Randomized trial examining the effect of exercise and wellness interventions on preventing postpartum depression and perceived stress.

BACKGROUND: Approximately 13-19% of postpartum women experience postpartum depression and a majority report at least some stress during the postpartum phase. Traditional interventions such as psychotherapy and antidepressant medications are often not feasible or desirable. The purpose of this study was to examine two low cost, brief, accessible interventions designed to prevent postpartum depression and perceived stress among women at high risk. METHODS: Participants (n = 450) who were on average four weeks postpartum, had a history of depression before pregnancy, and exercised less than 60 min per week were randomly assigned to one of the following three conditions: (1) 6-month telephone-based exercise intervention; (2) 6-month telephone-based wellness/support intervention (e.g., healthy eating, sleep, and perceived stress); or (3) usual care. RESULTS: Overall, 2.4% of participants met criteria for depression at 6 months and 3.6% at 9 months with no differences between groups. At 6 months following randomization, median symptoms of depression were significantly lower among wellness participants compared to usual care participants (b = - 1.00, SE = 0.46, p = .03). Perceived stress at 6 months post-randomization was significantly lower among exercise vs. usual care participants (b = - 2.00, SE = .98, p = .04) and exercise vs. wellness participants (b = - 2.20, SE = 1.11, p = .04). CONCLUSIONS: The wellness intervention was efficacious for preventing symptoms of depression; however, postpartum depression that met the diagnostic criteria was surprisingly low in all conditions among this at risk sample of postpartum women. Exercise interventions may have a protective effect on perceived stress among women at risk for postpartum depression. Practitioners should consider integrating exercise and wellness interventions into postpartum care. TRIAL REGISTRATION: Clinical Trials Number: NCT01883479 (06/21/2013).

The effect of sleep pattern changes on postpartum depressive symptoms.

BACKGROUND: Research indicates that poor sleep is associated with postpartum depression; however, little is known regarding this relationship among postpartum women who are at high for postpartum depression. This study examined the relationship between changes in self-reported sleep patterns (from six weeks to seven months postpartum) and depressive symptoms at seven months postpartum among women who were at high risk for postpartum depression. METHODS: Participants (n = 122) were postpartum women who were at an increased risk for postpartum depression (personal or maternal history of depression) and had participated in a randomized exercise intervention trial. For the current trial, participants completed the Pittsburgh Sleep Quality Index and Patient Health Questionnaire-9 (PHQ-9; assessed depression) at six weeks and seven months postpartum. RESULTS: Overall, sleep problems significantly improved from six weeks to seven months postpartum. However, linear regression analyses indicated that worsening or minimal improvement of sleep problems were associated with higher depressive symptoms at seven month postpartum. Regarding the specific types of sleep problems, self-reported changes in sleep latency (i.e., how long it takes to fall asleep at night), daytime dysfunction (i.e., difficulty staying awake during the day), and sleep quality (i.e., subjective rating of sleep quality) were associated with higher levels of depressive symptoms. CONCLUSIONS: Sleep problems typically improve during the postpartum phase. However, postpartum women who are at high risk for postpartum depression are at an increased risk for depressive symptoms later in the postpartum phase if sleep problems worsen or show only minimal improvement over time. Therefore, at the six-week postpartum clinic visit, women should receive education regarding potential worsening of sleep patterns and strategies for preventing sleep-related problems. TRIAL REGISTRATION: Registered with ClinicalTrials.gov ( NCT00961402 ) on August 18, 2009 prior to the start of the trial.

Evaluating the feasibility and efficacy of a home-based combined high intensity interval and moderate intensity training program for increasing physical activity among low-active adults: A randomized pilot trial.

BACKGROUND: High intensity interval training (HIIT), which includes short bursts of high-intensity physical activity (PA) followed by recovery, can increase PA by addressing time barriers and improving PA enjoyment. The purpose of this pilot study was to examine the feasibility and preliminary efficacy of a home-based HIIT intervention on PA. METHODS: Low active adults (n = 47) were randomly assigned to a home-based HIIT intervention or wait-list control lasting 12 weeks. Participants in the HIIT intervention received motivational phone sessions based on Self-Determination Theory and accessed a website that included workout instructions and videos demonstrating proper form. RESULTS: The HIIT intervention appears feasible based on retention, recruitment, adherence to the counseling sessions, follow-up rates, and the consumer satisfaction survey. HIIT participants reported more minutes of vigorous intensity PA at six weeks relative to control (no differences at 12 weeks). HIIT participants reported higher levels of self-efficacy for PA, enjoyment of PA, outcome expectations related to PA, and positive engagement with PA than the control. CONCLUSIONS: This study provides evidence for feasibility and possible efficacy of a home-based HIIT intervention for vigorous intensity PA; however, additional studies are needed with larger samples sizes to confirm efficacy of home-based HIIT interventions. TRIAL REGISTRATION: Clinical Trials Number: NCT03479177.

Rationale, design, and baseline data for the Healthy Mom II Trial: A randomized trial examining the efficacy of exercise and wellness interventions for the prevention of postpartum depression.

