# Exercise as it relates to Disease/Effects of exercise on women experiencing post-partum depression

This article is a critical analysis of the article: The effects of exercise and social support on mothers reporting depressive symptoms: A pilot randomized controlled trial. (Armstrong K, Edwards H, 2003)

## Background of Research

Postnatal Depression (PND) is a severe condition in childbearing women postpartum where the brain system will intervene in the depressive state of women.
Research into PND and discovering further options for prevention and treatment, is crucial. PND affects 10% of women in Australia during childbearing. Therefore, assessing other forms of prevention/treatment other than traditional counselling and medications, involving exercise interventions to decrease PND experiences for women. Exercise is known to provide improvements in depressive symptomology, though this theory has not yet been assessed on the women who experience PND.

## Where is the research from?

The certain research conduction was published in the International Journal of Mental Health Nursing. This fully refereed journal is Australian and New Zealand based Mental Health Nursing, examining current trends and developments for practise and research within mental health.
The authors are both apart of the Queensland University of Technology, Centre of Nursing research. Kylie Armstrong has a PHD and written a handful of articles based on nurse and clinical practise of related topics. Helen Edwards has a PHD also, along with several articles in the field relating to mental health, child abuse, nurse and clinical practise and many more. With the fields of research that are associated with the authors is considered advantageous to the knowledge provided within the article.

## What kind of research was this?

The research for this study was conducted in the form of a pilot Randomised Controlled Trail (RCT), which used multi-intervention programme for a group along with the control group to be used for later comparisons.
RCT that are strong and well-designed are able to assess whether an intervention provides strong enough evidence of a cause-effect relation and will enable change of practise to enhance patient outcome, therefore improving research effectiveness

## What did the research involve?

The study involved women 21-30 years of age with children between the ages of 6 months and 12 months, with an Edinburgh Postnatal Depression Score (EPDS) of ≥12. These women were recruited using two methods; 1. Health professional recommendations, 2. Self-recommendation. The women were randomly allocated to a multi-intervention or non-intervention group, following the completion of pre and post fitness testing and fitness questionnaires, the questionaries assess general well-being, depressive symptomology and anxiety.
Women allocated to the multi-intervention group were encouraged to attend three pram walking sessions for 30-40 minutes per week. This was to be exerted at a moderate intensity (60-75% of APHR – age predicated heart rate). Women allocated to the control intervention group were asked to perform the circular walking test at the start and end of the programme alongside the completion of the assigned questionnaires. These women were also offered phone support at week 6, encouraged to contact researchers for further concerns and continue any usual regime or social activities in place.
Limitations:
Firstly, women were found to be reluctant to participate due to the stigma involved in PND. Using the methods for recruitment of self-recommendation in this instant would have made the recruitment process challenging. Although, using a health professionals’ encouragement and suggestion to be a part of the study was smart as the women see the health professionals’ to be respected enabling them to trust their decision.
Secondly, the Cornish Walking Wheel Fitness test (CWW) was not a validated test to be using on the control group, as it had no been lab-based treadmill tested. This can make the comparison of the groups difficult and inaccurate for the selected control group.
Furthermore, attendance is always a significant limitation in studies. As the women were already threatened by the stigma associated with their PND, along with living with 6-12-month-old babies, it is crucial to use ways to help encourage this. The study does show that attendance for exercise sessions sat at 66%. As these sessions also considered the children, the highest percentage for non-attendance was due to child/children sickness.
Lastly, the results show very little movement in the results of the SSI Social Support Interview, as the questionnaires were believed to not be sensitive enough to detect proper changes in the women. Theis section of the study is important for the decrease of stigma, as women should be able to help relate to the other women of the multi-intervention, allowing them to relay their feelings and emotions on one another.

# Basic Results

The results showed that regardless of group placement, women would see an improvement over time. Although the women placed in the multi-intervention group did see significantly higher improvements at a faster rate at the 6- and 12-week check ins, the improvement of the control group still retained in the moderate to severe range.
The table provides Means and Standard Deviations of four scoring techniques used for comparison between the two intervention groups which was provided.
| Control Group | EPDS (0-30) | DASS (0-4) | GHQ (0-12) | SSI (0-135)' |
| Pre-Intervention | 18.40(4.77) | 2.25(1.48) | 8.00(3.80) | 89.90(15.86 |
| Week 6 | 13.50(4.53) | 1.80(1.69) | 5.70(4.00) | 84.10 (19.65) |
| Week 12 | 14.70 (7.66) | 1.70(1.57) | 5.10(4.09) | - |
| Multi-Intervention group | EPDS (0-30) | DASS (0-4) | GHQ (0-12) | SSI (0-135) |
| Pre-Intervention | 17.40 (4.65) | 1.80 (1.69) | 5.44 (3.88) | 97.00 (23.44) |
| Week 6 | 7.20 (4.32) | 0.08 (0.92) | 2.44 (1.81) | 101.60 (20.71) |
| Week 12 | 4.60 (3.34) | 0 (0) | 1.11 (1.17) | 101.60 (19.31) |
Edinburgh Postnatal Depression Score (EPDS), Depression Anxiety Stress Scale (DASS), 12-item General Health Questionnaire (GHQ), Social Support Interview (SSI)
The scores implicate the improvements between intervention groups. This study shows prof their hypothesis was correct, with significant change in scores for the multi-intervention participants. These results also support their findings for improvements in the control intervention group at the end of the 12 weeks, although these were not as drastic.

## Conclusions

As the study is smaller scale, it is unable to deem applicable and limited for the population of women with PND as a whole. The exercise encouraged is only a selected type of exercise to be accounted for the improvements of these women and their depressive symptomology. In future, further exercise opportunities could be used to enhance these results for women of a larger population. Although overall the 30-40-minute exercise and social support did show significant improvements for the women and this is encouraging for other studies to focus on using exercise to further enhance theses methodologies. Further, more work with social support will also encourage a better result, focusing on the encounters of the women.
Recent research does however further support the theory of exercise interventions as another prevention and treatment for reducing the severity of PND in childbearing women.

## Practical advice

Research supports the idea of exercise reducing depressive symptomology. This study proves that for women with PND. There are no major risks stated, as the exercise encouraged isn’t overly challenging, although there is mention of stretching pre and post session.
Effects of Exercise on Depression

## Further information/resources

Additional resources have been added below to further read for any interest or support.
Using Exercise to Tackle Postnatal Depression
Women’s Help; Postnatal Depression
Postpartum Depression Support Organisations
Postnatal Depressive Scale

## References

* 1 2 3 4 5 6 7 8 ARMSTRONG, K. AND EDWARDS, H, 2003,The effects of exercise and social support on mothers reporting depressive symptoms: A pilot randomized controlled trial,International Journal of Mental Health Nursing,12(2):130-138
* ↑ Noble R.,2005 Depression in women. Metabolism,54(5):49-5
* 1 2 NORTH T, McCULLAGH P, TRAN Z. 1990 Effect of Exercise on Depression. Exercise and Sport Sciences Reviews,18(1):379-416
* ↑ Usher K.,2020 International Journal of Mental Health Nursing
* ↑ Kendall J., 2003 Designing a research project: randomised controlled trials and their principles. Emergency Medicine Journal,20):164-168
* ↑ . Noonan V, Dean E. 2000 Submaximal Exercise Testing: Clinical Application and Interpretation. Physical Therapy,80(8):782-807
* ↑ . Margie D, McCurdy A, Mottola M, Skow R. 2018 Impact of prenatal exercise on both prenatal and postnatal anxiety and depressive symptoms: a systematic review and meta-analysis. British Journal of Sports Medicine,(52):1376-1385