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 Table of Contents  
Year : 2021  |  Volume : 12  |  Issue : 5  |  Page : 92-97

Guidelines for physical activity and exercise for women with hyperglycemia in pregnancy

1 Department of Medicine, Faisalabad Medical University, Faisalabad, Pakistan
2 Department of Neurology, Allied Hospital, Faisalabad, Pakistan
3 Department of Physiology, Ameer Ud Din Medical College, Lahore, Pakistan
4 Department of Gynaecology and Obstetrics, University Medical and Dental College, Faisalabad, Pakistan
5 Department of Gynaecology & Obstetrics, Isra University, Karachi Campus, Pakistan

Date of Submission19-Mar-2021
Date of Decision07-Jun-2021
Date of Acceptance30-Apr-2021
Date of Web Publication20-Jul-2021

Correspondence Address:
Dr. Shabeen Naz Masood
Isra University, Karachi Campus.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jod.jod_33_21

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Introduction: Lifestyle modification is the most important intervention for control of hyperglycemia in pregnancy (HIP). It includes medical nutrition therapy and exercise. Various guidelines have been published to assist physicians and obstetricians in prescribing physical activity and exercise as a part of management of HIP. Pregnancy provides a unique opportunity to motivate women for exercise. Modifications in recommendations regarding physical exercises are needed particularly for those on bed rest for obstetric indications, orthopedic disability, or competitive athletes. Objective: The objective of this article is to provide guidelines regarding exercise for women with HIP. Materials and Methods: These recommendations are made after reviewing various existing guidelines including American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, and American College of Sports Medicine. A literature search was done using PubMed, Cochrane Database, Google Scholar, EMBASE, various systematic reviews, and original articles. Search was done using key words “Physical Activity,” “Exercise during Pregnancy,” “Life Style in Pregnancy.” The aim was to identify correct and safe physical activity during pregnancy. Results: Exercise and physical activity is completely safe and recommended in pregnancy. Conclusion: Exercise is safe in pregnancy and should be encouraged in women to control hyperglycemia. They should be educated to continue lifestyle changes in postpartum period and later in life.

Keywords: Exercise, gestational diabetes mellitus, hyperglycemia in pregnancy, physical activity

How to cite this article:
Bilal A, Ahmed Z, Mohsin M, Fazal A, Khan S, Saeed S, Masood SN. Guidelines for physical activity and exercise for women with hyperglycemia in pregnancy. J Diabetol 2021;12, Suppl S1:92-7

How to cite this URL:
Bilal A, Ahmed Z, Mohsin M, Fazal A, Khan S, Saeed S, Masood SN. Guidelines for physical activity and exercise for women with hyperglycemia in pregnancy. J Diabetol [serial online] 2021 [cited 2021 Jul 30];12, Suppl S1:92-7. Available from: https://www.journalofdiabetology.org/text.asp?2021/12/5/92/321820

  Introduction Top

Hyperglycemia in pregnancy (HIP) is one of the most common metabolic disorders of pregnancy and is associated with multiple adverse maternal and fetal outcomes.[1] Pregnancy provides a unique opportunity to motivate women for exercise. Exercise has been found to be an effective non-therapeutic alternative to managing HIP as it facilitates glucose entry into muscles,[2] improves glycemic control, and reduces excessive weight gain during pregnancy and in the postpartum period.[1] Majority of the pregnant women do not engage in physical activity, despite all of these benefits. Physicians should carefully evaluate for obstetric and medical complications before advising exercise. The barriers to exercise in pregnant woman are usually fatigue, nausea, tiredness, and psychological, which should be addressed in order to encourage pregnant woman for physical activity.

  Recommendations for Exercise in HIP Top

Advise women to tailor exercise according to her physical endurance and increase the intensity of exercise gradually.

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[TAG:2]Contraindications to Exercise During Pregnancy[9]: Absolute Contraindications to Aerobic Exercise During Pregnancy[/TAG:2]

  • Hemodynamically significant heart disease

  • Restrictive lung disease

  • Cervical incompetence or cerclage

  • Multiple gestations at risk of premature labor

  • Persistent second- or third-trimester bleeding per vaginum

  • Placenta previa after 26 weeks of gestation

  • Premature labor during the current pregnancy

  • Ruptured membranes

  • Preeclampsia or pregnancy-induced hypertension

  • Severe anemia

  •   Relative Contraindications to Aerobic Exercise During Pregnancy Top

  • Moderate-to-severe anemia

  • Unevaluated maternal cardiac arrhythmias

  • Chronic bronchitis

  • Poorly controlled type 1 diabetes

  • Extreme morbid obesity

  • Extreme underweight (BMI less than 12)

  • History of extremely sedentary lifestyle

  • Intrauterine growth restriction in current pregnancy

  • Poorly controlled hypertension

  • Orthopedic limitations

  • Poorly controlled seizure disorders

  • Poorly controlled hyperthyroidism

  • Heavy smokers

  •   Exercise in Special Circumstances Top

    Exercise recommendations for women on bed rest

  • These exercises are meant to improve circulation in lower limbs to prevent DVT. The women should be advised as under:

  • ◦ Lie on left lateral position (she should not exercise while lying supine or in the right lateral position) [Figure 1]A and B].

  • ◦ Perform full flexion at ankle joint and toes and hold for 10 s, followed by full extension of ankle and toe and hold for 10 s [[Figure 2]A and B]: alternate this movement 10 times/h while awake.

