This study explored the effects of a low-intensity exercise program on fatigue and depression in postpartum women in Taiwan. 31 women participated in 6 exercise sessions over 3 weeks that focused on yoga, Pilates, and aerobic exercises. Their levels of fatigue and depression were measured before and after and compared to a control group of 30 women who did not participate. The exercise program significantly reduced physical fatigue, psychological fatigue, and fatigue symptoms, but did not significantly impact depression levels. The study demonstrated that low-intensity exercise can help reduce feelings of fatigue in postpartum women.
This ppt is to learn about the basics of cancer and mechanism of treatment of cancer through yoga. stats of cancer, major factors, research of yoga therapy on cancer, how to avoid cancer, benefits of yoga therapy. #beatcancer #cancer #cancersucks #cancerawareness #cancersurvivor #fightcancer #cancerfighter #cancerwarrior #cancersupport #oncology #fuckcancer #charity #breastcancer #childhoodcancer #children #breastcancerawareness #chemotherapy #cancerfree #cancerresearch #lithuaniancharity #survivor #vilnius #rkcharity #rkcharityfoundation #lithuania #lietuva #charitylithuania #gogold #lithuanian #bhfyp #yogatherapy #yoga #yogateacher #yogainspiration #yogapractice #yogalife #meditation #yogalove #yogaeverydamnday #yogaeveryday #yogajourney #yogaeverywhere #yogagirl #mindfulness #yogaforall #yogapose #yogi #yogaforlife #yogaposes #yogachallenge #yogalifestyle #wellness #yogadaily #love #yogini #namaste #yogateachertraining #yogabody #ayurveda #bhfyp
Laura Mann Center Integrative Lecture Series: Fall 2014Cara Feldman-Hunt
A Success Story: Incorporating Integrative Medicine into the Hospital and Outpatient Care
Courtney Jordan Baechler, MD, MS, Chief Wellness Officer Vice President, Penny George Institute for Health and Healing, Allina Health
This ppt is to learn about the basics of cancer and mechanism of treatment of cancer through yoga. stats of cancer, major factors, research of yoga therapy on cancer, how to avoid cancer, benefits of yoga therapy. #beatcancer #cancer #cancersucks #cancerawareness #cancersurvivor #fightcancer #cancerfighter #cancerwarrior #cancersupport #oncology #fuckcancer #charity #breastcancer #childhoodcancer #children #breastcancerawareness #chemotherapy #cancerfree #cancerresearch #lithuaniancharity #survivor #vilnius #rkcharity #rkcharityfoundation #lithuania #lietuva #charitylithuania #gogold #lithuanian #bhfyp #yogatherapy #yoga #yogateacher #yogainspiration #yogapractice #yogalife #meditation #yogalove #yogaeverydamnday #yogaeveryday #yogajourney #yogaeverywhere #yogagirl #mindfulness #yogaforall #yogapose #yogi #yogaforlife #yogaposes #yogachallenge #yogalifestyle #wellness #yogadaily #love #yogini #namaste #yogateachertraining #yogabody #ayurveda #bhfyp
Laura Mann Center Integrative Lecture Series: Fall 2014Cara Feldman-Hunt
A Success Story: Incorporating Integrative Medicine into the Hospital and Outpatient Care
Courtney Jordan Baechler, MD, MS, Chief Wellness Officer Vice President, Penny George Institute for Health and Healing, Allina Health
The six areas of yoga researches by Patanjali Research foundation are Physiology, Therapy, Rehabilitation, Occupational Health, Higher States of Consciousness and Public health.
Case study on Holistic Diabetic Care using Diet, Yoga, Resisted Exercises usi...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Dr Anna Campbell's keynote speech 'The Importance of Staying Active after a Cancer Diagnosis' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
The International Classification of Functioning (ICF) Core Set for breast can...Irish Cancer Society
A presentation given at the Irish Cancer Society's Survivorship Research Day at the Aviva Stadium, Dublin on Thursday, September 20th, 2013.
The International Classification of Functioning (ICF) Core Set for breast cancer – a prospective surveillance tool to identify rehabilitation needs - Marese Cooney
The six areas of yoga researches by Patanjali Research foundation are Physiology, Therapy, Rehabilitation, Occupational Health, Higher States of Consciousness and Public health.
Case study on Holistic Diabetic Care using Diet, Yoga, Resisted Exercises usi...iosrjce
IOSR Journal of Pharmacy and Biological Sciences(IOSR-JPBS) is a double blind peer reviewed International Journal that provides rapid publication (within a month) of articles in all areas of Pharmacy and Biological Science. The journal welcomes publications of high quality papers on theoretical developments and practical applications in Pharmacy and Biological Science. Original research papers, state-of-the-art reviews, and high quality technical notes are invited for publications.
Dr Anna Campbell's keynote speech 'The Importance of Staying Active after a Cancer Diagnosis' at the SCPN's 'Be Active Against Cancer' conference, Tuesday 4th February 2014.
The International Classification of Functioning (ICF) Core Set for breast can...Irish Cancer Society
A presentation given at the Irish Cancer Society's Survivorship Research Day at the Aviva Stadium, Dublin on Thursday, September 20th, 2013.
The International Classification of Functioning (ICF) Core Set for breast cancer – a prospective surveillance tool to identify rehabilitation needs - Marese Cooney
Agenda - Bancassurance Asia Summit 2015, SingaporeNikash Deka
The agenda of Bancassurance Asia Summit, Singapore, which was attended recently by Sharad Mathur. The highlighted sessions where he have participated as a Panel member, Panel moderator and Presenter.
Greek Life Needs Its Own Network - Help Me Refine the MessageSean Devlin
I'm working through this presentation and wanted to get it up and bounce it off some fresh eyes. Shoot me your revisions!
The value of a Sorority or a Fraternity is the network of its members.
