Skip to main content
Springer Nature Link
Log in

The effectiveness of exercise-based interventions for preventing or treating postpartum depression: a systematic review and meta-analysis

  • Review Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

Postpartum depression can have detrimental effects on both a mother’s physical and mental health and on her child’s growth and emotional development. The aim of this study is to assess the effectiveness of exercise/physical activity-based interventions in preventing and treating postpartum depressive symptoms in primiparous and multiparous women to the end of the postnatal period at 52 weeks postpartum. Electronic databases were searched for published and unpublished randomised controlled trials of exercise/physical activity-based interventions in preventing and treating depressive symptoms and increasing health-related quality of life in women from 4 to 52 weeks postpartum. The results of the studies were meta-analysed and effect sizes with confidence intervals were calculated. The Grading of Recommendations Assessment and Development and Evaluation (GRADE) system was used to determine the confidence in the effect estimates. Eighteen trials conducted across a range of countries met the inclusion criteria. Most of the exercise interventions were aerobic and coaching compared to usual care, non-intervention and active controls. Small effect sizes of exercise-based interventions in reducing depressive symptoms were observed collectively and the quality of evidence was low across the individual studies. Although exercise-based interventions could create an alternative therapeutic approach for preventing major depression in postpartum women who experience subthreshold elevated depressive symptoms, the clinical effectiveness and the cost-effectiveness of exercise-based and physical activity interventions need to be better established. There is a need for further more rigorous testing of such interventions in high-quality randomised controlled trials against active control conditions before large-scale roll-out of these interventions in clinical practice is proposed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  • Armstrong K, Edwards H (2003) The effects of exercise and social support on mothers reporting depressive symptoms: a pilot randomized controlled trial. Int J Mental Health Nurs 12(2):130–138

    Article  Google Scholar 

  • Armstrong K, Edwards H (2004) The effectiveness of a pram-walking exercise programme in reducing depressive symptomatology for postnatal women. Int J Nurs Pract 10(4):177–194

    Article  Google Scholar 

  • Austin MP, Hadzi-Pavlovic D, Priest SR, Reilly N, Wilhelm K, Saint K, Parker G (2010) Depressive and anxiety disorders in the postpartum period: how prevalent are they and can we improve their detection? Arch Womens Ment Health 13(5):395–401. https://doi.org/10.1007/s00737-010-0153-7

    Article  PubMed  Google Scholar 

  • Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S et al (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 64(4):401–406

    Article  Google Scholar 

  • Bauer A, Parsonage M, Knapp M, Lemmi V, Bayo A (2014) Costs of perinatal mental health problems. London School of Economics and Political Science, London

    Google Scholar 

  • Borenstein M, Hedges L, Higgins J, Rothstein H (2009) Introduction to meta-analysis. Wiley, Chichester

    Book  Google Scholar 

  • Buttner MM, Brock RL, O'Hara MW, Stuart S (2015) Efficacy of yoga for depressed postpartum women: a randomized controlled trial. Complement Ther Clin Pract 21(2):94–100. https://doi.org/10.1016/j.ctcp.2015.03.003

    Article  PubMed  Google Scholar 

  • Campolong K, Jenkins S, Clark MM, Borowski K, Nelson N, Moore KM, Bobo WV (2017) The association of exercise during pregnancy with trimester-specific and postpartum quality of life and depressive symptoms in a cohort of healthy pregnant women. Arch Womens Ment Health. https://doi.org/10.1007/s00737-017-0783-0

  • Carter T, Morres ID, Meade O, Callaghan P (2016) The effect of exercise on depressive symptoms in adolescents: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 55(7):580–590. https://doi.org/10.1016/j.jaac.2016.04.016

    Article  PubMed  Google Scholar 

  • Carter T, Morrell J, Bastounis A, Guo B, Callaghan P (2017) Systematic review and meta-analysis of exercise interventions for preventing or treating postpartum depression. PROSPERO CRD42017068376. Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017068376.

  • Centre for Reviews and Dissemination (2009) Systematic reviews: CRD's guidance for undertaking reviews in health care. University of York, Centre for Reviews & Dissemination.

