Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes

OUTCOMES OF MODERATE-INTENSITY CONTINUOUS EXERCISE ON FAT RATIO AND MAXIMAL OXYGEN CONSUMPTION IN COLLEGE STUDENTS

ABSTRACT Introduction: Declining physical quality, health status, and being overweight cause many college students to have physical problems. Continuous moderate-intensity exercise has become a widely used exercise method for many healthy people. Objective: Explore the outcome of continuous moderate-intensity exercise on college students' body fat rate and maximal oxygen uptake. Methods: The experiment will last for eight weeks. The control group did not practice other systematized exercises except daily physical activity and extracurricular sports. In addition to daily activities, the experimental group also performed moderate-intensity training in physical education classes. Results: In the training group, the average body fat rate decreased by 1.66%, the body fat content reduced by 1.21kg, and the skeletal muscle content increased by 1.44 compared to that before training. Vital capacity and maximal ventilatory capacity showed significant changes (P<0.05), of which maximal ventilatory capacity changed most significantly (P<0.01), from 79.63 ± 19.97L/min before the test to 98.65 ± 26.06L/min, with an average gain of 19.02L/min. Conclusion: Moderate-intensity continuous sports can effectively improve the cardiorespiratory function of current college students, increase body oxygen uptake, reduce body fat rate, and improve physical fitness, aiming to achieve a healthier physique. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

The Influence of Practising Physical Activity on the Prevention and Treatment of Gestational Diabetes: A Systematic Review

BACKGROUND

During pregnancy, maintaining an inadequate lifestyle (bad eating habits, stress, consumption of toxic substances, etc.) generates complications such as pre-eclampsia, overweight, lumbar pain and Gestational Diabetes.

OBJECTIVE

This review was carried out with the objective to determine the influence of practising physical activity on the prevention and treatment of Gestational Diabetes; and to evaluate the efficacy of interventions based on therapeutic exercise in the management of such diseases.

METHOD

A systematic review of the publications of the last five years in Medline, Pubmed, Web of Science and Cinahl databases was conducting with the terms Exercise and Gestational Diabetes.

RESULTS

25 articles were found, 9 were observational studies that analysed physical activity habits through questionnaires, and other 16 applied an intervention. With respect to the frequency of the sessions, most of these studies applied their interventions three times per week, with all of them obtaining positive results. Regarding intensity, all the studies that referred to it concluded that it must be at least moderate, highlighting that, at all times, the limitations of pregnant women must be taken into account.

CONCLUSION

Both for the prevention and treatment of this disease, the physical activity must be performed for a minimum of three times per week, at least in moderate intensity, and must be based on aerobic, resistance and strength exercises.

Physical activity for blood glucose control in gestational diabetes mellitus: rationale and recommendations for translational behavioral interventions

Gestational Diabetes Mellitus (GDM) is associated with adverse health outcomes during pregnancy and beyond. Previous randomized controlled trials of exercise interventions have demonstrated that exercise, conducted primarily during supervised sessions, improves maternal glycemic control in women with GDM. However, additional research is needed to develop physical activity interventions that are easily implemented in healthcare settings (e.g., recommendations and strategies to increase non-supervised physical activity). This narrative review presents: current physical activity recommendations for pregnancy and women with GDM; the scientific literature to date on physical activity, particularly walking, and blood glucose control in GDM; rationale for physical activity interventions targeting women with GDM that are appropriate for translation to the clinical setting (e.g., lifestyle interventions that include behavioral counseling with a health coach); and the strategies employed by previous, successful lifestyle interventions for pregnant and postpartum women that were based in clinical settings.Most previous exercise interventions for blood glucose control in women with GDM have included supervised exercise sessions, and will thus be difficult to translate to the health care system. However, lifestyle interventions for weight maintenance (i.e., healthy diet and physical activity) set in the health care system and delivered by health coaches have been successfully implemented in pregnant and postpartum populations. Therefore, we suggest that future trials examine lifestyle interventions that promote unsupervised walking with evidence-based behavioral strategies (e.g., goal setting, monitoring, and feedback) and consider incorporating the use of physical activity tracking devices to support these strategies.