This value is very poorly captured amongst Greek Systems today, and organizations such as these need to stop using someone else's social network and instead launch their own.
impact of riyazat ( physical activity) on mental health During pregnancy.pptxFaizaFurqan1
impact of physical exrecise on mental health during pregnancy
as we all know that during pregnancy women undergoes many changes like weight gain , nousea, vomitting , chages in the body shape mood swings so to counter all these physical exerscise like mild waliking jogging ,swimming are important and also a low self esteem , depression and anxiety of the outcome of the pregnancy , fear of vaginal deliveries
Physical Activity during Pregnancy and the Effect on Mothers and Fet.docxmattjtoni51554
Physical Activity during Pregnancy and the Effect on Mothers and Fetal Health
Abstract
1.2 Introduction:
Physical activity is an essential role that all people should engaged, aerobic and muscle strength exercises are an easy to do where the benefits of it are great, prevention, treatment of disease and keeping fit in all stage of life even in pregnancy period and this exercises can be modify to suit physical condition of the pregnant womens
Pregnancy is a blessing from Allah that every woman wishes. Pregnancy it’s condition that many changes it happened on women bodies from the day of fertilization to the day after delivery of the baby and the popular effect in women bodies it’s the increment of body weight, as it's known that many women they didn’t control them weight and they become overweight or obese, in this condition the pregnant woman she will be in danger, many diseases start with increase of the body weight and it may lead to a serious health problems. Without controlling the body weight increment, woman with a normal weight it may become an overweight or even obese.
In general overweight and obesity one of prevalence public issue that affect many countries in the world where it’s observe in all ages, adults, adolescents, and children it maybe became a global epidemic , the impact of this issue has a strong relationship with mortality and morbidity also this relationship have been known for more than 2000 between health professionals[1-2]. body mass index (BMI) is the way that give a right measurement for the total body fat compare with body weight, the method for calculation by determining the body weight in kilogram and divide it by height in meter squared, this way determine the degree of overweight easy with a reliable number.
There are interventions that can control the body weight before pregnancy period, during pregnancy period and after it, but the most important intervention that we will cover it’s the physical activity or exercise and the advantages for this intervention on the mother health and the outcome also the disadvantages that it can happen if available.
Physical activity and exercise has a great impact on health status, where there are many study done to prove this relation. where health outcome in people with physical inactivity is a major problem in the world and specially in developed countries. In worldwide physical inactivity appear in a huge number where one out of every five adults is physically inactive and the long period of sitting independent show that is a risk factor for mortality[3]
The healthy body weight in pregnancy it depends on the body mass index (BMI) so the WHO classify the BMI into four categories underweight: <18.5 kg/m2, normal weight: 18.5-24.99 kg/m2, overweight: 25-29.9 kg/m2, and obese ≥30 kg/m2 [4-5]. With this category, recognizing every case will be easy and right grouping will be more accurate.
all pregnant women are included in all age and different country.
Knowledge, Attitude and Practices of Expectant Mothers on Physical Activity A...ijtsrd
Pregnancy is often considered a crucial and complete metamorphic stage in a woman life. Undoubtedly as you continue your pregnancy, you will have numerous questions about various aspects of having a healthy and safe pregnancy. Being physically active during pregnancy contributes significantly towards the health and wellbeing of the mother as well as the child. The aim of the current study is understand the knowledge, attitude and practices of expectant mothers towards physical activity in pregnancy. A total of 100 expectant mothers in the third trimester, 50 of government hospital and 50 of private hospitals, were selected from different maternity hospitals across the city, Hyderabad, through random sampling. The data was collected through self administered questionnaires. Data compilation was done using Microsoft excel version 2010 and statistically analysed using chi square test. The results revealed that while majority of the expectant mothers from both the hospital settings agreed that physical activity is important during pregnancy, they reported decrease in physical activity following pregnancy which may be attributed to various reasons like the lack of advice from health care providers regarding physical activity majorly among the government hospital women and reported barriers like fatigue and pregnancy discomfort, lack of time and fear regarding the safety of physical activity during pregnancy. It was observed that greater number of expectant mothers of the government hospital performed adequate physical activity when compared to their counterparts. Thus, the study concludes that although there was no statistically significant difference in knowledge regarding the guidelines for physical activity in pregnancy yet the expectant mothers of government hospitals were more physically active than that of expectant mothers of the private hospital. Anam Fatima | Dr. P. Ashlesha ""Knowledge, Attitude and Practices of Expectant Mothers on Physical Activity - A Comparative Study"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-4 , June 2019, URL: https://www.ijtsrd.com/papers/ijtsrd23745.pdf
Paper URL: https://www.ijtsrd.com/medicine/gynecology/23745/knowledge-attitude-and-practices-of-expectant-mothers-on-physical-activity---a-comparative-study/anam-fatima
A novel rejuvenation program for cancer patients at Kaivalyadhama, IndiaYogacharya AB Bhavanani
Background: The modern intensive treatment for cancer leaves the patients physically and mentally
exhausted by the end of it. There is great potential for Yoga, the original mind-body medicine, in such a
situation as it conjointly emphasizes body, mind, and spirit, which may be particularly useful for
enhancing patients' social and spiritual well-being. Some studies have reported the effectiveness of
Yoga, meditation, and mindfulness as a rehabilitative and palliative therapy in various types of cancer.
Objectives: With the above background in mind, we created a 3-week residential program for cancer
patients to empower them in their journey, "back to health." The curriculum was geared specifically for
those who had undergone chemotherapy and/or radiation.
Methods: The program utilized the sister life sciences of Yoga and Ayurveda with a healthy dose of self-
education to assist patients in their recovery from the devastation of cancer and its modern treatment.
The modes of reintegration used in this program were designed to specifically address the physical,
mental, and psychic (spiritual) needs of the participants. The curriculum included various asanas, kriyas,
pranayama, mudras, and bandha, as well as chanting. Ayurvedic treatment based on panchkarma
science was designed and applied according to each patient's disposition. An educational component
was included to inform patients of potential carcinogenic factors in their life and to change their mindset
and attitudes from victimhood to self-empowerment. In order to scientifically validate the program,
physiological, biochemical, psychological, and Ayurvedic assessment of tridoshas was carried out.
Conclusion: Our special Cancer Rehabilitation Yoga program is expected to have several beneficial
effects for those recovering from the aftermath of anti-cancer therapies even at 3-month follow-up.
