Aerobic or Resistance Exercise for Improved Glycaemic Control and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Search Strategy
- -
- Participants: women, pregnancy, gestational diabetes, hyperglycaemia, diabetes
- -
- Intervention: exercise, aerobic, resistance
- -
- Comparison: physical activity, aerobic, resistance, control
- -
- Outcome: medication (insulin, metformin), glycaemic control, maternal outcome
- Randomised controlled trials
- Gestational diabetes mellitus
- Intervention of resistance exercise or aerobic exercise alone or in combination
- Comparator or control of either resistance, aerobic or no exercise
- Review or opinion articles
- Studies without published results
- Studies involving women with pre-existing diabetes
2.2. Study Selection
2.3. Data Extraction
2.4. Quality Assessment
3. Results
3.1. Literature Search
3.2. Characteristics
3.3. Fasting Glucose
3.4. Postprandial Glucose
3.5. Average Glucose
3.6. HbA1C
3.7. Insulin Use
3.8. Maternal Hypoglycaemia
3.9. Caesarean Section
3.10. Induction of Labour Rates and Labour Duration
3.11. Other Outcomes
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | Inclusion | Exclusion |
---|---|---|
Population/ participant | Women Pregnancy Gestational diabetes Hyperglycaemia Diabetes in pregnancy Treatment of Gestational Diabetes | Pre-gestational Diabetes Type 1 Diabetes Type 2 Diabetes Prevention of Gestational Diabetes |
Intervention | Exercise, aerobic, resistance Lasting at least two weeks | |
Comparison | Normal physical activity Aerobic exercise Resistance Control Lasting at least two weeks | |
Outcome | Glycaemic control Maternal outcomes | |
Study Design | Randomised controlled trial No language restriction Published paper Published abstract | Case report Case-control study Cohort study Commentary Guideline |
Author of RCT; Year Published Country | Sample Characteristics | Duration of Intervention | Intervention (Exercise) Characteristics | Outcomes |
---|---|---|---|---|
Adam 2014 [34] | Control n − 4 Intervention n = 39 | Duration of pregnancy | Standard counselling for physical activity Supervised individuals follow up with kinesiologist | Addition of insulin Mean dose of insulin Time to start insulin Weight gain |
Avery 1997 [35] United States | Control n = 14 GDM diagnosis 26.3 ± 8 weeks Intervention n = 15 GDM diagnosis 28.7 ± 3 weeks | Six weeks | Usual physical activity 30 min supervised cycling with 30 min unsupervised walking | Addition of insulin Caesarean birth Hypertensive disorders Maternal weight gain |
Awad 2019 [48] Egypt | Control n = 30 Diet plus insulin Intervention n = 30 Moderate intensity aerobic and circuit resistance exercise 3–4 times/week in addition to diet plus insulin | 24 weeks’ gestation until delivery | Diet plus insulin alone compared with combined strength and aerobic exercise plus diet plus insulin | Mode of delivery |
Bambicini 2012 [36] | Control n = 6 Intervention (aerobic) n = 6 Intervention (resistance) n = 5 | Duration of pregnancy | Seated listening to explanations about exercise Aerobic or resistance exercises | Mean glucose immediately after session and one hour later |
Bo 2014 [37] Italy | Control n = 99 GDM diagnosis 24–26 weeks Intervention n = 101 GDM diagnosis 24–26 weeks | 12–14 weeks | Not applicable Twenty minutes of unsupervised brisk walking seven times a week | Addition of insulin Caesarean birth Glycaemic control |
Brankston 2004 [38] Canada | Control n = 16 GDM diagnosis: not reported Intervention n = 16 GDM diagnosis: not reported | Eight weeks | Usual physical activity Resistance exercise on circuit: supervised for three sessions then supervised for three sessions per week | Additional medications Glycaemic control |
Bung 1991 [39] United States | Control n = 17 GDM diagnosis: 30.3 ± 2 weeks Intervention n = 17 GDM diagnosis: 30.3 ± 1.9 weeks Note: control was diet and insulin; diagnosis of GDM was persistent fasting glucose >5.88 mM but <7.22 mM and “failed diet therapy for a week” | Remainder of the pregnancy | Standard care Supervised in exercise laboratory: 45 min with breaks on recumbent bicycle | Adherence to intervention Caesarean birth Hypoglycaemia Glycaemic control |
De Barros 2010 [40] Brazil | Control n = 32 GDM Diagnosis 27.5 ± 3 weeks Intervention n = 32 GDM Diagnosis 28.4 ± 2.5 weeks | Eight weeks | Usual physical activity Resistance exercise (two supervised and one unsupervised) for 30–40 min | Additional medications Caesarean birth Weight gain |
Halse 2014 [41] Australia | Control n = 20 GDM Diagnosis 28.8 ± 1 week Intervention n = 20 GDM Diagnosis 28.9 ± 1 week | Six weeks | Usual physical activity Home cycle ergometer supervised three times a week and unsupervised for two sessions a week | Additional medications Caesarean birth Induction of labour Patient views Weight gain |
