Research suggests that exercise can have a moderating influence on the risk of depression in pregnancy as well as in the postpartum period. A lack of exercise during pregnancy has been associated with a higher rate of depression symptoms.
The American College of Obstetrics and Gynecology recommends 30 minutes of moderate exercise on most, if not all, days of the week for pregnant women who are not suffering any medical or obstetric complications.
In 2008, a team from Pennsylvania State University looked at the links between exercise, body image satisfaction, and postpartum depression. They gathered information from 230 pregnant women three times during pregnancy and at six weeks postpartum.
They found that the three factors were linked at each time-point. “Depression and body image satisfaction were main determinants of later depression in pregnancy and postpartum,” they report, adding that pre-pregnancy exercise was also a moderating influence.
“These preliminary findings suggest that depression and body image satisfaction are important psychological factors for intervention to improve women’s pregnancy and postpartum psychological health, and that exercise in the pre-pregnancy period may offer women protective effects against depression in early pregnancy,” they write.
The following year, in 2009, a team from Carolinas Medical Center, North Carolina, investigated the link. They analyzed figures from 2,169 women in their third trimester of pregnancy and two to six months postpartum.
But this time, no evidence was found that being physically active before or during pregnancy was protective against depression symptoms. However, women who were physically active both pre-pregnancy and during the last trimester were less likely to report “having little interest or pleasure.”
The researchers did not rule out a link, and concluded, “If confirmed in other studies, physical activity may be an additional option for women who want to ease postpartum depressive symptoms.”
Findings from a 2009 European study are slightly more positive. The researchers based in Copenhagen, Denmark, analyzed figures from 1,462 women with depression in the year after giving birth.
Women who engaged in “vigorous physical activity” during pregnancy had a 19 percent lower risk of requiring antidepressants than women who were not physically active. But physical activity did not affect the risk of depression severe enough to require hospital admission.
They conclude, “Our data are compatible with a protective effect of vigorous physical activity, but not for other measures of physical activity, against postpartum depression requiring antidepressant therapy.”
Jennifer S. Haas, MD, and her team from Brigham and Women’s Hospital, Boston, looked at the causes of health status among a multi-ethnic group of 1,809 women during and after pregnancy. They say, “Substantial changes in health status occurred over the course of pregnancy. For example, physical function declined during the third trimester and improved during the postpartum period.”
The rate of depressive symptoms rose from 12 percent prior to pregnancy to 25 percent during the third trimester, and then fell to 14 percent postpartum. Women who did not exercise prior to pregnancy were more than twice as likely to report depressive symptoms compared to women who exercised at least two hours per week.
“Lack of exercise was strongly and consistently associated with poor health status before, during, and after pregnancy,” they conclude. Results also indicate that lack of exercise during pregnancy may have been caused by fatigue as well as the depressive symptoms themselves.
Fortunately, home-based exercise may be just as effective as walking, swimming or taking classes. Researchers from McGill University, Canada found that a 12-week individualized home-based exercise intervention was significantly beneficial for women with postpartum depression. Fatigue levels were also lowered, partly due to reductions in perceived stress and increased energy expenditure, say the team.
Melanie S. Poudevigne, PhD, of Clayton State University, Georgia points out that the adverse consequences of inactivity “may be an especially important problem among pregnant women,” as up to 60 percent are inactive during pregnancy. She believes that regular physical activity contributes positively to physical and psychological health. As pregnancy progresses, she reports that leisure time and work-related physical activities decrease, as does the intensity and duration of physical activity overall.
A review of the research, carried out in 2007, focused on the potential role of exercise, particularly baby carriage walking, as an additional treatment for postpartum depression. Several studies supported participation in exercise programs as a useful treatment.
The reviewers, from Birmingham University, UK, write, “There are plausible mechanisms by which exercise could have such an effect.” They add, “Given the reluctance by some women to use antidepressant medication postpartum and the limited availability of psychological therapies, exercise as a therapeutic possibility deserves further exploration.”
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Haas, J. S. et al. Changes in the health status of women during and after pregnancy. Journal of General Internal Medicine, Vol. 20, January 2005, pp. 45-51.
Strom, M. et al. Leisure-time physical activity in pregnancy and risk of postpartum depression: a prospective study in a large national birth cohort. The Journal of Clinical Psychiatry, Vol. 70, December 2009, pp. 1707-14.
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