Does Walking Reduce Postpartum Depressive Symptoms? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals

BackgroundThe Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders.MethodsCANMAT convened a core editorial group of interdisciplinary academic clinicians and persons with lived experience (PWLE), and 3 advisory panels of PWLE and perinatal health and perinatal mental health clinicians. We searched for systematic reviews of prevention and treatment interventions for perinatal depressive, bipolar, anxiety, obsessive-compulsive and post-traumatic stress disorders (January 2013-October 2023). We prioritized evidence from reviews of randomized controlled trials (RCTs), except for the perinatal safety of medications where reviews of large high-quality observational studies were prioritized due to the absence of RCT data. Targeted searches for individual studies were conducted when systematic reviews were limited or absent. Recommendations were organized by lines of treatment based on CANMAT-defined levels of evidence quality, supplemented by editorial group consensus to balance efficacy, safety, tolerability and feasibility considerations.ResultsThe guideline covers 10 clinical sections in a question-and-answer format that maps onto the patient care journey: case identification; organization and delivery of care; non-pharmacological (lifestyle, psychosocial, psychological), pharmacological, neuromodulation and complementary and alternative medicine interventions; high-risk clinical situations; and mental health of the father or co-parent. Equity, diversity and inclusion considerations are provided.ConclusionsThis guideline's detailed evidence-based recommendations provide clinicians with key information to promote the delivery of effective and safe perinatal mental healthcare. It is hoped that the guideline will serve as a valuable tool for clinicians in Canada and around the world to help optimize clinical outcomes in the area of perinatal mental health.

A descriptive study of the timing and type of physical activity that is being resumed in early postpartum

Postpartum physical activity (PA) is an important component of the woman's health. Recently, more attention has been paid to develop guidance for safe return to PA after delivery, including return to running. Little is known about when women start PA after delivery and what type of PA they are practicing. The objectives were to (1) describe early postpartum PA (≤6 weeks), (2) compare women's characteristics between those who started any kind of PA and those who did not, and those who started and did not start running, and (3) explore predictors of PA and running. Ninety-one women, who were part of a longitudinal cohort study, were included. At 6 weeks postpartum, PA was assessed using a questionnaire. Predictors of PA and running were age, education, parity, pre-pregnancy body mass index, prenatal PA, gestational weight gain, prematurity, delivery mode, season, and breastfeeding. The Wilcoxon rank-sum test, Fischer's exact test, and logistic regression analyses were used. Eighty-five women (93%) resumed PA by 6 weeks postpartum. Walking was practiced by 92% of women for 127.0 ± 81.3 min/week. Running was the second most popular activity, practiced by 11% of women for 57.5 ± 31.8 min/week. Walking and running were started around 2.0 and 3.6 weeks after delivery, respectively. Women who delivered in spring or summer were more likely to resume PA by 6 weeks postpartum, and those who ran while pregnant had five-fold higher odds of starting to run by 6 weeks postpartum (OR:5.03, 95%CI 1.27; 19.92). These findings improve our understanding of PA practice, including running, in early postpartum.

Big-five personality traits and depression: chain mediation of self-efficacy and walking

Background

Depression is a major global public health concern, with research indicating a correlation between personality traits and depression. This study aimed to explore the potential mediating roles of self-efficacy and walking in the relationship between personality traits and depression among Chinese residents.

Methods

A cross-sectional questionnaire survey was conducted from July 10 to September 15, 2021, involving 11,031 Chinese residents across 23 provinces, 5 autonomous regions, and 4 municipalities Participants provided data on demographics, personality traits (using the Ten-Item Personality Inventory), self-efficacy (using the New General Self-Efficacy Scale), chronic disease self-management (using the Chronic Disease Self-Management Study Measures), and depression (using the Patient Health Questionnaire-9). After screening, data from 8,499 participants were analyzed. Sequential mediation models were employed, with the Big Five personality traits as predictors, depression as the outcome, and self-efficacy and walking as the mediators.

Results

Extraversion, agreeableness, conscientiousness, and emotional stability were negatively correlated with depression, with self-efficacy and walking as positive mediators in these relationships. Conversely, openness was positively associated with depression, and the self-efficacy-walking chain did not mediate this relationship but rather masked the effect of openness on depression.

Conclusions

Our findings suggest that self-efficacy and walking are significant mediators in the relationship between personality traits and depression, potentially mitigating the risk of depressive episodes.

Walking away from depression: the mediating role of walking activity in depression impacting blood glucose levels of people with diabetes or prediabetes

Introduction

Depression can exacerbate diabetes by impairing self-care behaviors and increasing the risk of complication; however, the underlying mechanism is still unclear. Given the suggested associations between walking activity, depression status, and blood glucose levels this study explores the intricate relationship between depression and blood glucose (BG) control, with a focus on walking activity as a behavioral mediator. The purpose of this study is to examine walking activity's mediating role in depression's impact on BG levels, investigating and validating the non-linear association between BG levels and walking activity. This retrospective real-world study demonstrates the potential of regular walking activity as a simple and accessible intervention to mitigate the negative effects of depression on BG levels in T2D and prediabetes.