Subjective observations so far reveal that the program led to overall empowerment of the participants.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. Effects of Postpartum Exercise Program on Fatigue
and Depression During “Doing-the-Month” Period
Yi-Li Ko · Chi-Li Yang* · Li-Chi Chiang**
ABSTRACT: This study explored the effectiveness of an exercise program on reducing levels of fatigue and
depression among postpartum women who were “doing-the-month” in a maternity center in Taiwan.
Previous studies related to postpartum have focused on depression rather than women’s feelings of
fatigue, and no study related to exercise has previously been conducted in a Taiwan maternity center. A
low-intensity exercise program was specifically designed and administered to 31 subjects in the
study’s intervention group. Another 30 subjects (the control group) followed a traditional,
non-physically active postpartum care regimen. Those in the intervention group were required to
participate in at least 6 exercise program sessions during their one month postpartum stay. All subjects
were asked to fill out a fatigue and depression questionnaire before and after the program. A Fatigue
Symptom Checklist (FSC) was used to measure fatigue, and the Center for Epidemiological Studies
Depression (CESD) was used to confirm the development of depression. Results showed statistically
significant differences between the two groups in terms of fatigue levels, with statistical
improvements (p < .05) registered by the intervention group in terms of levels of physical and
psychological fatigue and fatigue symptoms. However, no significant changes in depression between
the two groups were found. Study results demonstrate that a low-intensity exercise program can offer a
good platform for clinicians and researchers to help reduce fatigue in postpartum women.
Key Words: postpartum exercise, fatigue, depression, maternity center, Taiwanese women.
Introduction
The postpartum period is a critical transition time for
women, affecting significantly the physical and mental
health of mothers after childbirth. Postpartum fatigue and
depression are the two major psychological problems
occurring during the postpartum period reported and em-
phasized in the literature (Albright, 1993; Gardner &
Campbell, 1991; Lee & Zaffke, 1999; Troy, 2003). Re-
search found that 44% to 95% of postpartum mothers in the
United States experience postpartum fatigue (Atkinson &
Baxley, 1994; Milligan, Parks, Kitzman, & Lenz, 1997)
and 10-15% suffer from postpartum depression (Albright,
1993). In Taiwan, postpartum fatigue and depression also
represent common problems (Chen, Wang, Chung, Tseng,
& Chou, 2006; Ko, 2004). Postpartum fatigue is a predictor
of postpartum depression (Bozoky & Corwin, 2002; Ko
2004). Postpartum psychological problems can interfere
with a new mother’s ability to care for her infant and may
adversely affect her quality of life (Ko, 2004; Milligan,
Lenz, Parks, Pugh, & Kitzmon, 1996).
The promotion of postpartum health has been empha-
sized by many health care providers (Walker & Wilging,
2000). Sichel and Driscol suggested a “N*U*R*S*E”
approach to relieving postpartum depression. The “E”,
short for (physical) exercise, can improve postpartum
women’s sense of wellbeing (Sichel & Driscoll, 2002).
“Mad for Fitness” was developed by a healthcare team to
reduce postnatal depression in the belief that exercise can
reduce depression (Wilkinson, Phillips, Jackson, & Walker,
2003). Also, three review articles indicate exercise is bene-
ficial to the physical and psychological health of postpartum
177
Journal of Nursing Research Vol. 16, No. 3, 2008
RN, EdD, Associate Professor, Department of Nursing, Fu-Jen Catholic University; *PhD, Professor, School of Liberal Education, Shih Chien
University; **RN, PhD, Professor, School of Nursing & Dean of Student Affairs, China Medical University.
Received: December 3, 2007 Revised: April 11, 2008 Accepted: July 4, 2008
Address correspondence to: Li-Chi Chiang, No. 91, Hsueh-Shih Rd., Taichung 40402, Taiwan, ROC.
Tel: +886 (4) 2205-3366 ext. 1200; Fax: +886 (4) 2205-3748; E-mail: lichi514@mail.cmu.edu.tw
3. women (Daley, Macarthur, & Winter, 2007; Larson-Meyer,
2002), with significant benefits including increased lactation,
reduced bodyweight, less severe levels of depression, and
enhanced mothering abilities and capacity to implement
regular physical activity regimens for herself and her child.
Published studies have established the general importance of
regular exercise during the postpartum period. In order to
promote postnatal care, both the Society of Obstetricians and
Gynecologists of Canada, Clinical Practice Obstetrics
Committee/Canadian Society for Exercise Physiology
(SOGC/CSEP) in Canada (Davies, Wolfe, Mottola, &
MacKinnon, 2003) and American College of Obstetricians
and Gynecologists (ACOG) in the United States (Artal &
O'Toole, 2003) have published guidelines for exercise dur-
ing pregnancy and the postpartum period.
While most postpartum exercise programs focus on
relieving depression, relief of fatigue is often neglected
(Daley et al., 2007; Dennis, 2004). Although some inter-
ventions for depression have been better studied, met-
hodological limitations render their efficacy equivocal for
postpartum depression (Dennis, 2004). One survey study
found that women who are physically active during preg-
nancy earn better (lower) scores on a test designed to mea-
sure depressive symptoms during pregnancy and the
postpartum period (Nordhagen & Sundgot-Borgen, 2002).
Another aerobic exercise intervention program was found
to reduce anxiety and depression significantly (p < .05) fol-
lowing exercise and quiet rest (Koltyn & Schultes, 1997).
Although limited to a small number of studies, current evi-
dence supports a relationship between participation in
exercise and a reduction in postpartum depression. Given
the reluctance by some postpartum women to use antide-
pressant medication and the limited availability of appro-
priate psychological therapies, exercise as a therapeutic
approach deserves further exploration. Further research
using well-designed, randomized and controlled trial
methodologies is warranted (Daley et al., 2007; Larson-
Meyer, 2002; Mottola, 2002).
