Comparison of Home Exercise Under Supervision and Self Home Exercise in Pregnant Women with Gestational Diabetes: Randomized Controlled Trial

Comparison of Home Exercise Under Supervision and Self Home Exercise in Pregnant Women with Gestational Diabetes: Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Home Exercise Under Supervision and Self Home Exercise in Pregnant Women with Gestational Diabetes: Randomized Controlled Trial Merve Yılmaz Menek, Ayse Kavasoglu Kaya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3340855/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Jan, 2024 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 5 You are reading this latest preprint version Abstract Objective Exercise programs at home are successful in treating gestational diabetes by controlling blood glucose. The aim is to compare the efficacy of the self-directed home exercise program, the standard care alone and the supervised home exercise program in pregnant women with gestational diabetes on blood glucose, quality of life and pregnancy outcomes. Methods This randomized, parallel, single-blind study included forty-five pregnant women who were 24-28 weeks of gestation. Participants were randomly divided into the supervised home exercise group (SHEG), home exercise group (HEG) and control group (CG). While the home exercises program was taught and controlled by a physiotherapist in SHEG, the home exercise brochure was given without any training by the gynecologist in HEG. Control group maintained their usual daily care. The home exercise intervention included low to moderate structured exercise performed three days per week for 8 weeks. Their glucose responses, quality of life and pregnancy outcomes were assessed pre- and post intervention. Results Fasting glucose and 2 h postprandial glucose levels were improved statistically in SHEG and HEG groups after intervention (p<0.05). Differences in SHEG were statistically higher than HEG (p<0.017). When the HEG and CG were compared, there was no superiority between the two groups in all outcome measures except the physical health. Additionally, there were no statistically significant differences in values of cesarean birth and preterm birth between groups (p>0.05). Conclusions This study revealed that pregnant women should be under the supervision of physiotherapists while doing home exercises. Clinical Trial Registration The trial was approved by the registration of ClinicalTrials.gov and registration number: NCT05195333. Blood glucose Gestational diabetes mellitus Structured exercise Supervised home exercise Figures Figure 1 What does this study add to the clinical work The home exercises given with physiotherapist training during pregnancy were better than self-home exercises and standard care only in terms of improvement of blood glucose level and quality of life. Introduction During pregnancy, hormonal changes in women lead to a natural state of insulin resistance. However, the body compensates for this by secreting more insulin, which aids in maintaining normal blood glucose levels. If this compensatory mechanism fails, reduced glucose tolerance may progress to gestational diabetes mellitus (GDM) [ 1 ]. Both the woman and the child may experience severe immediate and long-term effects from GDM, including an elevated risk of metabolic disease [ 2 ]. Short-term complications may include respiratory distress syndrome, neonatal hypoglycemia, and other adverse outcomes such as intrauterine growth restriction, preterm birth, and pre-eclampsia [ 3 ]. Moreover, macrosomia, large for gestational age, and congenital anomalies may also occur [ 3 ]. Maternal inactivity and excessive prenatal weight gain rise the risk of type 2 diabetes, recurrent GDM, and adverse obstetric outcomes [ 4 ]. Recent literature has shown that regular exercise training is effective in improving glycemic control in GDM patients [ 5 ]. Aerobic training, which includes exercises like walking, jogging, running, cycling, swimming, and aqua aerobics, should be done at least three to four times a week for 50 to 150 minutes, with a daily maximum of 30 minutes. In addition, resistance training should be performed at least 2 times per week, according to international guidelines [ 6 ]. However, it is unclear whether supervised or home-based exercise is more effective. Ruchat and Mottola [ 7 ] compared supervised and partially supervised exercise interventions for GDM and found that supervised exercise was more effective on blood glucose level. In another study, participants who engaged in a home exercise program had lower daily postprandial glucose levels than the control group [ 8 ]. However, partially supervised exercise interventions with 2 supervised and 2 unsupervised sessions per week did not improve blood glucose control or limit insulin use [ 9 ]. Currently, there is no universally accepted approach for promoting perinatal exercise. While face-to-face exercise programs have been shown to increase exercise effectiveness in non-pregnant individuals, few studies have explored this approach with pregnant women [ 10 ]. In contrast, minimum-contact home-based interventions are more commonly used in prenatal interventions as they are easier to implement for pregnant women than structured exercise programs [ 10 ]. Many women with GDM prefer not to exercise despite the potential benefits because of a variety of barriers, including a lack of time, child care commitments, exhaustion, and a lack of access to exercise equipment [ 12 ]. As a result, by offering an attractive and familiar atmosphere, a supervised home-based exercise training program may be a promising way to encourage exercise adherence and remove barriers to exercise [ 11 , 12 ]. There are few research examining the efficacy of guided home exercise plans for treating GDM. This study compares the efficacy of a self-administered home exercise program, a home exercise program under supervision, and standard treatment in gestational diabetes. Material and Methods Study design Participants were randomly assigned (1:1:1) to one of three groups in this study. The study's protocol was registered on ClinicalTrials.gov (NCT05195333). This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Non-interventional Ethics Committee at Medipol University (File number: E-10840098-772.02-6739, Number:1337, date:23.12.2021). The diagnosis of gestational diabetes was made by the gynecologist based on oral glucose tolerance test (OGTT). Informed consent was obtained from all individual participants included in the study. A gynecologist and obstetrician in Medipol Camlica Hospital located in Istanbul, diagnosed each woman with gestational diabetes in this study. The followings were the study's inclusion requirements: Between 24 and 28 weeks of gestation, singleton pregnancy, body mass index (BMI) less than 45 kg/m 2 , venous plasma glucose level greater than 130 mg/dl according to a 75-g oral glucose tolerance test, and non-smokers who were not currently participating in a structured exercise program. If a woman was less than 18 years old, had undergone bariatric surgery, was unable to comprehend the consequences of the participation, or was using any drugs at the time of recruitment, she was excluded from the study. The study included the forty-nine individuals who met the inclusion criteria out of a total of 54 participants that were screened. Two participants were excluded due to orthopedic problems, and two declined to participate in the exercise program. Therefore, the study was conducted with a total of forty-five women. The algorithm for allocating participants to the study groups is presented in Fig. 1 . Using a randomized controlled trial design, with the main investigator being blinded, women who have gestational diabetes were randomly divided into SHEG, HEG and CG. Women were given numbers in the order of inclusion in the study. Then, considering these numbers, randomization was achieved using the ‘randomizer.org’ website. Forty five participants were divided into three groups. Intervention Supervised home exercise group (n = 15) Participants who were randomized to the SHEG were instructed to complete three supervised, home based exercise sessions per week from the 24th to 28th week of pregnancy until the end of the 32nd to 36th week. The home exercise program was developed by a physiotherapist and was taught to all participants at the hospital during a single instruction session. In addition to the home-based exercise program, these participants received weekly telephone calls for monitoring and support. The exercise program lasted 8 weeks. Home exercise group (n = 15) Participants in the HEG received a home exercise brochure without any instruction from the gynecologist. The purpose and detailed application methods of the exercises were not explained. Participants in this group were instructed to complete the exercises