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Exercise in

Gestational Diabetes

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Objectives

After completing this Module the participant


will be able to

Discuss the value of regular activity


Recognize the limitations regarding exercise especially
during the third trimester

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Background
Physical activity can prevent or delay type 2 DM in
individuals at risk
Studies show that pre-pregnancy exercise helps to
prevent GDM during pregnancy.
More intensity equals more benefits.
Any activity has more benefit than no physical activity in
prevention of GDM.

Oken et al, 2006, Zhang et al, 2006, Dempsey JC et al 2004


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Types of Exercise
Aerobic Exercise:
Aerobic means using oxygen for energy.
use large muscles (legs, shoulders, chest, and arms)
can be performed continuously
burns calories and is critical to losing fat and keeping it off.

Resistance Training
helps in increasing the number of Insulin receptors
Improves sensitivity of insulin receptors in skeletal muscle
maintains muscle while losing fat.
Upper arm resistance training shown to lower blood glucose

Jovanovic-Peterson et al 1989.
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Benefits of Exercise in GDM

Exercise causes significant decrease in:

fasting plasma glucose


1hour plasma glucose
HbA1c
insulin requirement

Jovanovic-Peterson et al 1989; Brankston et al, 2004.


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Where to start

Activity should be discussed with a medical


practitioner
Start with light to moderate exercise, i.e. 10 minute walk
after meals, upper body exercises while seated
30 minutes a day total is recommended

Appropriate exercise
Low-impact aerobics, swimming, yoga, light weights

Harris, White, 2005


Metzger, Buchanan et al 2007 6
Medical contraindications for exercise in
pregnancy
Haemodynamically significant heart disease, eg. Mod-
severe valvular heart disease, cardiomyopathy, cyanotic
heart disease
Restrictive lung disease
Preclampsia
Incompetent cervix/ cerclage
Multiple gestation at risk for premature labour
Persistent second or third trimester bleeding
Placenta praevia after 26 weeks gestation
Ruptured membranes

ACOG Committee on Obstetric Practice, 2002.


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Relative contraindications for exercise in
pregnancy
Severe anaemia History of extreme sedentary
Unevaluated cardiac lifestyle
arrhythmia Poorly controlled hypertension
Chronic bronchitis Orthopedic limitations
Poorly controlled type 1 Poorly controlled seizure
diabetes disorder
Extreme morbid obesity (BMI > Poorly controlled
40) hyperthyroidism
Extreme Underweight (BMI< Heavy smoker
12) Intrauterine growth restriction
Exercise in multiple gestation in current pregnancy
should be supervised

ACOG Committee on Obstetric Practice, 2002.


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Caution

Strenuous exercise could cause


Fetal distress
Uterine contractions
Maternal hypertension
Increased risk of soft tissue injury

Need to monitor
Blood glucose before and after exercise for women on
insulin or sulphonylureas

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Education before exercise

Avoid exercise in supine position after 2nd trimester (due


to possibility of supine hypotension)
Heart rate should not exceed 140 bpm
Stop activity if contractions are felt
If on insulin
avoid exercising when insulin is peaking
know how to recognize and treat hypoglycemia
carry fast acting glucose

Harris, White, 2005


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Summary
Any physical activity is better than no physical activity during
pregnancy

Even lower levels of physical activity have shown benefit in


control of blood sugars.

Aerobic activity of moderate intensity for 30mins/day on most


days of the week has shown benefits in metabolic control.

Upper body resistance training in addition to aerobic activity


has probable synergistic effects in lowering blood sugars.

Dempsy et al 2004, Liu et al 2008, Jovanovic-Peterson et al, 1989,


ACOG Committee on Obstetric Practice, 2002 11
References
Artal R, OToole M. Guidelines of the American College of Obstetricians and
Gynecologists for exercise during pregnancy and the postpartum period. Br J
Sports Med. 2003 February;37(1):612. doi: 10.1136/bjsm.37.1.6

Harris, GD, White, RD. Diabetes management and exercise in pregnant


patients with diabetes. Clinical Diabetes. 2005;23(4):165-168.

Metzger BE, Buchanan TA, Coustan DR, De Leiva A, Hadden DR, Hod M.
Summary and recommendations of the fifth international workshop-conference
on gestational diabetes mellitus, Diabetes Care. 2007; 30(suppl 2):S251-260.

Oken E, Ning Y, Rifas-Shiman SI, Radesky JS, Rich-Edwards JW, Gillman


MW. Association of physical activity and inactivity before and during pregnancy
with glucose tolerance. Obstet Gynecol 2006; 208: 2100-7.

Zhang C, Solomon CG, Manson JE, Hu FB. A prospective study of pregravid


physical activity and sedentary behaviours in relation to the risk of gestational
diabetes mellitus. Arch Intern Med. 2006; 166: 543-8
Contd.....

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References Contd....
Brankson gN, Mitchell BF, Ryan EA, Okun NB. Resistance exercise decreases
the need for insujlin in overeight women with gestational diabetes mellitus. Am.
J. Obstet Gynecol 2004; 190:188-93.

Dempsey JC, Butler CL, Sorenson TK et al. A case-control study of maternal


recreational physical activity and risk of gestational diabetes mellitus. Diabetes
Res Clin Practi 2004;66 203-215.

Jovanovic-Peterson L, Durak EP, Peterson CM, Randomised trial of diet


versus diet plus cardiovascular conditioning on glucose levels in gestational
diabetes. Am. J. Obstet Gynecol. 1989; 161: 415-419.

ACOG Committee on Obstetric Practice. ACOG committee opinion. Number


267, January 2002: exercise during pregnancy and the postpartum period. Inj.
J. Gynecal Obstet 2002; 77: 79-81.

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