The prevalence rate of fatigue, a possible predictor of
depression, was found by Bozoky & Corwin (2002) to be
higher than that of depression. In Taiwan, many women
express their postpartum psychological problem as fatigue
rather than depression (Ko, 2004). Some studies have
shown that regular exercise can reduce fatigue in healthy
women, women with a chronic disease (fibromyalgia)
(Karper & Stasik, 2003; Valkeinen, Hakkinen, Hannonen,
Hakkinen, & Alen, 2006), women suffering from breast
cancer (Headley, Ownby, & John, 2004), and sedentary
women (Annesi, 2002).
Annesi proposed theories of exercise-induced affec-
tive change and conducted a series of studies to examine
the effectiveness of different exercise programs on mood
(Annesi, 2004, 2005; Annesi & Westcott, 2004). Articles
in exercise psychology literature indicate that exercise
imparts a feeling of well-being to most persons who
participate in such. However, any negative changes which
may take place between pre- and post exercise may be
overlooked (Backhouse, Ekkekkis, Bidle, Foskett, &
Wiliams, 2007). Moderate aerobic exercise can improve
the affective response of people. Recently, the Cochrane
system has reported the positive effects of exercise therapy
on patients with chronic fatigue syndrome (Edmonds,
McGuire, & Price, 2004). They also mentioned that exer-
cise that is overly strenuous tends to increase dropout rates
and undermine program effectiveness. As postpartum
fatigue differs significantly from chronic fatigue syndrome
the study of the effectiveness of low-intensity exercise on
reducing the symptoms of postpartum fatigue is necessary.
Chinese culture places great importance on “post-
partum preservation” as critical to the overall wellness of
women who have given birth. Traditional Chinese custom
mandates that women be confined to the home and assisted
with tasks during the first month after childbirth. This
restrictive regimen is referred to as “Tso-Yueh-Tzu,” which
has been translated into English as “doing-the-month”
(Callister, 2006; Chien, Tai, Ko, Huang, & Sheu, 2006;
Heh, Fu, & Chin, 2001; Leung, Arthur, & Martinson, 2005).
As the process of pregnancy and delivery is believed
exhausting to the physical health of a woman, Chinese
tradition holds that she should follow established doing-
the-month practices, get plenty of bed rest and reduce
physical activity in order to regain her strength (Chen &
Wang, 2000). Although modernization has changed many
facets of traditional life in Taiwan, the idea of doing-the-
month remains highly esteemed, and a significant majority
of women still follow these practices to some extent. The
benefits associated with doing-the-month may reduce
physical discomfort and depression (Chien et al., 2006).
As no research has yet examined the effect on the
health of postpartum women of instructor-led postpartum
exercise programs held in a doing-the-month maternity
center, this study was designed to evaluate fatigue and
depression before and after subjects participated in a series
of six exercise sessions. The session was designed by study
178
J. Nursing Research Vol. 16, No. 3, 2008 Yi-Li Ko et al.
4. authors following well-established international guidelines
and conducted by an experienced aerobics coach.
Methods
Sample
Acontrol group pre-/post-program design was used in
this study. Participants were recruited from a maternity
center located in metropolitan Taipei and data were col-
lected from April 2006 through June 2006. Selection crite-
ria required that participants be able to speak and read
Mandarin, married, free of obstetrical complications and
over 20 years of age.
During the study period, a total of 79 potential partici-
pants were recruited during their first day of registration at
the maternity center and signed the consent form to engage
in this study. After research assistants’ explanation, a total
of 49 women agreed to participate in the low-intensity
exercise program. As 18 of the 49 did not complete the pro-
gram due to personal reasons, 31 women in total finished
the full six sessions. The 30 women recruited who ex-
pressed disinterest in joining the exercise program were
assigned to the control group. The Institutional Review
Board (IRB) at the maternity center approved this study.
Intervention
The goal of the low-intensity exercise program, which
incorporated Pilates, yoga movements and music, was to
improve cardiac-pulmonary functions, enhance muscle
strength and pliancy and achieve 50-60% maximal heart-
beat. Subjects were instructed by a professional aerobic
coach for one hour (10:30-11:30 am), three days each
week (Monday, Tuesday, and Friday). All the participants
were required to finish six sessions during their three week
stay in the maternity center. Program design was adopted
from the cornerstone textbook by Noble (1995), which
makes specific recommendations regarding appropriate
exercise principles for postpartum women.
Nurses invited mothers to join the low-intensity exer-
cise (intervention) group during the latter’s first week of
stay in the maternity center (April 2006). Those accepting
the invitation (the intervention group) participated 3 times
a week in a postpartum exercise session at the maternity
center lasting approximately one hour. The second author,
a professor of dancing and a registered aerobic exercise
coach, designed and planned the exercise program, with a
key goal to help participants achieve 60% maximal heart-
beat. Exercise intensity gradually increased over the
60-minute program through three phases. The first focused
on breathing and full body stretching; the second combined
yoga and Pilates aerobic exercises; and the third focused on
doing muscle training exercises. After each exercise ses-
sion, researchers made themselves available to subjects for
30 minutes for counseling and answering questions. For
validity, this intervention was approved by obstetric
physicians, women’s health experts and rehabilitation
physicians to assure its safety and suitability for post-
partum women.
At the start of the first session, researchers asked sub-
jects in the intervention group to fill out an initial (pre-
program) questionnaire, which gathered subjects’ de-
mographic data as well as information on experienced
levels of fatigue and depression. After participating in six
classes during the 3-week maternity center stay, the re-
searcher asked subjects to complete a final (post-program)
questionnaire and presented to participants a yoga mat as
an appreciation gift. A research assistant visited control
group subjects at their bedside, with the initial question-
naire administered during their first week of stay at the
maternity center and the final questionnaire administered
just before discharge from the maternal center.
Measurements
Fatigue was measured using the Fatigue Symptom
Checklist (FSC), which was first developed to measure
fatigue in Japanese industrial workers (Yoshitake, 1971).
