Effects of Exercise on Mild-to-Moderate Depressive Symptoms in the Postpartum Period A Meta-analysis

OBJECTIVE: To examine the influence of exercise on depressive symptoms and the prevalence of depression in the postpartum period. DATA SOURCES: A structured search of MEDLINE, EMBASE, CINAHL, Sport Discus, Ovid's All EBM Reviews, and ClinicalTrials.gov databases was performed with dates from the beginning of the databases until June 16, 2016. The search combined keywords and MeSH-like terms including, but not limited to, "exercise," "postpartum," "depression," and "randomized controlled trial." METHODS OF STUDY SELECTION: Randomized controlled trials comparing postpartum exercise (structured, planned, repetitive physical activity) with the standard care for which outcomes assessing depressive symptoms or depressive episodes (as defined by trial authors) were assessed. Trials were identified as prevention trials (women from the general postpartum population) or treatment trials (women were classified as having depression by the trial authors). Effect sizes with 95% confidence intervals (CIs) were calculated using Hedges'g method and standardized mean differences in postintervention depression outcomes were pooled using a random-effects model. TABULATION, INTEGRATION, AND RESULTS: Across all 16 trials (1,327 women), the pooled standardized mean difference was 20.34 (95% CI 20.50 to 20.19, I2537%), suggesting a small effect of exercise among all postpartum women on depressive symptoms. Among the 10 treatment trials, a moderate effect size of exercise on depressive symptoms was found (standardized mean difference -0.48, 95% CI -0.73 to -0.22, I-2=42%). In six prevention trials, a small effect (standardized mean difference -0.22, 95% CI -0.36 to -0.08, I-2=2%) was found. In women with depression preintervention, exercise increased the odds of resolving depression postintervention by 54% (odds ratio 0.46, Mantel-Haenszel method, 95% CI 0.25-0.84, I-2=0%). The trials included in this meta-analysis were small and some had methodologic limitations. CONCLUSION: Light-to-moderate intensity aerobic exercise improves mild-to-moderate depressive symptoms and increases the likelihood that mild-to-moderate depression will resolve.