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Effects of Exercise on Mild-to-Moderate Depressive Symptoms in the Postpartum Period: A Meta-analysis

McCurdy, Ashley P. BKin, BA; Boulé, Normand G. PhD; Sivak, Allison PhD; Davenport, Margie H. PhD

doi: 10.1097/AOG.0000000000002053
Contents: Review

OBJECTIVE: To examine the influence of exercise on depressive symptoms and the prevalence of depression in the postpartum period.

DATA SOURCES: A structured search of MEDLINE, EMBASE, CINAHL, Sport Discus, Ovid's All EBM Reviews, and ClinicalTrials.gov databases was performed with dates from the beginning of the databases until June 16, 2016. The search combined keywords and MeSH-like terms including, but not limited to, “exercise,” “postpartum,” “depression,” and “randomized controlled trial.”

METHODS OF STUDY SELECTION: Randomized controlled trials comparing postpartum exercise (structured, planned, repetitive physical activity) with the standard care for which outcomes assessing depressive symptoms or depressive episodes (as defined by trial authors) were assessed. Trials were identified as prevention trials (women from the general postpartum population) or treatment trials (women were classified as having depression by the trial authors). Effect sizes with 95% confidence intervals (CIs) were calculated using Hedges' g method and standardized mean differences in postintervention depression outcomes were pooled using a random-effects model.

TABULATION, INTEGRATION, AND RESULTS: Across all 16 trials (1,327 women), the pooled standardized mean difference was −0.34 (95% CI −0.50 to −0.19, I2=37%), suggesting a small effect of exercise among all postpartum women on depressive symptoms. Among the 10 treatment trials, a moderate effect size of exercise on depressive symptoms was found (standardized mean difference−0.48, 95% CI −0.73 to −0.22, I2=42%). In six prevention trials, a small effect (standardized mean difference−0.22, 95% CI −0.36 to −0.08, I2=2%) was found. In women with depression preintervention, exercise increased the odds of resolving depression postintervention by 54% (odds ratio 0.46, Mantel-Haenszel method, 95% CI 0.25–0.84, I2=0%). The trials included in this meta-analysis were small and some had methodologic limitations.

CONCLUSION: Light-to-moderate intensity aerobic exercise improves mild-to-moderate depressive symptoms and increases the likelihood that mild-to-moderate depression will resolve.

Postpartum exercise improves mild-to-moderate depressive symptoms and increases the likelihood of resolving mild-to-moderate depression in the postpartum period.

Program for Pregnancy and Postpartum Health, Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, the Women and Children's Health Research Institute, and the Alberta Diabetes Institute, University of Alberta, and the University of Alberta Libraries, Edmonton, Alberta, Canada.

Corresponding author: Margie H. Davenport, PhD, Program for Pregnancy and Postpartum Health, Faculty of Physical Education and Recreation, University of Alberta, 1-059D Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, Canada, T6G 2E1; email: margie.davenport@ualberta.ca.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Saeed Reza Toghi Eshghi for assistance with translation.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.