Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

A pedometer-based physical activity intervention for women with T2DM or early gestation hyperglycaemia: a pilot study (#336)

Julia E Martin 1 , Zoe Lambert 2 , John Bailey 3 , Andy Woods 3 , Surinder Baines 2 , Ben Ewald 4 5 , Katie Wynne 1 2 5 , Johanna Kuehn 1
  1. Department of Diabetes & Endocrinology, John Hunter Hospital, Newcastle, NSW, Australia
  2. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  3. Department of Obstetrics and Gynaecology, John Hunter Hospital, Newcastle, NSW, Australia
  4. Centre for Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW, Australia
  5. Hunter Medical Research Institute, Newcastle, NSW, Australia

Pregnant women with hyperglycaemia are at increased risk of birth complications, malformations and adverse intrauterine programming.1,2 Moderate intensity exercise improves maternal glycaemic control and reduces weight-gain.3,4 Lifestyle education improves fetal outcomes for women with gestational diabetes.5 ACSM and ACOG guidelines recommend 30 minutes moderate-intensity daily activity after the first trimester.6,7 There is little evidence to guide exercise intervention for pregnant women with type 2 diabetes or early hyperglycaemia.

Twenty-four women with type 2 diabetes or early (<20 weeks gestation) hyperglycaemia (ADIPS) were given lifestyle education and randomised to either incremental individualised physical activity targets from baseline (13-19 weeks) to 34 weeks gestation (n=10, intervention) or standard care (n=14, control). The intervention group wore a pedometer daily, were encouraged to identify an exercise partner8 and activity targets were increased by +10% (maximum target 10,000 steps/day) at each routine clinic visit. The control group did not receive targets, but wore a pedometer for one week at baseline, 26 and 34 weeks gestation. The activity levels of the fifteen women who completed the study increased from baseline to 26 weeks (4806±426 vs. 5775±669 steps/day), and declined to 34 weeks (4612±388 steps/day). The intervention group demonstrated an attenuated reduction in activity at 34 weeks (n=7, 5203±561 steps/day) compared to control (n=8, 4095±497 steps/day; Figure). Mean fasting glucose levels at 28 weeks were significantly reduced from baseline in the intervention group (-0.4±0.1mmol/l vs. -0.1±0.0mmol/l; Figure).

A pedometer-based intervention was mostly effective at improving activity levels in pregnancy. There was a low completion rate suggesting the intervention may not be sustainable. This cohort of women had lower activity levels than those of obese pregnant women published in the literature.9,10 Larger studies should investigate the acceptability and feasibility of exercise interventions and their impact on both maternal and fetal outcomes in this higher-risk group.

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  1. Australian Institute of Health and Welfare 'Diabetes in pregnancy: its impact on Australian women and their babies'. Diabetes Series Number 14 Cat.no. CVD 52 2010.
  2. Sweeting AN, Ross GP, Hyett J, Molyneaux L, Constantino M, Harding AJ, Wong J. Gestational diabetes mellitus in early pregnancy: evidence for poor pregnancy outcomes despite treatment. Diabetes Care 2016 39(1): 75-81.
  3. Erlich SF, Hedderson MM, Brown SD, Sternfeld B, Chasan-Taber L, Feng J, Adams J, Ching J, Crites Y, Quesenberry CP, Ferrara A. Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes. Diabetes Metab 2017.
  4. Erlich SF, Sternfeld B, Krefman AE, Hedderson MM, Brown SD, Mevi A, Chasan-Taber L, Quesenberry CP Jr, Ferrara A. Moderate and vigorous Intensity exercise during pregnancy and gestational weight gain in women with gestational diabetes. Matern Child Health J. 2016 20(6):1247-57.
  5. Brown J, Alwan NA, West J, Brown S, McKinlay CJ, Farrar D, Crowther CA. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database Syst Rev. 2017.
  6. Committee Opinion No.650 Summary: Physical Activity and Exercie During Pregnancy and the Postpartm Period Obstetrics & Gynaecology: December 2015-Volume 126-Issue 6-p1326-1327.
  7. Pescatello LS & American College of Sports Medicine 2014. ACSM's guidelines for exercise testing and prescription. Philadephia: Wolters Kluwer/Lippincott Wiliams & Wilkins Health.
  8. Christakis and Fowler. The spread of obesity in a large social network over 32 years. New Engl J Med 2007. 26;357(4):370-379.
  9. Renault K, Nørgaard K, Andreasen KR, Secher NJ, Nilas L. Physical activity during pregnancy in obese and normal-weight women as assessed by pedometer. Acta Obstet Gynecol Scand. 2010 89(7):956-61.
  10. Bisson M, Alméras N, Dufresne SS, Robitaille J, Rhéaume C, Bujold E, Frenetter J, Tremblay A and Marc I. A 12-week exercise program for pregnant women with obesity to improve physical activity levels: an open randomised preliminary study. PloS One 2015. 10(9):e0137742