Perceived Barriers and Motivators for Physical Activity in Women With Perinatal Depression

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Sylvia E. Badon
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Esti Iturralde
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Linda Nkemere
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Nerissa Nance
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Lyndsay A. Avalos
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Background: Physical activity (PA) can help reduce depression symptom severity in women with perinatal depression. However, PA is low, and barriers and motivators for PA among women with perinatal depression are not well understood. Methods: An ethnically diverse sample of women with perinatal depression was identified using a universal perinatal depression screening program. The authors conducted 8 focus groups (4 in pregnant women [n = 15] and 4 in postpartum women [n = 20]). Depression symptoms were measured using the Patient Health Questionnaire-8 at recruitment. Focus groups were analyzed using an inductive approach. Results: Pregnant participants were 27 weeks gestation, and postpartum participants were 11.5 months postpartum, on average. Depression symptoms were moderately severe (mean Patient Health Questionnaire-8 score: 16). Women identified practical barriers and motivators for PA common to perinatal women (physical health, parental responsibilities, PA tracking tools, and environmental factors) and described emotional and social factors influencing PA. Motivators included using PA to improve mood, relieve stress, boost self-image, and spend time with others. Bad mood, fear of social judgment, and feeling discouraged made it difficult to be active. Conclusion: PA interventions in women with perinatal depression should include components addressing emotional and social barriers to PA in addition to addressing additional common practical barriers to PA.

The authors are with Kaiser Permanente Northern California Division of Research, Oakland, CA, USA.

Badon (sylvia.e.badon@kp.org) is corresponding author.

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  • 1.

    Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression: a systematic review of prevalence and incidence. Obs Gynecol. 2005;106(5, pt 1):10711083. doi:10.1097/01.AOG.0000183597.31630.db

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod. 2009;24(1):146153. doi:10.1093/humrep/den342

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Yonkers KA, Wisner KL, Stewart DE, et al. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obs Gynecol. 2009;114(3):703713. doi:10.1097/AOG.0b013e3181ba0632

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Grigoriadis S, VonderPorten EH, Mamisashvili L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psych. 2013;74(4):e321e341. doi:10.4088/JCP.12r07968

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Beck CT. The effects of postpartum depression on maternal–infant interaction: a meta-analysis. Nurs Res. 1995;44(5):298304. PubMed ID: 7567486 doi:10.1097/00006199-199509000-00007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    O’Hara MW, McCabe JE. Postpartum depression: current status and future directions. Ann Rev Clin Psychol. 2013;9:379407.

  • 7.

    Murray L. The impact of postnatal depression on infant development. J Child Psychol Psychiatry. 1992;33(3):543561. doi:10.1111/j.1469-7610.1992.tb00890.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Quevedo LA, Silva RA, Godoy R, et al. The impact of maternal post-partum depression on the language development of children at 12 months. Child: Care Health Dev. 2012;38(3):420424.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Murray L, Cooper PJ. Postpartum depression and child development. Psychol Med.. 1997;27(2):253260. doi:10.1017/S0033291796004564

  • 10.

    Daley AJ, Macarthur C, Winter H. The role of exercise in treating postpartum depression: a review of the literature. J Midwifery Women’s Health. 2007;52(1):5662. doi:10.1016/j.jmwh.2006.08.017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    Craft LL, Perna FM. The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry. 2004;6(3):104111. doi:10.4088/PCC.v06n0301

  • 12.

    Perales M, Refoyo I, Coteron J, Bacchi M, Barakat R. Exercise during pregnancy attenuates prenatal depression: a randomized controlled trial. Evalu Health Prof. 2015;38(1):5972. doi:10.1177/0163278714533566

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Teychenne M, York R. Physical activity, sedentary behavior, and postnatal depressive symptoms: a review. Am J Prev Med. 2013;45(2):217227. PubMed ID: 23867030 doi:10.1016/j.amepre.2013.04.004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Evenson KR, Wen F. National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999–2006. Prev Med. 2010;50(3):123128. PubMed ID: 20053370 doi:10.1016/j.ypmed.2009.12.015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Borodulin K, Evenson KR, Herring AH. Physical activity patterns during pregnancy through postpartum. BMC Women’s Health. 2009;9(1):32. PubMed ID: 19925650 doi:10.1186/1472-6874-9-32

