Improve blood glucose level in women with gestational diabetes by increased physical exercise such as aerobic and resistance training.
Exercise for Gestational Diabetes
Due to the uncertainty of risks and benefits of exercise during gestational pregnancy, women tend to avoid exercise. However, proper training is both safe and beneficial in the treatment of gestational diabetes.
Is it ok to do exercise during Gestational Diabetes?
Appropriate exercise does not induce any harm on the fetus or mother
There is a general agreement that appropriate exercise does not induce any harm to the fetus. Ref: British Journal of Sports Medicine 2003 Feb; 37(1):6-12; discussion 12
Moderate physical activity is always emphasizing for any healthy pregnancy. In the case of gestational diabetes, it additionally helps their body for better utilization of the insulin thus helps control blood glucose level.
Studies have shown a variety of exercises ranging from low exerting forces such as Yoga to higher exerting forces such as aerobic classes and jogging can be safe for both mother and fetus.
Ref: Br J Sports Med. 2003 Feb; 37(1):6-12; discussion 12.
The American College of Obstetrics and Gynecology recommends a moderate exercise for 30 minutes per day at least for five days of a week, unless one has a medical or pregnancy complication.
Exercise has a powerful potential to assist with blood glucose control.
Therefore it is important to incorporate exercise into the care of women with gestational diabetes. Guidelines show gestational diabetes should do both aerobic and resistance training at a moderate intensity. Exercise has been proven to be beneficial in improving pregnancy outcomes in gestational diabetes.
A regular exercise program is an essential part of any healthy pregnancy. For GDM, however, it has added benefits in that it increases insulin sensitivity and glucose uptake by contracting skeletal muscles.
Caution: If you are having other medical conditions such as asthma, or heart disease may not be advisable to do exercise.
Additionally, if you are having pregnancy-related conditions such as:
low placenta,
bleeding,
recurrent miscarriage,
premature birth history, or
A weak cervix.
It may be harmful to do exercise. If you are having any of these conditions, then do not do exercise or consult your doctor.
Benefits of exercise during pregnancy
Maternal exercise provides significant benefits to both the health of the fetus and the child.
Benefits of exercise to the mother
Exercise during gestational diabetes produces various benefits to the mother; they are:
- Better glucose control - Help effective blood-glucose management. The exercise was now deemed to be safe and advantageous for glucose control for women with GDM. Ref: Diabetes. 1991 Dec; 40 Supplement 2():182-5.
- Reduce insulin requirement - a Recent study in which physical activity and diet interventions resulted in a lessened dependence on insulin for glucose control in women with GDM. Ref: American Journal of Obstetrics & Gynecology. 2004 Jan; 190(1):188-93.
- Sleep better - Start getting restful sleep.
- Total wellness - Make your body more flexible, thus relieving from body aches, stomach bloating, and swelling of feet. You start feeling better, look better, and energetic.
- Ease of labor - It prepares your body for s delivery. In the 1920s studies began to inform prenatal exercise programs with benefits recorded as increased ease of labor, improved muscle tone, increased fetal oxygenation, and facilitating post-partum weight loss. Ref: Williams & Wilkins: Baltimore; 1991. PP. 1–8.
- Improve cardiovascular function - Other physiological studies have reported an exercise in pregnant women to improve cardiovascular functions such as fitness, blood pressure, and peripheral edema. The JNP. 2007; 3:333–339.
- Helps to maintain required body weight. Especially useful for obese and overweight mothers.
The benefit of exercise to the fetus and child
Exercise during gestational diabetes produces various benefits to the child; they are:
- Lower birth weight - Studies found inverse relationships between birth weight and household physical activity. Ref: Med Hypotheses. 1980 Nov; 6(11):1157-70. The study found that women who exercised during pregnancy had babies with significantly lower birth weight. Ref: Diabetes. 1991 Dec; 40 Supplement 2():182-5.
- Increase in the gestational ages (lower risk of preterm birth).
- It improves neurodevelopment (lower body fat percentage).
- Infants have higher behavior regulatory ability and orientation.
What exercise types are suitable for gestational diabetes?
