Exercise reduces the risk of Post-natal depression

Hamstring stretch with side body stretch and tricep extension.

WHAT IS POST-NATAL DEPRESSION (PND)?

Post-natal depression (PND) is a very common mental health condition affecting women after childbirth. Some studies have shown that up to 13% of mothers suffer from PND, with mothers being at greatest risk of developing PND within the first three months after childbirth (Dennis., 2005; Norman, et al., 2010). PND is caused by a number of variables. Aside from hormonal changes that affect the limbic system and other regions in the brain responsible for our mental health, there are also psychosocial factors that affect how we feel. These might include weight gain, sleep deprivation, changes in lifestyle, lack of social support, stress, and perceived sense of control (Pivarnack, et al., 2006).

Along with Psychotherapy, exercise is a proven effective treatment that helps to reduce symptoms of PND but also reduce the risk of developing PND. Exercise has positive impacts on self-esteem, physical strength, weight-loss and improving energy levels. Regular exercise also improves sleep, reduces stress and improves general wellbeing. Many of the studies which currently examine the impact of exercise on PND use the Edinburgh Postnatal Depression Scale (EPDS) to evaluate mental health of mothers. The EPDS is a validated questionnaire used to evaluate how you have been feeling and can be used during pregnancy and after.

Edinburgh Postnatal Depression Scale EPDS

The questionnaire asks you to select the most appropriate answer that represents how you have been feeling over the past seven days. Answers may include ‘all the time, some of the time, not very often, and not at all’. You can link to the questionnaire by clicking on the heading above. Below are the questions that are asked in the questionnaire.

  1. I have been able to laugh and see the funny side of things.
  2. I have looked forward with enjoyment to things.
  3. I have blamed myself unnecessarily when things go wrong.
  4. I have been anxious or worried for no good reason.
  5. I have felt scared or panicky for no good reason.
  6. Things have been getting on top of me.
  7. I have been so unhappy that I have had difficulty sleeping.
  8. I have felt sad or miserable.
  9. I have been so unhappy that I have been crying.
  10. The thought of harming myself has occurred to me.

If after reading this information you are beginning to wonder if you suffer symptoms of PND, I would urge you to seek a professional opinion from your doctor. Beyond Blue, the Australian charitable foundation dedicated to helping those with depression and anxiety, offer many resources for clinicians and the general public.

You can take the test if this is something you’d prefer to do before seeking help. It’s also a good way to understand what some of the signs of post-natal depression are so that you can monitor your mental health. It is not a diagnostic tool but rather a screening test for the risk factors in developing PND. The international cut-off score is 13 (out of 30) for depression, but many publications suggest that a score above 9–10 should warrant further review and assessment from a trained medical practitioner.

While exercise is effective in reducing the risk of developing postnatal depression, the most “promising intervention is the provision of intensive, professionally based postpartum support” (Dennis, 2005, p.1). If you feel that you are experiencing symptoms of PND or now recognise that a close friend or relative might be, reach out for support from your doctor or treating healthcare practitioner. Mothers who develop PND are at much higher risk of future episodes and it also has an impact on child development through impairment of the mother-child bond. PND is not something to be ignored or overlooked.

EXERCISE & POSTNATAL DEPRESSION

The reason I’ve chosen to write a section on postnatal depression is to draw attention to the signs and symptoms of PND and to discuss briefly how exercise is used as a treatment of postnatal depression.

In 2010 a study was published by Physical Therapy, and it was the first high quality research trial to demonstrate how exercise reduces the risk of developing postnatal depression. It was a study conducted in Melbourne, Australia, that looked at the impact of an 8-week supervised exercise program combined with education for new mothers, compared to education alone. The participants were healthy mothers with no history of mental health conditions. The program consisted of 1 hour a week of exercise combined with 30 minutes of education about toys, baby massage, nutrition for mothers and other topics. The results were extremely positive. They showed that the number of women identified ‘at risk’ of developing PND reduced by 50% in the group that had exercise and education. What this means is that exercise has a very positive impact on mental health and physical wellbeing (Norman, Sherburn, Osborn, & Galea., 2010).

As motivated as you might be to exercise at home, please never forget the importance of surrounding yourself with a social network. The most ideal situation is to be involved in a group exercise class that allows for babies to be present, mothers to interact and socialise, while learning about safe and suitable exercises after child birth. A Japanese study found that one of the biggest risk factors for developing PND is social isolation. This study showed that 72% of Japanese mothers stay home with their children which results in a degree of social isolation (Hurana., 2013) . One of the major benefits of a post-pregnancy mothers group or exercise program is the ability to connect mothers and provide an exercise environment where babies are welcome too.