The FSC and its revisions were subsequently used in the
United States to measure levels of fatigue in new mothers
of full-term infants (Milligan et al., 1997). It is a thirty-item
scale with dichotomous (yes/no) responses and a total
score range of 0 to 30. There are three subscales in FSC,
include a 10-item physical fatigue subscale (items 0-10),
10-item psychological fatigue subscale (items 11-20), and
10-item fatigue symptom subscale (items 21-30). FSC
scores correlate positively with level of fatigue. Milligan et
al. (1997), which used FSC to measure postpartum fatigue
among 285 mothers, found internal consistency to range
between .82 and .95 at three time periods (immediately
postpartum, during hospitalization, and 6-weeks post-
partum). Construct validity was demonstrated through the
positive association in all three time periods between
fatigue scores and depression, multiparity, infant difficulty
and reduced sleep (Milligan et al., 1997). Internal consis-
tency of the FSC was .91 in this study, as assessed using
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Postpartum Exercise J. Nursing Research Vol. 16, No. 3, 2008
5. Cronbach’s a. Demographic variables included mother’s
age, body weight, obstetric history, number of pregnan-
cies, education level, work status, pattern of delivery and
exercise habit.
Depression was measured using the Chinese version
of the Center for Epidemiologic Studies Depression Scale
(CES-D Scale), with a score of 15 or above signaling
depression (Chien & Cheng, 1985). Individuals with high
CES-D scores (³ 15) were viewed as having probable
postpartum depression. The CES-D contains 20 Likert’s-
scale items with scores ranging from 0 to 60. The CES-D
was designed to assess level of depression symptoms
present in a general population, with emphasis on the
affective component of depressed mood. Depression
symptoms, while among the considerations used in diag-
nosing clinical depression, may also be present to some
degree in other diagnoses (including “normal”) (Radloff,
1977). The CES-D has been used extensively to measure
depression in postpartum women (Beeghly et al., 2002;
Walker, Timmerman, Kim, & Sterling, 2002). The reli-
ability and validity of the Chinese version of the CES-D
has been demonstrated previously in a Taiwanese popula-
tion (Chien & Cheng, 1985; Fu, Lee, & Chen, 2003). Based
on a cut-off score of 15, sensitivity, specificity, and mis-
classification rates were 92.0%, 91.0%, and 8.2%, respec-
tively, when CES-D findings were compared to cases
detected by the Clinical Interview Schedule (Chien &
Cheng, 1985). In this study, CES-D internal consistency
was .81, as assessed by Cronbach’s a.
Data Analysis
Statistical analyses were performed using SPSS 12.0
software (SPSS Inc, Chicago, Ill). Individual variables
were examined by percentage, mean, and standard devia-
tion. Bi-variable analyses were conducted using c2
statis-
tics, t-test, and repeated measures analysis of variance. A
two-tailed p value of < .05 was considered significant.
Results
Participant Characteristics
A total of 61 postpartum women (intervention group =
31, control group = 30) completed fatigue and depression
questionnaires. Table 1 shows the characteristics of control
and intervention groups. Mean age was 34.3 and 34.2 years,
respectively, and the mean gravida was 1.73 and 1.52,
respectively, for control and intervention groups. Fifteen
(50%) and 22 (71%) in control and intervention groups,
respectively, were primipara. Eight (26.7%) and 14 (45.2%),
respectively, received cesarean section; and 18 (60%) and
13 (41.9%), respectively, breastfed their infants exclusively.
Most subjects worked (range 83-87%) outside of the home
and were classified in the upper-middle and upper socioeco-
nomic classes. Most mothers belonged to nuclear families
(80% in the control group vs. 67.7% in the intervention
group). Most subjects did not regularly exercise (66.7% in
the control group vs. 74.2% in intervention group). There
were no significant differences noted in the family patterns
of these two groups. Before intervention, mothers in both
groups showed mild fatigue and moderate depression.
No significant pre-intervention difference between
groups was noted. As illustrated in Table 2, no significant
difference was identified in fatigue and depression levels
between the groups from answers given on the initial
(pre-program) questionnaire.
While fatigue levels differed significantly between
the two groups (fatigue p = .048) and over time (p = .001),
no interaction was identified between group and time. A
significant mean change in fatigue level of -3.36 (9.23
pre-program vs. 5.87 post-program) was identified in the
intervention group. The mean change of -1.53 (11.40
pre-program to 9.87 post-program) identified in the control
group was also significant. Level of depression did not dif-
fer significantly between the two groups (p = .115), al-
though there was significant mean change over time (p =
.033), with no interaction identified between group and
time. There was a borderline significant mean change in
depression level for the intervention group (p = .06), with a
mean score change of -1.71 (14.13 pre-program to 12.42
post-program), and a significant mean score change in the
control group, with a mean score change of -1.67 (16.20
pre-program to 14.53 post-program).
Comparing Fatigue Subscale Changes Within
the Two Groups
The intervention group experienced significant mean
changes in the three FSC subscales as follows: physical
fatigue (p < .05), with a mean change of -1.39; psy-
chological fatigue (p < .05); fatigue symptoms (p < .01),
with a mean change of -1.
The control group realized a significant change only
in the FSC physical fatigue subscale (p < .05), with a mean
change of -0.77. No significant differences in psycho-
logical fatigue and fatigue symptoms were noted (Table 3).
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J. Nursing Research Vol. 16, No. 3, 2008 Yi-Li Ko et al.
6. 181
Postpartum Exercise J. Nursing Research Vol. 16, No. 3, 2008
Table 1.
Demographic Data for Control and Intervention Groups
Control group (n = 30) Intervention group (n = 31)
Characteristics M ± SD n (%) M ± SD n (%) t/c2
p
Age (year) 34.33 ± 3.53 34.17 ± 3.20 -0.188- .852
Gravida
1 13 (43.3) 21 (67.7)
2 13 (43.3) 06 (19.4) 4.980 .173
3 03 (10.0) 02 (06.5)
³ 4 01 (03.3) 02 (06.5)
Primipara 15 (50.0) 22 (71.0) -1.830- .072
Education Level
University or higher 24 (80.0) 23 (74.2) 0.291 .069
College or lower 06 (20.0) 08 (25.8)
Work Status
Full-time job 23 (76.7) 25 (80.6) 0.144 .710
Others 07 (23.3) 06 (19.4)
Pattern of Delivery
NSD 22 (73.3) 17 (54.8) 2.262 .137
C/S 08 (26.7) 14 (45.2)
Breastfeeding
Exclusive 18 (60.0) 13 (41.9) 1.991 .164
Mix 12 (40.0) 08 (58.1)
Exercise
Yes 10 (33.3) 08 (25.8) 0.415 .527
No 20 (66.7) 23 (74.2)
Family Pattern
Nuclear family 24 (80.0) 21 (67.7) 1.184 .284
Others 06 (20.0) 10 (32.3)
Fatigue (pre-program) 11.40 ± 6.80 09.23 ± 6.46 -1.281- .205
Depression (pre-program) 16.20 ± 6.17 14.13 ± 5.12 -1.428- .159
Table 2.
