Does aerobic exercise reduce postpartum depressive symptoms? A systematic review and meta-analysis

Background There is currently no specific guidance on the role of exercise in managing postpartum depression in the UK and US, and international guidance is inconsistent. Aim To assess the effectiveness of aerobic exercise on postpartum depressive symptoms. Design and setting Systematic review and meta-analysis. There was no restriction to study site or setting. Method The databases MEDLINE, EMBASE, Cochrane Library, PsycINFO, SportDiscus, Clinical Trials.gov, and the World Health Organization International Clinical Trials Registry Platform were searched. Titles and abstracts, then full-text articles, were screened against inclusion criteria: RCTs measuring depressive symptoms in mothers ≤1 year postpartum; and interventions designed to increase aerobic exercise compared with usual care or other comparators. Included studies were assessed using the Cochrane Collaboration's risk of bias tool. Meta-analysis was conducted. Pre-planned subgroup analyses explored heterogeneity. Results Thirteen RCTs were included, with 1734 eligible participants. Exercise significantly reduced depressive symptoms when all trials were combined (standardised mean difference -0.44; 95% confidence interval = -0.75 to -0.12). Exploration of heterogeneity did not find significant differences in effect size between women with possible depression and in general postpartum populations; exercise only and exercise with co-interventions; and group exercise and exercise counselling. Conclusion This systematic review provides support for the effectiveness of exercise in reducing postpartum depressive symptoms. Group exercise, participant-chosen exercise, and exercise with co-interventions all may be effective interventions. These results should be interpreted with caution because of substantial heterogeneity and risk of bias

Towards a new social justice agenda: understanding political responses to crises

This In Focus Policy Briefing was written by Naomi Hossain of the institute of development Studies with inputs and advice from Kate Bishop, Robert Chambers, Kate Carroll, Rosalind Eyben, Richard Jolly, Claire Melamed and Rachel Sabates-Wheeler. The series editor is Carol Smithyes.Food riots across the developing world in 2008 sent powerful messages about the limits to people’s tolerance of acute economic insecurity. Yet political responses of this kind are mainly treated as the inevitable social convulsions after economic shocks – as natural, almost physiological responses to hunger. This briefing proposes that these political responses to crises can provide insights into popular perspectives on the global political issues of the day: global economic uncertainty, the moral limits to market freedom, and responsibilities of governments to protect against risk. Understanding such perspectives could inform emerging debates within development and help shape a new social justice agenda

Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis

Objective To compare the effect of home based and supervised centre based cardiac rehabilitation on mortality and morbidity, health related quality of life, and modifiable cardiac risk factors in patients with coronary heart disease