A Perspective on Exercise
20 year perspective and journey
 Work in the late 1980s

A Perspective on Exercise
My work at Sansum vs. my own two kids /
pregnancies
 Who is at risk?
 Training throughout pregnancy

◦ Just “who” can really exercise?
Monitoring in all three trimesters
 Modifying workloads – applying real
exercise standards to the pregnancy
population

GDM in the News
GDM in the News



More than 250,000 women
who give birth have diabetes
Harms developing baby – but
increases risk of diabetes later
in life
Costs are 55% higher for
delivery in diabetic women
GDM in the News
High BG numbers for fasting, post prandial,
or OGTT now pose greater risks
 Gaining weight in first trimester are at
higher risk of GDM

Theme for this presentation
What’s changed in exercise
programming for pregnancy
in general over the past 20
plus years?
 How can we apply these
types of programs to GDM
prevention and therapy?

Goals for Exercise






Exercise through entire pregnancy
Manage glucose and stress hormone levels
Develop a safe weight training program with
modifications
Stay with low impact aerobic training
Pilates and Yoga are gaining popularity
Post partum exercise – weight loss,
depression, improved fitness, life style habits
Goals of Exercise
#1 – Regulate blood sugars – both acute
(post exercise), and chronic (lower A1c)
 #2 – Regulate body weight gain – good
weight vs. excess fat
 #3 – Maintain good blood flow – reduce
edema, blood pressure increases, etc.
 #4 – Maintain or improve lifestyle.
Exercise sets the stage for health status of
mother and baby

Exercise in the Equation

So how do we integrate exercise into a
pregnancy for women at risk for GDM
that is safe, effective, and may cause a shift
in lifestyle habits that would last after the
baby is born?
Recent info on Exercise and
Pregnancy
Amazon shows
a lot of books
on the subject
– so the
information is
out there.
Exercise and GDM

Tieu, J. Dietary advice in pregnancy for preventing GDM. Chochrane
Database Syst. Rev. 2008.
◦ Low GI diets improved baby birthweights
◦ One trial used combination of standard exercise (?) with diet
◦ However – results in general were inconclusive

deBarros, MC, et al. Resistance exercise and glycemic control in women
with GDM. AJOG – 2010
◦ 21% of exercise vs. 56% required insulin, 80% of EX maintained BG levels throughout
trial

Tobias, DK – PA before and during pregnancy and risk of GDM. Diabetes
Care. 2010.
◦ Pre pregnancy PA in 34,900 participants – OR = .45 of highest / lowest
categories. EX in early pregnancy in 4,400 women was protective OR = .76. PA
assoc. with sig. reduction in GDM.

Clapp, JF. Effects of diet and exercise on insulin resistance in pregnancy.
Met. Synd. Relat. Dis. 2006
◦ Decrease in maternal and fetal weight
◦ Lowers insulin resistance, lowers blood glucose
Current Info on Exercise and Diabetes

Exercise must be important – as many web sites are
including it as part of the “prevention” formula
Sam’s Club and Prevention


What you get: For $99,
buyers of the program get
an annual subscription to a
web-based program that
includes an at-home blood
screening test that tracks
an individual's cholesterol,
blood sugar and
hemoglobin levels.
Buyers also get access to
a 24/7 nurse line, two
health coaching sessions,
recommended prevention
screenings, schedule and
alerts based on age, gender
and risks and a physician
summary that can be
shown to a doctor.
Exercise and GDM Prevention

1992 case study on the use of exercise
and the prevention of GDM
◦ Diagnosed in first pregnancy – exercise to
reduce symptoms
◦ Exercise in first trimester of second
pregnancy – less weight gain, higher fitness,
and no GDM diagnosis at 24 weeks.
◦ Compare first to second pregnancies – clear
that exercise had effect on outcome
◦ Eric P. Durak, MSc, Lois Jovanovic, MD, Charles M. Peterson, MD. The Use of
Exercise to Prevent Gestational Diabetes Mellitus: A Case Report. Sports
Medicine, Training, & Rehab Journal. 3:230, 1992
Exercise and GDM for Today

What do we know about exercise and
GDM today?
Can we prevent diabetes through
exercise?
Can we prevent GDM through exercise

http://www.gestationaldiabetes.org/Treatment/exercise.html

http://www.livestrong.com/article/112764-exercise-gestational-diabetes/
Exercise in the Equation

What’s missing?
◦ Comprehensive method of using exercise as
part of prevention
◦ Numbers are great – but using exercise
systematically can reduce numbers even more
◦ How can we construct the “perfect” exercise
program that can improve on the prevention
concept?
◦ Who’s qualified to conduct exercise programs
for “at risk” diabetic or pre-diabetic pregnant
women?
Exercise in the Equation

