Effects of Structured Exercise Regime in Gestational Diabetes Mellitus
Condition: Gestational Diabetes Mellitus
MeSH terms: Diabetes, Gestational; Diabetes Mellitus
Study type: Interventional

Summary: 
      Rehabilitation in the field of Obstetrics is an emerging field worldwide although it is still
      very much neglected in a country like Pakistan. Increasing prevalence of GDM has highlighted
      the importance of rehabilitation in this specific area. In USA upto14% of pregnancies get GDM
      problem, 6.8 to 10.4 % in China while in India 27.5% which is exceptionally high. Similarly
      in Pakistan it has become a common issue.

      Many observational studies have been done to find the risk factors and causes of GDM. However
      to the best of investigator's knowledge no experimental study have been done so far on the
      effects of exercise on physical, physiological and psychological aspects of GDM. Hence a
      randomized control trial is planned on diagnosed GDM patients in Fauji Foundation Hospital
      Rawalpindi who will recieve supervised structured exercise regeme for 5 weeks and their data
      will be recorded using reliable tools at the baseline and after 5 weeks to assess the effects
      of exercise.
    

Detailed description: 
      GDM is a medical condition of high maternal glucose level which is diagnosed only when women
      are pregnant and overcome after pregnancy. It results in various maternal and neonatal
      complications like caeserean delivery in mothers and obesity in children. Women having GDM
      have greater risk of diabetes and cardiovascular problems later in life which is threatening
      for us. Obese women are at increased risk of developing GDM and it is also a risk factor for
      developing high blood pressure and protein in the urine after 20 weeks of pregnancy that
      condition is known as preeclampsia.

      Many studies have shown that physically active women are less prone to develop GDM as compare
      to those women who have sedentary life style which draws attention towards the role of
      antenatal exercises for prevention and management of GDM and has become the first line
      treatment in developed countries. In addition to obesity and sedentary life style other known
      risk factors are family history, age of mother and number of children but there is no
      definite single cause of GDM yet discovered.

      Exercises programs during pregnancy are not usually practiced in our population and routine
      domestic activities are considered as enough for fitness. We have a common myth that pregnant
      women should not do treadmill or stationary cycle or any other aerobic activity which is
      really wrong and resulting in problems like GDM. Women following moderate exercise programs
      during their pregnancy have reported reduction in daily insulin administration dosage in
      comparison with women not doing any prescribed exercise. As Gestational weight gain is a
      major risk factor for GDM, exercises have given evidence to facilitate weight reduction.

      Exercise programs prescribed by physical therapists during pregnancy for preventing and
      managing GDM are considered useful and recommended by researchers and practitioners around
      the world but in developing countries like Pakistan, women are not receiving this method of
      treatment due to lack of awareness in general public, lack of referral system from
      gynaecologists and obstetricians and unavailability of women health Physical therapists in
      hospital set ups.

      This study will provide data showing the effects of exercise in biomarkers level and give the
      option of treatment to obstetricians.

      This will fill the research gap in the area of rehabilitation in GDM. This will also
      highlight the importance of women health physical therapists in obstetric conditions as there
      is less awareness of this speciality in Pakistan.

      This will provide the data regarding which type, intensity and duration of exercise should be
      recommendable while treating GDM.

      This study will open new doors for researchers to do long term studies on different
      biomarkers with different exercise types.
    

Intervention name(s): Structured Exercise for Experimental (Structured Exercise) Group; Control treatment for both groups
Intervention type(s): Other; Behavioral
Intervention description(s): Structured aerobic exercise regime of moderate intensity by using stationary cycle (3-5 MET) 10 min, brisk walk 10 min.
The combination of Stabilization exercise (10 repeatitions) and PFM training ( 20 repeatitions set).
Relaxation therapy including Mitchells physiological relaxation technique (10 repetitions) along with deep breathing exercises.; Medical and dietary interventions like insulin in addition of the postural education and back care from Physical Therapist.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: exercise; pregnancy