Utility of an outdoor group exercise program for improving postpartum mental health
DOI:
https://doi.org/10.14288/hfjc.v15i1.807Keywords:
Physical Activity, Mothers, COVID-19, Self-Efficacy, Anxiety, DepressionAbstract
Background: Rates of anxiety in postpartum women are higher than those in women from the general population. Physical activity is known to be an effective therapy for treating anxiety and depression and may be beneficial for new moms. Purpose: We determined the effect of an 8-week outdoor group exercise intervention on postpartum mental health, exercise self-efficacy, and exercise motivation. Methods: In this non-randomized study, 19 women less than 9 months postpartum participated in a bi-weekly outdoor group exercise program for 8 weeks. The group exercise intervention was a 45-minute group fitness class, TONETM, created by Les Mills International. Pre and post intervention, participants completed an online questionnaire to evaluate depression, trait anxiety, perceived stress, psychological needs, behavioural regulation, and exercise self-efficacy. Women also reported state anxiety before and after each exercise class. Results: Our 8-week bi-weekly exercise program for new mothers significantly reduced state anxiety pre-post each exercise class, as well as pre-post 8-week intervention. There were also non-significant improvements in depression, perceived stress and trait anxiety. In addition, we found a significant improvement in meeting basic psychological needs (competence), and a significant improvement in autonomous regulation (intrinsic motivation). There was no significant increase in exercise self-efficacy. Conclusion: A group exercise intervention was effective in improving postpartum mental health, but did not change exercise self-efficacy. To maximize physical activity benefits in new mothers, we suggest the inclusion of behavioral change support to further enhance the likelihood of adherence and self-efficacy for independent physical activity engagement.
References
Abend, R., Dan, O., Maoz, K., Raz, S., & Bar-Haim, Y. (2014). Reliability, validity and sensitivity of a computerized visual analog scale measuring state anxiety. J Behav Ther Exp Psychiatry, 45(4), 447–453. doi:10.1016/j.jbtep.2014.06.004
Beyer, K. M., Szabo, A., & Nattinger, A. B. (2016). Time spent outdoors, depressive symptoms, and variation by race and ethnicity. Am J Prev Med, 51(3), 281–290. doi:10.1016/j.amepre.2016.05.004
Borg, G. A. (1982). Psychophysical bases of perceived exertion. Med Sci Sports Exerc, 14(5), 377-381. Retrieved from https://journals.lww.com/acsm-msse/Abstract/1982/05000/Psychophysical_bases_of_perceived_exertion.12.aspx
Boyd, T. M. (2016). Autonomy, competence, relatedness, and personal growth initiative among postpartum women. Walden Dissertations and Doctoral Studies, 2792. https://scholarworks.waldenu.edu/dissertations/2792
Burke, S. M., Carron, A. V., Patterson, M. M., Estabrooks, P. A., Hill, J. L., Loughead, T. M., … Spink, K. S. (2005). Cohesion as Shared Beliefs in Exercise Classes. Small Group Res, 36(3), 267-288. doi:10.1177/1046496404267942
Calarco, J. M., Meanwell, E., Anderson, E. M., & Knopf, A. S. (2021). By default: How mothers in different-sex dual-earner couples account for inequalities in pandemic parenting. Socius, 7, 1-15. doi:10.1177/23780231211038783
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry, 150, 782-786. doi:10.1192/bjp.150.6.782
Cramp, A. G., & Bray, S. R. (2010). Postnatal women’s feeling state responses to exercise with and without baby. Matern Child Health J, 14(3), 343–349. doi:10.1007/s10995-009-0462-5
Davenport, M. H., Meyer, S., Meah, V. L., Strynadka, M. C., & Khutana, R. (2020). Moms are not OK: COVID-19 and maternal mental health. Front Glob Womens Health, 1. doi:10.3389/fgwh.2020.00001