three days per week for 8 weeks, from the 24th to 28th week of pregnancy until the end of the 32nd to 36th week, but no interviews were conducted to monitor their progress. The exercise program lasted 8 weeks as in SHEG. Control group (n = 15) The exercise intervention was not given to the control group, but they did Ronly eceive standard prenatal care from their healthcare providers, including dietary guidance for GDM. For a regular calorie intake, each participant received a customized food plan created by a nutritionist. An 1500 kcal/day low-glycemic, low-saturated fat diet was recommended as part of the dietary intervention. Additionally, all participants underwent regular checkups from their obstetricians and midwives every 4 to 5 weeks, followed by weekly visits until the 36th to 38th week of pregnancy. The exercises performed in the study were structured and of low to moderate intensity. These exercises comprised stretching, aerobic, coordination, warm-up and cool-down activities, as well as resistive exercises for the shoulder girdle and the flexor and extensor muscles of the knee and hip. Walking activities without any equipment and repetitive actions ranging from easy to difficult were also included as aerobic exercises. Exercises were progressed according to the Rating of Perceived Exertion (RPE) BORG scale, which has a scale from 6 to 20, with 6 signifying no exertion and 20 signifying "very, very hard" exertion. Exercises of moderate intensity were carried out to raise the level of fatigue experienced from the BORG scale of 11–12 to 13–14. A red-colored theraband was used for low-intensity resistance training, with 10 repetitions and 1 set. The home exercise protocols were identical for both the supervised and self-home exercise groups (Table 1 ). Table 1 Structured exercise program Exercise type Exercises Equipment Intensity of exercise Aerobic Exercises Stepping exercises Walking exercise Step forward and sideways Jogging in place Repetitive bilateral shoulder flexion Repetitive bilateral shoulder abduction Repetitive hand movement with the shoulder movements No equipment Progressive increase from 11–12 to 13–14 on the Borg Scale Resistive exercises Hip flexors strengthening Hip extensors strengthening Hip abductors strengthening Knee flexors and extensors strengthening Shoulder flexors and extensors strengthening Shoulder abductors strengthening Theraband and mat Red colour theraband, 10 rep/ 1 set Stretching exercises Quadriceps and hip flexors stretching Triceps and biceps stretching Gastrocnemius stretching in long sitting No equipment Warm up and cool down exercises Neck muscle stretching Trunk right/left lateral flexion Shoulder elevation and circumduction No equipment Outcome measurements Participants’ characteristics assessment included demographic information as maternal age, maternal weight gain, height, pregnancy history. Cesarean section and preterm delivery of the participants were recorded at the end of the treatment. Blood sample measurements Information on the Oral Glucose Tolerance Test (OGTT) was gathered from hospital documents. Three groups' pre- and post-intervention blood glucose levels were measured using this test while fasting and 2 hours after OGTT. The same laboratory within the Camlica Medipol University Hospital performed the laboratory testing. World Health Organization Quality of Life Instrument (WHOQOL-BREF) When assessing the quality of life of various patient populations and healthy people, the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire is frequently employed. The 26 items in this self-administered survey inquire about the respondent's impressions of their health and wellbeing during the preceding two weeks. In addition to QOL and general health questions, the questionnaire has four domains: physical health (7 items), psychological health (6 items), social relationships (3 items), and environmental health (8 items). On a Likert 5-point scale, the responses to the questions range from "disagree" or "not at all" to "completely agree" or "extremely." Better grades correspond to a higher quality of life [ 14 ]. Statistical Analyses The study's required sample size was estimated to be 42 with 80% power (α = 0.05, β = 0.20), effect size (f = 0.25) using the G power sample size calculator (G Power, v.3.0.10). The "SPSS (Statistical Package for Social Sciences) version 20" program was used to analyze the study's data. Data were analyzed between and among groups using "One Way ANOVA." The "Wilcoxon signed-rank" test was used to compare the groups' pre- and post-treatment results. For group difference analysis, the post hoc test "Tukey HSD" was employed. If the mean difference and the 95% confidence interval were greater than the smallest important difference, clinically meaningful differences were found. Results Baseline Characteristic Participants were divided into 3 groups and there were 15 participants in each group. Descriptive analysis was performed for baseline characteristics. The mean age of the SHEG was 35.06, the mean age of the HEG was 34.18, and the mean age of the CG was 36.85. Average of weight gained at the end of the study in SHEG was 20.13 kg, HEG was 21.25 kg and CG was 21.14 kg. Baseline characteristics of the participants shown in Table 2 . Table 2 Baseline characteristics of the participants Characteristic SHEG (n = 15) HEG (n = 15) CG (n = 15) Participants Maternal age (yr), mean (SD) 35.06 (4.31) 34.18 (2.16) 36.85 (2.79) Number of pregnancies First n (%) 7 (40) 8 (66.7) 8 (33.3) Second n (%) Third n (%) 5 (46.7) 3 (13.3) 7 (20) 0 (13.3) 6 (33.3) 1 (33.3) Maternal weight gain (kg), mean (SD) 20.13 (2.16) 21.25 (1.48) 21.14 (1.02) SHEG: Supervised home ecercise group, HEG: Home exercise group, CG: Control group, yr: years, SD: Standard deviation, kg: kilograms, cm: centimeter Effect of intervention Table 3 provides a comparison of the group's pre-post treatment evaluation parameters. When blood glucose levels were compared pre and post treatment, fasting glucose and 2 h postprandial glucose levels were improved statistically in SHEG and HEG groups (p 0.05). Additionally, in all three groups, there was a statistically significant difference in all of the quality of life metrics (p < 0.05). Table 3 Comparison of the values pre-treatment and post-treatment within the group Variable Pre-SHEG (Mean ± SD) Post- SHEG (Mean ± SD) p Pre-HEG (Mean ± SD) Post- HEG (Mean ± SD) p Pre-CG (Mean ± SD) Post-CG (Mean ± SD) p OGTT-Fasting glucose (mg/dl) 106.06 ± 5.56 91.20 ± 3.96 0.001 114.37 ± 4.60 97.00 ± 115.00 0.000 112.85 ± 3.77 108.64 ± 0.63 0.132 OGTT-2 hours glucose (mg/dl) 169.73 ± 16.70 148.26 ± 11.49 0.001 173.75 ± 8.42 164.12 ± 8.69 0.002 169.57 ± 7.25 163.00 ± 6.81 0.102 QOL-General health 7.53 ± 0.74 9.00 ± 0.75 0.001 7.00 ± 0.73 7.50 ± 0.51 0.005 7.42 ± 0.51 8.00 ± 0.55 0.005 QOL-Physical health 24.33 ± 1.95 30.26 ± 1.75 0.000 23.68 ± 1.35 26.18 ± 1.32 0.000 25.57 ± 1.45 25.14 ± 1.16 0.023 QOL-Psychological health 22.40 ± 1.76 27.20 ± 3.36 0.001 22.31 ± 2.08 24.62 ± 1.45 0.001 23.85 ± 1.02 25.14 ± 1.16 0.002 QOL-Social relationships 12.73 ± 1.70 17.33 ± 2.19 0.001 13.81 ± 1.51 15.62 ± 1.74 0.001 14.00 ± 0.78 15.00 ± 1.10 0.008 QOL-Environmental health 30.86 ± 1.75 35.13 ± 1.50 0.000 29.62 ± 1.74 31.31 ± 1.49 0.002 31.57 ± 1.34 33.00 ± 1.24 0.002 SHEG: Supervised home exercise group, HEG: Home exercise group, CG: Control group, SD: Standard deviation, OGTT: Oral glucose tolerance test, QOL: Quality of Life The comparison of cesarean birth and preterm birth between the the groups after intervention was given in Table 4 . There were no statistically significant differences in values of cesarean section and preterm birth between groups (p > 0.05). Table 5 displays the comparison of differences between groups as well as intra-group differences of values pre- and post-treatment. A statistically significant change was seen in all outcome measures when the pre- and post-treatment values were compared across the groups (p 0.05). Between the SHEG and HEG, there was a significant difference in every outcome parameter (p < 0.05). Differences in SHEG were statistically higher than HEG (p < 0.05). When the SHEG and CG were compared, the SHEG was found to be more effective than the CG in terms of fasting glucose, postprandial glucose and quality of life parameters (p < 0.05). Also, when the HEG and CG were compared, there was no superiority between the two groups in all outcome measures except the Physical health. Table 4 Comparison of cesarean birth and preterm birth between the the groups SHEG (n = 15) HEG (n = 15) CG (n = 15) p Cesarean section n (%) 5(33.3) 6(40) 8(53.3) 0.768 Preterm birth n (%) 2(13.3) 6(40) 7(46.7) 0.055 SHEG: Supervised home exercise group, HEG: Home exercise group, CG: Control group Table 5 Intra-group differences of values pre and post-treatment and comparison of differences between groups