Table 2. Measures and Results of included studies Quantitative studies reporting correlations or associations Measures Analysis Results Limitations 1. et al. (2008) Determinants of pregnancy and postpartum depression: Prospective influences of depressive symptoms, body image satisfaction, and exercise behavior Personal History Questionnaire; The Centers for Epidemiological (CES-D) Body Areas Satisfaction Scale (BASS); Leisure-Time Exercise Questionnaire (LTEQ) Four hierarchical regression analyses (HRA) were used to examine the contributions of DS, BIS, and EB for predicting depression across the study time periods DS, BIS, and EB were associated across the 3 pregnancy time points and postpartum; DS and BIS were main determinants of later depression in pregnancy and postpartum; the moderating influence of pre-pregnancy EB was evident in early pregnancy generalizability Self-report measures Prospective does not provide information on causal mechanisms 2. Orr et al. (2006). Exercise participation before and during pregnancy among urban, black women: The Baltimore Preterm Birth Study. Self-report of EB; 41-item Prenatal Social Environment Inventory (PSEI) used to assess exposure to stressors; CES-D; John Henryism Active Coping Scale (JHAC 12) used to measure propensity to cope actively with environmental stressors. Medical records checked for drug and alcohol behavior Bivariate associations were evaluated for statistical significance by using the chi-square statistic. 1) Increased coping correlated with increased EB) 2) Increased EB correlated with decreased depression. 3) Exposure to stressors and behavioural factors not associated with exercise participation before or during pregnancy generalizability 3. Watts et al. (2013) ). Depressive symptoms during pregnancy: Exploring the role of sitting. Mental Health and Physical Activity Depressive symptoms were measured using the Hospital Anxiety and Depression Scale (HADS). Sitting behaviour was measured the Australian Linear regression analyses were used to explore the relationship between sitting and depressive symptoms, whilst controlling for known covariates. The investigating “total sitting time” showed no association with depressive symptoms (F= .77, p = 0.38). The model investigating “planned Use of convenience sample which overrepresented ppts in trimester 2. Self-report measure of sitting time used. Underpowered.
Subjective Exercise Experiences SEES – completed weekly after exercise class weeks 2-5 & at beginning and end of programme (weeks 1 & 6) SEES has 3 subscales: positive well-being (PWB), psychological distress (PD) & fatigue (FA) feeling states. PWB was higher (d = 0.93) and PD and FA were lower (d = and -0.68, respectively) following acute exercise bout, as compared to the assessment. Cannot be certain as to the mechanisms of the changes reported in this paper, largely because of the lack of an “attention” control group in the study design. 17. Polman et al. (2007). Effect of a single bout of exercise on the mood of pregnant women. POMS ANOVAS (one and 2 way) used. Condition main effect for vigour, significant interaction between vigour and total mood. Post hoc comparisons - no differences between 3 conditions, both exercise classes increased vigour from pre to post exercise (P<0.01).Post hoc comparisons for depression show significant decrease in depression score for aqua condition (P <0.05) Non-random allocation. Exercise conditions – ppts already exercised and therefore may be predisposed to enjoy the exercise experience. 18. Guszkowska et al. (2013). Influence of a single physical exercise on mood states of pregnant women. Emotional states were assessed with the UWIST Mood Adjective arousal (TA), energetic arousal (EA) & hedonic tone (HT); Personality traits were measured with the NEO-FFI, LOT-R and STAI; data also 2 way ANOVA After a single class, the 2 groups differed significantly in 2 dimensions (EA & TA.) Ppts in the experimental condition had more energy, were less tense, and were more relaxed. The HT was higher in the group of exercising women. Lacks generalizability Assignment of ppts to the groups did not meet the conditions of randomization, as the respondents chose the group according to their preferences. in earlier stages of pregnancy, more physically active prior to pregnancy, and who rated demographic
depression: a randomized controlled trial. Chi-square test or Fisher’s Exact Test used to analyze categorical data. comparisons of baseline & follow-up mood outcome scores and of pre- and post-class assessment of STAI-S scores & salivary cortisol levels made using Wilcoxon signed rank test points in the TAU or yoga group. Program’s educational element might influence the mood of the participants in the yoga group. Potential effect of receiving attention from the instructor and also the subject-expectancy effect could contribute to findings Women’s prior beliefs about effects of yoga could influence mood. Homogeneity of group restricts generalizability.
Were CI's wide or were they sufficiently precise to aid If precision is lacking, is this because the study is NA Section 5: Summary 5.1 Are the study results internally valid (i.e. unbiased)? How well did the minimise sources of bias (i.e. adjusting for potential confounders)? Were there significant flaws in the study design? ++ + − NR NA Comments: 5.2 Are the findings generalisable to the source population (i.e. externally valid)? Are there sufficient details given about the study to determine if the findings are generalisable to the source population? Consider: participants, interventions and comparisons, outcomes, resource and policy implications. ++ + − NR NA Comments: Research Part 2 – Empirical Paper with Appendices The Effect of Exercise during Pregnancy on Mood
Table 3 Summary of Chi-Square tests of independence Variables df Pearson p Chi-Square Previous pregnancy Previous Physical Activity Marital Status Ethnicity Employment Previous Mental Health Education Religion 1 2 1 1 2 1 1 1 3.660 3.268 3.383 2.644 6.854 0.123 10.780 0.000 0.56 0.195 0.066* 0.104 0.032* 0.726 0.001* 0.082** p< *p <0.05 **Approaching significance