Personally, I’ve witnessed the positive impact of this program design. For the study by Norman et al (2010) I was one of the therapists guiding this program for several months during my Women’s health rotation at the Angliss Hospital, Ferntree Gully. It was encouraging to see so many mothers transform over the eight weeks and they all left the program with valuable knowledge and skills for running their individual and independent exercise. Many of the months stayed in contact and would run their exercise groups long after they finished the program. Many of the exercises that I use in my Women’s health programs today, come from the experience I gained while teaching on this program.

Participation in regular exercise has such a positive impact on physical and mental health. Hopefully the information presented here reinforces how important it is. If you don’t know where to start, try going for regular walks for 30 minutes or more at least 3–4 days a week. In total you should aim for 150 minutes of exercise per week. It is not always easy to participate in a regular group exercise program, not matter how much you may wish to, but that doesn’t stop you from being able to exercise at home. Below are a few suggested exercises that can be done at home.

This information is part of the educational component of HEY FIT MAMA — a online educational and fitness program for women during pregnancy and in the early post-partum stages. For more information on exercise during pregnancy and workout ideas check out www.heyfitmama.com

Sian :)

Swiss ball bridge: Start with your feet on the ball and legs straight. Squeeze and lift your pelvic floor muscles and then squeeze your bottom to lift your hips of the floor.
Opposite arm and leg extensions: Start with your arms lifted towards the ceiling. Engage your pelvic floor muscles and raise one leg, then the other into table-top position. The slowly extend one leg and the opposite arm above your head keeping control of your pelvic floor and trying not to let your back raise up off the floor.
Shoulder press: Sitting on the ball (or chair) and using weights or theraband reaching your arms forward and above your head to strengthen the front and top of your shoulders.
Side balance with leg raise: Such a fun balance exercise that strengthens the side of your stomach and hip. Balance over the side of the ball as seen here and try not to lean too much on the ball. If you balance is good you can perform leg raises to strengthen your buttock at the same time.
Clam with theraband: This is quite an advanced version of the ‘clam’ as both feet are raised and the legs are resisted with a theraband. The main aim is to engage your pelvic floor, then squeeze your heels together to feel the muscles behind your hip engage. These are the deep hip rotators and very important for hip and pelvic stability.
Reverse wheelbarrow: Such a great exercise for strengthening your stomach muscles without having to do a crunch. Balance on the ball with your elbows in a kneeling plank position. If you’re looking for more, roll the ball forwards and backwards to challenge your plank stability. Make sure you tuck your tailbone underneath to begin with as this will help target the abdominal muscles.
Hamstring stretch: This hamstring stretch uses the theraband so that you can still sit up straight and keep your lower back is a safe position. Hamstring flexibility is so important for the way we bend and move, particularly if you’re lifting a baby up and down all day.
Tricep dip: Knees bend or legs straight depends on how strong you feel. As you bend your elbows to lower into the dip make sure your shoulders don’t round forward. Really squeeze your triceps to push yourself back up again, as this helps to reduce pressure through the wrist and target the exercise to where its needed.
Simple floor plank: Can been done on knees or with legs straight. Make sure your hands are under your shoulders, push yourself away from the floor to prevent collapsing through your elbows and shoulders. I like to create a ‘tug of war’ by pushing my arms forward and feet backwards and imagine I’m lengthening my entire body.
Foam roller gluteal stretch: Whether you use a ball, foam roller or just the stretch, keeping your gluteal muscles flexible is so important for the function of your hip and back. I love the ball and roller as it allows me to sink into any super tight spots and work through the trigger points.

REFERENCES.

Artal, R., & O’Toole, M. (2003). Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British journal of sports medicine, 37(1), 6–12.

Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British journal of psychiatry, 150(6), 782–786.

Dennis, C. L. (2005). Psychosocial and psychological interventions for prevention of postnatal depression: systematic review. Bmj, 331(7507), 15.

Eberhard‐Gran, M., Eskild, A., Tambs, K., Opjordsmoen, S., & Ove Samuelsen, S. (2001). Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatrica Scandinavica, 104(4), 243–249.

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,5(03), 432.

Norman, E., Sherburn, M., Osborne, R. H., & Galea, M. P. (2010). An exercise and education program improves well-being of new mothers: a randomized controlled trial. Physical Therapy, 90(3), 348–355.

Rice, M. J., Records, K., & Williams, M. (2001). Postpartum depression: Identification, treatment, and prevention in primary care. The Clinical Letter for Nurse Practitioners, 5, 1–4.

Pivarnik, J. M., Chambliss, H. O., Clapp, J. F., Dugan, S. A., Hatch, M. C., Lovelady, C. A., … & Williams, M. A. (2006). Impact of physical activity during pregnancy and postpartum on chronic disease risk. Medicine & Science in Sports & Exercise, 38(5), 989–1006.

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