Effects of physical activity intervention in preventing perinatal anxiety and depression among primiparas in Shanxi Province, China

In China, the prevalence of perinatal depression (PND), perinatal anxiety (PNA), and comorbid anxiety and depression (CAD) has increased in recent decades, especially in primiparas, with significant consequences for women, infants, and families. Physical activity (PA) intervention was a low-cost, highly accessible approach for preventing PND and PNA. However, pregnant women were often physically inactive due to various barriers. Hence, addressing the gap between women’s intentions and actions was becoming important. This study aimed to design, implement and evaluate a modified PA programme in reducing PND, PNA, and CAD as the primary outcome among primiparas in Shanxi Province, China. A randomised, single-blind, parallel-group trial study was conducted in Heji Hospital Affiliated with Changzhi Medical College. One hundred and twenty eligible primiparas were recruited and randomised into intervention (n = 60) or control group (n = 60). The intervention group (IG) attended a 13- week PA programme and the control group (CG) received the usual care. The social cognitive theory was used as the theoretical framework to develop the PA programme, consisting of psychological sessions and individualised PA. Data were measured using questionnaires across three time points: at baseline, post-intervention, and six weeks after delivery. These questionnaires included information on primipara’s sociodemographic profile, depression (Edinburgh Postnatal Depression Scale), anxiety (Perinatal Anxiety Screening Scale), CAD, movement behaviour (low physical activity level, sedentary behaviour and sleep duration) (International Physical Activity Scale). Data were analysed using SPSS 26.0, involving descriptive statistics, parametric or non-parametric technique, and generalised linear mixed model. The confidence interval was set at 95% and a level of significance of 0.05. The intent-to-treat principle was applied for lost follow-up. A significant group × time interaction was found for depression and anxiety scores (p = 0.001; p = 0.032), and for the incidence of anxiety (p = 0.038), CAD(p = 0.003), low physical activity (LPA) level (p = 0.002) and sleep duration < 8h/d (p = 0.025). Compared to the CG, the IG substantially reduced depression and anxiety scores (p = 0.001, p = 0.001; p = 0.023, p = 0.002), as well as the rates of depression (p = 0.019, p = 0.032), CAD (p = 0.024, p = 0.003), LPA level (p = 0.000, p = 0.048), sedentary time > 6h/d (p = 0.008, p = 0.034) and sleep duration < 8h/d (p = 0.000, p = 0.001) at post-intervention and six weeks postpartum. No significant differences were observed within the IG over time, except depression scores (p = 0.028) and LPA level (p = 0.002). The PA programme was superior in managing PND, PNA, CAD and movement behaviour. These findings could help the policymakers and practitioners integrate primiparas' mental health and movement behaviour into their public health initiative, thus minimizing consequences of perinatal mental health on future generations.

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