هل يُمكِن أن تُساعد ممارسة الرياضة على تخفيف اكتئاب ما بعد الولادة؟

Exercise help to relieve postnatal depression after the birth of a baby, called postnatal or postpartum depression (PND), is common. Thought to affect between 10 and 20% of new mothers, some of the main symptoms are frequent crying, a feeling of listlessness and tiredness, and an inability to fully bond with their baby. The reasons why some women are more susceptible to PND than others have not been fully established, but with many reporting that they had unrealistic expectations of what being a mother would feel like and others struggling with low self esteem due to an altered body shape, perhaps the high proportion of women diagnosed with PND is unsurprising. The vast array of physico-chemical and hormonal changes that occur during pregnancy and beyond probably play a role, however the exact mechanisms and contributing factors are still unclear.

The problem

Despite its high prevalence and the long-term health risks it poses, not just to the mother, but also her baby… despite the fact that it can impact a woman’s relationship with her husband, her friends and other family members… despite the fact that in its most severe form, it can lead to suicidal thoughts… despite all of this, and more, current treatment options are limited to say the least.

Postnatal health and weight management is important. Following pregnancy, many women are left with excess weight and reduced fitness, at a time when being fit and healthy is vital. The problem is that whilst this is widely known, there are no universal guidelines to support and instruct women on how to maximise their health and fitness post-childbirth.

So, can exercise help?

Let’s consider the literature first. There have been a significant number of studies demonstrating that regular exercise is beneficial for the general population. There have even been studies showing the importance of mothers-to-be maintaining a good level of overall fitness throughout their pregnancies. In the general population, physical activity has been shown to reduce stress, anxiety and depression; it has an important role in the promotion of good mental health.

The National Institute for Health and Clinical Excellence (NICE) in the UK recommends that for adults with mild/moderate depression a structured group physical activity programme should form part of their ‘facilitated self-help’. The NICE guidelines on the management of PND make no specific mention of physical activity being used as an adjuvant tool, although they do refer people to the section of facilitated self help under the guidelines for clinical depression.

An older version of the NICE guidelines did indicate that moderate exercise could benefit women with PND, but newer versions seem to have removed this statement. Perhaps, this is unsurprising. Literature searches and meta analyses are fairly inconclusive. Data on the benefits of exercise for women struggling after childbirth is conflicting and positive associations are weak.

There is a need for more robust, longer-term studies. Without the evidence to support it, few health institutes will be prepared to list the undertaking of physical activity as a viable treatment option. However, with many women reluctant to take antidepressants whilst breastfeeding and caring for a child, alternative approaches are required.

It is, of course, important to consider both viewpoints. Not all women will want to exercise after the birth of their baby. Some will have childcare considerations, others will be adhering to breastfeeding and sleeping routines that minimise the opportunities for undertaking physical activity. The general fatigue that accompanies looking after a newborn can make it difficult to generate sufficient enthusiasm for exercising. It is certainly not a solution for everyone, but for some, it may be a good way of relieving some of the stress and anxiety they have after giving birth.

Personal Reflection

When I write articles, I do not always feel it is appropriate to share my personal feelings. This is not usually the medium for doing that; this is a place to present the facts, supported by the most recent published research. But, this is a topic I feel quite passionately about. I do believe exercise can improve a negative mindset, I am a great advocate of group exercise programmes and this is why.

I never had clinically diagnosed PND, but, like many women, I struggled after giving birth; I missed my independence and I found it a very socially isolating experience. In many ways, the second time round was easier, we knew what we were letting ourselves in for; life had changed significantly with our first baby. how much difference would another one really make (the absolute naivety of that statement is a topic for another time!)? What was difficult with round two, was that we had recently moved overseas; we moved when I was 12 weeks pregnant. And so, I found myself living in a different country, with no family, few meaningful friendships, a husband that worked, a toddler and a newborn.

I still would not say I was depressed; I did not struggle in the way that some women do, but I was lonely and that can have a big impact on a person’s quality of life. I lived for the weekends, when my husband was home, but by then was too irritable and tired to make the most of it. Things changed hugely for me when I found a postnatal exercise class to join. I could take the baby and nobody minded if I had to stop part way through and breastfeed, but the main thing was, it was something for me; the focus being on me, and not on the baby. Sure, he got to come along, have a change of scene, stare at himself in a mirror and dribble over other baby’s toys; so you could say we both benefitted. I made friends, like-minded women, who were in a very similar position to me; I got fitter and felt better about my own body; I improved my energy levels and, ultimately, improved the relationship I had with my husband and my children.

So, yes, I will take on board what the science says, I will not guarantee physical activity as the best and only way of relieving the symptoms of PND. But, I will suggest that if you are struggling, find a type of exercise that works for you, with or without baby (there is no shame in having a break sometimes), and go for it.

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Sources:

• “1 Guidance: Depression in Adults: Recognition and Management: Guidance.” NICE, https://www.nice.org.uk/guidance/cg90/chapter/1-Guidance#step-2-recognised-depression-persistent-subthreshold-depressive-symptoms-or-mild-to-moderate.
• “1 Recommendations: Antenatal and Postnatal Mental Health: Clinical Management and Service Guidance: Guidance.” NICE, https://www.nice.org.uk/guidance/cg192/chapter/1-Recommendations.
• Carter, Tim, et al. “The Effectiveness of Exercise-Based Interventions for Preventing or Treating Postpartum Depression: a Systematic Review and Meta-Analysis.” Archives of Womens Mental Health, vol. 22, no. 1, Feb. 2019, pp. 37–53., doi:10.1007/s00737-018-0869-3.
• Daley, Amanda J, et al. “The Effectiveness of Exercise as a Treatment for Postnatal Depression: Study Protocol.” BMC Pregnancy and Childbirth, vol. 12, no. 1, 9 June 2012, doi:10.1186/1471-2393-12-45.
• Saligheh, Maryam, et al. “The Relationship between Postnatal Depression, Sociodemographic Factors, Levels of Partner Support, and Levels of Physical Activity.” Frontiers in Psychology, vol. 5, 14 July 2014, doi:10.3389/fpsyg.2014.00597.