E684 Full PDF
E684 Full PDF
E684 Full PDF
HAM-D = The Hamilton Rating Scale for Depression. PHQ-9 = The Patient Health Questionnaire-9. SCID = Structured Clinical Interview for DSM. SD = standard deviation. WIC = Special Supplemental Nutrition Program for Women,
Decrease in EPDS in intervention adherent participants), a lack of clarity on reducing depressive symptoms (SMD
selective outcome reporting, a lack of robust difference –1.10, 95% CI = –1.99 to –0.21,
significant at 6 months not at
No significant difference in
The funnel plot was visually inspected effects of group exercise and participant
for the main analysis including all trials. choice exercise on depressive symptoms
There appeared to be a lack of smaller were not significantly different (test for
studies with results indicating an increase subgroup differences: c² 3.89, P = 0.05), I 2
6 and 12 months
EPDS
Authors of four trials provided additional mental health in the UK or the US.7,35
postpartum lifestyle
goals for managing
data for this review: DaCosta et al,23 Surkan This systematic review provides support
Leaflet on healthy
et al,27 Lewis et al,29 and Boath et al.34 for exercise as an effective treatment for
reducing postpartum depressive symptoms,
Usual care
to –0.00), I 2 55% (Table 2),22–25,28,33,34 and in social support among peers. Exercise
general postpartum populations (-0.57, 95% contexts also varied between structured,
22
94
CI = –1.12 to –0.02, I 2 92%) (Table 2).26,27,29–32 group-based exercise and tailored exercise
Depressed population
populations was not significantly different in analyses to account for this variation,
(test for subgroup differences c² 0.62, and potential causes of heterogeneity were
P = 0.43, I 2 0%) (further details available from explored in subgroup analyses; however,
Table 1 continued. Trial characteristics
depressive symptoms (SMD –0.56, 95% outcomes; the median duration of follow-
Birmingham, UK
CI = –1.13 to 0.01, I 2 89%).23,25,28–30,32–34 Exercise up was 6 months from recruitment (IQR
with co-interventions had a significant effect 3.6 months).
on reducing depressive symptoms (–0.35, The methodological quality of several of
95% CI = –0.66 to –0.04, I 2 72%).22,24,26,27,31 the included trials was low. Exclusion of
The effect of exercise-only interventions non-adherent participants, insufficiently
and exercise co-interventions on depressive robust sequence generation, and unclear
Infants, and Children.
symptoms was not significantly different (test blinding of outcome assessors resulted in
for subgroup differences: c² 0.41, P = 0.52, I 2 an increased risk of bias. Only two included
Boath 201534
Daley 201533
0%) (Table 2) (further details available from trials in ‘depressed’ populations recruited
the authors on request). women with a diagnosis of depression
(ICD-10 or DSM-IV);33,34 the remainder
Exercise context. Group exercise used screening questionnaires such as the
Figure 2. Meta-analysis of the effect of exercise on EPDS 20 to indicate women with possible confounding. The effectiveness of exercise
depressive symptoms (standardised mean difference). depression. The EPDS has the advantage of was explored in different populations,
CI = confidence interval. SD = standard deviation.
being relatively short and simple to complete, intervention types, and exercise contexts,
but has been reported to have considerable which has not been previously attempted.
heterogeneity in sensitivity and specificity
for detecting postpartum depression across Comparison with existing literature
different settings and populations.36 The evidence in this field has increased
There was a lack of assessment of substantially since the review by Daley et al
exercise duration and intensity in included in 2009.14 Although the primary effect size
studies; of those that did provide this in this review is smaller than that reported
information, only two included an objective by Daley et al (SMD –0.44, 95% CI = –0.75
measure of exercise.31,33 Exercise intensity to –0.12 rather than –0.81, 95% CI = –1.53
can be difficult to determine accurately by to –0.1014), the CI surrounding the effect is
self-report. For future research, objective narrower here, indicating more precision.
accelerometry would allow for greater In this review, the effect of exercise in
accuracy and more meaningful comparison depressed postpartum populations was
between intervention types. smaller than that reported in a recent
This review has several strengths. review of exercise in general adult
Recommended methods were followed; depressed populations (SMD –0.62, 95%
searching was systematic and not limited CI = –0.81 to –0.42),10 indicating that there
by language of publication. The review was may be differences in the way general adult
restricted to RCTs to reduce the potential for populations and postpartum populations