Table 5.

Characteristics of included studies investigating the effect of physical activity interventions on psychological outcomes.

Author/Year/Country	Study Design/Settings	Participant Characteristics/Sample Size/Number of Withdrawals	Intervention Components	Interveners	Assessed Outcomes on Gestational Weight Gain/Data Collection Time Points	Assessment Tools for Outcome Assessment	Findings
Huang et al. 2011; Taiwan	Three-group randomized controlled trial; clinic at a local medical center in northern Taiwan	Adult women before the 16th week of gestation n = 240 (First intervention group (EP): 80, second intervention group (EPP): 80, control group: 80) Withdrawals EP: 19, EPP: 16 control: 16	Comprising dietary and physical activity components Physical activity components First intervention group (EP) Counselling and information dissemination Six sessions of individual counselling, focusing on goal setting in physical activity behaviors. A brochure containing information on the recommended exercise types and their benefits was also provided. The intervention lasted from the 16th gestational week to 6 months postpartum. Second intervention group (EPP) Same intervention as the EP group, but it lasted from 24–48 h after delivery to 6 months post-partum and consisted of only three counselling sessions. Control group Usual care	Nurse	Depression Data collected at: Baseline Six months postpartum	Beck Depression Inventory	Between-group comparisons Participants in the first intervention group (EP group) exhibited a significantly lower extent of increase in the depression score compared to those in the second intervention group (EPP group) and control group (p < 0.001)
Songoygard et al. 2012; Norway	Randomized controlled trial; Local hospitals in Trondheim and Stavanger	Adult pregnant women attending ultrasound examination during the 18th week of pregnancy n = 855 (Intervention: 429, control: 426) Withdrawals Intervention: 50, control: 86	Intervention group: Supervised exercise program Supervised group exercise sessions, each lasting 60 min, held once per week over a 12-week period. Sessions consisted of 30–35 min low-impact aerobics, 20–25 min strength exercises, and 5–10 min of stretching, body awareness, breathing and relaxation exercises. Home-based exercise program Included a 45-min home exercises twice per week, consisting of endurance training and strength and balance exercises. Control group: Standard antenatal care	Physiotherapists	Depression Data collected at: Baseline Postintervention 3-month postpartum	Edinburgh Postnatal Depression Scale (EPDS)	Between-group comparisons At 3-month postpartum, no difference in the EPDS score was observed between the intervention and control groups (intervention: 2.52 ± 2.90; control: 2.52 ± 3.30); p = 0.35. Among participants who exhibited compliance to the intervention only, no difference in EPDS score was observed between the two groups (p = 0.79). Subgroup analysis By including only participants who did not do exercise before pregnancy in the analysis, the intervention was found to cause a significant reduction in the proportion of participants with an EPDS score of 10 or more (p = 0.03). However, the intervention did not cause a significant reduction in the proportion of participants with an EPDS score of 13 or more (p = 0.11)
Gustafsson et al. 2016; Norway	Randomized controlled trial; Local hospitals in Trondheim and Stavanger	Adult pregnant women attending ultrasound examination during the 18th week of pregnancy n = 855 (Intervention: 429, control: 426) Withdrawals Intervention: 33, control: 61	Intervention group: Supervised exercise program Supervised group exercise sessions, each lasting 60 min, held once per week over a 12-week period. Sessions consisted of 30–35 min low-impact aerobics, 20–25 min strength exercises, and 5–10 min of stretching, body awareness, breathing and relaxation exercises. Home-based exercise program Included a 45-min home exercises twice per week, consisting of endurance training and strength and balance exercises. Control group: Standard antenatal care	Physiotherapists	Psychological well-being (anxiety and depression) Data collected at: Baseline Postintervention	Psychological General Well-being Index	Between-group comparisons After the intervention, no significant differences were observed between groups in all of the outcomes investigated, including anxiety (p = 0.23) and depressed mood (p = 0.90).