Current thoughts on exercise for
pregnancy
◦ Upper body ergometry is still a standard
◦ Many types to chose in health club setting
Other forms of Exercise

In the Home
◦ Walking program
◦ Swimming
◦ Strength training and stretching

At work
◦ Walking / machine work

With friends
◦ Small group fitness program through
pregnancy
An Exercise Prescription
Exercising based on HR and PRE
 Exercising multiple times per day
 Training for BG control
 Time of day to best exercise
 Biomechanics and balance issues
 Type of aerobic machine
 Weight lifting for pregnancy

◦ Functional performance training for two
An Exercise Prescription

Times per week = 3-5
◦ Work up from 1-2 times at start
◦ May walk 2X per day for BG control
◦ Monitor BG levels post exercise

Training Type
◦ Breathing and imagery training (BG response)
◦ Linear movement patterns (front/ back, side to side)
◦ Light to moderate stretching
 Yoga programs
 Standing Pilates
Strength through Pregnancy

Weight lifting for pregnancy
◦ Functional performance training for
two
◦ Small muscle group exercise
◦ Sets and reps
◦ Rest period
◦ Hydration / rehydration
◦ Tubing, medicine ball, balance
◦ http://www.youtube.com/watch?v=mPzSniJZv4Y&feature=r
elated - Exercise
◦ with Dr. Kathy
Strength in Pregnancy

Modifying
range of
motion in
exercise
(squat),
and even
picking up
weights.
Strength in Pregnancy
Use of rubber
tubing training
 Use of body weight
exercises

◦ Wall push ups
◦ Body weight fitness
ball squats
Yoga for Pregnancy

One of the best
types of
exercises for
increased oxygen,
range of motion,
pain reduction,
and relaxation
Yoga and Pregnancy

Working
on range of
motion
while
keeping a
wide stance
for balance
Pilates and Pregnancy

Pregnancy
exercises for
upper body
strengthening
that do not
affect the
abdominal
area
Pilates and Pregnancy

Post
partum
core
training
exercises

Pilates
instructor
KarenaLineb
ack
Contraindications
Contraindication
Solution
Toxemia / high blood pressure
Breathing exercises , stretches, ITP type
exercise program
Ketones / excess proteins
MD recommendations
Edema / pain in feet
Water exercise / foot (general) massage
Low back pain / lordosis
Posture exercises, stretches, Pilates
training, massage
Joint laxity
Water training, slow rhythmic exercises,
walking program, aerobic machines
Cost of exercise program

3 pairs of neopreme dumb bells
◦ 5 lb, 8 lb, 10 lb.
Yoga Mat
 3 rubber tubing cords
 45-55 CM fitness ball
 1-2 exercise videos
 Good pair of shoes

◦ TOTAL
$50-55.00
$25.00
$18.00
$25.00
$20.00
$55.00
$150-200.00
Is exercise part of the “standard of
prenatal care”?
Referrals / information from doctors
 Oncologists need a listing of qualified
instructors from health clubs, Pilates
studios, and private practice trainers
 Work with physical therapist and pre
natal nurses in terms of medical issues

Diet and GDM
What about diet – what
is critical in terms of
changing metabolism?
 Movement to Ornish /
vegetarian
 ADA general
recommendations for
diet to manage diabetes
 Hidden sugars –
substitutes and HFCS

Facebook – diet and pregnancy
Holistic medicine and GDM

Holistic medicine – is
there a place for
GDM prevention?
◦ Stress reduction
techniques
◦ Use of pre-natal
supplements
◦ Organic foods
Self care – self management

How about self care – what can
women do to improve their
odds of prevention?
◦ Daily food logs
◦ Visits to RD in first trimester
◦ Develop a life-long exercise
program
◦ Learning to avoid diabetes-related
risks
Working with the Exercise
Community
What about the diabetes community –
how can they incorporate exercise?
Work with local health clubs and
YMCAs to provide programs
 Computer based outcomes for glucose
/ body weight / A1c / lipids, etc.
 Follow ups after pregnancy

Fitness for the long haul

Long term health consequences of regular
exercise
◦ Develop all exercise plans in first trimester
◦ Have initial instruction and supervision as
needed
◦ Write down fitness and diabetes outcomes!
◦ Monitoring of BG pre and post exercise – see
trends over weeks (see graph next slide)
BG monitoring over time
Future GDM and Wellness Issues

Future thoughts and
action plan for exercise
and GDM
◦ Health club referrals
◦ Bi-lingual education
programs for exercise
◦ Information packet /
referral pad in OB-GYN
offices
Questions ? ? ? ? ? ? ? ? ? ? ? ? ?