‘Neapolitan workouts’ offer hope against surging post-natal depression

New study suggests postpartum mothers who engage in blended workouts of cardio, strength and core training experience decreased levels of depression and anxiety

‘Neapolitan workouts’ that blend cardio, strength and core training could play an important role in protecting new mothers from soaring levels of post-natal depression and anxiety, new research has found.

A pilot study led by researchers at the University of the Fraser Valley in Canada looked at the impact of regular group exercise among new mothers between six weeks and nine months postpartum.

Over eight weeks, 21 women participated in bi-weekly Les Mills TONE™ classes – 45-minute sessions combining cardio, strength, and core training. Participants had options to vary intensity based on their fitness levels and time since giving birth.

The women reported a significant reduction in state anxiety (i.e. anxiety in the current moment). This decreased from an average of 3.6/10 (where 0 was no anxiety) before each exercise session, to 1.6/10 immediately after each session – a decrease of 55%.

And at the end of the eight weeks, the women reported significantly lower levels of state anxiety than at the start of the program, falling from 3.3/10 to 1.9/10 – a 42% decrease.

There were also improvements in depression and perceived stress, with small to moderate effect sizes, but these changes were not statistically significant. As well as feeling more motivated to exercise, the mothers found the classes contributed to their basic psychological needs by increasing feelings of autonomy, competence and perceptions of bonding and relatedness.

Postpartum mental health issues have seen a sharp increase since the start of the pandemic, with 40% of new mothers now reporting depression, compared with 15% pre-pandemic. Anxiety is also a growing issue, with 72% of new moms facing moderate to high anxiety, compared with 29% previously.

“At a time when women face significantly increased risk of postpartum mental issues, our research found group exercise proved effective in boosting mental wellbeing for new mothers, helping particularly with acute anxiety and meeting the basic psychological needs that are especially important after childbirth,” says Lead Researcher Dr Gillian Hatfield, Associate Professor at the University of the Fraser Valley.

“To maximize physical activity benefits for new mothers, we believe the inclusion of behavioral change support would further enhance the likelihood of long-term exercise adherence. Future research is needed to explore the role socially supportive environments have to play in this; we also plan to explore the impact other types of workouts can have.”

Bryce Hastings, Les Mills Head of Research, says choosing the right type of exercise is an important factor in helping new moms making a gentle and sustainable return to exercise.

“What you might call ‘Neapolitan workouts’ that give a flavor of three key training disciplines like cardio, strength and core are ideal for new moms, as they offer variety and a broad range of benefits,” adds Bryce.

“Seeking workouts that offer the flexibility to find your level and continually progress are really important for new moms, while adding social elements by training with others is another great way to reinforce the habit.”

Participants in the study were encouraged to increase or decrease intensity based on their own abilities. This is essential whether you’re a fitness newbie or an elite-level exerciser, notes Les Mills international presenter and trainer Dee Rowell.

“No one should feel pressure to bounce back or recover quickly after birth. Our journeys during conception, pregnancy and postpartum are all different, so we just need to do what feels right,” says Dee, who recently gave birth and found her return to exercise took longer than expected.

“I've got a new appreciation for moving slower. I made a promise to give myself time and grace and remember what my body has been through. An aesthetic goal has never been in my mind. I just want to be fit and strong.”


Twenty-one women less than one year postpartum volunteered to participate in a bi-weekly group exercise program for 8 weeks.

All women were at least 6-weeks postpartum and had been given physician clearance to begin exercising again. Classes were offered twice per week at an outdoor location due to restrictions on indoor exercise during the study period which coincided with the COVID-19 pandemic.

The group exercise intervention was the 45-minute group fitness class Les Mills TONEÔ, which aims to strengthen core musculature, improve aerobic fitness and balance, and increase muscular strength and endurance.

Participants were given the option to bring their baby to the group fitness class to help reduce potential barriers with exercise engagement. Previous research has demonstrated no significant difference in anxiety outcomes when 45-minute aerobic exercise sessions were completed with or without baby present (Cramp & Bray, 2010). In each class, the instructor provided options to either increase or decrease the intensity of each exercise. In addition, options for using the baby as weight if the mother had to be attending to the baby during exercise were provided.

Before and after the 8-week exercise intervention, participants completed online questionnaires. For mental health outcomes, in addition to state anxiety, postpartum depression, trait anxiety, and perceived stress were measured. Depression was assessed using the Edinburgh Postnatal Depression Scale, which is the most common and widely used screening instrument for assessing perinatal anxiety and depression (Gibson, McKenzie-McHarg, Shakespeare, Price, & Gray, 2009).

At the completion of the program, participants additionally completed the Physical Activity Group Environment Questionnaire (PAGEQ) (Estabrooks & Carron, 2000) to assess the experience of engaging in group exercise with other new mothers, while adhering to COVID-19 restrictions. Group cohesion was measured utilizing PAGEQ, which measures four separate constructs: individual members’ attraction to the group task (ATG-T), individual members’ perception of attraction, acceptance, and social interaction within the group (ATG-S), individual members’ perceptions of bonding and closeness to the collective task (GI-T), as well as individual members’ perceptions of integrating into the social atmosphere of the group (GI-S).


Media requests: press@lesmills.com



Les Mills is the global leader in group fitness and creator of 20 programs available in leading fitness facilities around the world. Les Mills programs include the world’s first group exercise resistance training workout BODYPUMP™, BODYCOMBAT™ (martial arts), RPM™ (indoor cycling), BODYBALANCE™ (yoga), LES MILLS GRIT™ (30-minute high-intensity interval training) and the revolutionary immersive cycle experience, THE TRIP™. Each workout is refreshed and updated with new choreography and music every three months.

The company was founded by Les Mills – a four-time Olympian and head coach of New Zealand’s track and field team – who opened his first gym in 1968 with the aim of taking elite sports training to the masses. Today, Les Mills workouts are delivered by 140,000 certified instructors in 21,000 clubs across 100 countries and are available as live, livestream, virtual and immersive classes, as well as via the LES MILLS+ streaming platform.