Effect of the Intervention on Fatigue and Depression Change
Control group (n = 30) Intervention group (n = 31)
Pre-program Post-program Pre-program Post-program F (p)
Dimensions
and Subscales M ± SD M ± SD M ± SD M ± SD Group Time Group ´ time
Fatigue
Physical 5.00 ± 2.88 4.23 ± 3.06 3.97 ± 3.14 2.58 ± 2.54 4.060 (.048)* 10.361 (.002)** 0.860 (.358)
Psychological 3.17 ± 2.76 2.70 ± 3.14 2.35 ± 2.74 1.39 ± 1.63 3.230 (.077)* 5.078 (.028)* 0.620 (.434)
Symptoms 3.23 ± 2.24 2.93 ± 2.78 2.90 ± 2.10 1.90 ± 1.70 1.743 (.192)* 6.838 (.011)* 1.938 (.164)
Total scores 11.40 ± 6.800 9.87 ± 8.11 9.23 ± 6.46 5.87 ± 4.54 4.062 (.048)* 11.858 (.001)** 1.647 (.204)
Depression 16.20 ± 6.170 14.53 ± 6.940 14.13 ± 5.120 12.42 ± 5.370 2.553 (.115)* 4.794 (.033)* 0.001 (.978)
*p < .05. **p < .01.
7. Discussion
Postpartum exercise has been promoted, relatively
unsuccessfully, to Taiwanese women primarily through
handouts and booklets available in obstetric wards.
“Doing-the-month,” a highly valued traditional birth recu-
peration strategy in Taiwan, restricts postpartum mothers
to one month of bed rest and limited physical activity. Such
traditional mores conflict with Western principles that
encourage postpartum women to accept exercise as critical
to their healthy lifestyle. As Taiwan continues to search for
accommodation between the traditional and modern, it is
appropriate that proven modern concepts on postpartum
health be integrated into traditional care concepts. The
postpartum exercise in this study represents a newly
designed exercise program that incorporates yoga, Pilates
and music into a “package” that should be culturally
acceptable to postpartum Taiwanese mothers. Increasing
urbanization and other factors are increasingly replacing
the traditional custom of doing-the-month at home, with
help from the mother or mother-in-law, with doing-the-
month at maternity centers, assisted by trained profes-
sionals. Such changes provide a good opportunity to
advocate modern exercise opinions to postpartum women.
Results indicated that the women in the intervention
group did not reduce their depression significantly. Both
groups decreased levels of fatigue and depression after one
month of care. However, women in the control group
improved only in their physical fatigue; not in their emo-
tional fatigue or physical symptoms. Women in the inter-
vention group not only achieved a significant reduction in
physical fatigue, but also in emotional fatigue and physical
symptoms (Table 3). Several possible reasons that may
explain these findings include: (1) women staying in the
maternity center were rested and cared for by nurses, which
reduced overall fatigue - especially physical fatigue. This
finding is consistent with a description given by Chien et
al. (2006) that doing-the-month may reduce physical and
depression symptoms; (2) the low-intensity exercise pro-
gram may improve emotional fatigue and physical symp-
toms. The significant improvement found in participant
emotional status is in line with previous study results
(Klotyn & Schultes, 1997). By integrating Pilates, yoga
activities and music into an aerobic postpartum exercise
program positively affected the mental health of per-
periums (Watson, Milat, Thomas, & Currie, 2005). These
results are also consistent with those achieved by exercise
programs designed for women with breast cancer (Headley
et al., 2004), and for sedentary women (Annesi, 2002). Sig-
nificant reductions in depression were very difficult to
achieve in the brief time allowed for this study. As post-
partum fatigue was the predictor of postpartum depression
employed in previous studies, reductions in depression are
predictable once fatigue is relieved (Bozoky & Corwin,
2002; Ko, 2004). As achieving significantly reduced
depression levels may require longer periods of physical
intervention, a long-term exercise program should be
designed and assessed in the future.
In Chinese culture, people typically describe discom-
fort as a problem of the physical rather than psychological
182
J. Nursing Research Vol. 16, No. 3, 2008 Yi-Li Ko et al.
Table 3.
Comparison of Fatigue Symptom Checklist (FSC) Subscale Changes Within Two Groups
Pre-program Post-program
FSC subscales M ± SD M ± SD t p
Fatigue
Physical fatigue
Control group 5.00 ± 2.88 4.23 ± 3.06 2.340 .026*
Intervention group 3.97 ± 3.14 2.58 ± 2.54 2.405 .023*
Psychological fatigue
Control group 3.17 ± 2.76 2.70 ± 3.14 1.039 .307*
Intervention group 2.35 ± 2.74 1.39 ± 1.63 2.147 .040*
Physical symptoms
Control group 3.23 ± 2.24 2.93 ± 2.78 0.781 .441*
Intervention group 2.90 ± 2.10 1.90 ± 1.70 3.145 *.004**
*p < .05. **p < .01.
8. (Chen & Liu, 1995; Chien et al., 2006; Tseng & Hsu,
1969). As such, most women describe their psychological
problem postpartum as “fatigue” rather than depression
(Chen & Liu, 1995). Chronic fatigue without resolve is
highly likely to turn into postpartum depression if not
properly addressed. Although exercise may not fit into the
rubric of traditional doing-the-month mores, which focus
on maintaining and restoring energy levels during the
postpartum period, an appropriately designed light exer-
cise regimen may be acceptable for implementation among
postpartum women. The light exercise program designed
as part of this study is easy and safe, and encourages
women to adopt a more active lifestyle soon after delivery.
