Recent Findings on Exercise Therapy for Blood Glucose Management in Patients with Gestational Diabetes
Abstract
:1. Introduction
2. GDM and Exercise Therapy
3. Pre-Exercise Assessment for Pregnant Women
3.1. Prohibitions Related to Physical Activity
3.2. Pre-Exercise Assessment
4. Current Pregnancy Exercise Guidelines
5. Comprehensive Recommendations Based on Exercise Guidelines
5.1. Exercise Volume
5.2. Exercise Intensity
5.3. Exercise Types (Recommended/Not Recommended)
5.3.1. Recommended Exercises
5.3.2. Not Recommended Exercises
5.4. Criteria for Exercise Cessation and Caution for Diabetes-Related Exercise
6. Analysis of Exercise Intervention Studies for GDM
7. Conclusions
- -
- Safe and optimal blood glucose levels for GDM patients during exercise.
- -
- Optimal blood glucose levels and frequency of blood glucose monitoring for patients with GDM in relation to exercise.
- -
- Potential risk factors and prevention methods for exercise-induced hypoglycemia in GDM patients receiving insulin.
- -
- Guidelines for exercise-related insulin dosage adjustment in GDM patients.
- -
- Guidelines for food intake based on blood glucose levels and exercise volume in GDM patients.
- -
- Risk factors for exercise-related hypoglycemia and hyperglycemia in GDM patients not receiving insulin.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Classification | Pregnancy | Pregnancy and Diabetes | Non-Pregnancy and Diabetes | |
---|---|---|---|---|
Health complication | Healthy | GDM | T2DM | T1DM |
Exercise recommendation | Recommended | Recommended | Recommended | Recommended |
Purpose of exercise | Improving the health of pregnant women | Improving the health of pregnant women and achieving target blood glucose levels | Achieving target blood glucose levels | Preventing diabetic complications, improvement of cardiovascular fitness, and enhancement of physical fitness |
Primary causes of blood glucose levels | - | Increased insulin resistance due to multiple placental hormones (human placental lactogen, estrogens, progesterone, cortisol, and placental growth hormone) | Increased insulin resistance | Insulin secretion deficiency |
Medication | - | Insulin (only a minor percentage of GDM patients) | Oral hypoglycemic agent, insulin | Insulin |
Effects of exercise on blood glucose regulation | Prevention of GDM onset | Blood glucose reduction during exercise | Blood glucose reduction during exercise | Minimal effect on blood glucose reduction |
Application of exercise therapy | During pregnancy | From the 26th to 28th week of pregnancy until delivery | After being diagnosed with diabetes | After being diagnosed with diabetes |
Existence of exercise guidelines | Yes | No specialized exercise guidelines for GDM | Yes | Yes |
Organization for providing exercise guidelines | ACOG, SOGC/CSEP | ADA, KDA | ADA, KDA | ADA |
Exercise guidelines | 150 min per week of moderate-intensity aerobic exercise and resistance training | 150 min per week of moderate-intensity aerobic exercise and resistance training | Moderate-intensity aerobic exercise and resistance training (150 min/week or high-intensity 75 min/week) | Moderate-intensity aerobic exercise, resistance training (150 min/week) |
Preventive strategies for exercise-induced hypoglycemia | - | Not present | Caution when taking oral insulin-releasing agents Customized carbohydrate intake recommendations based on pre-exercise blood glucose levels | Determine carbohydrate intake recommendations based on pre-exercise blood glucose levels |
Monitoring blood glucose in relation to exercise | - | Not present | Before and after exercise Changes in overall health, intensity of the exercise, or exercise duration Administration of insulin secretagogues or insulin Hypoglycemia or hyperglycemia | Before and after exercise Changes in overall health, intensity of the exercise, or exercise duration Administration of insulin secretagogues or insulin Hypoglycemia or hyperglycemia |
Insulin dosage adjustment strategies related to exercise | - | Not present | Adjust meals and insulin based on exercise intensity and duration | Adjust meals and insulin based on exercise intensity and duration |
Absolute and Relative Contraindications to Exercise | ACOG (2015) [27] | SOGC/CSEP (2018) [28] | ||
---|---|---|---|---|
Absolute | Relative | Absolute | Relative | |
Ruptured membranes | O | - | O | |
Premature labor | O | - | O | |
Unexplained persistent vaginal bleeding | O | - | O | |
Placenta previa | O | - | O | - |
Preeclampsia | O | - | O | - |
Incompetent cervix | O | - | O | - |
Intrauterine growth restriction | - | O | O | - |
High-order multiple pregnancy (e.g., triplets) | - | - | O | - |
Uncontrolled type 1 diabetes | - | O | O | - |
Uncontrolled hypertension | - | O | O | - |
Gestational hypertension | O | - | - | O |
Uncontrolled thyroid disease | - | O | O | - |
Other serious cardiovascular, respiratory, or systemic disorder | O | - | O | - |
Premature labor during the current pregnancy | O | - | - | - |
Preeclampsia- or pregnancy-induced hypertension | O | - | - | - |
Severe anemia | O | - | - | - |
Recurrent pregnancy loss | - | - | - | O |
A history of spontaneous preterm birth | - | - | - | O |
Mild/moderate cardiovascular or respiratory disease | - | - | - | O |
Malnutrition | - | - | - | O |
Eating disorder | - | - | - | O |
Twin pregnancy after the 28th week | - | - | - | O |
Anemia | - | O | - | O |
Unevaluated maternal cardiac arrhythmia | - | O | - | - |
Chronic bronchitis | - | O | - | - |
Extreme morbid obesity | - | O | - | - |
Extreme underweight | - | O | - | - |
History of extremely sedentary lifestyle | - | O | - | - |
Orthopedic limitations | - | O | - | - |