  • Claesson IM, Klein S, Sydsjo G, Josefsson A (2014) Physical activity and psychological well-being in obese pregnant and postpartum women attending a weight-gain restriction programme. Midwifery 30(1):11–16. https://doi.org/10.1016/j.midw.2012.11.006

    Article  PubMed  Google Scholar 

  • Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, Mead GE (2013) Exercise for depression. Cochrane Database Syst Rev 9:CD004366. https://doi.org/10.1002/14651858.CD004366.pub6

    Article  Google Scholar 

  • Da Costa D, Lowensteyn I, Abrahamowicz M, Ionescu-Ittu R, Dritsa M, Rippen N et al (2009) A randomized clinical trial of exercise to alleviate postpartum depressed mood. J Psychosom Obstet Gynaecol 30(3):191–200. https://doi.org/10.1080/01674820903212136

    Article  PubMed  Google Scholar 

  • Daley AJ, Winter H, Grimmett C, McGuinness M, McManus R, MacArthur C (2008) Feasibility of an exercise intervention for women with postnatal depression: a pilot randomised controlled trial. Br J Gen Pract 58(548):178–183. https://doi.org/10.3399/bjgp08X277195

    Article  PubMed  PubMed Central  Google Scholar 

  • Daley AJ, Blamey RV, Jolly K, Roalfe AK, Turner KM et al (2015) A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial. Psychol Med 45(11):2413–2425. https://doi.org/10.1017/S0033291715000409

    Article  CAS  PubMed  Google Scholar 

  • Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634. https://doi.org/10.1136/bmj.315.7109.629

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Falah-Hassani K, Shiri R, Dennis CL (2016) Prevalence and risk factors for comorbid postpartum depressive symptomatology and anxiety. J Affect Disord. 198:142–147

    Article  Google Scholar 

  • Farias-Antunez S, Xavier MO, Santos IS (2017) Effect of maternal postpartum depression on offspring's growth. J Affect Disord 228:143–152. https://doi.org/10.1016/j.jad.2017.12.013

    Article  PubMed  Google Scholar 

  • Fazzi C, Saunders DH, Linton K, Norman JE, Reynolds RM (2017) Sedentary behaviours during pregnancy: a systematic review. Int J Behav Nutr Phys Act 14(1):32. https://doi.org/10.1186/s12966-017-0485-z

    Article  PubMed  PubMed Central  Google Scholar 

  • Field T (2018) Postnatal anxiety prevalence, predictors and effects on development: a narrative review. Infant Behav Dev. 51:24–32

    Article  Google Scholar 

  • Forsyth J, Boath E, Henshaw C, Brown H (2017) Exercise as an adjunct treatment for postpartum depression for women living in an inner city—a pilot study. Health Care Women Int 38(6):635–639. https://doi.org/10.1080/07399332.2017.1295049

    Article  PubMed  Google Scholar 

  • Gaston A, Cramp A (2011) Exercise during pregnancy: a review of patterns and determinants. J Sci Med Sport 14(4):299–305. https://doi.org/10.1016/j.jsams.2011.02.006

    Article  PubMed  Google Scholar 

  • Guyatt GH, Oxman AD, Vist GE Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. https://doi.org/10.1136/bmj.39489.470347.AD

    Article  PubMed  PubMed Central  Google Scholar 

  • Haruna M, Watanabe E, Matsuzaki M, Ota E, Shiraishi M, Murayama R, Yeo S (2013) The effects of an exercise program on health-related quality of life in postpartum mothers: a randomized controlled trial. Health 05(03):432–439. https://doi.org/10.4236/health.2013.53058

    Article  Google Scholar 

  • Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Sterne JAC (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343. https://doi.org/10.1136/bmj.d5928

  • Keller C, Ainsworth B, Records K, Todd M, Belyea M, Vega-López S et al (2014) A comparison of a social support physical activity intervention in weight management among post-partum Latinas. BMC Public Health 14(1):971. https://doi.org/10.1186/1471-2458-14-971

    Article  PubMed  PubMed Central  Google Scholar 

  • LeCheminant JD, Hinman T, Pratt KB, Earl N, Bailey BW, Thackeray R, Tucker LA (2014) Effect of resistance training on body composition, self-efficacy, depression, and activity in postpartum women. Scand J Med Sci Sports. 24(2):414–421

