Table 2 An overview of the studies found in the systematic review and narrative analysis

Cramp and Brawley [42] Canada

RCT

57 women who had given birth between 6 weeks and 1 year previously. Women were randomized to one of two conditions:

Control: n = 31 standard exercise treatment (SE)

Intervention: n = 26 standard exercise treatment plus group-mediated cognitive behavioral intervention (GMCB)

Mean age: 31.5 years

Program: Uni-faceted with behavior change sessions

Theoretical framework: Group-Mediated Cognitive Behavioral intervention (GMCB)

Duration: 2 months (4 weeks supervised group training and 4 weeks home based phase)

Group-based PA characteristics: Participants in both conditions participated in a 4-week intensive phase where participants received standard exercise training. Participants in the GMCB intervention group an additional 4 week home-based self-structured exercise. The first phase consisted of supervised, group delivered, centre-based standard exercise training fitness classes twice a week. Delivery of exercise to the group was through the same certified instructors at the same site. Intervention participants in the GMCB treatment received six, 20-min group-mediated cognitive behavioral training sessions on developing self-regulatory skills for self-management of PA and to overcome postpartum specific barriers to self-manage PA

Comparison: Standard exercise treatment (SE) without the GMCB components

Outcome measures: The 7-day Physical Activity Recall (7-PAR) questionnaire was utilized to assess self-reported PA and a 17-item modified version of Garcia and King's barrier efficacy scale measured self-regulatory efficacy

At 2-month follow-up

Study retention was high (85%) and there was no selective effect of retention for either treatment

Self-reported PA p < 0.01

Self-regulatory efficacy p < 0.05

Lee et al. [40] Scotland

Gilinsky PhD thesis [41]

RCT

65 women who had given birth between 6 weeks and 1 year previously

Intervention n = 33

Control n = 32

Mean age: 33.5 years

Program: “More Active MuMs in Stirling (MAMMiS)”; Uni-faceted, with behavior change sessions

Theoretical framework: Transtheoretical Model (TTM)

Duration: 3 months with 6 months follow-up

Group-based PA characteristics: Participants could attend one session/week for 10 weeks and all women were encouraged to attend. Walks were conducted at a moderate-intensity (e.g., brisk pace) between 30 to 55 min per session

Comparison: Traditional control group which received a NHS Health Scotland publication with information on physical activity guidelines and advice on implementation

Outcome measures: postnatal weight, body composition, psychological general well-being Adapted General Well-Being Index (AGWBI), and fatigue using a visual analogue scale (VAS)

At 6-month follow-up

Study retention was high, as all received the intervention or control condition and 91% (59/65) completed 6-month measurements

Objective PA (counts p/min) p = 0.57

Postnatal weight (kg) p = 0.80

Body composition (BMI kg/m²) p = 0.80

Fat mass (kg) p = 0.81

Psychological well-being p = 0.19

Fatigue p < 0.01

Norman et al. [43] Australia

RCT

135 women recruited at time of hospital discharge

Intervention n = 62

Control n = 73

Mean age: 29.3 years (intervention) 30.1 years (control)

Program: “Mother and Baby” (M&B); Multifaceted

Theoretical framework: Not reported

Duration: 2 months with 12-week follow-up

Group-based PA characteristics: The intervention group received specialized exercise, 1 h per week, provided by a women’s health physical therapist combined with parenting education. Each week, women undertook one hour of group exercise with their babies, facilitated by a physical therapist, which involved cardiovascular and strength components. Each of the eight exercise sessions was adapted for each woman depending on the type of delivery and her recovery. Participants also had a 30-min parent education session delivered by health care professionals, including physical therapists, dietitians, speech pathologists, health psychologists, and midwives

Comparison: The control group received a leaflet on parenting education mailed to them every week over 8 weeks

Outcome measures: Psychological well-being (Positive Affect Balance Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and PA levels were assessed at baseline, after 8 weeks (post-program), and then 4 weeks later

