Exercise as it relates to Disease/Exercise as it relates to Disease/Benefits of pram-walking to reduce symptoms of postnatal depression

This is an analysis of the Journal article 'the Effectiveness of a Pram-walking Exercise Programme in Reducing Depressive Symptomatology for Postnatal Women'. It was a study conducted by K. Armstrong et al. in 2004 and found in the International Journal of Nursing Practice, 10; 177-194.

Background
It is well known that exercise can relieve stress and increase people’s overall health and well-being and mental health is no exception. There are countless studies that support the theory that physical activity plays a major role in the reduction of depression-related symptoms. Some of the ways that exercise is thought to improve psychological well-being include biological mechanisms such as endorphin release, decreased amount of cortisol released in response to stress and an overall increase in fitness. There are also behavioural and personal factors believed to be associated with improved mental health such as an increased sense of self-worth and a better level of social support. Post-natal depression (PND) is no different when it comes to using physical activity as a form of treatment due to these benefits.

PND is a form of depression affecting 12-15% of women shortly after giving birth. It is common to experience conditions such as extreme tiredness, irritability and mood swings after giving birth. However, women diagnosed with PND experience these symptoms for an abnormal duration or some of a higher severity such as difficulty breastfeeding, or fear of not caring for the baby, resulting in a depressive state specific to PND. The following study, conducted by K. Armstrong and H. Edwards in 2004, examines women with PND and how a pram-walking exercise program could potentially relieve the symptomatology associated with the disease.

About the Research
This study was a randomised, controlled study lead by two PhD students at the Queensland University of Technology in 2004. It was conducted over a 12 week period and compared two groups of women with PND and investigates how their depressive symptoms changed in relation to what activity they were subject to.

Procedure
The 24 participants, who all had at least one child between 6 weeks and 18 months of age and have an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or above were recruited from around the Gold Coast, Australia. They were then split into a pram-walking group or a social support group. Prior to the two groups beginning their programs, their fitness was tested using the Cornish Walking Wheel to determine their Vo2 max, their levels of depression was assessed using the EPDS and other measures such as age, height, weight, marital status, income and number of children were also recorded. The pram walking group were invited to attend two 40 minute session a week, performed at a moderate intensity, maintaining heart rate levels at 60-75% of their age predicted max heart rate. The pram-walking programme was exclusive to the women in the pram-walking group whereas both groups of women were invited to attend the social support sessions. The social support sessions were held once a week at a community centre that provided an environment much similar to a daycare where both mothers and children could attend Although these sessions were not structured, mothers were encouraged to talk to and seek support from the other mothers in the group. Both of these programs proceeded for 12 weeks.

Results
Due to five women pulling out of the study, data was collected for 19 participants; nine pram walkers and 10 in the social group. All demographic results were similar at the combined attendance rate from both groups was 74%, with the main reason women did not attend sessions being child-related. The basic results from the study support the statement that frequent physical activity can be implemented to reduce symptoms of post-natal depression, and the pram-walking group increased their Vo2 max, whereas the average Vo2 max from the social support group decreased. After analyzing the data, the researchers interpreted that a positive correlation between exercise and depression exists and more specifically, a positive correlation between a pram-walking program and PND.

Implications and limitations
This research suggests that physical activity, especially pram-walking, could be a suitable method to aid in the treatment of PND. Therefore, more exercise intervention programs should be designed and implemented to aid the reduction of PND symptoms. Such programs should be promoted at hospitals, obstetrician's clinics and infant health centres. This study could also be used to further assess the influence of physical activity on other types of depression. However, due to the small sample of the study and the limited number of similar studies, it should be understood that exercise interventions should currently only be used in conjunction with other treatments such as medication and therapy under specialists' supervision. With further research on this topic, using physical activity as a form of treatment has major potential to relieve PND patients of their symptoms. Nevertheless, there are a few limitations to this kind of research. It may be difficult for women to attend the sessions due to the new demands of having a young infant to care for. That said, it is challenging to recruit an adequate amount of postnatal women to collect larger data sets, which would result in more reliable studies. Also, due to smaller sample sizes, it becomes harder to generalise for all postnatal women, therefore less accurate to suggest that physical activity could be used to treat the whole of the targeted population.

Conclusion
There is still a lot of research to be done on physical activity’s affect on PND, so it should not be used as the primary, or only, form of treatment at present. As the research suggests, it is able to be conjunction with medication and/or therapy, until the outcomes of this research topic becomes reliable