Utility of an outdoor group exercise program for improving postpartum mental health

Authors

  • Gillian Hatfield University of the Fraser Valley
  • Iris Lesser
  • Carl Nienhuis

DOI:

https://doi.org/10.14288/hfjc.v15i1.807

Keywords:

Physical Activity, Mothers, COVID-19, Self-Efficacy, Anxiety, Depression

Abstract

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

Downloads

Published

2022-03-31

How to Cite

Hatfield, G., Lesser, I., & Nienhuis, C. (2022). Utility of an outdoor group exercise program for improving postpartum mental health. The Health & Fitness Journal of Canada, 15(1), 18–30. https://doi.org/10.14288/hfjc.v15i1.807

Issue

Vol. 15 No. 1 (2022)

Section

ARTICLES

License

Copyright (c) 2022 Gillian Hatfield, Iris Lesser, Carl Nienhuis

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Terms of Publication

Authors who publish with this journal agree to the following terms:

  • Authors retain copyright and grant the Health & Fitness Journal of Canada’s right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  • Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  • Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
  • The Contributor (author(s)) represents and guarantees that the Contributor is the sole proprietor of the work and the Contributor has full power to make this Agreement and grant that the work does not infringe the copyright or other proprietary right of any other person; and the work contains no libellous or other unlawful matter and makes no improper invasion of the privacy of any other person. The Contributor also represents and is responsible for the accuracy of the work.
  • The Contributor will read, correct, and return promptly galleys and page proofs to the Editor (or designate). The Contributor will be responsible for the completeness and accuracy of these corrections. If the Contributor does not return galleys and page proofs within the schedule agreed upon with the Editor (or designate), the Publisher may proceed without the Contributor corrections.
  • When applicable, the Contributor agrees to obtain written permissions and letters of agreement for all matter contained in the work that is protected by existing copyright, paying any permission fees for the use of text or illustrations controlled by others, and furnishing the Publisher with written evidence of the copyright owner’s authorization to use the material.
  • When applicable, the Contributor agrees to obtain written permission for inclusion of any photographic materials involving a human subject, and provide the Publisher with written evidence of the subject’s authorization to use this material. In the case of subjects who have not reached the age of majority, the Contributor agrees to obtain and furnish the Publisher with written permission from the parent and/or legal guardian.
  • The Contributor may draw on and refer to material in the work in preparing other articles for publication in scholarly and professional journals and papers for delivery at professional meetings, provided that credit is given to the work and to the Publisher.
  • This agreement may not be changed unless the Contributor and the Publisher agree to the change by means of a formal addendum signed by the Contributor and the Publisher’s representative.
  • This agreement shall be construed and governed according to the laws of the province of British Columbia and shall be binding upon the parties hereto, their heirs, successors, assigns, and personal representatives. Should any formal proceedings related to this agreement be brought, such formal proceeding may be brought only in the province of British Columbia.

By submitting an article to the Health & Fitness Journal of Canada the Contributor has accepted and agreed to all terms outlined in the copyright notice.