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1. Exercise in
Gestational Diabetes
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2. 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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3. 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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4. 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
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Jovanovic-Peterson et al 1989.

5. 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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6. 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
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Harris, White, 2005
Metzger, Buchanan et al 2007

7. 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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8. Relative contraindications for exercise in
pregnancy
• Severe anaemia
• Unevaluated cardiac
arrhythmia
• Chronic bronchitis
• Poorly controlled type 1
diabetes
• Extreme morbid obesity (BMI >
40)
• Extreme Underweight (BMI<
12)
• Exercise in multiple gestation
should be supervised
• History of extreme sedentary
lifestyle
• Poorly controlled hypertension
• Orthopedic limitations
• Poorly controlled seizure
disorder
• Poorly controlled
hyperthyroidism
• Heavy smoker
• Intrauterine growth restriction
in current pregnancy
ACOG Committee on Obstetric Practice, 2002.
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9. 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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10. 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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11. 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

12. References
Artal R, O’Toole 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):6–12. 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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13. 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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