Miquelutti et al. 2013; Brazil	Randomized controlled trial; A local hospital and four primary healthcare centers in Sao Paulo	Adult women with singleton pregnancy, at 18–24 weeks of gestation n = 205 (Intervention: 103, control: 102) Withdrawals Intervention: 3, control: 1	Intervention group: Supervised exercise program Attendance to 50-min sessions of nonaerobic exercises that involve the contraction of pelvic floor muscles. Counselling Oral guidance on pain prevention and control, and information provided to increase participants’ awareness on pelvic floor muscles Home-based exercise program Participants were also provided with a guide for performing exercises at home. These exercises include pelvic floor muscle training, stretching, exercises to improve venous return in lower limbs, exercises on abdominal muscles and training on progressive relaxation techniques. Control group: Attendance to educational sessions on breastfeeding, signs and symptoms of labor, as well as visits to delivery ward	Physiotherapists	Anxiety Data collected at: 18–24 weeks of pregnancy 28–30 weeks of pregnancy 36–38 weeks of pregnancy	State-trait anxiety inventory	Between-group comparison No significant difference in anxiety levels was observed between groups at all data collection timepoints. (p values not reported)
Robledo-Colonia et al. 2012; Columbia	Randomized controlled trial; Three local hospitals in Cali	Adult pregnant women at 16–20 weeks of gestation n = 80 (Intervention: 40, control: 40) Withdrawals Intervention: 3, control: 3	Intervention group: Supervised exercise program Group exercise classes held three times per week, each lasting for 60 min, for a period of three months. These sessions consist of walking, aerobic exercises, stretching and relaxation Control group: Did not attend the exercise classes	Physiotherapists and physicians	Depression Data collected at: Baseline Postintervention (3 months after baseline data collection)	Center for Epidemiological Studies-Depression Scale (CES-D)	Between-group comparisons The intervention induced a more significant decrease in the CES-D score among the intervention participants, compared to controls. A difference of four points in the reduction in CES-D score was observed between intervention and control groups.
Haakstad et al. 2016; Norway	Secondary analysis of randomized controlled trial; Local community	Adult women within the first 24 weeks of pregnancy n = 105 (Intervention: 52, Control: 53) Withdrawals Intervention: 0, control: 0	Intervention group: Supervised exercise program Supervised 1-hour sessions of aerobic dance at least twice per week for 12 weeks. The exercises emphasized cardiovascular endurance training and strength training. Aerobic dance sessions comprise 5-min warm up exercise, 35 min of endurance training and aerobic dance, 15 min of strength training of deep abdominal stabilization muscles, pelvic floor and back muscles, followed by 5 min of stretching, relaxation and body awareness exercises. Music was played during these sessions. Unsupervised exercise program 30-min sessions of self-imposed moderate-intensity physical activity. Control group: Asked to practice their usual physical activity habits	Aerobics instructors	Maternal pregnancy depression Data collected at: Baseline Postintervention	WHOQOL-BREF SF-36	Between-group comparisons Intention-to-treat analysis No significant difference in the score for the frequency of having negative mood feelings such as sadness, despair, anxiety and depression between groups at postintervention, where higher score indicates lower frequency of such feelings (p = 0.4) No significant difference in the proportion of participants reporting pregnancy depression between groups at postintervention. (p = 0.07) Per-protocol analysis with participants exhibiting 100% exercise adherence Significant difference was observed in the score for the frequency of having negative mood feelings between groups at postintervention (p = 0.01) Difference in the proportion of participants reporting pregnancy depression between groups did not reach statistical significance at postintervention (p = 0.4)
Perales et al. 2015; Spain	Randomized controlled trial; University Hospital of Fuenlabrada in Madrid	Adult women with uncomplicated and singleton gestations n = 184 (Intervention: 101, control: 83) Withdrawals Intervention: 11, control: 6	Intervention group: Supervised exercise program Supervised physical conditioning program of light- to moderate-intensity aerobic activity three times per week, each lasting 55–60 min. It comprises 5–8 min of walking and muscle stretching, followed by aerobic dance, exercises targeting muscles on the legs, buttocks and abdomen, pelvic floor muscle training and balancing exercises, and a cool-down session. Control group: Not specified	Qualified fitness specialists	Depression during pregnancy Data collected at: Week 9–12 of pregnancy (First trimester) Week 38–39 of pregnancy (Third trimester)	Center for Epidemiological Studies—Depression scale (CES-D)	Within-group comparisons For intervention group, a significant decrease in depression score was observed at postintervention. (p = 0.001). A small effect size was observed (Cohen’s d = 0.29) For control group, a significant increase in depression score was observed at postintervention. (p = 0.039). A small effect size was observed (Cohen’s d = 0.22) Between-group comparisons Significantly lower depression score was observed among the intervention participants compared to the control participants at postintervention (p = 0.005), while no significant difference in depression score was observed between groups at baseline (p = 0.71). A small effect size was observed (Cohen’s d = 0.46)