Methods

A cohort of 989 users with T2D and prediabetes, who regularly tracked their steps levels and BG levels for 12 months using the Dario digital health platform was evaluated. The mediating role of the monthly average number of steps on the relationship between the self-reported depression status and lagged monthly average BG was assessed. Additionally, the association between monthly walking activity and monthly average BG was tested using a piecewise linear mixed effects model.

Results

Users with self-reported depression demonstrated increased BG levels compared to users without depression (B=8.00, P=.01). The association between depression and monthly average number of steps was significant (B=-.27, P<.005) and monthly average number of steps significantly predicted the following months' average BG (B=-.81, P=.001), adjusting for depression. The monthly average number of steps significantly mediated the effect of self-reported depression on the following month's average BG (M=.22, P<.005). Further sensitivity analysis demonstrated model robustness over various periods. Finally, non-linear dynamics of walking activity over time was validated using unseen data showing a decrease in monthly average BG for users with over an average of 400 steps per day (B=-1.87, P<.01).

Discussion

This study shows how regular walking may reduce the negative impact of depression on BG levels in people with T2D. Our findings advocate for the integration of walking activity into treatment protocols as a cost-effective, accessible intervention strategy to improve glycemic management and depressive symptoms in this population.

The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis

Background

Previous literature lacks summative information on the mental health benefits achieved from different forms of walking.

Objective

The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.

Methods

This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.

Results

This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).

Conclusions

Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

Development and validation of the physical exercise program "Active Mums" for postpartum recovery: application of the CReDECI-2 guidelines

Postpartum physical activity is a public health issue. Reporting on the quality of exercise interventions designs must be ensured in view of the reproducibility and successful implementation of such studies. The objective was to develop and preliminary validate a physical exercise program for postpartum recovery, aiming to promote physical fitness and health of the new mothers. The study was carried out through the three stages of development, piloting, and evaluation. The Consensus on Exercise Reporting Template (CERT) was used to describe the postpartum exercise program. The Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare (CReDECI2) was followed to develop and preliminary validate the program. A tailored postpartum exercise program was developed based on evidence-based international recommendations to be implemented by qualified exercise professionals. A pilot intervention of 16 weeks was carried out, engaging a group of postpartum women. The viability of the program was subsequently evaluated by all participants. The present work provided guidance to develop a study protocol with a larger sample in order to prove the effectiveness of a supervised postpartum exercise program on selected parameters of health.

The effects of online facial muscle training with resonance vocalization on mental health in postpartum women: A single-arm pilot study

BACKGROUND

Mental health problems among expectant and nursing mothers also affect their infants, partners, and families. While physical activity is a potential method for preventing postpartum depression (PPD), it is difficult for postpartum women to find the time for physical exercise. A recent study reported that improving communication between expectant couples can be used as a preventive intervention for PPD, and a systematic review and meta-analysis recently reported decreased facial emotional expressivity in individuals with different non-psychotic disorders. Therefore, we focused on facial muscle training and its potential as prevention for PPD.

OBJECTIVE

We evaluated the effectiveness of online facial muscle training with resonance vocalization using real-time video conferencing programs on the PPD of postpartum women at 2-3 months.

DESIGN

We recruited 20 postpartum women and used a single-arm, prospective, pre-post design.

METHODS

All subjects participated in 30 min of online facial muscle training with resonance vocalization once a week for 4 weeks. The first and final sessions were performed using a real-time remote chat application, and the second and third sessions were performed on demand. Scores on the Edinburgh Postnatal Depression Scale (EPDS) as an indicator of PPD were used as the primary outcome. Secondary outcomes included the appearance ratio of a happy facial expression, analyzed using FaceReader™; mood, which was measured using a visual analog scale; and stress level, which was measured using a smartwatch.

RESULTS

The training had a significant effect on EPDS, appearance ratio of a happy facial expression, and mood; however, it did not affect physical stress.

CONCLUSIONS

In the future, intervention studies with a higher evidence level, such as a crossover randomized controlled trial, are required.