Approximately 13-19% of women experience postpartum depression and approximately one-third of women who have a history of depression develop depression during the postpartum phase. Exercise is an efficacious intervention for depression among adults; however, few studies have examined the effect of exercise on postpartum depression. The purpose of this study was to conduct a randomized controlled trial examining the effect of exercise and wellness interventions on preventing postpartum depression among women at risk. Specifically, women (n = 450) who were on average 4.35 weeks postpartum and had a history of depression were randomly assigned to one of the following three conditions: (1) Telephone-based exercise intervention; (2) telephone-based wellness/support intervention (covered topics such as sleep, stress, and healthy eating); or (3) usual care. Both interventions lasted six months. The exercise intervention was based on social cognitive theory and the Transtheoretical model and was specifically designed to motivate postpartum women to exercise. The primary dependent variable was depression based on the Structured Clinical Diagnostic Interview (SCID). Secondary dependent variables included the Edinburgh Postnatal Depression Scale, PHQ-9, and Perceived Stress Scale. Potential mediator variables included quality of sleep, postpartum social support, fatigue, and exercise attitudes. Questionnaires were administered at baseline, six, and nine months. The purpose of this paper is to summarize the methodology, study design, and baseline data for this study. This trial will provide important information regarding the efficacy of exercise and wellness interventions for preventing postpartum depression.

The relationship between employment status and depression symptomatology among women at risk for postpartum depression.

Approximately 13%-19% of new mothers report depression during the postpartum period. Returning to work after childbirth is associated with depression; however, it is unclear if this finding applies to women who are at high risk for postpartum depression. The purpose of this study was to examine the relationship between employment status and depression symptomatology among women at risk for postpartum depression (defined as personal or maternal history of depression). This study was a post hoc analysis from a previously conducted randomized controlled trial. Participants (n = 124; ages 18-42) were 7 months postpartum and had participated in a randomized trial examining the efficacy of an exercise intervention for the prevention of postpartum depression (study was conducted from January 2010 through November 2011). Participants completed questionnaires examining demographic characteristics and psychosocial variables at 6 weeks and 7 months postpartum. The Edinburgh Postnatal Depression Scale was administered at 7 months postpartum to assess depression symptomatology. Sixty-eight percent of the participants reported that they were employed at 7 months postpartum. Employment at 7 months postpartum was associated with lower depression symptomatology (as measured by the Edinburgh Postnatal Depression Scale) after controlling for condition assignment, marital status, and having other children. Among women who worked outside of the home, there were no differences between those who worked full-time versus part-time on depression symptomatology. Employment may be a protective factor for postpartum depression symptomatology; however, we cannot infer causation given this study's cross-sectional design. Postpartum women at risk for depression who are contemplating employment should consider the possible protective effect of employment on depression.

Mindfulness-based yoga intervention for women with depression.

OBJECTIVES: The purpose of this study was to examine the efficacy of a 12-week mindfulness-based yoga intervention on depressive symptoms and rumination among depressed women. DESIGN: Prospective, randomized, controlled 12 week intervention pilot study. Depressive symptoms were assessed at baseline, post-intervention (12 weeks), and one-month follow-up. SETTING: Women with a history of diagnosed depression and currently depressed were randomized to a mindfulness-based yoga condition or a walking control. INTERVENTIONS: The mindfulness-based yoga intervention consisted of a home-based yoga asana, pranayama and meditation practice with mindfulness education sessions delivered over the telephone. The walking control condition consisted of home-based walking sessions and health education sessions delivered over the phone. MAIN OUTCOME MEASURES: The Beck Depression Inventory (BDI) and Ruminative Responses Scale (RRS). RESULTS: Both groups reported decreases in depressive symptoms from baseline to post-intervention, f(1,33)=34.83, p<0.001, and from baseline to one-month follow-up, f(1,33)=37.01, p<0.001. After controlling for baseline, there were no significant between group differences on depression scores at post-intervention and the one-month follow-up assessment. The mindfulness-based yoga condition reported significantly lower levels of rumination than the control condition at post-intervention, after controlling for baseline levels of rumination, f(1,31)=6.23, p<0.01. CONCLUSIONS: These findings suggest that mindfulness-based yoga may provide tools to manage ruminative thoughts among women with elevated depressive symptoms. Future studies, with larger samples are needed to address the effect of yoga on depression and further explore the impact on rumination.

The Relationship between Prenatal Antidepressant Use and the Decision to Breastfeed among Women Enrolled in a Randomized Exercise Intervention Trial.

BACKGROUND: Despite the numerous health benefits associated with breastfeeding, only 49% of postpartum women in the United States breastfeed at 6 months. Therefore, it is important to understand factors that may influence a woman's decision to breastfeed. OBJECTIVE: The purpose of this study was to examine the relationship between prenatal antidepressant use and the decision to breastfeed among postpartum women. METHODS: Participants were postpartum women (N = 87) who had participated in a randomized trial examining the efficacy of a 6-month exercise intervention for the prevention of postpartum depression (2009-2012). Participants were recruited from the upper Midwest and were at risk for postpartum depression. Participants completed telephone-based questionnaires assessing their prenatal antidepressant use and breastfeeding behavior. RESULTS: Seventeen percent of the participants took an antidepressant medication during pregnancy and 91% breastfed at birth. After controlling for baseline depressive symptoms, body mass index, and condition assignment, participants who were taking an antidepressant during pregnancy were less likely to initiate breastfeeding than participants who were not taking an antidepressant during pregnancy, ß = -2.042, P < .05 (odds ratio = 0.130; 95% confidence interval, 0.024-0.696). CONCLUSION: Our study indicates that prenatal antidepressant medication use may be a potential barrier to breastfeeding initiation. Additional research is needed to better understand the factors that play a role in the relationship between prenatal antidepressant use and breastfeeding initiation.