Results show that the light exercise program was not only
accepted by postpartum women, but also promoted their
psychological health. Further research to assess the long-
term effects of exercise is still necessary.
The increasing number of women who choose to stay
in maternity centers to receive total doing-the-month care
and complete rest highlights the evolution away from tradi-
tional family mores. The birth rate in Taiwan has dropped
significantly over the past two decades. According to the
Population Reference Report Bureau (PRB), the average
fertility rate in Taiwan was just 1.1 in 2006, the lowest in
the world. Modern Taiwanese women seek significantly
greater independence than that enjoyed by earlier genera-
tions. Our study found that more than 70% of families were
nuclear. Currently, some one-quarter of postpartum
Taiwanese women elect to “do the month” in a maternity
center rather than at home or elsewhere (Chien et al.,
2006). Good quality care provided by such centers may
help relieve physical and psychological stresses because of
the reduced strains and conflicts that doing-the-month
traditionally causes in families. Incorporating an appro-
priate exercise program into maternity center care should
make a center more attractive to women comparing mater-
nity center options. In order to improve both the long-term
psychological and physiological health of the mother,
nurses should teach proper postpartum exercise techniques
to new mothers before their discharge from the hospital.
Although quantitative data found no significant de-
crease in fatigue and depression between the two groups,
qualitative interviews conducted during the data collection
found that intervention group mothers enjoyed a feeling of
relatively greater support, better sleep quality, and an
abatement of constipation and lower back pain problems.
Mothers participating in the exercise program had more
opportunity to interact with others and share breastfeeding
and personal experiences, which helped them better adjust
to their new role as a mother.
Conclusions
Results indicated that levels of fatigue and depression
do not differ significantly between the two groups. How-
ever, scores for the intervention group improved in terms of
psychological fatigue and physical symptoms, as com-
pared with the control group. This low-intensity postpartum
exercise program is viable for application in practice.
Study Limitations
Exercise effectiveness requires longitudinal follow
up. The time period of this study was only two months, and
the small sample size did not permit a broad-based as-
sessment of statistically significant differences. The ran-
domized trial, while an important design, was very diffi-
cult to implement in the practical setting of this study.
Acknowledgments
This study was supported by grant 94-2413-H-
255-001 from the National Science Council, Taiwan, ROC.
References
Albright, A. (1993). Postpartum depression: An overview.
Journal of Counseling & Development, 71(3), 316–320.
Annesi, J. J. (2002). Relation of rated fatigue and changes in
energy after exercise and over 14 weeks in previously
sedentary women exercisers. Perceptual and Motor
Skills, 95(3, Pt. 1), 719–727.
Annesi, J. J. (2004). Mood states of formerly sedentary youn-
ger and older women at weeks 1 and 10 of a moderate
exercise program. Psychological Report, 94(3, Pt. 2),
1337–1342.
Annesi, J. J. (2005). Correlations of depression and total
mood disturbance with physical activity and self-
concept in preadolescents enrolled in an after-school
exercise program. Psychological Report, 96(3, Pt. 2),
891–898.
Annesi, J. J., & Westcott, W. L. (2004). Relationship of feel-
ing states after exercise and Total Mood Disturbance
over 10 weeks in formerly sedentary women. Per-
ceptual and Motor Skills, 99(1), 107–115.
Artal, R., & O’Toole, M. (2003). Guidelines of the America
College of Obstetricians and Gynecologists for exercise
183
Postpartum Exercise J. Nursing Research Vol. 16, No. 3, 2008
9. during pregnancy and the postpartum period. British
Journal of Sports Medicine, 37(1), 6–12.
Atkinson, L. S., & Baxley, E. G. (1994). Postpartum fatigue.
American Family Physician, 50(1), 113–118.
Backhouse, S. H., Ekkekkis, P., Bidle, S. J., Foskett, A., &
Wiliams, C. (2007). Exercise makes people feel better
but people are inactive: Paradox or artifact? Journal of
Sport and Exercise Psychology, 29(4), 498–517.
Beeghly, M., Weinberg, M. K., Olson, K. L., Kerman, H.,
Riley, J., & Tronick, E. Z. (2002). Stability and change
in level of maternal depressive symptom atology during
the first postpartum year. Journal of Affective Disorders,
71(1–3), 169–180.
Bozoky, I., & Corwin, E. J. (2002). Fatigue as a predictor of
postpartum depression. Journal of Obstetric, Gyneco-
logic, and Neonatal Nursing, 31(4), 436–443.
Callister, L. C. (2006). Doing-the-month: Chinese post-
partum practices. MCN: The American Journal of Ma-
ternal Child Nursing, 31(6), 390.
Chen, C. H., & Liu, C. Y. (1995). Chinese culture and
postpartum depression. The Journal of Nursing, 42(1),
91–94. (In Chinese.)
Chen, C. H., Wang, S. Y., Chung, U. L., Tseng, Y. F., &
Chou, F. H. (2006). Being reborn: The recovery process
of postpartum depression in Taiwanese women. Journal
of Advanced Nursing, 54(4), 450–456.
Chen, L. L., & Wang, C. C. (2000). Attitude and behavior to-
wards postpartum recuperation in traditional Chinese
medicine. The Journal of Nursing Research (Taiwan),
8(1), 49–58. (In Chinese.)
Chien, C. P., & Cheng, T. A. (1985). Depression in Taiwan:
Epidemiological survey utilizing CES-D. Psychiatria et
Neurologia Japonica, 87(5), 335–338.
Chien, L. Y., Tai, C. J., Ko, Y. L., Huang, C. H., & Sheu, S. J.
(2006). Adherence to “Doing-the-month” practices is
associated with fewer physical and depressive symp-
toms among postpartum women in Taiwan. Research in
Nursing & Health, 29(5), 374–383.
Daley, A. J., Macarthur, C., & Winter, H. (2007). The role of
exercise in treating postpartum depression: A review of
the literature. Journal of Midwifery & Women’s Health,
52(1), 56–62.