Exercise During the First Trimester of Pregnancy and the Risks of Abnormal Screening and Gestational Diabetes Mellitus

OBJECTIVE

To estimate the effects of exercise during the first trimester on the risks of abnormal screening and gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

Data come from PETALS, a prospectively followed pregnancy cohort (n = 2,246, 79% minorities) receiving care at Kaiser Permanente Northern California. A Pregnancy Physical Activity Questionnaire was used to assess exercise. Glucose testing results for screening and diagnostic tests were obtained from electronic health records. Inverse probability of treatment weighting and targeted maximum likelihood with data-adaptive estimation (machine learning) of propensity scores and outcome regressions were used to obtain causal risk differences adjusted for potential confounders, including prepregnancy BMI, exercise before pregnancy, and gestational weight gain. Exercise was dichotomized at 1) the cohort's 75th percentile for moderate- to vigorous-intensity exercise (≥13.2 MET-h per week or ≥264 min per week of moderate exercise), 2) current recommendations (≥7.5 MET-h per week or ≥150 min per week of moderate exercise), and 3) any vigorous exercise.

RESULTS

Overall, 24.3% and 6.5% had abnormal screening and GDM, respectively. Exercise meeting or exceeding the 75th percentile decreased the risks of abnormal screening and GDM by 4.8 (95% CI 1.1, 8.5) and 2.1 (0.2, 4.1) fewer cases per 100, respectively, in adjusted analyses.

CONCLUSIONS

Exercise reduces the risks of abnormal screening and GDM, but the amount needed to achieve these risk reductions is likely higher than current recommendations. Future interventions may consider promoting ≥38 min per day of moderate-intensity exercise to prevent GDM.

Movement Behavior during Pregnancy and Adverse Maternal-Fetal Outcomes in Women with Gestational Diabetes: A Pilot Case-Control Study

Gestational diabetes mellitus (GDM) is a major complication in pregnancy. GDM is associated with a higher risk for adverse maternal–fetal outcomes. Associations between movement behavior, including physical activity (PA) and sedentary behavior (SB), and maternal–fetal outcomes are still unclear. The objective of this study was to investigate associations between movement behavior and adverse maternal–fetal outcomes in women with GDM. A total of 68 women with GDM (20–35 weeks, 32.1 ± 5.8 years) were included in this pilot case-control study. The cases were defined by the presence of an adverse composite maternal–fetal outcome (preterm birth, newborn large for gestational age, and neonatal hypoglycemia). Controls were defined as no adverse maternal–fetal outcome. PA intensities and domains, steps/day (pedometer), and SB were analyzed. A total of 35.3% of participants showed adverse maternal–fetal outcomes (n = 24). The controls showed a higher moderate-intensity PA level than the cases (7.5, 95%CI 3.6–22.9 vs. 3.1, 95%CI 0.4–10.3 MET-h/week; p = 0.04). The moderate-intensity PA level was associated with a lower risk for adverse maternal–fetal outcomes (OR 0.21, 95%CI 0.05–0.91). No significant associations were observed for other PA and SB measures (p > 0.05). In conclusion, moderate-intensity PA during pregnancy seems to have a protective role against adverse maternal–fetal outcomes in women with GDM.

Translating Research on Diabetes and Obesity in Pregnancy Into Prevention: The 2019 Norbert Freinkel Award Lecture

