The Effect of Exercise on Preventing PostPartum Depression

Recent estimates indicate that approximately 10-15% of women giving birth experience
depression during the postpartum period (Dietz et al., 2007; Gaven et al., 2005). Research
indicates that psychological interventions are efficacious for treating postpartum
depression (Dennis & Hodnett, 2007). However, it is important to also focus on the
prevention of postpartum depression given many women do not seek treatment (Dennis &
Chung-Lee, 2006) and those who do seek treatment may have already experienced negative
consequences related to depression including cessation of breastfeeding and poor
maternal-child bonding (Dennis & McQueen, 2007; Murray et al., 1999). Unfortunately,
research indicates that psychological interventions are not efficacious in the prevention of
postpartum depression among women at risk for postpartum depression (for a review see Dennis
& Creedy, 2004). Consequently, there is a need to test new and innovative interventions for
the prevention of postpartum depression. Exercise interventions have been shown to be
effective for the treatment of depression among adults and therefore, this intervention may
be efficacious in the prevention of postpartum depression. The purpose of the present pilot
study is to examine the feasibility of recruiting and retaining participants at risk for
postpartum depression for a randomized trial examining an exercise intervention for the
prevention of postpartum depression. We will also examine the preliminary efficacy of the
exercise intervention on the prevention of postpartum depression. Specifically, 120
sedentary, healthy pregnant women who have a history of at least one depressive episode
and/or have a maternal family history of depression will be recruited from various ObGyn
clinics, psychiatry clinics, and via advertisements. Once the potential participants
receive healthcare provider consent to exercise (approximately two weeks following a vaginal
delivery and four weeks following a c-section), participants will then be randomly assigned
to either an exercise intervention or a health and wellness contact control condition. The
exercise condition will consist of telephone-based counseling sessions designed to motivate
postpartum women to become physically active. This theory-based intervention will be based
on interventions shown to be effective in previous studies. The contact control condition
will consist of scheduled telephone sessions with a health educator on issues related to
health and wellness (e.g., stress reduction, sleep, nutrition). The specific aims of the
study will be 1) to determine the feasibility of recruiting and retaining pregnant and
postpartum women for an exercise intervention trial and 2) to determine the effect of a
home-based behavioral exercise intervention on depression (as measured by the Structured
Clinical Interview for DSM-IV Axis I Disorders; SCID-I and the PHQ-9) among postpartum
women. Physical activity adherence will be assessed using the 7-Day Physical Activity
Recall Interview (Blair et al., 1985) and accelerometers (i.e., an objective assessment of
physical activity).

Inclusion Criteria:

- We will recruit healthy, sedentary (defined as exercising 60 minutes or less per
week) women who are at least 18 years of age and at least 28 weeks pregnant or less
than one month postpartum (n=120). Participants will be required to obtain written
consent from their healthcare provider to participate. This written consent will be
obtained following delivery of the newborn. Participants will complete a telephone
screening interview to assess eligibility. Current depressive episode will be
assessed using the PHQ-9 (cut-off will be 10 or higher). As we have done in previous
trials, we will have a protocol in place that deals with participants expressing
suicidal ideation ranging from referring them to their healthcare provider and/or
calling emergency assistance, depending on intent. To be included, participants must
be willing to be randomly assigned to either of the two study arms. Additionally,
participants will read and sign a consent form approved by the University of
Minnesota and have all of their questions will be answered prior to participating.

Exclusion Criteria:

- No healthcare provider consent to participate

- Pre-existing hypertension or diabetes

- Current participation in exercise (defined as exercising 60 or more minutes per week)

- Currently enrolled in another exercise or weight management study

- Less than 18 years of age

- Another member of household participating in the study

- Unable to speak, comprehend, read, or write fluently in the English language

- Unable to walk for 30 minutes continuously

- Musculoskeletal problems such as arthritis, gout, osteoporosis, or back, hip or knee
pain that may interfere with exercising

- Exercise-induced asthma

- Any condition that would make exercise unsafe or unwise

- Taking medication that interferes with heart rate response to exercise such as beta
blockers

- Hospitalization for a psychiatric disorder in the past six months

- Current depressive episode and/or currently receiving antidepressant medication or
psychotherapy for depression (those who are depressed and who are not in treatment
will be referred to their physician or psychiatrist for follow-up care)

In addition to the initial exclusion criteria listed above, we will withdraw the exercise
intervention and instruct the participant to contact their healthcare provider if the
participant develops a medical issue in which exercise would be unsafe.