Da Costa, D., Lowensteyn, I., Abrahamowicz, M., Ionescu-Ittu, R., Dritsa, M., Rippen, N., … Khalifé, S. (2009). A randomized clinical trial of exercise to alleviate postpartum depressed mood. J Psychosom Obstet Gynecol, 30(3), 191-200. doi:10.1080/01674820903212136
Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268. doi:10.1207/S15327965PLI1104_01
Dennis, C. L., Coghlan, M., & Vigod, S. (2013). Can we identify mothers at-risk for postpartum anxiety in the immediate postpartum period using the State-Trait Anxiety Inventory? J Affect Disord, 150(3), 1217-1220. doi:10.1016/j.jad.2013.05.049
Dritsa, M., Dupuis, G., Lowensteyn, I., & Da Costa, D. (2009). Effects of home-based exercise on fatigue in postpartum depressed women: who is more likely to benefit and why? J Psychosom Res, 67(2), 159-163. doi:10.1016/j.jpsychores.2009.01.010
Ellis, K., Pears, S., & Sutton, S. (2019). Behavioural analysis of postnatal physical activity in the UK according to the COM-B model: a multi-methods study. BMJ Open, 9(8), e028682. doi:10.1136/bmjopen-2018-028682
Estabrooks., P. A. & Carron, A. V. (2000). The Physical Activity Group Environment Questionnaire: An instrument for the assessment of cohesion in exercise classes. Group Dyn Theory Res Pract, 4(3), 230–243. doi:10.1037/1089-2699.4.3.230
Gaston, A., Cramp, A., & Prapavessis, H. (2012). Enhancing self-efficacy and exercise readiness in pregnant women. Psychol Sport Exerc, 13(5), 550-557. doi:10.1016/j.psychsport.2012.03.001
Gibson, J., McKenzie-McHarg, K., Shakespeare, J., Price, J., & Gray, R. (2009). A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand, 119(5), 350-364. doi:10.1111/j.1600-0447.2009.01363.x
Hale, B. S., & Raglin, J. S. (2002). State anxiety responses to acute resistance training and step aerobic exercise across eight weeks of training. J Sports Med Phys Fitness, 42(1), 108-112. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11832884/
Hinkley, T., Crawford D., Salmon, J., Okely, A. D., & Hesketh, K. (2008). Preschool children and physical activity: a review of correlates. Am J Prev Med, 34(5), 435–441. doi:10.1016/j.amepre.2008.02.001
Hinton, P. S., & Olson, C. M. (2001). Postpartum exercise and food intake: the importance of behavior-specific self-efficacy. J Am Diet Assoc, 101(12), 1430–1437. doi:10.1016/S0002-8223(01)00345-5
Juříková, J., & Havelka, R. (2019). Physical activity in puerperium period. EpSBS, 55, 288-296. doi:10.15405/epsbs.2019.02.37
Kołomańska-Bogucka, D., & Mazur-Bialy, A. I. (2019). Physical activity and the occurrence of postnatal depression-A systematic review. Medicina (Kaunas), 55(9), 560. doi:10.3390/medicina55090560
Lee, E. H. (2012). Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res, 6(4), 121–127. doi:10.1016/j.anr.2012.08.004
Lovell, G. P., Gordon, J. A., Mueller, M. B., Mulgrew, K., & Sharman, R. (2016). Satisfaction of basic psychological needs, self-determined exercise motivation, and psychological well-being in mothers exercising in group-based versus individual-based contexts. Health Care Women Int, 37(5), 568-582. doi:10.1080/07399332.2015.1078333
Mailey, E. L., Huberty, J., Dinkel, D., & McAuley, E. (2014). Physical activity barriers and facilitators among working mothers and fathers. BMC Public Health, 14(1), 657. doi:10.1186/1471-2458-14-657
Markland, D., & Tobin, V. (2004). A modification to the behavioural regulation in exercise questionnaire to include an assessment of amotivation. J Sport Exerc Psychol, 26(2), 191-196. doi:10.1123/jsep.26.2.191
Miller, Y. D., Trost, S. G., & Brown, W. J. (2002). Mediators of physical activity behavior change among women with young children. Am J Prev Med, 23(2 Suppl), 98-103. doi:10.1016/s0749-3797(02)00484-1
Miller, Y. D., & Brown, W. J. (2005).