Aerobic exercise can reduce fasting and postprandial glucose levels and potentially reduce insulin requirement.
Aerobic training increases insulin stimulatory action and thus increases blood glucose uptake via a different pathway.
In regards to elevated fasting glucose, aerobic exercise can indeed reduce blood glucose levels in individuals with hyperglycemia, potentially reducing and delaying the need for insulin medication. Furthermore, following aerobic exercise, insulin levels also drop, reducing the chance of hypoglycemia. However, after an intense bout of exercise, a hyperglycemic response may be observed for up to 2 h post-exercise. Ref: Diabetes Care. 2010 Dec; 33(12):2692-6.
Aerobic exercise is any activity that uses large muscle groups in a rhythmic manner such as walking, jogging, aerobic dance, swimming, hydrotherapy aerobics, rope skipping, hiking, rowing, etc.
In addition to aerobic exercise, resistance strength training and flexibility exercise are also beneficial and safe for gestational women and fetus.
Resistance training increases muscle mass and can increase blood glucose uptake independent of an insulin response as insulin does not influence musculature glucose uptake.
Both ACSM (American College of Sports Medicine) and ESSA (Exercise and Sports Science Australia) recommend combined aerobic and resistance exercise. This combination is more effective for blood glucose management, body composition improvement, and fitness outcomes. Ref: Diabetes Care. 2010 Dec; 33(12):2692-6. & J Sci Med Sport. 2012 Jan; 15(1):25-31.
Choose both aerobic and resistance training for more benefits.
Activating, both of these metabolic pathways may be more physiologically beneficial than utilizing only one channel or exercising using only resistance training or aerobic training.
Learn how to start & end the exercise session for increased benefits.
Warm up’s of between 5-10 min at a low to moderate intensity using aerobic activities can increase body temperature and reduce post-exercise muscle soreness and stiffness.
Performing a post-exercise cool down is recommended if vigorous exercise is performed to reduce the risk of a vasovagal response, which may lead to syncope.
When can you do the exercise for maximum benefits?
After food, the blood glucose level rises, it may be advantageous to exercise for an hour after a meal.
Frequency and duration of exercise
For women who were previously sedentary, it may be more convenient for them to start an exercise program in the second trimester. After start exercising most of the initial discomforts of morning sickness, nausea and fatigue have settled down.
As previously discussed, an exercise in early pregnancy can reduce the risk of gestational diabetes, therefore sooner the woman can comfortably exercise the better.
Start with 15 min of continuous aerobic exercise 3 times a week.
Women with little physical activity history should begin with 15 min of continuous aerobic exercise three times a week with a graded increase to 30 min at least four times a week. Ref: Diabetes Care. 2010 Dec; 33(12):2692-6.
Avoid doing exercise more than 45 min continuously.
ACOG advises against exercising for more than 45 min continually because of a risk of increased fetal temperature. However, this temperature rise is seen to be negligible when the exercise is self-paced in an environment that has adequate temperature control. Ref: Br J Sports Med. 2003 Feb; 37(1):6-12; discussion 12.
In regards to resistance training, ACSM and ESSA recommend a minimum of twice a week on non-consecutive days and ideally three times a week.
Each training session should include 5-10 (ACSM) or 8-10 (ESSA) exercises involving the major muscle groups (upper body, lower body, and core). And 10-15 repetitions (ACSM) or 8-10 repetitions (ESSA) each set at a minimum of one (ACSM) or two (ESSA) sets for strength gains, but up to four sets for optimal glucose uptake and strength gains. Considering these recommendations, for optimal benefits during pregnancy, up to three sets at moderate intensity may be more appropriate.
Precautions to terminate the exercise
If you experience any of the following warning signs such as
- Vaginal bleeding,
- Dizziness,
- A headache,
- Chest pain,
- Muscle weakness,
- Preterm labor,
- Decreased fetal movement,
- Amniotic fluid leakage,
- Calf pain or swelling and
- Dyspnea without exertion.
Then you should terminate doing exercise. And it is essential to consult a doctor to regain stability of the mother’s and fetus’ condition as soon as possible.