  • ◦ Do alternate flexion and extension of both legs at knee and hip joints 10 times/h while awake [[Figure 3]A.

  • ◦ Combination of movements of the arms at the shoulder joint with the exercises of the lower limbs (as detailed above) will help in glycemic control and prevention of DVT.
  • Figure 1: Lie on left lateral position. A: dorsiflex feet for 10 s, B: plantarflex feet for 10 s

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    Figure 2: A: plantarflexion of feet and B: dorsiflexion of feet

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    Figure 3: Alternate flexion and extension movements at hip joint and knee joints and movements of arms at shoulder joints in left lateral position

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    Exercises for women with orthopedic limitations of lower limbs

  • Women with orthopedic limitations of knee and hip joints should avoid weight-bearing exercises.

  • Cycling and swimming can be continued.

  • Advise to walk while sitting in chair (sitting walk).

  • Steps to be followed [Figure 4]A and B]:

  • ◦ Sit in a high chair with feet dangling above ground.

  • ◦ Posture should be upright.
  • Figure 4: Alternate flexion and extension movement at hip joint and knee joints and movements of arms at shoulder joints

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  • •Combined paddling movements of legs with circular movements of arms.

  • Recommendations for athletes

  • Competitive athletes can continue training under supervision throughout pregnancy if there are no maternal or fetal contraindications.

  • Heavy lifting (10–20 kg more than 20 times/week) should be avoided during pregnancy.[11],[12],[13]

  • Avoid dehydration (especially during prolonged training sessions in hot and humid weather).

  • Monitor fluid balance by self-weighing before and after the session.

  • Observe urine color (clear to pale yellow color indicates adequate hydration).

  • Monitor heart rate in training.

  • The following heart rate can be used as reference (note: for non-athlete women],[ recommendations are different.[14],[15],[16] See section on Recommendations for exercise in HIP):

  • Age 20–29 years: 145–160 beats/minute;

  • Age 30–39 years: 140–156 beats/minute.

  • Should take extra calories for high intensity prolonged and frequent exercises.

  • She should avoid and recognize overtraining syndrome if the following symptoms are observed[17]:

  • ◦ Early and excessive fatigue

  • ◦ Sleep disorders

  • ◦ Lack of weight gain

  • ◦ Persistent tachycardia at rest

  • ◦ Increased frequency of musculoskeletal injuries

  • •Discontinue/modify training if there is[18] previous or current history of a small for gestational age infant.

  • [TAG:2]Exercise Equivalents[19][/TAG:2]

    Help the females to balance exercise with other non-exercise daily physical activities such as household chores, child-care, gardening, etc., to avoid over or under exertion. Females not having occupational physical activity during pregnancy should be encouraged to increase participation in household chores and care-giving activities related to children and other family members as an alternative form of exercise.

      Conclusion Top

    Exercise is safe in pregnancy and should be encouraged in women with HIP to control blood sugar excursions [Table 1]. They should be advised and educated to continue these lifestyle changes in the postpartum period and thereafter to prevent obesity and future development of diabetes.
    Table 1: List of activities and energy cost of each activity

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      Annexure 1 Top

    Age-predicted maximal heart rate:

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      Annexure 2 Top

    Borg scale

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    The authors acknowledge Mr Javed Jabbar, Department of Obstetrics and Gynecology, Isra University, Karachi Campus, for technical help.

    Financial support and sponsorship


    Conflicts of interest

    Ahmed Bilal, Zaheer Ahmed, Maham Mohsin, Ayesha Fazal, Saadia Khan, Saira Saeed, and Shabeen Naz Masood declare that they have no conflicts of interest.

    Author contributions

    Dr Ahmed Bilal: Conception, design of guidelines, and final approval of the version to be published.

    Dr Zaheer Ahmed: Design of the study, literature search, and drafting the article.

    Dr Maham Mohsin: Design and literature search.

    Dr Ayesha Fazal: Figures and illustrations and intellectual content.

    Dr Saadia Khan: Design of study.

    Dr Saira Saeed: Intellectual content and reviewing.

    Dr Shabeen Naz Masood: Interpretation of the guidelines, revising it critically for important intellectual content, and final approval of the version.

      References Top

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    Davies GA, Wolfe LA, Mottola MF, MacKinnon C; Society of Obstetricians and Gynecologists of Canada, SOGC Clinical Practice Obstetrics Committee. Joint SOGC/CSEP Clinical Practice Guideline: Exercise in pregnancy and the postpartum period. Can J Appl Physiol 2003;28:330-41. PMID: 12955862.  Back to cited text no. 4
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    Target Heart Rates Chart [Internet]. www.heart.org. 2021 [cited March 7, 2021]. Available from: https://www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates. [Last accessed on 20XX XXX XX].  Back to cited text no. 6
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    Taskinen H, Kyyrönen P, Hemminki K. Effects of ultrasound, shortwaves, and physical exertion on pregnancy outcome in physiotherapists. J Epidemiol Community Health 1990;44:196-201. doi: 10.1136/jech.44.3.196. PMID: 2273355; PMCID: PMC1060641.  Back to cited text no. 12
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      [Figure 1], [Figure 2], [Figure 3], [Figure 4]

      [Table 1], [Table 2], [Table 3], [Table 4]


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