Poorly controlled seizure disorder | - | O | - | - |
Heavy smoking | - | O | - | - |
Other significant medical conditions | - | - | - | O |
Classification | ACOG [29] | SOGC/CSEP [28] | ACSM [30] | ADA [16] | ADA [24] | KDA [23] | |
---|---|---|---|---|---|---|---|
Target population | Women with uncomplicated pregnancies | All pregnant women without contraindication | Pregnant women | T1DM T2DM GDM | T1DM T2DM GDM | Women with diabetes | |
Components of exercise prescription | Exercise frequency | At least 3~4 days/week | Minimum 3 days/week | Most or all days of the week | Most or all days of the week | 3~7 days | 5~7 days |
Exercise Intensity | Less than 60~80% of age-predicted maximum maternal heart rate (usually not exceeding 140 beats/min) 13~14 (somewhat hard) on RPE Conversation during physical activity | Moderate intensity 40~59% HRR Conversation during physical activity | Conversation during physical activity | Moderate intensity | Moderate intensity 40~59% HRR 13~14 (somewhat hard) on RPE | Moderate or low intensity | |
Exercise duration | 30~60 min/day | At least 150 min/week | 20~30 min/day | 20~30 min/day | 20~30 min/session | 30 min/day At least 150 min/week | |
Exercise recommended | Aerobic exercise: walking, stationary cycling, dancing, water aerobics Resistance exercise: using weights and/or elastic bands Stretching | Aerobic exercise: brisk walking, stationary cycling, swimming, aquafit Resistance exercise Stretching | Aerobic exercise: walking, swimming, stationary cycling, low-impact aerobics, running Resistance exercise Pelvic floor muscle training | Aerobic or resistance exercise | Aerobic exercise: walking, stationary cycling, aquatic activities Running (only if already highly active prior to pregnancy) Resistance exercise Prenatal yoga | Aerobic exercise | |
Activities to be avoided | Activities at high risk of abdominal trauma or imbalance Scuba diving Exercise at altitudes above 1800 m Activities at excessive heats and humidities High intensity or prolonged exercise longer than 45 min | Activities at excessive heats and humidities Scuba diving Exercise at altitudes above 2500 m Activities at risk of falling or physical contact (horseback riding, downhill skiing, ice hockey, gymnastics) | Sports/activities that may cause loss of balance or trauma to the mother or fetus Activities at risk of falling, jumping, and quick changes in direction Scuba diving Hot yoga Exercise lying flat on the back after the 1st trimester Exercise using the Valsalva maneuver | Not present | Activities lying flat on the back after the 1st trimester Scuba diving Activities at risk of falling or physical contact (horseback riding, downhill skiing, water skiing, soccer, outdoor cycling, basketball, most racquet sports) | Not present | |
Condition for discontinuation of exercise | Vaginal bleeding Amniotic fluid leakage Regular painful contractions Chest pain Abdominal pain Calf pain or swelling Dyspnea before exertion Dizziness Headache | Vaginal bleeding Amniotic fluid leakage Regular and painful uterine contraction Severe chest pain Increased shortness of breath during rest Dizziness or faintness during rest | Vaginal bleeding Amniotic fluid leakage Regular painful uterine contractions Chest pain Calf pain or swelling Increased shortness of breath Dizziness, syncope, or faintness during rest Headache | Not present | Vaginal bleeding Amniotic fluid leakage Regular painful uterine contractions Decreased fetal movement Dizziness Increased shortness of breath during rest Chest pain Calf pain or swelling Dizziness Headache | Not present | |
Considerations for exercise in diabetes | Safe blood glucose levels for GDM patients during exercise | Not present | Not present | Not present | Not present | Not present | Not present |
Medication | Not present | Not present | Not present | Understand risk of hypoglycemia during exercise for the 1st trimester | Not present | Not present | |
Timing for exercise | Not present | Not present | Not present | Not present | Not present | Simple activities, such as walking for 10~15 min after each meal | |
Exercise-related risk of hypoglycemia | High intensity or prolonged exercise longer than 45 min | Not present | Not present | Not present | Not present | Not present | |
Adjusting medication for exercise | Not present | Not present | Not present | Not present | Appropriate food intake and insulin for insulin user during physical activities | Not present | |
Summary | Most detailed guidelines for pregnant women | Basic guidelines for pregnant women | Basic guidelines for pregnant women | Focus on type 1 and type 2 diabetes (T1DM, T2DM) | Guidelines centered More on pregnant women than GDM | Guidelines centered more on pregnant women than GDM | |
Referenced guidelines * | ACOG (2015) [27] | ACSM (2014) [34] | SOGC/CSEP (2018) [28] ACOG (2015) [27] | ACOG (2015) [27] | ACOG (2002) [35] | ADA (2021) [7] |
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Jung, A.R.; Seo, Y.; Lee, J.; Hwang, J.G.; Yun, S.; Lee, D.T. Recent Findings on Exercise Therapy for Blood Glucose Management in Patients with Gestational Diabetes. J. Clin. Med. 2024, 13, 5004. https://doi.org/10.3390/jcm13175004
Jung AR, Seo Y, Lee J, Hwang JG, Yun S, Lee DT. Recent Findings on Exercise Therapy for Blood Glucose Management in Patients with Gestational Diabetes. Journal of Clinical Medicine. 2024; 13(17):5004. https://doi.org/10.3390/jcm13175004
Chicago/Turabian StyleJung, Ah Reum, Yongsuk Seo, Jooyoung Lee, Jae Gu Hwang, Somi Yun, and Dae Taek Lee. 2024. "Recent Findings on Exercise Therapy for Blood Glucose Management in Patients with Gestational Diabetes" Journal of Clinical Medicine 13, no. 17: 5004. https://doi.org/10.3390/jcm13175004