title: A pragmatic randomized controlled trial to evaluate the effectiveness of a facilitated exercise intervention as a treatment for postnatal depression: the PAM-PeRS trial.
abstract: BACKGROUND
  Postnatal depression affects about 10-15% of women in the year after giving birth. Many women and healthcare professionals would like an effective and accessible non-pharmacological treatment for postnatal depression.
  
  
  METHODS
  Women who fulfilled the International Classification of Diseases (ICD)-10 criteria for major depression in the first 6 months postnatally were randomized to receive usual care plus a facilitated exercise intervention or usual care only. The intervention involved two face-to-face consultations and two telephone support calls with a physical activity facilitator over 6 months to support participants to engage in regular exercise. The primary outcome was symptoms of depression using the Edinburgh Postnatal Depression Scale (EPDS) at 6 months post-randomization. Secondary outcomes included EPDS score as a binary variable (recovered and improved) at 6 and 12 months post-randomization.
  
  
  RESULTS
  A total of 146 women were potentially eligible and 94 were randomized. Of these, 34% reported thoughts of self-harming at baseline. After adjusting for baseline EPDS, analyses revealed a -2.04 mean difference in EPDS score, favouring the exercise group [95% confidence interval (CI) -4.11 to 0.03, p = 0.05]. When also adjusting for pre-specified demographic variables the effect was larger and statistically significant (mean difference = -2.26, 95% CI -4.36 to -0.16, p = 0.03). Based on EPDS score a larger proportion of the intervention group was recovered (46.5% v. 23.8%, p = 0.03) compared with usual care at 6 months follow-up.
  
  
  CONCLUSIONS
  This trial shows that an exercise intervention that involved encouragement to exercise and to seek out social support to exercise may be an effective treatment for women with postnatal depression, including those with thoughts of self-harming.
authors: Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham,Birmingham,UK.
authors: A J
authors: AJ
authors: Daley
authors: Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham,Birmingham,UK.
authors: R V
authors: RV
authors: Blamey
authors: Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham,Birmingham,UK.
authors: K
authors: K
authors: Jolly
authors: Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham,Birmingham,UK.
authors: A K
authors: AK
authors: Roalfe
authors: Academic Unit of Primary Health Care, University of Bristol,Bristol,UK.
authors: K M
authors: KM
authors: Turner
authors: Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham,Birmingham,UK.
authors: S
authors: S
authors: Coleman
authors: Perinatal Mental Health Service, The Barberry, Birmingham and Solihull Mental Health Foundation Trust,Birmingham,UK.
authors: M
authors: M
authors: McGuinness
authors: Institute of Psychological Medicine and Clinical Neurology, Cardiff University,Cardiff,UK.
authors: I
authors: I
authors: Jones
authors: Academic Unit of Primary Health Care, University of Bristol,Bristol,UK.
authors: D J
authors: DJ
authors: Sharp
authors: Public Health, Epidemiology and Biostatics, School of Health and Population Sciences, University of Birmingham,Birmingham,UK.
authors: C
authors: C
authors: MacArthur
mesh_terms: D000328:Adult; D003863:Depression / Q000628:therapy*; D019052:Depression, Postpartum / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D011569:Psychiatric Status Rating Scales; D016728:Self-Injurious Behavior; D012944:Social Support; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Depression; exercise; postnatal depression; primary care