Jovanovic-Peterson 1989 [42] United States | Control n = 9 GDM diagnosis at 28 weeks Intervention n = 10 GDM diagnosis at 28 weeks | Six weeks | Usual physical activity Aerobic exercise: 20 min for three times a week, supervised, using ergometer | Additional medications Adherence to intervention Hypertensive disorders Glycaemic control |
Qadir 2018 [44] Singapore | Control n = 5 GDM “newly diagnosed” Intervention n = 5 GDM “newly diagnosed” | Eight weeks | Usual physical activity measured by pedometer Patient education and structured exercise class once a week Usual physical activity measured by pedometer | Average daily steps Glycaemic control |
Ramos 2015 [43] | Control n = 4 Intervention n = 2 | Ten weeks | 50 min stretching and relaxation once a week 50 min aerobic session three times a week | Mean HbA1c Homeostatic model assessment (HOMA) |
Sklempe Kocic 2018 [45] Croatia | Control n = 20 GDM diagnosis: 20.8 ± 6 weeks Intervention n = 18 GDM diagnosis 22.2 ± 6 weeks | Six weeks | Usual physical activity Combined aerobic and resistance exercise (two supervised sessions) plus seven sessions of unsupervised walking | Additional medications Caesarean Birth Glycaemic control Weight gain |
Youngwanichsetha 2014 [46] Thailand | Control n = 85 GDM diagnosis: 24–30 weeks Intervention n = 85 GDM diagnosis: 24–30 weeks | Eight weeks | Not applicable Fifteen to twenty minutes of supervised yoga five times a week | Glycaemic control |
Author of RCT; Year Published | Selection Bias (Random Sequence Generation) | Selection Bias (Allocation Concealment) | Performance Bias (Double Blinding) | Detection Bias (Blinding of Outcome Assessment) | Attrition Bias (Incomplete Outcome Data) | Reporting Bias (Selective Reporting) | Other Bias |
---|---|---|---|---|---|---|---|
Adam 2014 [34] | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear |
Avery 1997 [35] | Low | Unclear | High | Unclear | High | Unclear | Low |
Awad 2019 [48] | Unclear | Unclear | High | Unclear | Unclear | Unclear | Low |
Bambicini 2012 [36] | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear |
Bo 2014 [37] | Unclear | Low | High | Low | Low | Low | Low |
Brankston 2004 [38] | Low | Low | High | High | Unclear | High | Unclear |
Bung 1991 [39] | Unclear | Unclear | Unclear | Unclear | High | Unclear | Unclear |
De Barros 2010 [40] | Low | Low | High | High | Low | Unclear | Low |
Halse 2014 [41] | Unclear | Low | High | High | High | High | Low |
Jovanovic-Peterson 1989 [42] | Low | Unclear | High | Unclear | Low | High | High |
Qadir [44] | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear |
Ramos 2015 [43] | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear | Unclear |
Sklempe Kocic 2018 [45] | Low | Unclear | High | Low | Low | High | Low |
Youngwanichsetha 2014 [46] | Unclear | Unclear | High | Low | Low | High | Low |
Paper | Intervention | Sample Characteristics | Main Outcome | Findings |
---|---|---|---|---|
Adam et al. [34] | Standard counselling for physical activity compared with supervised individual follow up with kinesiologist | Control n − 40 Intervention n = 39 | Addition of insulin Mean dose of insulin Time to start insulin Weight gain | No difference |
Avery et al. [35] | Usual physical activity compared with supervised cycling and unsupervised walking | Control n = 14 GDM diagnosis 26.3 ± 8 weeks Intervention n = 15 GDM diagnosis 28.7 ± 3 weeks | Addition of insulin Apgar < 7 at 1 min Apgar < 7 at 5 min Birthweight Caesarean birth Gestation at birth Hypertensive disorders Maternal weight gain | No difference in insulin requirement No difference in CS, hypertensive disorders |
Awad et al. [48] | Diet plus insulin alone compared with combined strength and aerobic exercise plus diet plus insulin | Control n = 30 Diet plus insulin Intervention = 30 Moderate intensity aerobic and circuit resistance exercise 3–4 times/week in addition to diet plus insulin | Mode of delivery | Reduced CS rate in control group |
Bambicini et al. [36] | Explanation about exercise compared with aerobic or strength-based exercise | Control n = 6 Intervention (aerobic) n = 6 Intervention (resistance) n = 5 | Mean glucose immediately after session and one hour later | No difference |
Bo et al. [37] | Twenty minutes of brisk walking 7 times per week | Control n = 99 GDM diagnosis 24–26 weeks Intervention n = 101 GDM diagnosis 24–26 weeks | Addition of insulin Caesarean birth Glycaemic control | No difference in insulin requirements, CS, macrosomia, fasting glucose Reduction in postprandial glucose and HbA1C with intervention |