Variable SHEG (diff Mean ± SD) HEG (diff Mean ± SD) CG (diff Mean ± SD) Diff. p p (SHEG − HEG ) p (SHEG-CG) p (HEG-CG) OGTT- Fasting glucose (mg/dl) 14 ± 86 ± 2.97 8.31 ± 3.34 4.21 ± 5.16 .000 SHEG-HEG < 0.001 SHEG-CG 0.001 OGTT- 2 hours glucose (mg/dl) 21.46 ± 8.66 9.62 ± 2.75 6.57 ± 3.75 .000 SHEG-HEG < 0.001 SHEG-CG 0.001 QOL-General health 1.46 ± 0.91 0.50 ± 0.51 0.57 ± 0.51 .000 SHEG-HEG < 0.001 SHEG-CG 0.001 QOL-Physical health 5.93 ± 1.48 2.50 ± 0.81 0.57 ± 0.75 .000 SHEG-HEG < 0.001 SHEG-CG < 0.001 HEG-CG < 0.001 QOL-Psychological health 4.80 ± 2.21 2.31 ± 1.40 1.28 ± 0.72 .000 SHEG-HEG < 0.001 SHEG-CG 0.001 QOL-Social relationships 4.60 ± 1.54 1.81 ± 0.98 1.00 ± 0.96 .000 SHEG-HEG < 0.001 SHEG-CG 0.001 QOL-Environmental health 4.26 ± 0.88 1.68 ± 1.13 1.42 ± 0.93 .000 SHEG-HEG < 0.001 SHEG-CG 0.001 Diff: Difference, SHEG: Supervised home exercise group, HEG: Home exercise group, CG: Control group, SD: Standard deviation, OGTT: Oral glucose tolerance test, QOL: Quality of Life Discussion The study found that both the supervised and self home exercise programs were effective in improving blood glucose levels and quality of life, while there were no significant differences in birth outcomes among the groups. Additionally, the results indicated that the supervised home exercise program was more effective than the self home exercise program and the control group. Moreover, the self home exercise program and the standard care showed similar effects on blood glucose levels. Home exercise programs had little or no effect on fasting glucose levels, HbA1c, insulin require, insulin sensitivity index, gestational age at delivery, preterm birth, birth weight, or head circumference in women with gestational diabetes, according to one meta-analysis [ 15 ]. Home-based exercise regimens do not appear to have an effect on the recurrence or glycemic control of gestational diabetes, despite epidemiological research suggesting that greater physical activity lowers the risk of gestational diabetes and improves glucose tolerance throughout pregnancy [ 11 ]. In another study, the introduction of a home-based exercise after a diagnosis of GDM led to improved daily postprandial glucose management, but there were no significant changes in HbA1c, glucose tolerance, or the insulin response to the post-intervention OGTT [ 7 ]. The effectiveness of home exercise programs in gestational diabetes is not well understood, and there are only a few studies investigating the effectiveness of supervised home exercise. For example, one trial started a 14-week supervised home exercise program at 14 weeks gestation, but it had little impact on the return of gestational diabetes, overall glucose intolerance, or insulin sensitivity [ 16 ]. This result is unexpected because epidemiological evidence supports a decrease in GDM risk with increased physical activity, and experimental research has shown advantages of regular exercise for glucose tolerance during pregnancy. Another trial by Ong et al. [ 11 ] discovered that 10 weeks of monitored home exercise starting at week 18 of pregnancy prevented obese pregnant women from experiencing a deterioration in their ability to tolerate glucose. In our study, we found that the supervised home exercise group was more effective than the self-exercise group and the control group. This could be due to the fact that supervised home exercise is strictly supervised and has a high compliance rate, which increases the advantages of exercise for gestational diabetes. The high compliance rate was probably also influenced by the intervention's supervised home-based setting, which allowed participants to complete the exercise in a welcoming environment. The outcomes in this study revealed no apparent differences between the control group and the group participating in self-home exercise. Participants who did self home exercise had similar outcomes as those who received only standard care, possibly due to the lack of supervision and motivation. Another study comparing face-to-face and home exercise interventions for GDM showed that face-to-face exercise had a medium effect on postprandial blood glucose levels at 36-weeks gestation [ 17 ]. In our study, we found that a supervised home exercise program was more effective than a self home-based program and the standard care condition. We believe that the reason supervised or face-to-face exercises have been more effective than unsupervised exercises is likely due to ensuring continuity of the exercises. In the current study, pregnant women who were diagnosed with GDM at 24–28 weeks of gestation were included. Some authors have suggested that exercises should be started in the first trimester since placental function and gene expression are programmed by the first trimester [ 11 , 18 ]. However, in some studies, including ours, exercises were started after the diagnosis of GDM [ 7 , 19 ]. We believe that starting exercises after the diagnosis is necessary. Moreover, aerobic or resistive exercises have mostly been preferred for improving glycemic control in the treatment of gestational diabetes [ 20 , 21 , 22 ]. Resistance exercise at a moderate intensity was proven to be successful by Yaping et al. [ 23 ] in lowering blood glucose levels in women with GDM. They also showed that resistance training may improve glycemic control through a mechanism related to its beneficial effects on type 2 diabetes. As both gestational diabetes and type 2 diabetes are mainly characterized by hyperglycemia, structured aerobic and resistive exercises were found to be helpful in managing blood glucose control in type 2 diabetes in one study [ 24 ]. Similarly, in patients with gestational diabetes, structured combined exercises have also been shown to be effective in some studies [ 21 , 25 ]. According to a systematic review, women with insulin controlled GDM who participated in a combined aerobic and resistive exercise program experienced a reduction in their glycaemic levels compared to those who received standard care [ 26 ]. We chose a structured combined exercise regimen similar to these studies to control both fasting and postprandial glucose levels, and our exercise program had a compatible effect with them. The effects of exercise on pregnancy complications in gestational diabetes have been a topic of debate. While one study found no difference in maternal and infant health between the exercise and standard care groups [ 23 ], others have reported conflicting results [ 27 , 28 ]. It is expected that as blood glucose levels improve, the risk of preterm birth and the need for cesarean delivery will decrease [ 29 ]. However, in our study, we did not observe any statistically significant differences in preterm or cesarean delivery rates between the supervised and self home exercise groups and the control group, despite differences in blood glucose levels. This may be due to the high maternal weight gain observed in all three groups in our study. Excessive weight gain during pregnancy is a known risk factor for increased pregnancy complications in GDM [ 30 ]. Strength and Limitation of the Study The study’s strength is that it is one of the few studies comparing home exercise with supervised and self. Performing the intervention in cooperation with physiotherapist and gynecologist is another strength of this study The limitations included a lack of the intended number of participants and short-term follow-up. Also, the drug doses and daily glucose monitoring of the participants for glycemic control were not examined in this study. Conclusions The results of our study indicated that pregnant women who received home exercises with physiotherapist guidance had better outcomes in terms of blood glucose levels and quality of life compared to those who did self-home exercises or received standard care only. However, there were no significant differences in pregnancy outcomes between the groups receiving the self-directed, supervised home exercise program and standard care. This study highlights the importance of having pregnant women under the supervision of physiotherapists during home exercises. We recommend that physiotherapists take a more active role in planning, monitoring, and implementing exercise programs for pregnant women, and that a multidisciplinary approach involving physiotherapists and gynecologists be adopted in the treatment of GDM to enhance the effectiveness of interventions. Declarations Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing interests The authors have no relevant financial or non-financial interests to disclose. Author Contributions Both authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Merve Yilmaz Menek.The first draft of the manuscript was written by Merve Yilmaz Menek and both authors commented on previous versions of the manuscript. Both authors read and approved the final manuscript. Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Non-interventional Ethics Committee at Medipol University (File number: E-10840098-772.02-6739, Number:1337, date:23.12.2021). References American Diabetes Association (2013) Diagnosis and classification of diabetes mellitus. Diabetes Care 36 (1): 67-74. https://doi.org/10.2337/dc13-S067. Boney CM, Verma A, Tucker R, et al (2005) Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115(3): 290-296. https://doi.org/10.1542/peds.2004-1808. Burlina S, Dalfrà MG, Lapolla A (2009) Short- and long-term consequences for offspring exposed to maternal diabetes: a review. J Matern Fetal Neonatal Med 32(4): 687-694. https://doi.org/10.1080/14767058.2017.1387893. Reece EA (2010) The fetal and maternal consequences of gestational diabetes mellitus. J Matern Fetal Neonatal Med 23(3):199-203. https://doi.org/10.3109/14767050903550659. American Diabetes Association Professional Practice Committee (2022) 15. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2022. Diabetes Care 45:232-243. https://doi.org/10.2337/dc22-S015. Savvaki D, Taousani E, Goulis DG, et al (2018) Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations. Hormones (Athens) 17:521-529. https://doi.org/10.1007/s42000-018-0085-6. Ruchat SM, Mottola MF (2013) The important role of physical activity in the prevention and management of gestational diabetes mellitus. Diabetes Metab Res Rev 29(5):334-346. https://doi.org/10.1002/dmrr.2402. Halse RE, Wallman KE, Newnham JP, et al (2014) Home-based exercise training improves capillary glucose profile in women with gestational diabetes. Med Sci Sports Exerc 46(9):1702-1709. https://doi.org/10.1249/MSS.0000000000000302. Artal R, Catanzaro RB, Gavard JA, et al (2007) A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus. Appl Physiol Nutr Metab 32(3):596-601. https://doi.org/10.1139/H07-024. Phelan S, Phipps MG, Abrams B, et al (2011) Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. Am J Clin Nutr 93(4):772-779. https://doi.org/10.3945/ajcn.110.005306. Ong MJ, Guelfi KJ, Hunter T, et al (2009) Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women. Diabetes Metab 35(5):418-421. https://doi.org/10.1016/j.diabet.2009.04.008 Li L, Shi G, Zhang X, et al (2021) Analysis and Intervention of Factors Affecting Abnormal Postpartum Glucose Tolerance and Gestational Recurrence in Gestational Diabetes. Evid Based Complement Alternat Med. 2021:8470944. https://doi.org/10.1155/2021/8470944 Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377-381. https://pubmed.ncbi.nlm.nih.gov/7154893/. Vahedi S (2010) World Health Organization Quality-of-Life Scale (WHOQOL-BREF): Analyses of Their Item Response Theory Properties Based on the Graded Responses Model. Iran J Psychiatry 5(4):140-153. https://pubmed.ncbi.nlm.nih.gov/22952508/. Bao H, Yu P, Song X, et al (2020) The influence of home-based exercise on gestational diabetes: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 33(13):2300-2305. https://doi.org/10.1080/14767058.2018.1548595. Guelfi KJ, Ong MJ, Crisp NA, et al (2016) Regular Exercise to Prevent the Recurrence of Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstet Gynecol 128(4):819-827. https://doi.org/10.1097/AOG.0000000000001632. Downs DS, Dinallo JM, Birch LL, et al (2017) Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes. Psychol Sport Exerc 30:73-81. https://doi.org/10.1016/j.psychsport.2017.02.003. Yu Y, Xie R, Shen C, et al (2018) Effect of exercise during pregnancy to prevent gestational diabetes mellitus: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 31:1632-1637. https://doi.org/10.1080/14767058.2017.1319929. Halse RE, Wallman KE, Dimmock JA, et al (2015) Home-Based Exercise Improves Fitness and Exercise Attitude and Intention in Women with GDM. Med Sci Sports Exerc 47(8):1698-1704. https://doi.org/10.1249/MSS.0000000000000587. Brankston GN, Mitchell BF, Ryan EA, et al (2004) Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus. Am J Obstet Gynecol 190(1):188-193. https://doi.org/10.1016/s0002-9378(03)00951-7. Sklempe Kokic I, Ivanisevic M, Kokic T, et al (2018) Acute responses to structured aerobic and resistance exercise in women with gestational diabetes mellitus. Scand J Med Sci Sport 28(7):1793-1800. https://doi.org/10.1111/sms.13076. Qazi WA, Babur MN, Malik AN, et al (2020) Effects of structured exercise regime on Glycosylated Hemoglobin and C reactive protein in patients with Gestational Diabetes Mellitus: A randomized controlled trial. Pak J Med Sci 36(7):1449-1453. https://doi.org/10.12669/pjms.36.7.2488. Yaping X, Huifen Z, Meijing Z, et al (2021) Effects of Moderate-Intensity Aerobic Exercise on Blood Glucose Levels and Pregnancy Outcomes in Patients With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Diabetes Ther 12(9):2585-2598. https://doi.org/10.1007/s13300-021-01135-6. Menek MY, Budak M (2022) Effect of exercises according to the circadian rhythm in type 2 diabetes: Parallel-group, single-blind, crossover study. Nutr Metab Cardiovasc Dis 32(7):1742-1752. https://doi.org/10.1016/j.numecd.2022.04.017. Sklempe Kokic I, Ivanisevic M, Biolo G, et al (2018) Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial. Women Birth 31(4):232-238. https://doi.org/10.1016/j.wombi.2017.10.004. Keating N, Coveney C, McAuliffe FM, et al (2022) Aerobic or Resistance Exercise for Improved Glycaemic Control and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus: A Systematic Review. Int J Environ Res Public Health 19(17):10791. https://doi.org/10.3390/ijerph191710791. Xie Y, Zhao H, Zhao M, et al (2022) Effects of resistance exercise on blood glucose level and pregnancy outcome in patients with gestational diabetes mellitus: a randomized controlled trial. BMJ Open Diabetes Res Care 10(2):002622. https://doi.org/10.1136/bmjdrc-2021-002622. Buhary BM, Almohareb O, Aljohani N, et al (2016) Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study. Indian J Endocrinol Metab 20(4):481-90. https://doi.org/10.4103/2230-8210.183478. Wang C, Guelfi KJ, Yang HX (2016) Exercise and its role in gestational diabetes mellitus. Chronic Dis Transl Med 2(4):208-214. https://doi.org/10.1016/j.cdtm.2016.11.006. American Diabetes Association (2018) 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes Care 41(1):137-143. https://doi.org/10.2337/dc18-S013. Supplementary Files Checklist.docx Cite Share Download PDF Status: Published Journal Publication published 06 Jan, 2024 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Reviewers agreed at journal 08 Oct, 2023 Reviewers invited by journal 08 Oct, 2023 Editor invited by journal 20 Sep, 2023 Editor assigned by journal 12 Sep, 2023 First submitted to journal 09 Sep, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3340855","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":238573253,"identity":"76bebcd7-2122-4d77-88d6-17a98e3d657d","order_by":0,"name":"Merve Yılmaz Menek","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIie3RsUrDQBjA8e84SJZr50hL36BQKFyVDH2ViJAsySQEESknwnWJu75NQiBZjnQ96GCDkFlx6dCKF9OhSNqsDveHu+XuB3d8ADrd/80aqg1tADBRiwEY3UTdBDxpCGoI6TD1uWEpAp1kvHyurE9+ScbLvLqXd/ZwZj4y+AhTmA/iVkJFTi9euUWocNy1LzxyFSUMvRQpkL7TTqSLp72axE62DnhKJvKa4R5X5MTL6FuFp/uarEp+G3wfyP4ckQZ6RzWRNwYO2IGgc0S4qIyKmlR44GfNX5Ko8AgRJ0ieQbwNFyO68sov/8Gez8ynZLMN7ZEZtZPf0PGs1Twhhs5J7v4QnU6n0x33AwVAWpP6YLXkAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-6993-7983","institution":"Istanbul Medipol University: Istanbul Medipol Universitesi","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Merve","middleName":"Yılmaz","lastName":"Menek","suffix":""},{"id":238573254,"identity":"2616760e-928b-4c31-82fd-82619ad25cd0","order_by":1,"name":"Ayse Kavasoglu Kaya","email":"","orcid":"","institution":"Istanbul Medipol University: Istanbul Medipol Universitesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ayse","middleName":"Kavasoglu","lastName":"Kaya","suffix":""}],"badges":[],"createdAt":"2023-09-09 20:52:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3340855/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3340855/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-023-07339-4","type":"published","date":"2024-01-06T15:01:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44537081,"identity":"3d8de38f-e194-4ad0-ac25-909bba1c45e2","added_by":"auto","created_at":"2023-10-12 20:33:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50385,"visible":true,"origin":"","legend":"\u003cp\u003eDesign and flow of the participants\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3340855/v1/123d1ed16dc88b22ce543a7a.png"},{"id":49315644,"identity":"706db84a-f0f4-4e85-abbb-f26783930100","added_by":"auto","created_at":"2024-01-08 15:09:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":517930,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3340855/v1/a4bcddc6-23b0-453b-b346-ae64d0b082a8.pdf"},{"id":44537080,"identity":"44e621ec-d051-4f2e-ad47-2c4068ab3341","added_by":"auto","created_at":"2023-10-12 20:33:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":24954,"visible":true,"origin":"","legend":"","description":"","filename":"Checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-3340855/v1/5c0b6d812454bf80cf281b16.docx"}],"financialInterests":"","formattedTitle":"Comparison of Home Exercise Under Supervision and Self Home Exercise in Pregnant Women with Gestational Diabetes: Randomized Controlled Trial","fulltext":[{"header":"What does this study add to the clinical work","content":"\u003cp\u003eThe home exercises given with physiotherapist training during pregnancy were better than self-home exercises and standard care only in terms of improvement of blood glucose level and quality of life.