    Article  CAS  Google Scholar 

  • Lewis BA, Gjerdingen DK, Avery MD, Sirard JR, Guo H, Schuver K, Marcus BH (2014) A randomized trial examining a physical activity intervention for the prevention of postpartum depression: the healthy mom trial. Ment Health Phys Act 7(1):42–49. https://doi.org/10.1016/j.mhpa.2013.11.002

    Article  Google Scholar 

  • Matthey S (2004) Calculating clinically significant change in postnatal depression studies using the Edinburgh Postnatal Depression Scale. Journal of Affective Disorders 78(3):269–272. https://doi.org/10.1016/s0165-0327(02)00313-0

    Article  PubMed  Google Scholar 

  • McCurdy AP, Boule NG, Sivak A, Davenport MH (2017) Effects of exercise on mild-to-moderate depressive symptoms in the postpartum period: a meta-analysis. Obstet Gynecol 129(6):1087–1097. https://doi.org/10.1097/aog.0000000000002053

    Article  PubMed  Google Scholar 

  • Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339. https://doi.org/10.1136/bmj.b2535

  • Morrell CJ, Slade P, Warner R, Paley G, Dixon S, Walters SJ, Brugha T, Barkham M, Parry G, Nicholl J (2009a) Clinical effectiveness of health visitor training in psychologically informed approaches for depression in postnatal women—pragmatic cluster randomised trial in primary care. BMJ 338:a3045

    Article  Google Scholar 

  • Morrell CJ, Warner R, Slade P, Dixon S, Walters S, Paley G, Brugha T (2009b) Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation. The PoNDER trial. Health Technol Assess 13(30):1–153

    Article  Google Scholar 

  • Morrell CJ, Sutcliffe P, Booth A, Stevens J, Scope A, Stevenson M et al (2016) A systematic review, evidence synthesis and meta-analysis of quantitative and qualitative studies evaluating the clinical effectiveness, the cost-effectiveness, safety and acceptability of interventions to prevent postnatal depression. Health Technol Assess 20(37)

  • National Institute for Health and Care Excellence (2014) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]. Retrieved from https://www.nice.org.uk/guidance/cg192

  • Norman E, Sherburn M, Osborne RH, Galea MP (2010) An exercise and education program improves well-being of new mothers: a randomized controlled trial. Phys Ther 90(3):348–355. https://doi.org/10.2522/ptj.20090139

    Article  PubMed  Google Scholar 

  • Pope CJ, Xie B, Sharma V, Campbell MK (2013) A prospective study of thoughts of self-harm and suicidal ideation during the postpartum period in women with mood disorders. Arch Womens Ment Health 16(6):483–488. https://doi.org/10.1007/s00737-013-0370-y

    Article  PubMed  Google Scholar 

  • Poyatos-Leon R, Garcia-Hermoso A, Sanabria-Martinez G, Alvarez-Bueno C, Cavero-Redondo I, Martinez-Vizcaino V (2017) Effects of exercise-based interventions on postpartum depression: a meta-analysis of randomized controlled trials. Birth 44(3):200–208. https://doi.org/10.1111/birt.12294

    Article  PubMed  Google Scholar 

  • Pritchett RV, Daley AJ, Jolly K, (2017) Does aerobic exercise reduce postpartum depressive symptoms? a systematic review and meta-analysis. British Journal of General Practice 67 (663):e684-e691

  • Putnam KT, Wilcox M, Robertson-Blackmore E, Sharkey K, Bergink V et al (2017) Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium. Lancet Psychiatry. 4(6):477–485

    Article  Google Scholar 

  • Robichaud KP (2009) The effects of an exercise intervention on the psychological well-being of postpartum women. Diss Abstr Int: Section B: Sci Eng 69(7-B):4124

    Google Scholar 

  • Ryan R, Hill S (2016). How to GRADE the quality of the evidence. Cochrane Consumers and Communication Group. Retrieved from http://cccrg.cochrane.org/author-resources.

