The effects of an exercise program on health-related quality of life in postpartum mothers: A randomized controlled trial

Megumi Haruna, Etsuko Watanabe, Masayo Matsuzaki, Erika Ota, Mie Shiraishi, Ryoko Murayama, Mikako Yoshida, SeonAe Yeo

Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The Uni-versity of Tokyo, Tokyo, Japan.
University of North Carolina at Chapel Hill, School of Nursing, North Carolina, United State of America.

DOI: 10.4236/health.2013.53058                

Abstract

Background and Objective: There is controversy on the psychological effects of postpartum exercise. The study aimed to evaluate the effectiveness of a postpartum exercise program on health-related quality of life and psychological well-being. Methods: We conducted a randomized controlled trial in Tokyo, Japan. The intervention groups participated in ball-exercise classes (weekly exercise of 90 minutes for four weeks) at three months postpartum. The exercise class included the following: 1) greeting and warm-up; 2) aerobic exercise involving bouncing on an exercise ball 55 or 65 cm in diameter; 3) rest and self-introduction; 4) stretching and cooling down. The primary outcome measure was health-related Quality of Life (QOL) assessed using the MOS Short-Form 36-Item Health Survey (SF-36v2). The secondary outcome measures were Rosenberg Self-Esteem Scale (RSES) and Edinburgh Postnatal Depression Scale (EPDS) scores. The intervention group was compared to the control group at four months postpartum. Results: Of the 120 women screened, 110 women met the study criteria. Nine could not be included and the remaining 101 were allocated randomly into intervention and control groups (50 and 51 participants respectively). Analysis of covariance adjusting for baseline values indicated that the SF36 subscales of physical functioning (p = 0.018) and vitality (p = 0.016) significantly improved in the intervention group compared to the control group, although there were no significant differences between the groups in the SF36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. The RSES increased in the intervention group (p = 0.020) compared to the control group. No significant group differences were observed in EPDS scores. Conclusions: The postpartum exercise class program provided to healthy postpartum women appears to have contributed to promoting health-related QOL and self-esteem.

Keywords

Exercise; Health Related Quality of Life; Postpartum Depression; Randomized Controlled Trial; Self-Esteem

