Exercise as it relates to Disease/Exercise and postnatal depression and fatigue, how affective can it be?

What is the background to this research?
Postnatal depression (PND) and fatigue are two major common issues that occur during the postnatal period and although it is unclear exactly why this occurs it is believed to be due to a variety of reasons. Pregnancy is one of the most significant changes that occurs in adult life because you have to adapt to new major responsibility’s that can alter the social life, financial status, family rapport, occupation and can impact a woman physically, mentally and emotionally. There are a range of different approaches in dealing with treatment of PND and fatigue. This article by professor Jalil Babapoor heiroddin and colleagues at the university of Tabriz in Iran looks in to the intervention/treatment of PND and fatigue Through home-based antenatal and postnatal exercise. There are a range of studies that show the benefits of exercise on mothers suffering from perinatal depression.

Where is the research from?
This article conducted in Tabriz Iran at the Tabriz University of Medical science published in august 2013. One of the authors of This study ‘Jalil Babapoor heiroddin’ phD is a professor of psychology in the faculty of education and psychology at the university of Tabriz in Iran. He has spent many years teaching and researching the effects of exercise on PDS and recently released a paper in 2017 on “The association of exercise during pregnancy with trimester-specific and postpartum quality of life and depressive symptoms in a cohort of healthy pregnant women”4. The occupation of the other workers includes lectures, associate professor and student research committee of the midwifery department at Tabriz University.The research was financed and supported by the faculty of Research at Tabriz university medical sciences and the midwifery department at the university of Tabriz and it is unlikely there is any bias from the department as there is no commercial gain from this research.

What kind of research was this?
This research is a randomised control trial that aims to reduce certain bias by randomly allocating participants in to groups with different treatments for each group including a control group and two intervention groups. The research was dependent on a self-analysis and questionnaire that can impact the validity and reliability of the research through intrinsic and extrinsic factors

What did the research involve?
The randomised control trial was conducted on three groups of 127 women between 26-32 weeks pregnant who were not currently suffering from PDS or fatigue. Depression and fatigue were measured using the Edinburgh postnatal depression scale (EPDS ) and fatigue identification form (FIF) taken at a baseline, 1 month and two months after delivery. The mean age of women was 25 years with majority of participants being housewives. The participants were recruited from 14 public health centres in Tabriz, Iran based on their medical records. The control group were given an ordinary pre/postnatal 40-minute education session, the women in intervention group one was given a theoretical and practical educational session for 40 minutes these sessions were about the importance of exercise during pregnancy and were recommended to do 20-30 minutes of light exercise (stretching/breathing) per day. Intervention group 2 women were recommended to do the same light intensity exercise until 2 months post-delivery depending on individual capabilities. Intervention group 2 were required to exercise at least 3 times a week altering the frequency and intensity depending on their ability. The method of approach for this study had some limitations that could impact accuracy of results. This is due to the “low level of adherence” of participants with the ‘most common reason being “time management”

What were the basic results?

 * The study results show that neither scores significantly changed between the three groups. The study showed that the majority of participants had a low score in both the EPDS and FIF with a low percentage of participants scoring >13 in each group. There was no significant difference in scores between groups[1].
 * EPDS scores developed no substantial differences in mean rank among the three groups at the baseline or post-partum’.
 * Similarly, the FIF scores presented ‘no significant differences in mean rank among the three groups at baseline or 1-2 months post-partum.[1]
 * The researchers found no significant correlation between home based antenatal and post-natal exercise on the effects of PND and fatigue.
 * Although all three groups showed a slight decrease in EPDS with no significant change in the mean rank the largest decrease in scores >13 came from intervention group 2 who participated in pre-natal and post-partum exercise.

What conclusions can we take from this research?
The conclusion I have made from this research article is very similar to the researcher’s perspective in that they were right in stating that there were no significant results gathered from this study. In the methodology that was used there was no way in which the researchers could develop a definitive way of determining the affect. However, the research can be used as a stepping stone into further research on suitable exercises in the intervention of post-partum depression and fatigue. Cochrane review on ‘exercise and depression ’ state that resistance exercises or higher intensity are more effective than low intensity for treatment of PDS and fatigue. This study provides some examples of other research that show the positive affect exercise can have on PND and fatigue such as Armstrong K and colleague’s, Ko and colleagues , and Drista and colleagues. other recent research articles with similar results include Vargas-Terrones, M. and colleague’s on the positive effect of exercise programs reducing the effect of perinatal depression. Pritchett, R.V. and collegues on the affects of aerobic exercise on post-partum depression.

Practical advice
This research can provide information for a range of health practioners, researchers and also the general public such as mothers looking to broaden their knowledge in this area of health.
 * Mothers struggling with or worried about PND and fatigue should include exercise into their daily or weekly routine., not only does exercise assist with boosting serotonin levels and aiding in reducing PDS and fatigue it also has many health benefits.
 * Exercise recommendations vary depending on a mother’s situational circumstances (i.e. c-section/regular birth, time management, location and severity of fatigue.
 * Group exercise settings such as pram walking has proven to be highly effective for mothers experiencing PND and fatigue.
 * For researchers that are interested in further research of this study another randomised controlled clinical trial would best develop evidence on the relationship between exercise and postnatal depression. The most affective approach would involve a control group (PDS & fatigue non exercise) to be compared with intervention group (PDS & fatigue who participate in exercise program). Both control and intervention group should have similar pre-natal activity levels and similar situational circumstances. This study could be repeated with different exercises noting volume and intensity to increase knowledge on the affect it can have.

Further information/resources
Information for further research
 * Beyond blue https://healthyfamilies.beyondblue.org.au/pregnancy-and-new-parents/maternal-mental-health-and-wellbeing/depression
 * Postnatal depression information https://www.babycenter.com.au/a557236/postnatal-depression-pnd

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