\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eDuring pregnancy, hormonal changes in women lead to a natural state of insulin resistance. However, the body compensates for this by secreting more insulin, which aids in maintaining normal blood glucose levels. If this compensatory mechanism fails, reduced glucose tolerance may progress to gestational diabetes mellitus (GDM) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Both the woman and the child may experience severe immediate and long-term effects from GDM, including an elevated risk of metabolic disease [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Short-term complications may include respiratory distress syndrome, neonatal hypoglycemia, and other adverse outcomes such as intrauterine growth restriction, preterm birth, and pre-eclampsia [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, macrosomia, large for gestational age, and congenital anomalies may also occur [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Maternal inactivity and excessive prenatal weight gain rise the risk of type 2 diabetes, recurrent GDM, and adverse obstetric outcomes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Recent literature has shown that regular exercise training is effective in improving glycemic control in GDM patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Aerobic training, which includes exercises like walking, jogging, running,\u003c/p\u003e \u003cp\u003ecycling, swimming, and aqua aerobics, should be done at least three to four times a week for 50 to 150 minutes, with a daily maximum of 30 minutes. In addition, resistance training should be performed at least 2 times per week, according to international guidelines [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, it is unclear whether supervised or home-based exercise is more effective. Ruchat and Mottola [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] compared supervised and partially supervised exercise interventions for GDM and found that supervised exercise was more effective on blood glucose level. In another study, participants who engaged in a home exercise program had lower daily postprandial glucose levels than the control group [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, partially supervised exercise interventions with 2 supervised and 2 unsupervised sessions per week did not improve blood glucose control or limit insulin use [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Currently, there is no universally accepted approach for promoting perinatal exercise. While face-to-face exercise programs have been shown to increase exercise effectiveness in non-pregnant individuals, few studies have explored this approach with pregnant women [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In contrast, minimum-contact home-based interventions are more commonly used in prenatal interventions as they are easier to implement for pregnant women than structured exercise programs [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Many women with GDM prefer not to exercise despite the potential benefits because of a variety of barriers, including a lack of time, child care commitments, exhaustion, and a lack of access to exercise equipment [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As a result, by offering an attractive and familiar atmosphere, a supervised home-based exercise training program may be a promising way to encourage exercise adherence and remove barriers to exercise [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. There are few research examining the efficacy of guided home exercise plans for treating GDM. This study compares the efficacy of a self-administered home exercise program, a home exercise program under supervision, and standard treatment in gestational diabetes.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eParticipants were randomly assigned (1:1:1) to one of three groups in this study. The study's protocol was registered on ClinicalTrials.gov (NCT05195333). This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Non-interventional Ethics Committee at Medipol University (File number: E-10840098-772.02-6739, Number:1337, date:23.12.2021). The diagnosis of gestational diabetes was made by the gynecologist based on oral glucose tolerance test (OGTT). Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e \u003cp\u003eA gynecologist and obstetrician in Medipol Camlica Hospital located in Istanbul, diagnosed each woman with gestational diabetes in this study. The followings were the study's inclusion requirements: Between 24 and 28 weeks of gestation, singleton pregnancy, body mass index (BMI) less than 45 kg/m\u003csup\u003e2\u003c/sup\u003e, venous plasma glucose level greater than 130 mg/dl according to a 75-g oral glucose tolerance test, and non-smokers who were not currently participating in a structured exercise program. If a woman was less than 18 years old, had undergone bariatric surgery, was unable to comprehend the consequences of the participation, or was using any drugs at the time of recruitment, she was excluded from the study.\u003c/p\u003e \u003cp\u003eThe study included the forty-nine individuals who met the inclusion criteria out of a total of 54 participants that were screened. Two participants were excluded due to orthopedic problems, and two declined to participate in the exercise program. Therefore, the study was conducted with a total of forty-five women. The algorithm for allocating participants to the study groups is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eUsing a randomized controlled trial design, with the main investigator being blinded, women who have gestational diabetes were randomly divided into SHEG, HEG and CG. Women were given numbers in the order of inclusion in the study. Then, considering these numbers, randomization was achieved using the \u0026lsquo;randomizer.org\u0026rsquo; website. Forty five participants were divided into three groups.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eSupervised home exercise group (n\u0026thinsp;=\u0026thinsp;15)\u003c/strong\u003e \u003cp\u003eParticipants who were randomized to the SHEG were instructed to complete three supervised, home based exercise sessions per week from the 24th to 28th week of pregnancy until the end of the 32nd to 36th week. The home exercise program was developed by a physiotherapist and was taught to all participants at the hospital during a single instruction session. In addition to the home-based exercise program, these participants received weekly telephone calls for monitoring and support. The exercise program lasted 8 weeks.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHome exercise group (n\u0026thinsp;=\u0026thinsp;15)\u003c/strong\u003e \u003cp\u003eParticipants in the HEG received a home exercise brochure without any instruction from the gynecologist. The purpose and detailed application methods of the exercises were not explained. Participants in this group were instructed to complete the exercises three days per week for 8 weeks, from the 24th to 28th week of pregnancy until the end of the 32nd to 36th week, but no interviews were conducted to monitor their progress. The exercise program lasted 8 weeks as in SHEG.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eControl group (n\u0026thinsp;=\u0026thinsp;15)\u003c/strong\u003e \u003cp\u003eThe exercise intervention was not given to the control group, but they did Ronly eceive standard prenatal care from their healthcare providers, including dietary guidance for GDM. For a regular calorie intake, each participant received a customized food plan created by a nutritionist. An 1500 kcal/day low-glycemic, low-saturated fat diet was recommended as part of the dietary intervention. Additionally, all participants underwent regular checkups from their obstetricians and midwives every 4 to 5 weeks, followed by weekly visits until the 36th to 38th week of pregnancy.