Brankston et al. [38] | Usual physical activity Resistance exercise on circuit: supervised for three sessions then supervised for three sessions per week | Control n = 16 GDM diagnosis: not reported Intervention n = 16 GDM diagnosis: not reported | Additional medications Glycaemic control | Increased latency to insulin treatment in intervention group No difference in number of women requiring insulin or the dose used No difference in fasting or postprandial glucose levels |
Bung et al. [39] | Standard care Supervised 45 min session on recumbent bicycle | Control n = 17 GDM diagnosis: 30.3 ± 2 weeks Intervention n = 17 GDM diagnosis: 30.3 ± 1.9 weeks Note: control was diet and insulin; diagnosis of GDM was persistent fasting glucose >5.88 mM but <7.22 mM and “failed diet therapy for a week” | Adherence intervention Caesarean birth Hypoglycaemia Glycaemic control | No difference in CS, average glucose levels |
De Barros et al. [40] | Usual physical activity Resistance exercise (two supervised and one unsupervised) for 30–40 min | Control n = 32 GDM Diagnosis 27.5 ± 3 weeks Intervention n = 32 GDM Diagnosis 28.4 ± 2.5 weeks | Additional medications Caesarean birth Weight gain | No difference in latency to use of insulin or dose required Reduction in number of women requiring insulin No difference in caesarean section |
Halse et al. [41] | Usual physical activity Home cycle ergometer supervised three times a week and unsupervised for two sessions a week | Control n = 20 GDM Diagnosis 28.8 ± 1 week Intervention n = 20 GDM Diagnosis 28.9 ± 1 week | Compliance, maternal attitudes to exercise, aerobic fitness, onset of labour, mode of delivery, duration of labour | No difference in maternal obstetric outcomes, improved fitness, attitude, and exercise intention |
Halse et al. [47] | Usual physical activity Home cycle ergometer supervised three times a week and unsupervised for two sessions a week | Control n = 9 GDM diagnosis at 28 weeks Intervention n = 10 GDM diagnosis at 28 weeks | Glycaemic control | No difference in fasting glucose, HbA1C, insulin use, dose, or latency to starting insulin Improved post prandial glucose and average glucose |
Jovanovic-Peterson et al. [42] | Usual physical activity Aerobic exercise: 20 min for three times a week, supervised, using ergometer | Control n = 5 GDM “newly diagnosed” Intervention n = 5 GDM “newly diagnosed” | Additional medications Adherence to intervention Hypertensive disorders Glycaemic control | Improved fasting glucose with intervention No difference in obstetric or maternal outcomes |
Qadir et al. [44] | Usual physical activity measured by pedometer Patient education and structured exercise class once a week Usual physical activity measured by pedometer | Control n = 4 Intervention n = 2 | Average daily steps Glycaemic control | No difference in glycaemic control |
Ramos et al. [43] | 50 min stretching and relaxation once a week 50 min aerobic session three times a week | Control n = 20 GDM diagnosis: 20.8 ± 6 weeks Intervention n = 18 GDM diagnosis 22.2 ± 6 weeks | Improved HbA1C in intervention | |
Sklempe Kokic [45] | Usual physical activity Combined aerobic and resistance exercise (two supervised sessions) plus seven sessions of unsupervised walking | Control n = 85 GDM diagnosis: 24–30 weeks Intervention n = 85 GDM diagnosis: 24–30 weeks | Additional medications Caesarean Birth Glycaemic control Weight gain | Improved postprandial glucose with intervention, no difference in maternal obstetric outcomes |
Youngwanichsetha et al. [46] | Not applicable Fifteen to twenty minutes of supervised yoga five times a week | Glycaemic control | Improved fasting glucose, post prandial glucose, HbA1C with intervention |
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Keating, N.; Coveney, C.; McAuliffe, F.M.; Higgins, M.F. Aerobic or Resistance Exercise for Improved Glycaemic Control and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus: A Systematic Review. Int. J. Environ. Res. Public Health 2022, 19, 10791. https://doi.org/10.3390/ijerph191710791
Keating N, Coveney C, McAuliffe FM, Higgins MF. Aerobic or Resistance Exercise for Improved Glycaemic Control and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus: A Systematic Review. International Journal of Environmental Research and Public Health. 2022; 19(17):10791. https://doi.org/10.3390/ijerph191710791
Chicago/Turabian StyleKeating, Niamh, Ciara Coveney, Fionnuala M. McAuliffe, and Mary F. Higgins. 2022. "Aerobic or Resistance Exercise for Improved Glycaemic Control and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus: A Systematic Review" International Journal of Environmental Research and Public Health 19, no. 17: 10791. https://doi.org/10.3390/ijerph191710791