Recruitment of general practices
Of 262 practices invited to assist with study recruitment, 56 (21%) agreed, 67 (26%) declined, and 139 (53.1%) did not respond. Of those practices that agreed (n = 56), three later withdrew, 18 provided no patient lists when requested, and 10 reported no eligible patients at the time of the study; thus 25/262 (9.5%) practices provided lists of eligible patients.
Recruitment took place between October 2005 and May 2006. Fifty-three women expressed an interest in taking part, of whom 27 (51%) were identified from general practice records, 12 (23%) by the specialist mother and baby unit, 10 (19%) from health visitor referral, and four (8%) self-referred. A higher proportion of women responded to an invitation from the mother and baby unit (12/28; 42.9%) than their GP (27/96; 28.1%). Six women were subsequently found to be ineligible, and nine withdrew prior to randomisation or did not return the baseline questionnaire, leaving 38 eligible patients who were randomised (recruitment rate 4–5 patients per month). Denominator data were only available for GPs (n = 96) and the mother and baby unit (n = 28). Trial recruitment from these sources was 23.1% (28/121; 124 potentially eligible minus three screened as further ineligible; Figure 1).
Characteristics of randomised participants
Most participants were aged between 29 and 31 years, had one or two children, lived with their husband/partner, and were not currently breastfeeding their infant. Most participants were employed, taking antidepressants, had low levels of social support, and lived in more deprived communities (). A total of 26.3% of the sample were of non-white ethnicity. At baseline, 33 of the 38 participants (exercise group, n = 17; usual care, n = 16) recorded an EPDS score >12, and in 4 of the 38 participants the EPDS score was 12 (exercise group, n = 2; usual care, n = 2).
Baseline demographic characteristics of participants by study group.
Exercise participation and EPDS score
No significant mean difference between the groups was found for the frequency of participation in mild, moderate, or vigorous exercise, although scores for moderate-intensity exercise favoured the exercise group. The exercise group reported significantly higher adjusted mean self-efficacy for exercise scores than usual care (P = 0.002). EPDS scores did not differ significantly between the groups ().
Adherence (intervention group only)
Descriptive analysis of data from the exercise diaries of the 11 participants who completed and returned these, indicated that participants engaged in exercise for a mean of 174 minutes (standard deviation = 73.6) per week. Ten of these 11 women were able to achieve the intervention goal of at least 105 minutes' exercise per week.
Of women who were randomised to the exercise intervention, 14 (70%) returned their responses to the intervention evaluation questionnaire. All responders stated exercise should be encouraged in women who are experiencing low mood. Eleven of the 14 women thought that exercise helped to improve their low mood. Twelve women reported that their general health had improved.
The most popular reasons given for participation in the study were to help depression/low mood (n = 7), enhance motivation to exercise (n = 4), help others experiencing similar symptoms (n = 3), and to have a goal to reach each day and to gain a sense of achievement (n = 2).
Most women reported they had enjoyed the exercise they had been doing during the intervention (n = 11). The most popular type of exercise was walking. The majority (n = 8) felt that they would do more exercise if there were group walking sessions with other women experiencing low mood after childbirth; four women were unsure; and two women did not feel groups would be useful. The main barriers to exercise faced by mothers were childcare and family responsibilities (n = 10), lack of time (n = 6), feeling tired (n = 4), weather (n = 4), and physical and psychological health problems related to mother or infant (n = 3).