Davies, G. A., Wolfe, L. A., Mottola, M. F., & MacKinnon, C.
(2003). Joint SOGC/CSEP clinical practice guideline:
Exercise in pregnancy and the postpartum period. Cana-
dian Journal of Applied Physiology, 28(3), 330–341.
Dennis, C. L. (2004). Treatment of postpartum depression,
part 2: A critical review of nonbiological interventions.
The Journal of Clinical psychiatry, 65(9), 1252–1265.
Edmonds, M., McGuire, H., & Price, J. (2004). Exercise
therapy for chronic fatigue syndrome. Cochrane Data-
base of Systematic Reviews 2004 Issue 3 Art. No.
CD003200.
Fu, C. C., Lee, Y. M., & Chen, J. D. (2003). Association be-
tween depression symptoms and twelve-year mortality
among elderly in rural community in Taiwan. Journal
of the Formosan Medical Association, 102(4), 234–
239.
Gardner, D. L., & Campbell, B. (1991). Assessing post-
partum fatigue. MCN: The American Journal of Mater-
nal Child Nursing, 16(5), 264–266.
Headley, J. A., Ownby, K. K., & John, L. D. (2004). The ef-
fect of seated exercise on fatigue and quality of life in
women with advanced breast cancer. Oncology Nursing
Forum, 31(5), 977–983.
Heh, S. S., Fu, Y. Y., & Chin, Y. L. (2001). Postpartum social
support experience while “doing-the-month” in Taiwan-
ese women. The Journal of Nursing Research, 9(3),
13–24.
Karper, W. B., & Stasik, S. C. (2003). A successful, long-
term exercise program for women with fibromyalgia
syndrome and chronic fatigue and immune dysfunction
syndrome. Clinical Nurse Specialist, 17(5), 243–248.
Ko, Y. L. (2004). Postpartum fatigue. The Journal of
Nursing, 51(6), 75–79. (In Chinese.)
Koltyn, K. F., & Schultes, S. S. (1997). Psychological effects
of an aerobic exercise session and a rest session follow-
ing pregnancy. Journal of Sports Medicine and Physical
Fitness, 37(4), 287–291.
Larson-Meyer, D. E. (2002). Effect of postpartum exercise
on mothers and their offspring: A review of the litera-
ture. Obesity Research, 10(8), 841–853.
Lee, K. A., & Zaffke, M. E. (1999). Longitudinal changes in
fatigue and energy during pregnancy and the postpartum
period. Journal of Obstetric, Gynecologic, and Neonatal
Nursing, 28(2), 183–191.
Leung, S. K., Arthur, D., & Martinson, I. M. (2005). Per-
ceived stress and support of the Chinese postpartum
ritual “doing-the-month”. Health Care for Women
International, 26(3), 212–224.
Milligan, R., Lenz, E. R., Parks, P. L., Pugh, L. C., &
Kitzman, H. (1996). Postpartum fatigue: Clarifying a
concept. Scholarly Inquiry for Nursing Practice, 10(3),
279–291.
Milligan, R. A., Parks, P. L., Kitzman, H., & Lenz, E. R.
(1997). Measuring women’s fatigue during the post-
partum period. Journal of Nursing Measurement, 5(1),
3–16.
184
J. Nursing Research Vol. 16, No. 3, 2008 Yi-Li Ko et al.
10. Mottola, M. F. (2002). Exercise in the postpartum period:
Practical applications. Current Sports Medicine Reports,
1(6), 362–368.
Noble, E. (1995). Essential exercises for the childbearing
year: A guide to health and comfort before and after your
baby is born (4th ed.). Harwich, MA: New Life Images.
Nordhagen, I. H., & Sundgot-Borgen, J. (2002). Physical ac-
tivity among pregnant women in relation to preg-
nancy-related complaints and symptoms of depression.
Tidsskrift for den Norske Laegeforening, 122(5),
470–474.
Radloff, L. S. (1977). The CES-D Scale: A self-report de-
pression scale for research in the general population.
Applied Psychological Measurement, 1(3), 385–401.
Sichel, D., & Driscoll, J. W. (2002). Care for women with
postpartum depression: “N*U*R*S*E” approach. Jour-
nal of Midwifery & Women’s Health, 47(5), 392.
Troy, N. W. (2003). Is the significance of postpartum fatigue
being overlooked in the lives of women? MCN: The
American Journal of Maternal Child Nursing, 28(4),
252–257.
Tseng, W. S., & Hsu, J. (1969). Chinese culture, personality
formation and mental illness. International Journal of
Social Psychiatry, 16(11), 5–14.
Valkeinen, H., Hakkinen, A., Hannonen, P., Hakkinen, K., &
Alen, M. (2006). Acute heavy-resistance exercise-in-
duced pain and neuromuscular fatigue in elderly women
with fibromyalgia and in healthy controls: Effects of
strength training. Arthritis Rheumatology, 54(4),
1334–1339.
Walker, L., Timmerman, G. M., Kim, M., & Sterling, B.
(2002). Relationships between body image and depres-
sion symptoms during postpartum in ethnically diverse,
low income women. Women & Health, 36(3), 101–121.
Walker, L. O., & Wilging, S. (2000). Rediscovering the “M”
in “MCH”: Maternal health promotion after childbirth.
Journal of Obstetric, Gynecologic, and Neonatal Nurs-
ing, 29(3), 229–236.
Watson, N., Milat, A. J., Thomas, M., & Currie, J. (2005).
The feasibility and effectiveness of pram walking
groups for postpartum women in western Sydney.
Health Promotion Journal of Australia, 16(2), 93–99.
Wilkinson, J., Phillips, S., Jackson, J., & Walker, K. (2003).
“Mad for Fitness”: An exercise group to combat a high
incidence of postnatal depression. The Journal of
Family Health Care, 13(2), 44–48.
Yoshitake, H. (1971). Relations between the symptoms and
the feeling of fatigue. Ergonomics, 14(1), 175–186.
185
Postpartum Exercise J. Nursing Research Vol. 16, No. 3, 2008