Epidemiological studies on the intergenerational transmission of hyperglycemia and obesity via in utero exposure have established the scientific foundation for the vicious cycle of diabetes and obesity. The findings compel us to address an urgent public health question: how do we break this vicious cycle and implement upstream prevention strategies that are feasible for patients and health care delivery systems? To address this question, it is necessary to work across a continuum of translational research from basic science, epidemiology, and efficacy trials to pragmatic trials, which, along with evaluations of health programs, may lead to implementation of positive changes in clinical care. Three strategies for translating research on diabetes and obesity in pregnancy into prevention are discussed: 1) identifying diagnostic criteria of gestational diabetes mellitus (GDM) practicable in clinical settings to implement treatment and prevention, 2) examining trends in the prevalence of diabetes in pregnancy and related complications across racial/ethnic groups to plan prevention efforts, and 3) developing and evaluating scalable upstream diabetes and obesity prevention interventions. Upstream preventive interventions aimed at breaking the vicious cycle are discussed. Areas of future research needed to break the vicious cycle are identified. Evaluating the effectiveness of programs for the management of pregnancy hyperglycemia is necessary to reduce complications. Understanding racial/ethnic differences in the pathophysiology of GDM and its complications will be important for risk stratification. Pragmatic trials in real-world clinical settings for upstream prevention are needed to break the vicious cycle at the population level. Finally, leveraging basic science with intergenerational studies will inform targeted interventions.

Exercise During the First Trimester and Infant Size at Birth: Targeted Maximum Likelihood Estimation of the Causal Risk Difference

This cohort study sought to estimate the differences in risk of delivering infants who were small or large for gestational age (SGA or LGA, respectively) according to exercise during the first trimester of pregnancy (vs. no exercise) among 2,286 women receiving care at Kaiser Permanente Northern California in 2013-2017. Exercise was assessed by questionnaire. SGA and LGA were determined by the sex- and gestational-age-specific birthweight distributions of the 2017 US Natality file. Risk differences were estimated by targeted maximum likelihood estimation, with and without data-adaptive prediction (machine learning). Analyses were also stratified by prepregnancy weight status. Overall, exercise at the cohort-specific 75th percentile was associated with an increased risk of SGA of 4.5 (95% CI: 2.1, 6.8) per 100 births, and decreased risk of LGA of 2.8 (95% CI: 0.5, 5.1) per 100 births; similar findings were observed among the underweight and normal-weight women, but no associations were found among those with overweight or obesity. Meeting Physical Activity Guidelines was associated with increased risk of SGA and decreased risk of LGA but only among underweight and normal-weight women. Any vigorous exercise reduced the risk of LGA in underweight and normal-weight women only and was not associated with SGA risk.

Do the body mass index and the diagnosis of gestational diabetes mellitus influence the level of physical activity during pregnancy and postpartum?

Obesity and lack of physical exercise are associated with the increase of diabetes mellitus in women of reproductive age and during the gestational period. The objective of the present study was to evaluate physical activity levels during the pregnancy and postpartum periods and the influence of body mass index (BMI) in women with gestational diabetes mellitus (GDM) or low risk pregnancy. The Pregnancy Physical Activity Questionnaire (PPAQ), translated and validated for Portuguese, was used for the evaluation of physical activity (PA) level. The sample was stratified according to preconception BMI and the presence or absence of diagnosis of GDM, resulting in four groups with 66 participants each: low risk pregnancy (LRP) with normal weight (BMI ≥ 18.5 and ≤ 24 kg/m2), LRP and overweight/obese (BMI ≥ 25 kg/m2), GDM with normal weight and GDM with overweight/obese. The level of PA of each participant was measured as Metabolic Equivalent of Task (MET) during the preconceptional period (T0), in the third trimester of gestation (T1), and three months after delivery (T2). The comparison of the MET values showed that the values found in the evaluation three months after delivery (T2) were higher than 1.00 (1.10 MET for the LRP-normal weight, 1.06 MET for LRP-overweight/obese, 1.02 MET for the GDM- normal weight, 1.07 MET for the GDM-overweight/obese). On the pre-gestational (T0) and third trimester (T1) analyzes, the values were less than 1.00 MET. The analysis between groups in relation to BMI and diagnosis of GDM showed no difference.

Physical activity level in women with gestational diabetes mellitus: Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil) study

BACKGROUND

The aim of this study was to investigate physical activity and associated factors in women with gestational diabetes mellitus (GDM).

METHODS

This cross-sectional study was performed on 2706 women as part of the Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil) study, recruited between 2012 and 2016 in Brazil. A structured questionnaire was used to assess physical activity. Descriptive and Poisson regression analyses were used to investigate physical activity and associated factors.