Feasibility of a Supervised Postpartum Exercise Program and Effects on Maternal Health and Fitness Parameters-Pilot Study

The postpartum period is marked by profound changes in women at physical, psychological, and physiological levels. Many of these changes persist after four to six weeks postpartum, and most women do not resume their levels of physical activity, which increases the risk of remaining inactive for many years. It is crucial to implement effective programs that promote exercise during the postpartum period. The objective of this study was to test the feasibility and analyze the effects of a structured and supervised postpartum exercise program on maternal health and fitness parameters. To analyze the potential effects of the intervention, the level of physical activity, quality of life, pelvic girdle and low back pain, fatigue, depression, and the level of functional and physical fitness were assessed at baseline, after 8 weeks, and after 16 weeks of intervention. Feedback on the exercise program was collected after the final assessment. The results showed that a structured and supervised postpartum exercise program was feasible and safe and produced positive effects on selected maternal health and fitness parameters. These results will encourage a study protocol with a larger sample in order to prove its effectiveness, improve the guidelines for postpartum exercise, and incorporate this program into a routine healthcare setting.

Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews

OBJECTIVE

To synthesise the evidence on the effects of physical activity on symptoms of depression, anxiety and psychological distress in adult populations.

DESIGN

Umbrella review.

DATA SOURCES

Twelve electronic databases were searched for eligible studies published from inception to 1 January 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Systematic reviews with meta-analyses of randomised controlled trials designed to increase physical activity in an adult population and that assessed depression, anxiety or psychological distress were eligible. Study selection was undertaken in duplicate by two independent reviewers.

RESULTS

Ninety-seven reviews (1039 trials and 128 119 participants) were included. Populations included healthy adults, people with mental health disorders and people with various chronic diseases. Most reviews (n=77) had a critically low A MeaSurement Tool to Assess systematic Reviews score. Physical activity had medium effects on depression (median effect size=-0.43, IQR=-0.66 to -0.27), anxiety (median effect size=-0.42, IQR=-0.66 to -0.26) and psychological distress (effect size=-0.60, 95% CI -0.78 to -0.42), compared with usual care across all populations. The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals. Higher intensity physical activity was associated with greater improvements in symptoms. Effectiveness of physical activity interventions diminished with longer duration interventions.

CONCLUSION AND RELEVANCE

Physical activity is highly beneficial for improving symptoms of depression, anxiety and distress across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. Physical activity should be a mainstay approach in the management of depression, anxiety and psychological distress.

PROSPERO REGISTRATION NUMBER

CRD42021292710.

The impact of physical activity intervention on perinatal depression: A systematic review and meta-analysis

BACKGROUND

No meta-analysis has analyzed the effect of physical activity level, period of physical activity intervention, and duration of intervention, on perinatal depression. This study was to evaluate the impact of physical activity intensity, dose, period, and duration on perinatal depression.

METHODS

The literature was searched via the PubMed, Embase, Cochrane Library, and Web of Science databases. Weighted mean difference (WMD) or the risk ratio (RR) was used as the effect indicator, and the effect size was represented by the 95 % confidence interval (CI). Subgroup analysis based on the perinatal stage, physical activity intensity, physical activity equivalent, and intervention duration was performed.

RESULTS

Totally, 35 studies including 5084 women were included. Physical activity could reduce the incidence and severity of depression in perinatal women. Among depressed women with prenatal depression, low-intensity physical activity, with metabolic equivalents (METs)-min/week being <450, was associated with lower levels of depression. In the general population, the risk of postpartum depression was lower in the physical activity group when the duration of intervention was ≥12 weeks, being II, III stage, and ≥450 METs-min/week. Both low and moderate-intensity physical activity were beneficial to an improved depression severity among depressed women with postpartum depression, and moderate exercise intervention could decrease the risk of postpartum depression in general pregnant women.

LIMITATIONS

Different types of physical activities may affect the effectiveness of interventions.

CONCLUSION

Our study indicated physical activity specifically targeted at pregnant women could reduce depression risk and severity.

Relationship between seasons and postpartum depression: A systematic review and meta-analysis of cohort studies

OBJECTIVE

As the reproduction season's effect on the mental health status is unknown, this study aims to explore the association between seasons and postpartum depression.

METHODS

A comprehensive search in databases, including PubMed, Cochrane Library, and EMBASE, was performed to identify studies reporting the relationship between reproduction season and postpartum depression. The latter was assessed using certain methods. Moreover, the study design and duration, sample size, the definition of four seasons, outcome assessment, method, and conclusion were extracted. Two independent authors screened the studies independently, and PRISMA 2020 was used as the reporting standard (PRISMA registration ID is 284524).

RESULTS

A total of five studies including 103,986 participants met our criteria. In the sensitivity analysis, the result of the meta-analysis shows that women who gave birth in spring, summer, or autumn had a lower risk of postpartum depression compared to those who gave birth in winter (RR: 0.83; 95% confidence interval [CI]: 0.78-0.88).

CONCLUSION

Women who gave birth in the other seasons were less likely to have postpartum depression compared to those who gave birth in winter. This result could help couples make overall decisions and help the puerpera take preventive measures against postpartum depression.