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Evenson KR, Herring AH, Wen F. Self-reported and objectively measured physical activity among a cohort of postpartum women: the PIN Postpartum study. J Phys Act Health. 2012;9(1):520. PubMed ID: 22232505 doi:10.1123/jpah.9.1.5

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Olson CM, Strawderman MS, Hinton PS, Pearson TA. Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum. Int J Obes Relat Metab Disord: J Int Assoc Study Obes. 2003;27(1):117127. doi:10.1038/sj.ijo.0802156

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Hull EE, Rofey DL, Robertson RJ, Nagle EF, Otto AD, Aaron DJ. Influence of marriage and parenthood on physical activity: a 2-year prospective analysis. J Phys Act Health. 2010;7(5):577583. PubMed ID: 20864752 doi:10.1123/jpah.7.5.577

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Albright CL, Maddock JE, Nigg CR. Physical activity before pregnancy and following childbirth in a multiethnic sample of healthy women in Hawaii. Women Health. 2005;42(3):95110. PubMed ID: 16901890 doi:10.1300/J013v42n03_06

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Pereira MA, Rifas-Shiman SL, Kleinman KP, Rich-Edwards JW, Peterson KE, Gillman MW. Predictors of change in physical activity during and after pregnancy: project viva. Am J Prev Med. 2007;32(4):312319. PubMed ID: 17383562 doi:10.1016/j.amepre.2006.12.017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Battle CL, Scott BLD, Fritzson AE, Howard M, Abrantes AM. Acceptability and perceived benefits of exercise among pregnant and postpartum women seeking psychiatric care. Women’s Health Rep. 2020;1(1):212217. doi:10.1089/whr.2020.0039

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    Coll CV, Domingues MR, Gonçalves H, Bertoldi AD. Perceived barriers to leisure-time physical activity during pregnancy: a literature review of quantitative and qualitative evidence. J Sci Med Sport/Sports Med Aus. 2017;20(1):1725. doi:10.1016/j.jsams.2016.06.007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Harrison AL, Taylor NF, Shields N, Frawley HC. Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. J Physiother. 2018;64(1):2432.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    MacMillan Uribe AL, Olson BH. Exploring healthy eating and exercise behaviors among low-income breastfeeding mothers. J Hum Lact. 2019;35(1):5970. PubMed ID: 29723099 doi:10.1177/0890334418768792

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Murray-Davis B, Grenier L, Atkinson SA, et al. Experiences regarding nutrition and exercise among women during early postpartum: a qualitative grounded theory study. BMC Pregnancy Childbirth. 2019;19(1):368. PubMed ID: 31638920 doi:10.1186/s12884-019-2508-z

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Saligheh M, McNamara B, Rooney R. Perceived barriers and enablers of physical activity in postpartum women: a qualitative approach. BMC Pregnancy Childbirth. 2016;16(1):131. PubMed ID: 27256279 doi:10.1186/s12884-016-0908-x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Albright CL, Saiki K, Steffen AD, Woekel E. What barriers thwart postpartum women’s physical activity goals during a 12-month intervention? A process evaluation of the Na Mikimiki Project. Women Health. 2015;55(1):121. PubMed ID: 25402618 doi:10.1080/03630242.2014.972014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Evenson KR, Aytur SA, Borodulin K. Physical activity beliefs, barriers, and enablers among postpartum women. J Women’s Health. 2009;18(12):19251934. doi:10.1089/jwh.2008.1309

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Shelton SL, Lee SS. Women’s self-reported factors that influence their postpartum exercise levels. Nurs Womens Health. 2018;22(2):148157. PubMed ID: 29628054 doi:10.1016/j.nwh.2018.02.003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Dimidjian S, Goodman SH. Preferences and attitudes toward approaches to depression relapse/recurrence prevention among pregnant women. Behav Res Therapy. 2014;54:711. doi:10.1016/j.brat.2013.11.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31.

    Buist A, Bilszta J, Barnett B, et al. Recognition and management of perinatal depression in general practice--a survey of GPs and postnatal women. Aus Fam Phys. 2005;34(9):787790.

    • Search Google Scholar
    • Export Citation
  • 32.

    Whitton A, Warner R, Appleby L. The pathway to care in post-natal depression: women’s attitudes to post-natal depression and its treatment. Br J General Prac: J Royal Coll General Pract. 1996;46(408):427428.

