Mini Commentary
DOI: 10.1111/1471-0528.13053 www.bjog.org
Exercise improves depressive symptoms during pregnancy G Shivakumar VA North Texas Health Care System, Dallas, TX, USA Linked article: This is a mini commentary on Daley AJ, Foster L, Long G, Palmer C, Robinson O, Walmsley H, Ward R et al. To view this article visit http://dx.doi.org/10.1111/1471-0528.12909. Published Online 9 September 2014. In this study, Foster et al. (BJOG 2014 in press) conducted a metaanalysis of published clinical trials of exercise for antenatal depression and found that exercise is beneficial for improving and preventing depressive symptoms during pregnancy. This result is a further indication that exercise is an important therapeutic consideration for pregnant women, especially for those preferring nonpharmacological strategies. The meta-analysis included randomised clinical studies that examined different forms of exercise, all with the goal of either treating or preventing depressive symptoms during pregnancy. There was significant variability among the various study samples. Four studies included samples of pregnant women with depressive symptoms who were randomised to yoga or t’ai chi as exercise intervention groups. Three of those studies (Field et al. J Bodyw Mov Ther 2012;16: 204–9, Field et al. Complement Ther Clin Pract 2013;19:6–10, Vieten C & Astin J. Arch Womens Ment Health 2008;11:67–74) strongly favored the exercise group in comparison with the control group (consisting of a non-exercise group) for
overall symptom reduction at the end of the study. One study (Field et al. J Bodyw Mov Ther 2013;17:397–403) had a head-to-head comparison of yoga and t’ai chi and the groups did not differ in their outcomes. This suggests that all forms of non-aerobic exercise may be beneficial without clear superiority of one form over another. There was one study of yoga for pregnant women who were at risk of depression as defined by previous histories of depression. A type of yoga, Hatha Yoga, improved mood and emotional wellbeing. There was only one study that examined aerobic exercise in healthy volunteers. Participants were randomised to either an exercise or a non-exercise intervention. The exercise group completed 60 minutes of aerobic exercise programme, three times a week, for 3 months. As expected, the exercise group showed a significant reduction in their depressive scores in comparison with the non-exercise group. In the absence of randomised controlled studies of aerobic exercise for antenatal depression, this study brings research a step closer to showing that aerobic exercise is favourable
Published 2014. This article is a U.S. Government work and is in the public domain in the USA
for healthy pregnant women for optimal mental health. The authors noted that there was significant heterogeneity among the study samples. Despite using standardised inclusion and exclusion criteria, clinical trials varied by study intervention, duration of intervention and timing during pregnancy, included different forms of exercise (aerobic versus non-aerobic) and sample sizes. The results of this review should be carefully weighed against these limitations. The take-home message of this review is that exercise (whether aerobic or non-aerobic) improves and perhaps prevents depressive symptoms during pregnancy. The direction and the magnitude of the effect sizes seen in the clinical trials included in this meta-analysis are consistent with published observational and epidemiological studies among pregnant and nonpregnant women. Furthermore, data from nonpregnant women have shown that there is a strong indication for moderate to high-intensity aerobic exercise to be more effective for major depression. Currently, a definitive conclusion about the use
1
Mini Commentary
of exercise as a treatment for major depressive disorders during pregnancy cannot be made because of the modest sample sizes and lack of well-controlled randomised con-
2
trolled studies. Hence, future studies are needed to specifically address whether exercise can be helpful for major depression in pregnant women.
Disclosure of interests The author has no commercial or other conflicting interests related to this paper. &
Published 2014. This article is a U.S. Government work and is in the public domain in the USA
DOI: 10.1111/1471-0528.13053 www.bjog.org
Exercise improves depressive symptoms during pregnancy G Shivakumar VA North Texas Health Care System, Dallas, TX, USA Linked article: This is a mini commentary on Daley AJ, Foster L, Long G, Palmer C, Robinson O, Walmsley H, Ward R et al. To view this article visit http://dx.doi.org/10.1111/1471-0528.12909. Published Online 9 September 2014. In this study, Foster et al. (BJOG 2014 in press) conducted a metaanalysis of published clinical trials of exercise for antenatal depression and found that exercise is beneficial for improving and preventing depressive symptoms during pregnancy. This result is a further indication that exercise is an important therapeutic consideration for pregnant women, especially for those preferring nonpharmacological strategies. The meta-analysis included randomised clinical studies that examined different forms of exercise, all with the goal of either treating or preventing depressive symptoms during pregnancy. There was significant variability among the various study samples. Four studies included samples of pregnant women with depressive symptoms who were randomised to yoga or t’ai chi as exercise intervention groups. Three of those studies (Field et al. J Bodyw Mov Ther 2012;16: 204–9, Field et al. Complement Ther Clin Pract 2013;19:6–10, Vieten C & Astin J. Arch Womens Ment Health 2008;11:67–74) strongly favored the exercise group in comparison with the control group (consisting of a non-exercise group) for
overall symptom reduction at the end of the study. One study (Field et al. J Bodyw Mov Ther 2013;17:397–403) had a head-to-head comparison of yoga and t’ai chi and the groups did not differ in their outcomes. This suggests that all forms of non-aerobic exercise may be beneficial without clear superiority of one form over another. There was one study of yoga for pregnant women who were at risk of depression as defined by previous histories of depression. A type of yoga, Hatha Yoga, improved mood and emotional wellbeing. There was only one study that examined aerobic exercise in healthy volunteers. Participants were randomised to either an exercise or a non-exercise intervention. The exercise group completed 60 minutes of aerobic exercise programme, three times a week, for 3 months. As expected, the exercise group showed a significant reduction in their depressive scores in comparison with the non-exercise group. In the absence of randomised controlled studies of aerobic exercise for antenatal depression, this study brings research a step closer to showing that aerobic exercise is favourable
Published 2014. This article is a U.S. Government work and is in the public domain in the USA
for healthy pregnant women for optimal mental health. The authors noted that there was significant heterogeneity among the study samples. Despite using standardised inclusion and exclusion criteria, clinical trials varied by study intervention, duration of intervention and timing during pregnancy, included different forms of exercise (aerobic versus non-aerobic) and sample sizes. The results of this review should be carefully weighed against these limitations. The take-home message of this review is that exercise (whether aerobic or non-aerobic) improves and perhaps prevents depressive symptoms during pregnancy. The direction and the magnitude of the effect sizes seen in the clinical trials included in this meta-analysis are consistent with published observational and epidemiological studies among pregnant and nonpregnant women. Furthermore, data from nonpregnant women have shown that there is a strong indication for moderate to high-intensity aerobic exercise to be more effective for major depression. Currently, a definitive conclusion about the use
1
Mini Commentary
of exercise as a treatment for major depressive disorders during pregnancy cannot be made because of the modest sample sizes and lack of well-controlled randomised con-
2
trolled studies. Hence, future studies are needed to specifically address whether exercise can be helpful for major depression in pregnant women.
Disclosure of interests The author has no commercial or other conflicting interests related to this paper. &
Published 2014. This article is a U.S. Government work and is in the public domain in the USA