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe exercises performed in the study were structured and of low to moderate intensity. These exercises comprised stretching, aerobic, coordination, warm-up and cool-down activities, as well as resistive exercises for the shoulder girdle and the flexor and extensor muscles of the knee and hip. Walking activities without any equipment and repetitive actions ranging from easy to difficult were also included as aerobic exercises. Exercises were progressed according to the Rating of Perceived Exertion (RPE) BORG scale, which has a scale from 6 to 20, with 6 signifying no exertion and 20 signifying \"very, very hard\" exertion. Exercises of moderate intensity were carried out to raise the level of fatigue experienced from the BORG scale of 11\u0026ndash;12 to 13\u0026ndash;14. A red-colored theraband was used for low-intensity resistance training, with 10 repetitions and 1 set. The home exercise protocols were identical for both the supervised and self-home exercise groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStructured exercise program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExercises\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eEquipment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntensity of exercise\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAerobic Exercises\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eStepping exercises\u003c/p\u003e \u003cp\u003eWalking exercise\u003c/p\u003e \u003cp\u003eStep forward and sideways\u003c/p\u003e \u003cp\u003eJogging in place\u003c/p\u003e \u003cp\u003eRepetitive bilateral shoulder flexion\u003c/p\u003e \u003cp\u003eRepetitive bilateral shoulder abduction\u003c/p\u003e \u003cp\u003eRepetitive hand movement with the shoulder movements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProgressive increase from 11\u0026ndash;12 to 13\u0026ndash;14 on the Borg Scale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResistive exercises\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eHip flexors strengthening\u003c/p\u003e \u003cp\u003eHip extensors strengthening\u003c/p\u003e \u003cp\u003eHip abductors strengthening\u003c/p\u003e \u003cp\u003eKnee flexors and extensors strengthening\u003c/p\u003e \u003cp\u003eShoulder flexors and extensors strengthening\u003c/p\u003e \u003cp\u003eShoulder abductors strengthening\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTheraband and mat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRed colour theraband, 10 rep/ 1 set\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStretching exercises\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eQuadriceps and hip flexors stretching\u003c/p\u003e \u003cp\u003eTriceps and biceps stretching\u003c/p\u003e \u003cp\u003eGastrocnemius stretching in long sitting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWarm up and cool down exercises\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNeck muscle stretching\u003c/p\u003e \u003cp\u003eTrunk right/left lateral flexion\u003c/p\u003e \u003cp\u003eShoulder elevation and circumduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measurements\u003c/h2\u003e \u003cp\u003eParticipants\u0026rsquo; characteristics assessment included demographic information as maternal age, maternal weight gain, height, pregnancy history. Cesarean section and preterm delivery of the participants were recorded at the end of the treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eBlood sample measurements\u003c/h2\u003e \u003cp\u003eInformation on the Oral Glucose Tolerance Test (OGTT) was gathered from hospital documents. Three groups' pre- and post-intervention blood glucose levels were measured using this test while fasting and 2 hours after OGTT. The same laboratory within the Camlica Medipol University Hospital performed the laboratory testing.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eWorld Health Organization Quality of Life Instrument (WHOQOL-BREF)\u003c/h2\u003e \u003cp\u003eWhen assessing the quality of life of various patient populations and healthy people, the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire is frequently employed. The 26 items in this self-administered survey inquire about the respondent's impressions of their health and wellbeing during the preceding two weeks. In addition to QOL and general health questions, the questionnaire has four domains: physical health (7 items), psychological health (6 items), social relationships (3 items), and environmental health (8 items). On a Likert 5-point scale, the responses to the questions range from \"disagree\" or \"not at all\" to \"completely agree\" or \"extremely.\" Better grades correspond to a higher quality of life [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eThe study's required sample size was estimated to be 42 with 80% power (α\u0026thinsp;=\u0026thinsp;0.05, β\u0026thinsp;=\u0026thinsp;0.20), effect size (f\u0026thinsp;=\u0026thinsp;0.25) using the G power sample size calculator (G Power, v.3.0.10). The \"SPSS (Statistical Package for Social Sciences) version 20\" program was used to analyze the study's data. Data were analyzed between and among groups using \"One Way ANOVA.\" The \"Wilcoxon signed-rank\" test was used to compare the groups' pre- and post-treatment results. For group difference analysis, the post hoc test \"Tukey HSD\" was employed. If the mean difference and the 95% confidence interval were greater than the smallest important difference, clinically meaningful differences were found.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eBaseline Characteristic\u003c/h2\u003e \u003cp\u003eParticipants were divided into 3 groups and there were 15 participants in each group. Descriptive analysis was performed for baseline characteristics. The mean age of the SHEG was 35.06, the mean age of the HEG was 34.18, and the mean age of the CG was 36.85. Average of weight gained at the end of the study in SHEG was 20.13 kg, HEG was 21.25 kg and CG was 21.14 kg. Baseline characteristics of the participants shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSHEG\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHEG\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCG\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal age (yr), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.06 (4.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.18 (2.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.85 (2.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of pregnancies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond n (%)\u003c/p\u003e \u003cp\u003eThird n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (46.7)\u003c/p\u003e \u003cp\u003e3 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (20)\u003c/p\u003e \u003cp\u003e0 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (33.3)\u003c/p\u003e \u003cp\u003e1 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaternal weight gain (kg), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.13 (2.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.25 (1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.14 (1.02)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSHEG: Supervised home ecercise group, HEG: Home exercise group, CG: Control group, yr: years, SD: Standard deviation, kg: kilograms, cm: centimeter\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEffect of intervention\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides a comparison of the group's pre-post treatment evaluation parameters. When blood glucose levels were compared pre and post treatment, fasting glucose and 2 h postprandial glucose levels were improved statistically in SHEG and HEG groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there was no statistically significant difference in fasting glucose and 2 h postprandial glucose in the control group (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Additionally, in all three groups, there was a statistically significant difference in all of the quality of life metrics (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the values pre-treatment and post-treatment within the group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre-SHEG \u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost- SHEG\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePre-HEG (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePost- HEG (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePre-CG\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePost-CG (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOGTT-Fasting glucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106.06\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e114.37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e97.00\u0026thinsp;\u0026plusmn;\u0026thinsp;115.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e112.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e108.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOGTT-2 hours glucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169.73\u0026thinsp;\u0026plusmn;\u0026thinsp;16.