive statistics was used to show the absolute and relative frequencies and performance and demographic characteristics of the samples; inferential statistics such as Chi square test and paired t-test used. RESULTS: The demographic findings in the present study show that there is no significant difference in characteristics of the units studied between the study and control groups (Table 1). The results of the tests for comparing the effects of training on postpartum depression showed that there was a significant reduction in the studied group and the depression score decreased from 17.69 ± 3.78 to 16.09 ± 3.05 (p = 0.02). Also, the results showed that there was a significant decrease in hidden and obvious anxiety in the study group after exercise (p <0.05), while there was no changes in the control group (Table 2). Table 1: The demographics of the infertile women in the control and experimental groups. Group Case group n=37 Control Group n=37