JMIR Publications

ABSTRACT

Background:

Strong evidence suggests physical activity (PA) can ameliorate postpartum depression (PPD) symptoms; however, many postpartum individuals do not meet PA guidelines. Electronic health (eHealth) interventions are a promising approach to address common barriers to PA during postpartum.

Objective:

To test the effectiveness of a tailored eHealth PA intervention for increasing PA and decreasing depressive symptoms in individuals at high risk for PPD.

Methods:

We conducted a remote randomized controlled trial within the Kaiser Permanente Northern California health care delivery system. From November 2020 to September 2022, individuals 2-6 months postpartum at high risk for PPD were randomized to an eHealth PA intervention (n=50) or usual care (n=49). The eHealth PA intervention group received access to an online library of 98 10-minute workout videos developed for postpartum individuals, including interaction with their infants. At baseline, 3 months, and 6 months post-randomization, surveys were used to assess depressive symptoms, PA, sleep quality, anxiety symptoms, perceived stress, and mother-infant bonding. PA was also measured using a wrist-worn accelerometer for 7 days at each timepoint. Primary outcomes were depressive symptoms and device-measured moderate/vigorous intensity PA (dm-MVPA) at 3 months post-randomization. Secondary outcomes were self-reported MVPA (sr-MVPA) at 3- and 6-months post-randomization and depressive symptoms and dm-MVPA at 6 months post-randomization. Intent-to-treat and modified intent-to-treat (excluding participants in the intervention group who did not watch at least one video) analyses were conducted using linear regression adjusted for variables used in the randomization procedure and using multiple imputation to account for missing data.

Results:

Participants were 4 months postpartum at baseline with moderately severe depressive symptoms (mean PHQ-8 score=12.6), on average. Intent-to-treat analyses indicated no association between the intervention and change in depressive symptoms (mean difference= -0.7; 95%CI: -4.0, 2.5), dm-MVPA per day (mean difference= -4.3 minutes; 95%CI: -31.0, 22.0), or sr-MVPA per week (mean difference= 3.5 MET-hours; 95%CI: -5.0, 12.0) at 3 months post-randomization or 6 months post-randomization (depressive symptoms: mean difference= -0.2; 95%CI: -3.4, 3.1; dm-MVPA: mean difference= -11.0 minutes; 95%CI: -44.0, 22.0; sr-MVPA: mean difference= -1.6 MET-hours; 95%CI: -11.0, 8.2). Engagement with the intervention was suboptimal; although 52% (n=26) of participants in the intervention group logged on to the intervention website and watched at least one video, median minutes watched peaked at 10 minutes/week two weeks post-randomization, then fell to zero for the rest of the follow-up period. Results from modified intent-to-treat analyses were similar to those from intent-to-treat analyses.

Conclusions:

An eHealth PA intervention tailored to postpartum individuals did not affect depressive symptoms or PA among those at high risk for PPD, likely due to low engagement. Additional research to develop effective and engaging PA interventions is needed to help alleviate PPD symptoms and decrease PPD risk. Clinical Trial: ClinicalTrials.gov NCT04414696