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148.26\u0026thinsp;\u0026plusmn;\u0026thinsp;11.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e173.75\u0026thinsp;\u0026plusmn;\u0026thinsp;8.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e164.12\u0026thinsp;\u0026plusmn;\u0026thinsp;8.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e169.57\u0026thinsp;\u0026plusmn;\u0026thinsp;7.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e163.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-General health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-Physical health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-Psychological health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e25.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-Social relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e14.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e15.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-Environmental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.86\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e31.57\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e33.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eSHEG: Supervised home exercise group, HEG: Home exercise group, CG: Control group, SD: Standard deviation, OGTT: Oral glucose tolerance test, QOL: Quality of Life\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comparison of cesarean birth and preterm birth between the the groups after intervention was given in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. There were no statistically significant differences in values of cesarean section and preterm birth between groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e displays the comparison of differences between groups as well as intra-group differences of values pre- and post-treatment. A statistically significant change was seen in all outcome measures when the pre- and post-treatment values were compared across the groups (p 0.05). Between the SHEG and HEG, there was a significant difference in every outcome parameter (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Differences in SHEG were statistically higher than HEG (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). When the SHEG and CG were compared, the SHEG was found to be more effective than the CG in terms of fasting glucose, postprandial glucose and quality of life parameters (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Also, when the HEG and CG were compared, there was no superiority between the two groups in all outcome measures except the Physical health.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of cesarean birth and preterm birth between the the groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSHEG (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHEG (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCG (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(46.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSHEG: Supervised home exercise group, HEG: Home exercise group, CG: Control group\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntra-group differences of values pre and post-treatment and comparison of differences between groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVariable\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSHEG\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(diff Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eHEG\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(diff Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eCG\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(diff Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eDiff.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(SHEG\u003c/em\u003e\u003csup\u003e\u003cem\u003e\u0026minus;\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eHEG )\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(SHEG-CG)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(HEG-CG)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOGTT- Fasting glucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u0026thinsp;\u0026plusmn;\u0026thinsp;86\u0026thinsp;\u0026plusmn;\u0026thinsp;2.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.31\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.21\u0026thinsp;\u0026plusmn;\u0026thinsp;5.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSHEG-HEG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eSHEG-CG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHEG-CG\u0026thinsp;\u0026gt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOGTT- 2 hours glucose (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.62\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSHEG-HEG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eSHEG-CG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHEG-CG\u0026thinsp;\u0026gt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-General health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSHEG-HEG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eSHEG-CG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHEG-CG\u0026thinsp;\u0026gt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-Physical health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSHEG-HEG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eSHEG-CG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eHEG-CG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-Psychological health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSHEG-HEG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eSHEG-CG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHEG-CG\u0026thinsp;\u0026gt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-Social relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSHEG-HEG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eSHEG-CG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHEG-CG\u0026thinsp;\u0026gt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQOL-Environmental health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eSHEG-HEG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eSHEG-CG\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHEG-CG\u0026thinsp;\u0026gt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eDiff: Difference, SHEG: Supervised home exercise group, HEG: Home exercise group, CG: Control group, SD: Standard deviation, OGTT: Oral glucose tolerance test, QOL: Quality of Life\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study found that both the supervised and self home exercise programs were effective in improving blood glucose levels and quality of life, while there were no significant differences in birth outcomes among the groups. Additionally, the results indicated that the supervised home exercise program was more effective than the self home exercise program and the control group. Moreover, the self home exercise program and the standard care showed similar effects on blood glucose levels.\u003c/p\u003e \u003cp\u003eHome exercise programs had little or no effect on fasting glucose levels, HbA1c, insulin require, insulin sensitivity index, gestational age at delivery, preterm birth, birth weight, or head circumference in women with gestational diabetes, according to one meta-analysis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Home-based exercise regimens do not appear to have an effect on the recurrence or glycemic control of gestational diabetes, despite epidemiological research suggesting that greater physical activity lowers the risk of gestational diabetes and improves glucose tolerance throughout pregnancy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In another study, the introduction of a home-based exercise after a diagnosis of GDM led to improved daily postprandial glucose management, but there were no significant changes in HbA1c, glucose tolerance, or the insulin response to the post-intervention OGTT [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The effectiveness of home exercise programs in gestational diabetes is not well understood, and there are only a few studies investigating the effectiveness of supervised home exercise. For example, one trial started a 14-week supervised home exercise program at 14 weeks gestation, but it had little impact on the return of gestational diabetes, overall glucose intolerance, or insulin sensitivity [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This result is unexpected because epidemiological evidence supports a decrease in GDM risk with increased physical activity, and experimental research has shown advantages of regular exercise for glucose tolerance during pregnancy. Another trial by Ong et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] discovered that 10 weeks of monitored home exercise starting at week 18 of pregnancy prevented obese pregnant women from experiencing a deterioration in their ability to tolerate glucose. In our study, we found that the supervised home exercise group was more effective than the self-exercise group and the control group. This could be due to the fact that supervised home exercise is strictly supervised and has a high compliance rate, which increases the advantages of exercise for gestational diabetes. The high compliance rate was probably also influenced by the intervention's supervised home-based setting, which allowed participants to complete the exercise in a welcoming environment.