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Gavin, N.I., Gaynes, B.N., Lohr, K.N., Meltzer-Brody, S., Gartlehner, G. and Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics & Gynecology, 106, 1071-1083. doi:10.1097/01.AOG.0000183597.31630.db
[2]	Okano, S., Sugiyama, T. and Nishiguchi, H. (2007) A screening system for postnatal depression in Japanese primary health care. Japanese Journal of Maternal Health, 48, 16-20. (in Japanese) http://ci.nii.ac.jp/naid/110006274310
[3]	Hoedjes, M., Berks, D., Vogel, I., Franx, A., Visser, W., Duvekot, J.J., Habbema, J.D., Steegers, E.A. and Raat, H. (2011) Symptoms of post-traumatic stress after preeclampsia. Journal of Psychosomatic Obstetrics & Gynecology, 32, 126-134. doi:10.3109/0167482X.2011.599460
[4]	Nagata, M., Ito, K., Suzuki, A. and Matsuura, K. (2007) Application of the EPDS scale for maternal and child health activity in local settings—Follow-up results from neonatal visits to three-month-infant health checkups. Japanese Journal of Maternal Health, 48, 289-294. (in Japanese)
[5]	Ministry of Health, Labour and Welfare (2007) http://www.mhlw.go.jp/toukei/saikin/hw/ktyosa/ktyosa07/1-3.html
[6]	Deslandes, A., Moraes, H., Ferreira, C., Veiga, H., Silveira, H., Mouta, R., Pompeu, F.A., Coutinho, E.S. and Laks J. (2009) Exercise and mental health: Many reasons to move. Neuropsychobiology, 59, 191-198. doi:10.1159/000223730
[7]	Armstrong, K. and Edwards, H. (2004) The effectiveness of a pramwalking exercise programme in reducing depressive symptomatology for postnatal women. International Journal of Nursing Practice, 10, 177-194. doi:10.1111/j.1440-172X.2004.00478.x
[8]	Heh, S.S., Huang, L.H., Ho, S.M., Fu, Y.Y. and Wang, L.L. (2008) Effectiveness of an exercise support program in reducing the severity of postnatal depression in Taiwanese women. Birth, 35, 60-65. doi:10.1111/j.1523-536X.2007.00192.x
[9]	Dritsa, M., Da Costa, D., Dupuis, G., Lowensteyn, I. and Khalifé, S. (2008) Effects of a home-based exercise intervention on fatigue in postpartum depressed women: Results of a randomized controlled trial. Annals of Behavioral Medicine, 35, 179-187. doi:10.1007/s12160-008-9020-4
[10]	Da Costa, D., Lowensteyn, I., Abrahamowicz, M., IonescuIttu, R., Dritsa, M., Rippen, N., Cervantes, P. and Khalifé, S. (2009) A randomized clinical trial of exercise to alleviate postpartum depressed mood. Journal of Psychosomatic Obstetrics & Gynecology, 30, 191-200. doi:10.1080/01674820903212136
[11]	Norman, E., Sherburn, M., Osborne, R.H. and Galea, M.P. (2010) An exercise and education program improves well-being of new mothers: A randomized controlled trial. Physical Therapy, 90, 348-355. doi:10.2522/ptj.20090139
[12]	Cramp, A.G. and Bray, S.R. (2009) Postnatal women’s feeling state responses to exercise with and without baby. Maternal and Child Health Journal, 14, 343-349. doi:10.1007/s10995-009-0462-5
[13]	Montoya Arizabaleta, A.V., Orozco Buitrago, L., Aguilar de Plata, A.C., Mosquera Escudero, M. and Ramirez-Velez, R. (2010) Aerobic exercise during pregnancy improves health-related quality of life: A randomised trial. Journal of Physiotherapy, 56, 253-258. doi:10.1016/S1836-9553(10)70008-4
[14]	Martin, C.K., Church, T.S., Thompson, A.M., Earnest, C.P. and Blair, S.N. (2009) Exercise dose and quality of life: A randomized controlled trial. Archives of Internal Medicine, 169, 269-278. doi:10.1001/archinternmed.2008.545
[15]	Devereux, K., Robertson, D. and Briffa, N.K. (2005) Effects of a water-based program on women 65 years and over: A randomised controlled trial. The Australian Journal of Physiotherapy, 51, 102-108. doi:10.1016/S0004-9514(05)70038-6
[16]	Fukuhara, S. and Suzukamo, Y. (2004) Manual of SF-36v2 Japanese version. Institute for Health Outcomes & Process Evaluation Research, Kyoto.
[17]	Haley, S.M., McHorney, C.A. and Ware Jr., J.E. (1994) Evaluation of the MOS SF-36 physical functioning scale (PF-10): I. Unidimensionality and reproducibility of the Rasch item scale. Journal of Clinical Epidemiology, 47, 671-684. doi:10.1016/0895-4356(94)90215-1
[18]	Rosenberg, M. (1965) When dissonance fails: On eliminating evaluation apprehension from attitude measurement. Journal of Personality and Social Psychology, 95, 28-42. doi:10.1037/h0021647
[19]	Yamamoto, M., Matsui, Y. and Yamanari, Y. (1982) The structure of perceived aspects of self. Japanese Journal of Educational Psychology, 30, 64-68. (in Japanese)
[20]	Cox, J.L., Holden, J.M. and Sagovsky, R. (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. The British Journal of Psychiatry, 150, 782-786. doi:10.1192/bjp.150.6.782
[21]	Okano, T., Murata, M., Masuji, F., Tamaki, R., Nomura, J., Miyaoka, H. and Kitamura, T. (1996) Validation and reliability of a Japanese version of the EPDS. Archives of Psychiatric Diagnosis and Clinical Evaluation, 7, 525- 533. (in Japanese)
[22]	Faul, F., Erdfelder, E., Lang, A.G. and Buchner, A. (2007) G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175-191. doi:10.3758/BF03193146
[23]	Kamysheva, E., Skouteris, H., Wertheim, E.H., Paxton, S.J. and Milgrom, J. (2008) Examination of a multi-factorial model of body-related experiences during pregnancy: The relationships among physical symptoms, sleep quality, depression, self-esteem, and negative body attitudes. Body Image, 5, 152-163. doi:10.1016/j.bodyim.2007.12.005
[24]	Gjerdingen, D., Fontaine, P., Crow, S., McGovern, P., Center, B. and Miner, M. (2009) Predictors of mothers’ postpartum body dissatisfaction. Women Health, 49, 491-504. doi:10.1080/03630240903423998
[25]	Koniak-Griffin, D. (1994) Aerobic exercise, psychological well-being, and physical discomforts during adolescent pregnancy. Research in Nursing & Health, 17, 253-263. doi:10.1002/nur.4770170404
[26]	Daley, A., Winter, H., Grimmett, C., McGuinness, M., McManus, R. and MacArthur, C. (2008) Feasibility of an exercise intervention for women with postnatal depression: A pilot randomised controlled trial. British Journal of General Practice, 58, 178-183.