Effect of a Tailored eHealth Physical Activity Intervention on Physical Activity and Depression During Postpartum: Randomized Controlled Trial (The Postpartum Wellness Study)
Bibliographic record
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 randomized controlled trial within the Kaiser Permanente Northern California integrated 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 ten-minute workout videos developed for postpartum individuals, including interaction with their infants. At baseline, 3 months, and 6 months postrandomization, 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-to-vigorous intensity PA (dm-MVPA) at 3 months postrandomization. Secondary outcomes were self-reported MVPA (sr-MVPA) at 3 and 6 months postrandomization and depressive symptoms and dm-MVPA at 6 months postrandomization. Intent-to-treat and modified intent-to-treat (excluding participants in the intervention group who did not watch at least 1 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 [Patient Health Questionnaire-8] score=12.6), on average. Intent-to-treat analyses indicated no association between the intervention and change in depressive symptoms (mean difference=-0.9; 95% CI -3.3 to 1.5), dm-MVPA per day (mean difference=-4.5 minutes; 95% CI -23.5 to 14.5), or sr-MVPA per week (mean difference=3.8; 95% CI -1.9 to 9.5) at 3 months postrandomization or 6 months postrandomization (depressive symptoms: mean difference=-1.3; 95% CI -3.7 to 1.1; dm-MVPA: mean difference=1.3 minutes; 95% CI -18.9 to 21.5; sr-MVPA: mean difference=-1.8 MET-hours; 95% CI -7.7 to 4.2). Engagement with the intervention was suboptimal; although 52% (n=26) of participants allocated to the intervention group logged on to the intervention website and watched at least 1 video, the median minutes watched per week peaked at 10 minutes 2 weeks postrandomization, 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. Additional research to develop effective and engaging PA interventions is needed to help alleviate PPD symptoms and decrease PPD risk.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".