    • Search Google Scholar
    • Export Citation
  • 33.

    Turner KM, Sharp D, Folkes L, Chew-Graham C. Women’s views and experiences of antidepressants as a treatment for postnatal depression: a qualitative study. Fam Pract. 2008;25(6):450455. doi:10.1093/fampra/cmn056

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Tehrani H, Majlessi F, Shojaeizadeh D, Sadeghi R, Hasani Kabootarkhani M. Applying socioecological model to improve women’s physical activity: a randomized control trial. Iran Red Crescent Med J. 2016;18(3):e21072.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Avalos LA, Raine-Bennett T, Chen H, Adams AS, Flanagan T. Improved perinatal depression screening, treatment, and outcomes with a universal obstetric program. Obs Gynecol. 2016;127(5):917925. doi:10.1097/AOG.0000000000001403

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Flanagan T, Avalos LA. Perinatal obstetric office depression screening and treatment: implementation in a health care system. Obs Gynecol. 2016;127(5):911915. doi:10.1097/AOG.0000000000001395

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Spitzer RL, Williams JB, Kroenke K, Hornyak R, McMurray J. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD Patient Health Questionnaire Obstetrics-Gynecology Study. Am J Obs Gynecol. 2000;183(3):759769. doi:10.1067/mob.2000.106580

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38.

    Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):15961602. doi:10.1007/s11606-007-0333-y

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Morgan D, Hoffman K. Focus groups. In: Flick U, ed. The SAGE Handbook of Qualitative Data Collection. London: SAGE Publications; 2018:250263.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40.

    Hughes D, DuMont K. Using focus groups to facilitate culturally anchored research. In: Revenson T, ed. Ecological Research to Promote Social Change: Methodological Advances from Community Psychology. New York: Kluwer Academic/Plenum; 2002:257289.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    Wong LP. Focus group discussion: a tool for health and medical research. Singapore Med J. 2008;49(3):256260; quiz 261.

  • 42.

    Joseph RP, Ainsworth BE, Keller C, Dodgson JE. Barriers to physical activity among African American women: an integrative review of the literature. Women Health. 2015;55(6):679699. PubMed ID: 25909603 doi:10.1080/03630242.2015.1039184

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Hall AE. Perceived barriers to and benefits of physical activity among black and white women. Women Sport Phys Act J. 1998;7(2):132.

  • 44.

    Kroenke K, Strine TW, Spitzer RL, Williams JB, Berry JT, Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114(1-3):163173. PubMed ID: 18752852 doi:10.1016/j.jad.2008.06.026

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Evaluat. 2006;27(2):237246. doi:10.1177/1098214005283748

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606613. doi:10.1046/j.1525-1497.2001.016009606.x

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    ACOG Committee Opinion No. 736: optimizing postpartum care. Obs Gynecol. 2018;131(5):e140e150. doi:10.1097/AOG.0000000000002633

  • 48.

    Ginis KA, Nigg CR, Smith AL. Peer-delivered physical activity interventions: an overlooked opportunity for physical activity promotion. Transl Behav Med. 2013;3(4):434443. PubMed ID: 24294332 doi:10.1007/s13142-013-0215-2

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49.

    Schmittdiel JA, Brown SD, Neugebauer R, et al. Health-plan and employer-based wellness programs to reduce diabetes risk: the Kaiser Permanente Northern California NEXT-D Study. Prev Chronic Dis. 2013;10:E15.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50.

    Cording J. How COVID-19 Is Transforming The Fitness Industry. Forbes. 2020. https://www.forbes.com/sites/jesscording/2020/07/13/covid-19-transforming-fitness-industry/?sh=635bb7c230a7.

    • Search Google Scholar
    • Export Citation
  • 51.

    Masters GA, Asipenko E, Bergman AL, et al. Impact of the COVID-19 pandemic on mental health, access to care, and health disparities in the perinatal period. J Psychiatr Res. 2021;137:126130. PubMed ID: 33677216 doi:10.1016/j.jpsychires.2021.02.056

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52.

    Kotlar B, Gerson E, Petrillo S, Langer A, Tiemeier H. The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. Reprod Health. 2021;18(1):10. doi:10.1186/s12978-021-01070-6

    • Crossref
    • Search Google Scholar
    • Export Citation
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