At 3-month follow-up

The retention rate for those commencing the study was 96%

Psychological well-being p = 0.58

Depression p = 0.19

Self-reported PA (mins p/w) p = 0.87

Ostbye et al. [44] USA

RCT

450 women, enrolled 6 weeks postpartum, recruited through obstetrics clinics and community posters (stratified by black versus other and primiparous versus multiparous) using block randomization

Intervention n = 225

Control n = 225

Mean age: 30.9 years

Program: “Active Mothers Postpartum” (ACTIVMOMS); Multifaceted

Theoretical framework: Social Cognitive Theory, Stage of Readiness, and Motivation models

Duration: 9 months

Group-based PA characteristics: Eight healthy eating classes (Mom’s Time Out [MTO]), ten physical-activity group sessions (ACTIVMOMS classes) and six telephone counselling sessions. Given the intervention’s strong emphasis on walking, a sport stroller was provided to encourage walking for exercise outside of class and after the end of the intervention. The ACTIVMOMS classes encouraged walking and demonstrated activities designed to enhance recovery from pregnancy, including aerobics, strength and flexibility training, and pelvic-floor exercises. Using a front-facing baby carrier, mothers could exercise with their babies in a mom-and-tot format if desired. Every 6 weeks, women received one of six counselling sessions from a trained counsellor, lasting about 20 min each

Comparison: The control group received biweekly newsletters with general tips for postpartum mothers. Women in both groups received monetary incentives on completion of each follow-up assessment

Outcome measures: self-reported physical-activity recall and television time (7-day physical-activity recall [7-PAR], food-frequency questionnaire [FFQ] and weight)

At 9-month follow-up

The retention rate for those commencing the study was 94%

Daily caloric intake p = 0.37

Self-reported PA (Vigorous intensity mins p/w) p = 0.99

TV hours/day p = 0.08

Weight (kg) p = 0.25

Timlin and Simpson [45] Ireland

RCT

32 first time mothers were recruited from a Sure Start Community Centre if they had a baby aged between 6 weeks to 1-year-old

Intervention n = 16

Control n = 16

Mean age: 28 years

Program: Dru Yoga; Unifaceted

Theoretical framework: Not reported

Duration: 1 month

Characteristics: The participants in the intervention group attended for a one-hour Dru yoga session, once a week, for 4 weeks. The Dru yoga programme consisted of four parts and was designed to meet the needs of postpartum women. The intervention group were also offered a 20-min Dru yoga DVD to take home and practice at least twice a week. Participants were asked to keep a diary and write in it each week how many times they completed the DVD

Comparison: The control group received no treatment but received the Dru Yoga DVD at the completion of the intervention

Outcome measures: Physical Activity Readiness Questionnaire (PAR-Q), perceived stress (Perceived Stress Scale), mood, (Positive and Negative Affect Schedules [PANAS]) and coping (Brief Cope)

At 1-month follow-up

The retention rate for those commencing the study was 100%

PA readiness = Not reported

Perceived stress p = 0.85

Mood p = 0.24

Coping p = 0.27

Zourladani et al. [46] Greece

RCT

40 primiparous women recruited at four to 6 weeks postpartum

Intervention n = 20

Control n = 20

Mean age: 31.3 years

Program: Unifaceted

Theoretical framework: Not reported

Duration: 3 months

Characteristics: The intervention group participated in a low impact exercise training programme, involving 50–60 min of aerobic, stretching and strengthening exercise, three days a week, for 12 weeks. It began with a ten minute warm-up, including low impact dance aerobics and stretching of the main muscle groups, followed by 20–25 min of low impact aerobics. A 15–20-min muscle strengthening programme followed, which consisted of exercises for the upper and lower back, abdominal muscles, and pelvic floor. It was delivered by a fitness specialist

Comparison: The control group did not take part in any exercise programme

Outcome measures: psychosocial well-being (Lederman Postpartum Self-Evaluation Questionnaire), weight, and infant feeding method

At 3-month follow-up

The retention rate for those commencing the study was not reported

Weight (kg) p = 0.67

Psychosocial wellbeing p < 0.05