RESULTS

Counseling regarding physical activity practices was reported by 47.4% and 34.3% of women before and after a diagnosis of GDM, respectively. During pregnancy, 26% of women were classified as inactive, 39.7% were classified as insufficiently active, and 34.3% were classified as active. Compared with prepregnancy, 63.1% of women reported a decrease in physical activity levels during pregnancy. The prevalence of being inactive during pregnancy was higher among women who did not live with a partner (P = 0.003), had a lower household income (P = 0.01), were employed (P < 0.001), and who had four or more children (P < 0.001).

CONCLUSION

Among Brazilian women with GDM, physical activity levels and practices were low, with most women reporting decreased physical activity during pregnancy. A low socioeconomic status was associated with lower physical activity. These findings indicate the need to reinforce the importance of physical activity in the management of GDM in Brazil.

Dietary pattern in pregnancy and risk of gestational diabetes mellitus (GDM)

AIM

Among the most common metabolic disorders during pregnancy is gestational diabetes mellitus (GDM). This research was conducted to examine the dietary pattern in women with GDM.

MATERIAL AND METHODS

In this case-study, 204 pregnant women (104 cases and 100 control women) were chosen through convenient sampling and random sampling. The subjects' food intakes were assessed using semi-quantitative food frequency questionnaire, while their activities evaluated by physical activity questionnaire. Anthropometric indices were measured based on standard instructions, and the body mass index was calculated. The dietary patterns were determined using principal component analysis and its relationship with preeclampsia was tested using logistic regression method.

RESULTS

Unhealthy and healthy dietary patterns were found among the pregnant women. In the unhealthy group, after modifying the effect of confounding variables, a significant relationship was observed between dietary pattern and having gestational diabetes (OR = 2.838,95% CI:1.039-7.751). In the healthy group, on the other hand, the people in the fourth quartile had 149% and 184% higher chance not to catch gestational diabetes before and after modification with confounders, respectively (OR = 0.284,95% CI:0.096-0.838), when compared with people in the first quartile.

CONCLUSION

The findings indicated that selection of foods including fruits, vegetables, low-fat dairies, etc. as healthy dietary pattern is associated with diminished risk of GDM among pregnant women. Determining healthy dietary pattern during pregnancy, considering the foods consumed among pregnant women, as a useful and practical guide during this period can be publicized for training and nutritional interventions.

Combined intervention of swimming plus metformin ameliorates the insulin resistance and impaired lipid metabolism in murine gestational diabetes mellitus

Gestational diabetes mellitus (GDM) has short- and long- term influence on pregnant women and fetus. Swimming, as an aerobic exercise, can effectively improve the blood glucose level in GDM, but the effect of mild swimming alone was not very substantial. Metformin, as an oral antidiabetic drug, has obvious hypoglycemic effect, and is economic also, but the long-term effect on pregnant women and fetus has not been completely clear. We hypothesize that combined intervention of mild swimming and low dose of metformin, may effectively reduce blood glucose, improve the pregnancy outcomes in GDM dams, but simultaneously avoiding the adverse effects caused by overdose of drug and impotence of mild swimming. The streptozotocin was used to stimulate C57BL/6J mice to develop GDM, by which serum glucose, TC, TG, LDL-C were increased significantly, meanwhile HDL-C was decreased significantly in the GDM control (DC) group compared with the normal control group. Swimming or metformin intervention slightly or moderately improves hyperglycemia, insulin sensitivity and lipid metabolism both in liver and skeletal muscle from GDM mice, while combined therapy of swimming plus metformin markedly ameliorated hyperglycemia (FPG, decreased by 22.2–59.5% from G10 to G18 versus DC group), insulin sensitivity (2.1 and 2.8 fold increase, respectively, in AKT activity versus DC group) and de novo lipogenesis (3.2 and 7.0 fold decrease, respectively, in ACC activity, and 1.94 and 5.1 fold decrease, respectively, in SREBP2 level, versus DC group) both in liver and skeletal muscle from GDM mice. We conclude that the combined intervention by metformin plus swimming may be more effective than single action to ameliorate glucose and lipid metabolism via improving insulin sensitivity in GDM mice.