  • Saeedi S (2013) Effect of exercise program on symptoms of postpartum depression. Iran J Obstet, Gynecol Infertility 15(34):26–31

    Google Scholar 

  • Saligheh M, Hackett D, Boyce P, Cobley S (2017) Can exercise or physical activity help improve postnatal depression and weight loss? A systematic review. Arch Womens Ment Health 20(5):595–611. https://doi.org/10.1007/s00737-017-0750-9

    Article  PubMed  Google Scholar 

  • Schunemann H, Oxman A, Higgins J, Vist, G, Glasziou P, Guyatt G, & on behalf of the Cochrane Applicability and Recommendations Methods Group and the Cochrane Statistical Methods Group. (2008). Presenting results and ‘Summary of findings’ tables. In J. Higgins & S. Green (Eds.), Cochrane handbook for systematic reviews of interventions. Cochrane book series. Chichester: Wiley-Blackwell.

  • Shelton S (2015) Postpartum depressive symptoms: a study of influencing factors and an intervention for improvement. Dissertation, Georgia State University.

  • StataCorp (2015) Stata statistical software: release 14. College Station, TX: StataCorp LP.

  • Sterne J, Egger M, Moher D (2008) Chapter 10: addressing reporting biases. In: Higgins J, Green S (eds) Cochrane handbook for systematic reviews of interventions, Cochrane book series. Wiley-Blackwell, Chichester, UK

    Google Scholar 

  • Surkan PJ, Gottlieb BR, McCormick MC, Hunt A, Peterson KE (2012) Impact of a health promotion intervention on maternal depressive symptoms at 15 months postpartum. Matern Child Health J 16(1):139–148. https://doi.org/10.1007/s10995-010-0729-x

    Article  PubMed  Google Scholar 

  • Teychenne M, York R (2013) Physical activity, sedentary behavior, and postnatal depressive symptoms: a review. Am J Prev Med 45(2):217–227. https://doi.org/10.1016/j.amepre.2013.04.004

    Article  PubMed  Google Scholar 

  • Thiruppathi A, Prasana B, Mastaniah E, Vamsidhar N, Himabindu P (2014) A structured physical activity and health care education beats postpartum depression for primipara mothers: a pilot randomized controlled trial. Int J Physiother 1(3):144. https://doi.org/10.15621/ijphy/2014/v1i3/53468

    Article  Google Scholar 

  • Turner KM, Sharp D, Folkes L, Chew-Graham C, (2008) Women's views and experiences of antidepressants as a treatment for postnatal depression: a qualitative study. Family Practice 25 (6):450-455

  • Wisner KL, Sit DK, McShea MC, Rizzo DM et al (2013) Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 70(5):490–498. https://doi.org/10.1001/jamapsychiatry.2013.87

    Article  PubMed  PubMed Central  Google Scholar 

  • World Health Organisation (WHO) 2017 Maternal mental health. WHO http://www.who.int/mental_health/maternal-child/maternal_mental_health/en/. Accessed 02 February 2018.

  • Yang CL, Chen CH (2018) Effectiveness of aerobic gymnastic exercise on stress, fatigue, and sleep quality during postpartum: a pilot randomized controlled trial. Int J Nurs Stud 77:1–7. https://doi.org/10.1016/j.ijnurstu.2017.09.009

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was funded by the Nottingham City Clinical Commissioning Group’s National Institute for Health Research Capability Funding

Author information

Authors and Affiliations

  1. University of Nottingham, Nottingham, UK

    Tim Carter, Anastasios Bastounis, Boliang Guo & C Jane Morrell

Authors
  1. Tim Carter
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Anastasios Bastounis
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Boliang Guo
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. C Jane Morrell
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Tim Carter.

Ethics declarations

Conflict of Interest

Tim Carter, Anastasios Bastounis, Boliang Guo and C Jane Morrell declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Carter, T., Bastounis, A., Guo, B. et al. The effectiveness of exercise-based interventions for preventing or treating postpartum depression: a systematic review and meta-analysis. Arch Womens Ment Health 22, 37–53 (2019). https://doi.org/10.1007/s00737-018-0869-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-018-0869-3

Keywords