Diagnosis to Delivery: A randomised clinical trial of Postmeal Walking
as a Non-Pharmacological Treatment of Gestational Diabetes
Abstract
Objective The aim of this study was to determine whether postmeal
walking is an effective and feasible alternate to standard-care advice
of 30-min continuous walking for the management of gestational diabetes
(GDM). Design, Setting Randomised controlled trial conducted in
Australia. Sample, Methods Forty women with GDM were randomised between
28-30 weeks’ gestation into either standard-care (CTL; 30-min continuous
walking) or standard care with advice for PMW (10-min walking after main
meals). ActivPAL inclinometers and continuous glucose monitors (CGM)
were worn from 28 weeks to 35 weeks. Birth outcomes were also collected.
A linear mixed model analysed the changes from baseline (28 week)
through to 35 weeks’ gestation between continuous and postmeal walking.
Main Outcome Measure Postprandial glucose. Results Twenty-six women
(PMW: n=12, CTL: n=14; 35 5 y) completed the intervention. 3 h
postprandial glucose at lunch and dinner, were ~0.25 and
~0.35 mmol/L, respectively higher in PMW vs. CTL (group:
p = 0.04). 24 h, nocturnal and fasting glucose were similar. PMW spent
~57 min/d more in sitting time and ~11
min/d less stepping time vs. CTL (group: p= 0.02 and 0.05). Both PMW and
CTL had high adherence to exercise prescriptions, physical activity
decreased with gestation. No difference in birth outcomes. Conclusions
Postmeal walking was less effective than the standard care physical
activity guidelines of thirty minutes continuous walking. More research
on the optimal duration and intensity of postmeal walks to improve
postprandial responses are needed. Strategies that mitigate sedentary
time in pregnancy are also warranted.