Author Reply

We thank Dr. Liu et al. [1] for their thoughtful comments on our randomized trial [2]. Our trial showed that a structured aerobic exercise program, initiated in the first trimester and continued until 35 weeks, significantly reduced maternal depressive symptoms three months after delivery. Women in the intervention group had a 70% relative risk reduction in Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 12 compared with controls [2]. These results support exercise as a promising preventive strategy in maternal mental health. As highlighted in the letter [1], adherence is a key determinant of effectiveness. In our study, about 11% of participants did not meet adherence criteria, largely due to pregnancy complications or personal barriers. Nonetheless, most women achieved meaningful participation, demonstrating the feasibility of structured exercise within antenatal care. Liu et al. [1] also note that postpartum is a critical period when depressive symptoms often manifest, yet exercise participation typically declines. Although our trial did not extend the intervention beyond delivery, observational data and meta-analyses suggest that resuming or maintaining physical activity postpartum reduces risk of postpartum depression [3]. Incorporating physical activity assessment into routine postnatal checks, offering mother-infant exercise classes, and leveraging digital health solutions could help sustain benefits beyond pregnancy. Implementation strategies must also be adapted to local contexts. Our trial focused on low-risk gestations. Replication in different subsets of women will be essential to generalizability. Cost-effectiveness analyses and culturally tailored interventions may help integrate exercise counselling into standard antenatal and postnatal care globally. Finally, exercise offers benefits beyond mental health, including improved gestational age at delivery and reduced neonatal intensive care admission observed [2, 4, 5]. These findings underscore its broader value and strengthen the case for incorporation into maternal health pathways. In conclusion, we agree with Liu et al. [1] that the next challenge lies in bridging research and practice. Structured antenatal exercise reduces postpartum depressive symptoms, and integrating exercise promotion into antenatal and postnatal care has the potential to yield substantial public health gains. G.S and M. L writing and conception. The authors have nothing to report. The authors declare no conflicts of interest. The authors have nothing to report. This article is linked to Liu et al. papers. To view this article, visit https://doi.org/10.1111/1471-0528.70053.