Negotiating Physical Activity for Perinatal Mental Health

Negotiating Physical Activity for Perinatal Mental Health

Exercise is commonly prescribed as one method to help improve one’s mental health (Ekkekakis 2013, Hu et al 2020, Heissel et al., 2023, Stubbs et al 2018, Vella et al 2023). However, a major barrier to begin an exercise routine can often be lack of motivation and fatigue, which is experienced by those suffering from depression (Faulkner and Biddle 2004, Glowacki et al  2017). Postpartum depression and other mental health illness is quite common, with research suggesting a prevalence of up to 20% in new mothers (Bauer et al 2014). Many new moms are told by health care providers to exercise during pregnancy and postpartum. However, advice and guidance on how to overcome barriers to exercising, including mental health barriers, is not addressed often enough. 

Most research is focused on the benefits of exercise for mental health support in the general population and postpartum, but rarely addresses the barriers the postpartum population experiences related to mental health. An online survey by Goncalves et al recently set out to fill this gap in knowledge, exploring how women negotiate physical activity for their mental health and the barriers to participating in physical activity associated with mental health illness. 186 mothers were included in the study, from 6 weeks postpartum up until 4 years postpartum, three main themes were found in this qualitative study: barriers to physical activity associated with mental illness, strategies to negotiate being active for perinatal mental health, and guilt associated with not being active enough.

Barriers to physical activity 

• Lack of support/childcare, 
• Lack of funds for fitness classes/memberships during low maternity pay or unpaid maternity leave
• Depression 
• Feelings of guilt/anxiety leaving the baby - “Going from being a successful career and being self assured to feeling that I was way out of my depth. Feeling a failure as a mother for not being able to breast feed (was due to huge postpartum hemorrhage). Constant guilt and anxiety. Guilt about being a working mother. Missing out on social and support groups as I am a working mother and the main breadwinner…”
• fear/anxiety about being active, ““Partly because of time. Classes are not on at convenient times, they don't allow you to bring children or provide childcare, I'm anxious about going because my fitness and body has changed so much…”
• Lack of motivation from feeling tired being a caretaker all day 
• Weather
• Fatigue
• Lack of time
• Childcare duties 
• Physical limitations 
• Choosing other things to do if baby is napping (life admin, spending time with partner, relaxing)

Strategies Women used to Remain Active

• Support from spouse, family, or other social support in the form of childcare, or encouragement, “Myself, my mother in law who helps with childcare, my employer who encourages me to take a proper break from work, my best friend who encourages me to keep active.”
• Being active with their children 
• Making it a priority  
• Wanting to model an active lifestyle for their children 
• Seeing the benefits to health and family
• Home based exercise to decrease barriers of weather, struggling to get out and feeling self conscious in group fitness classes
• Outdoor activities to improve mood was a repeating theme as well, “I find exercise quietens my mind and gives me a sense of calm. Also being outdoors helps me a lot.”

Guilt and undervaluing walking (guilt about not being active enough, regular walking not viewed as physical activity exacerbating feelings of guilt)

• Many of the respondents were regularly walking but did not consider this as physical activity 
• Feeling of guilt through check in conversations with health care providers 
• Many women would report walks as a family or with friends but would also check “I am not physically active” on their survey questionnaire

As guilt was a strong theme, rest assured that walking regularly is enough to improve your mental and physical health, especially when dealing with several of the barriers outline above.  

Even just walking twice per week has been shown to provide mental health benefits (teychenne et al 2020. When also considering physical activity for mental health including social activity and being outdoors, such as walking with a friend, there are even more benefits to help improve mental health, compared to physical activity alone (Teychenne et al 2020, Vella et al 2023). 

Further recommendations include gradual return to activity, whether delivery mode was vaginal or cesarean. If you feel overwhelmed about where to begin with return to physical activity and exercise, all of our therapists at Femina PT are experienced with postpartum rehabilitation and would be able to provide a comprehensive assessment of strength and function to help tailor a plan specific to your needs and current abilities. Reach out to our team to get started.

Resources:

1. Bauer, A., Parsonage, M., Knapp, M., Iemmi, V., Adelaja, B., & Hogg, S. (2014). The costs of perinatal mental health problems. London: Centre for Mental Health and London School of Economics, 44.
2. Ekkekakis, P. (2023). Physical activity as a mental health intervention in the era of managed care: A rationale. In Routledge handbook of physical activity and mental health (pp. 1-32). Routledge.
3. Faulkner, G., & Biddle, S. J. (2004). Exercise and depression: Considering variability and contextuality. Journal of Sport and Exercise Psychology, 26(1), 3-18.
4. Glowacki, K., Duncan, M. J., Gainforth, H., & Faulkner, G. (2017). Barriers and facilitators to physical activity and exercise among adults with depression: A scoping review. Mental health and physical activity, 13, 108-119.
5. Gonçalves AV, Makuch MY, Setubal MS, Barros NF, Bahamondes L. A Qualitative Study on the Practice of Yoga for Women with Pain-Associated Endometriosis. J Altern Complement Med. 2016;22(12):977-982. doi:10.1089/acm.2016.0021
6. Heissel, A., Heinen, D., Brokmeier, L. L., Skarabis, N., Kangas, M., Vancampfort, D., ... & Schuch, F. (2023). Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. British journal of sports medicine, 57(16), 1049-1057.
7. Hu, M. X., Turner, D., Generaal, E., Bos, D., Ikram, M. K., Ikram, M. A., ... & Penninx, B. W. (2020). Exercise interventions for the prevention of depression: a systematic review of meta-analyses. BMC public health, 20, 1-11.
8. Stubbs, B., Vancampfort, D., Hallgren, M., Firth, J., Veronese, N., Solmi, M., ... & Kahl, K. G. (2018). EPA guidance on physical activity as a treatment for severe mental illness: a meta-review of the evidence and Position Statement from the European Psychiatric Association (EPA), supported by the International Organization of Physical Therapists in Mental Health (IOPTMH). European Psychiatry, 54, 124-144.
9. Teychenne, M., White, R. L., Richards, J., Schuch, F. B., Rosenbaum, S., & Bennie, J. A. (2020). Do we need physical activity guidelines for mental health: What does the evidence tell us?. Mental health and physical activity, 18, 100315.
10. Vella, S. A., Aidman, E., Teychenne, M., Smith, J. J., Swann, C., Rosenbaum, S., ... & Lubans, D. R. (2023). Optimising the effects of physical activity on mental health and wellbeing: A joint consensus statement from Sports Medicine Australia and the Australian Psychological Society. Journal of Science and Medicine in Sport, 26(2), 132-139.