Determinants of active leisure for
women with young children—An
“ethic of care” prevails. Leis Sci, 27(5), 405–420. doi:10.1080/01490400500227308
Miquelon, P., & Castonguay, A. (2016). Motives for participation in physical activity and observance of physical activity recommendations among adults with type 2 diabetes. Can J Diabetes, 40(5), 399-405. doi:10.1016/j.jcjd.2016.02.009
Moore, L. L., Lombardi, D. A., White, M. J., Campbell, J. L., Oliveria, S. A., & Ellison, R. C. (1991). Influence of parents' physical activity levels of young children. J Pediatr, 118(2), 215-219. doi:10.1016/S0022-3476(05)80485-8
Nakić Radoš, S., Tadinac, M., & Herman, R. (2018). Anxiety during pregnancy and postpartum: Course, predictors and comorbidity with postpartum depression. Acta Clin Croat, 57(1), 39-51. doi:10.20471/acc.2017.56.04.05
Nienhuis, C. P., & Lesser, I. A. (2020). The impact of COVID-19 on women’s physical activity behavior and mental well-being. Int J Environ Res Public Health, 17(23), 9036. doi:10.3390/ijerph17239036
Olson, C. M., Strawderman, M. S., Hinton, P. S., & Pearson, T. A. (2003). Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum. Int J Obes Relat Metab Disord, 27(1), 117–127. doi:10.1038/sj.ijo.0802156
Phillips, L. A., & Johnson, M. A. (2018). Interdependent effects of autonomous and controlled regulation on exercise behavior. Pers Soc Psychol Bull, 44(1), 49-62. doi:10.1177/0146167217733068
Physical activity and exercise during pregnancy and the postpartum period: ACOG committee opinion, Number 804. (2020). Obstet Gynecol, 135(4), e178-e188. doi:10.1097/AOG.0000000000003772
Resnick, B., & Jenkins, L. S. (2000). Testing the reliability and validity of the Self-Efficacy for Exercise Scale. Nurs Res, 49(3), 154-159. doi:10.1097/00006199-200005000-00007
Rice, K., & Williams, S. (2021). Women’s postpartum experiences in Canada during the COVID-19 pandemic: a qualitative study. CMAJ Open, 9(2), e556-e562. doi:10.9778/cmajo.20210008
Rowlands, I. J., & Redshaw, M. (2012). Mode of birth and women's psychological and physical wellbeing in the postnatal period. BMC Pregnancy Childbirth, 12, 138. doi:10.1186/1471-2393-12-138
Ryan, R. M., & Deci, E. L. (2017). Self-determination theory: Basic psychology needs in motivation, development and wellness. New York, NY: Guildford Press. doi:10.1521/978.14625/28806
Saligheh, M., McNamara, B., & Rooney, R. (2016). Perceived barriers and enablers of physical activity in postpartum women: a qualitative approach. BMC Pregnancy Childbirth, 16(1), 131. doi:10.1186/s12884-016-0908-x
Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory (STAI). Palo Alto, CA: Consulting Psychologists Press.
Vlachopoulos, S. P., Ntoumanis, N., & Smith, A. L. (2010). The basic psychological needs in exercise scale: Translation and evidence for cross-cultural validity. Int J Sport Exerc Psychol, 8(4), 394-412. doi:10.1080/1612197X.2010.9671960
Warburton, D. E. R., Charlesworth, S., Ivey, A., Nettlefold, L., & Bredin, S. S. D. (2010). A systematic review of the evidence for Canada's Physical Activity Guidelines for Adults. Int J Behav Nutr Phys Act, 7(1), 39. doi:10.1186/1479-5868-7-39
Wenzel, A., Haugen, E. N., Jackson, L. C., & Brendle, J. R. (2005). Anxiety symptoms and disorders at eight weeks postpartum. J Anxiety Disord, 19(3), 295-311. doi:10.1016/j.janxdis.2004.04.001
Wilson, P. M., Rodgers, W. M., Loitz, C. C., & Scime, G. (2006). “It’s who I am… really!” The importance of integrated regulation in exercise contexts. J Appl Biobehav Res, 11(2), 79-104. doi:10.1111/j.1751-9861.2006.tb00021.x
Wilson, P. M., Sabiston, C. M., Mack, D. E., & Blanchard, C. M. (2012). On the nature and function of scoring protocols used in exercise motivation research: An empirical study of the behavioural regulation in exercise questionnaire. Psychol Sport Exerc, 13(5), 614-622. doi:10.1016/j.psychsport.2012.03.009
Zamarro, G., & Prados M. J. (2021). Gender differences in couples divisions of childcare, work and mental health during COVID-19. Rev Econ Househ, 19(1), 11-40. doi:10.1007/s11150-020-09534-7
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