Diagnosis to Delivery: A randomised clinical trial of Postmeal Walking as a Non-Pharmacological Treatment of Gestational Diabetes

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.