title: The Preliminary Feasibility of a Telehealth Exercise Intervention for Women with Postpartum Depression
Creators: name: Turner, Jemma C
Publisher: name: Griffith University
Year: 2023
Subjects: subject: postpartum
subject: exercise
subject: telehealth
subject: postpartum depression

description: Background: Postpartum Depression (PPD) is a debilitating disorder characterised as serious depressive episodes prevalent following childbirth. PPD is one of the most common complications associated with childbirth, and if untreated, can persist for up to three years into the postpartum period. Women with PPD experience barriers to accessing health care including stigma, shame, financial and time constraints, and practical considerations like lack of child-minding and transport. In Australia, postpartum women experience the lowest physical activity levels of all vulnerable populations and barriers to exercise coincide with the barriers to care for PPD including time and financial constraints, and family commitments. Therefore, women with PPD are unlikely to be reaping the physical and mental health related benefits to participating in regular physical activity. Telehealth has been proposed as a potential method for delivery of exercise interventions in vulnerable populations. The aim of this thesis was to determine the preliminary feasibility of an evidence-based physical activity and exercise promotion intervention delivered via telehealth for women with postpartum depression. Methods: This thesis includes two studies, [1] a quantitative systematic literature review and, [2] a preliminary feasibility study. The quantitative systematic literature review examined and synthesised the methods, intervention characteristics and outcome measures of telehealth physical activity and exercise interventions for postpartum women. The feasibility study was informed by results from [1]. Women indicated for postpartum depression (EPDS score of &gt;9) at screening were recruited to a single arm, pre-post exercise intervention. Participants received 6-weeks of exercise prescription and up to three weekly, live online video consultations with a university level exercise practitioner (Accredited Exercise Scientist). The acceptability (participant satisfaction), implementation (degree of execution, completed exercise sessions, capability), demand (expressed interest of use, participant recruitment and enrolment), and preliminary efficacy (EPDS, minutes of physical activity, body composition, muscular strength, cardiovascular fitness, health-related quality of life) informed preliminary feasibility. Results: At the initial search for the quantitative systematic literature review, 1036 records were identified and after applying the inclusion and exclusion criteria, 16 studies were included in the review. The TIDieR checklist was utilised as a reporting assessment framework as it is designed to determine the reporting standard and replicability of interventions. Domains evaluated included participant recruitment and exclusion criteria, participant demographic information, intervention duration, whether participants were provided with an individualised exercise prescription or physical activity promotion advice only, exercise prescription (if applicable) and delivery mode, telehealth contact, and outcome measures were examined. The recommendations from the review that were implemented in the intervention were use of a university level exercise practitioner to deliver the intervention, assessment of health-related outcomes, and provision of individualised exercise prescription. Five women (median [IQR] age 37 years [28 – 40], time postpartum 21 months [4 – 29]) were recruited over a 9-month period. All participants completed the intervention including the in-person assessments at baseline and follow-up. All participants rated that they were strongly satisfied with the exercise prescription and video consultations and demonstrated very high exercise adherence (&gt;75% of exercise sessions completed, 100% of video consultations attended, achieved the physical activity guidelines for 5/6 weeks). Participants rated the exercise delivery mobile application between somewhat and strongly satisfied. The most common motivational factor for exercise adherence was the use of flexible exercise sessions (5/5) closely followed by individualised goal setting and exercise prescription (4/5), using a mobile application for exercise delivery (4/5) and home-based exercise (4/5). There were improvements in all health-related outcomes at follow-up and most notably four participants were no longer indicted for postpartum depression (EPDS&lt;9). Conclusion: The preliminary feasibility demonstrated in this study indicates the need to evaluate the effect of exercise interventions delivered via telehealth for women with PPD in larger powered randomised controlled trials. Future interventions for women with PPD should include use of university level exercise practitioner for exercise delivery; individualised exercise prescription; representative and acceptable recruitment strategies; assess health-related outcomes including postpartum depression symptoms, body composition, muscular strength, cardiovascular fitness, and quality of life; and consider population specific exercise delivery mobile applications that caters to the needs of women with PPD. Despite the vast heterogeneity of the participants and intervention provided, improvement in health-related outcomes was consistent. Participants rated being strongly satisfied with the key components of the intervention and demonstrated very high exercise adherence. Future, high quality telehealth delivered exercise interventions for women with PPD will add to the required evidence pool for the effect of exercise for PPD and contribute to the future synthesis of population specific exercise guidelines.