School of Physical Education, China University of Geosciences (Wuhan), Wuhan, China.
PLoS One. 2023 Nov 29;18(11):e0287650. doi: 10.1371/journal.pone.0287650. eCollection 2023.
Aerobic exercise is widely recognized for improving mental health and reducing negative emotions, including anxiety. However, research on its role in preventing and treating postpartum depression (PPD) has yielded inconsistent results. Some studies show positive effects on PPD symptoms, while others find limited impact, suggesting various factors at play, such as exercise type, intensity, and individual differences. To address this gap, our study aims to comprehensively gather evidence on the preventive and therapeutic effects of aerobic exercise for PPD. We'll focus on differences in exercise program design and implementation, exploring how these factors impact intervention outcomes. By identifying effective exercise approaches, we aim to provide more comprehensive exercise prescription recommendations for this vulnerable population.
We conducted a quantitative systematic review of the study in 5 representative databases for the effect of aerobic exercise on PPD. Meta-analysis and network meta-analysis were performed with Review-Manager.5.4 and Stata.16.0 software, respectively. This study has been registered on the official Prospero website, and the registration code is CRD42023398221.
Twenty-six studies with 2,867 participants were eventually included and the efficacy of aerobic exercise in preventing and treating postpartum depression is significant compared to standard care. (MD = -1.90; 95%CL: -2.58 to -1.21; I2 = 86%). Subgroup analysis suggests that the intervention objective (prevention vs. treatment) of exercise could potentially be a source of heterogeneity in this study, as the "Test for subgroup difference" revealed the presence of significant distinctions (p = 0.02<0.05). The "Test for subgroup difference" yielded non-significant results for both the supervised vs. unsupervised subgroup comparison (p = 0.55 > 0.05) and the individual vs. team subgroup comparison (p = 0.78 > 0.05). Nonetheless, when assessing their effect sizes [Subtotal (95%CL)], the supervised exercise group [-1.66 (-2.48, -0.85)] exhibited a slightly better performance than the unsupervised exercise group [-1.37 (-1.86, -0.88)], while the team exercise group [-1.43 (-1.94, -0.93)] slightly outperformed the individual exercise group [-1.28 (-2.23, -0.33)]. Network meta-analysis indicated that moderate intensity (3545 min) group demonstrated a more pronounced intervention effect compared to low intensity (5060 min) group [-2.63 (-4.05, -1.21)] and high intensity (2030 min) group [-2.96 (-4.51, -1.41)], while the 34 times/week group had a more significant intervention effect compared to 12 times/week groups [-2.91 (-3.99, -1.83)] and 56 times/week groups [-3.28 (-4.75, -1.81)]. No significant differences were observed in pairwise comparisons of intervention effects among the five common types of aerobic exercises. (95%CL including 0). The Surface Under the Cumulative Ranking curve (SUCRA) results align with the findings mentioned above and will not be reiterated here.
The efficacy of aerobic exercise in preventing and treating postpartum depression is significant compared to standard care, with a greater emphasis on prevention. The optimal prescribed exercise volume for intervention comprises a frequency of 34 exercise sessions per week, moderate intensity (3545 minutes). Currently, several uncharted internal factors influence the optimal intervention effect of aerobic exercise, such as the potential enhancement brought by team-based and supervised exercise. Given the absence of significant differences in certain results and the limitations of the study, it is essential to exercise caution when interpreting the outcomes. Further research is needed in the future to provide a more comprehensive understanding.
有氧运动被广泛认为可以改善心理健康，减轻负面情绪，包括焦虑。然而，关于其在预防和治疗产后抑郁症（PPD）方面的作用的研究结果并不一致。一些研究表明有氧运动对 PPD 症状有积极影响，而另一些研究则发现影响有限，这表明有各种因素在起作用，如运动类型、强度和个体差异。为了解决这一差距，我们的研究旨在全面收集关于有氧运动预防和治疗 PPD 的证据。我们将重点关注运动方案设计和实施方面的差异，探讨这些因素如何影响干预结果。通过确定有效的运动方法，我们旨在为这一脆弱人群提供更全面的运动处方建议。
我们在 5 个具有代表性的数据库中进行了一项关于有氧运动对 PPD 影响的定量系统评价。使用 Review-Manager.5.4 和 Stata.16.0 软件进行荟萃分析和网络荟萃分析。本研究已在官方 Prospero 网站上注册，注册号为 CRD42023398221。
最终纳入了 26 项研究，共 2867 名参与者，有氧运动在预防和治疗产后抑郁症方面的疗效明显优于常规护理。（MD=-1.90；95%CL：-2.58 至-1.21；I2=86%）。亚组分析表明，运动干预的目标（预防与治疗）可能是本研究异质性的一个来源，因为“分组检验”显示存在显著差异（p=0.02<0.05）。“分组检验”对监督与非监督亚组比较（p=0.55>0.05）和个体与团队亚组比较（p=0.78>0.05）的结果均不显著。然而，当评估它们的效应大小[总和（95%CL）]时，监督运动组[-1.66（-2.48，-0.85）]的表现略优于非监督运动组[-1.37（-1.86，-0.88）]，而团队运动组[-1.43（-1.94，-0.93）]略优于个体运动组[-1.28（-2.23，-0.33）]。网络荟萃分析表明，中等强度（3545 分钟）组与低强度（5060 分钟）组[-2.63（-4.05，-1.21）]和高强度（2030 分钟）组[-2.96（-4.51，-1.41）]相比，干预效果更为显著，而每周 34 次的组与每周 12 次的组[-2.91（-3.99，-1.83）]和每周 56 次的组[-3.28（-4.75，-1.81）]相比，干预效果更为显著。五种常见的有氧运动类型之间的干预效果比较无显著差异（95%CL 包含 0）。累积排序曲线下面积（SUCRA）的结果与上述结果一致，此处不再赘述。
与标准护理相比，有氧运动在预防和治疗产后抑郁症方面的疗效显著，且更侧重于预防。干预的最佳推荐运动量包括每周 34 次运动，中等强度（3545 分钟）。目前，一些未知的内部因素会影响有氧运动的最佳干预效果，例如团队和监督运动可能带来的增强效果。由于某些结果没有显著差异，且研究存在局限性，在解释结果时应保持谨慎。未来需要进一步研究，以提供更全面的认识。