\u003c/p\u003e \u003cp\u003eThe outcomes in this study revealed no apparent differences between the control group and the group participating in self-home exercise. Participants who did self home exercise had similar outcomes as those who received only standard care, possibly due to the lack of supervision and motivation. Another study comparing face-to-face and home exercise interventions for GDM showed that face-to-face exercise had a medium effect on postprandial blood glucose levels at 36-weeks gestation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In our study, we found that a supervised home exercise program was more effective than a self home-based program and the standard care condition. We believe that the reason supervised or face-to-face exercises have been more effective than unsupervised exercises is likely due to ensuring continuity of the exercises.\u003c/p\u003e \u003cp\u003eIn the current study, pregnant women who were diagnosed with GDM at 24\u0026ndash;28 weeks of gestation were included. Some authors have suggested that exercises should be started in the first trimester since placental function and gene expression are programmed by the first trimester [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, in some studies, including ours, exercises were started after the diagnosis of GDM [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. We believe that starting exercises after the diagnosis is necessary. Moreover, aerobic or resistive exercises have mostly been preferred for improving glycemic control in the treatment of gestational diabetes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Resistance exercise at a moderate intensity was proven to be successful by Yaping et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] in lowering blood glucose levels in women with GDM. They also showed that resistance training may improve glycemic control through a mechanism related to its beneficial effects on type 2 diabetes. As both gestational diabetes and type 2 diabetes are mainly characterized by hyperglycemia, structured aerobic and resistive exercises were found to be helpful in managing blood glucose control in type 2 diabetes in one study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Similarly, in patients with gestational diabetes, structured combined exercises have also been shown to be effective in some studies [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. According to a systematic review, women with insulin controlled GDM who participated in a combined aerobic and resistive exercise program experienced a reduction in their glycaemic levels compared to those who received standard care [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. We chose a structured combined exercise regimen similar to these studies to control both fasting and postprandial glucose levels, and our exercise program had a compatible effect with them.\u003c/p\u003e \u003cp\u003eThe effects of exercise on pregnancy complications in gestational diabetes have been a topic of debate. While one study found no difference in maternal and infant health between the exercise and standard care groups [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], others have reported conflicting results [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. It is expected that as blood glucose levels improve, the risk of preterm birth and the need for cesarean delivery will decrease [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, in our study, we did not observe any statistically significant differences in preterm or cesarean delivery rates between the supervised and self home exercise groups and the control group, despite differences in blood glucose levels. This may be due to the high maternal weight gain observed in all three groups in our study. Excessive weight gain during pregnancy is a known risk factor for increased pregnancy complications in GDM [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrength and Limitation of the Study\u003c/h2\u003e \u003cp\u003eThe study\u0026rsquo;s strength is that it is one of the few studies comparing home exercise with supervised and self. Performing the intervention in cooperation with physiotherapist and gynecologist is another strength of this study\u003c/p\u003e \u003cp\u003eThe limitations included a lack of the intended number of participants and short-term follow-up. Also, the drug doses and daily glucose monitoring of the participants for glycemic control were not examined in this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results of our study indicated that pregnant women who received home exercises with physiotherapist guidance had better outcomes in terms of blood glucose levels and quality of life compared to those who did self-home exercises or received standard care only. However, there were no significant differences in pregnancy outcomes between the groups receiving the self-directed, supervised home exercise program and standard care. This study highlights the importance of having pregnant women under the supervision of physiotherapists during home exercises. We recommend that physiotherapists take a more active role in planning, monitoring, and implementing exercise programs for pregnant women, and that a multidisciplinary approach involving physiotherapists and gynecologists be adopted in the treatment of GDM to enhance the effectiveness of interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Merve Yilmaz Menek.The first draft of the manuscript was written by Merve Yilmaz Menek and both authors commented on previous versions of the manuscript. Both authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Non-interventional Ethics Committee at Medipol University (File number: E-10840098-772.02-6739, Number:1337, date:23.12.2021).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Diabetes Association (2013) Diagnosis and classification of diabetes mellitus. Diabetes Care 36 (1): 67-74. https://doi.org/10.2337/dc13-S067.\u003c/li\u003e\n\u003cli\u003eBoney CM, Verma A, Tucker R, et al (2005) Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115(3): 290-296. https://doi.org/10.1542/peds.2004-1808.\u003c/li\u003e\n\u003cli\u003eBurlina S, Dalfr\u0026agrave; MG, Lapolla A (2009) Short- and long-term consequences for offspring exposed to maternal diabetes: a review. J Matern Fetal Neonatal Med 32(4): 687-694. https://doi.org/10.1080/14767058.2017.1387893.\u003c/li\u003e\n\u003cli\u003eReece EA (2010) The fetal and maternal consequences of gestational diabetes mellitus. J Matern Fetal Neonatal Med 23(3):199-203. https://doi.org/10.3109/14767050903550659.\u003c/li\u003e\n\u003cli\u003eAmerican Diabetes Association Professional Practice Committee (2022) 15. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2022. Diabetes Care 45:232-243. https://doi.org/10.2337/dc22-S015.\u003c/li\u003e\n\u003cli\u003eSavvaki D, Taousani E, Goulis DG, et al (2018) Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations. Hormones (Athens) 17:521-529. https://doi.org/10.1007/s42000-018-0085-6.\u003c/li\u003e\n\u003cli\u003eRuchat SM, Mottola MF (2013) The important role of physical activity in the prevention and management of gestational diabetes mellitus. Diabetes Metab Res Rev 29(5):334-346. https://doi.org/10.1002/dmrr.2402.\u003c/li\u003e\n\u003cli\u003eHalse RE, Wallman KE, Newnham JP, et al (2014) Home-based exercise training improves capillary glucose profile in women with gestational diabetes. Med Sci Sports Exerc 46(9):1702-1709. https://doi.org/10.1249/MSS.0000000000000302.\u003c/li\u003e\n\u003cli\u003eArtal R, Catanzaro RB, Gavard JA, et al (2007) A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus. Appl Physiol Nutr Metab 32(3):596-601. https://doi.org/10.1139/H07-024.\u003c/li\u003e\n\u003cli\u003ePhelan S, Phipps MG, Abrams B, et al (2011) Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. Am J Clin Nutr 93(4):772-779. https://doi.org/10.3945/ajcn.110.005306.\u003c/li\u003e\n\u003cli\u003eOng MJ, Guelfi KJ, Hunter T, et al (2009) Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women. Diabetes Metab 35(5):418-421. https://doi.org/10.1016/j.diabet.2009.04.008\u003c/li\u003e\n\u003cli\u003eLi L, Shi G, Zhang X, et al (2021) Analysis and Intervention of Factors Affecting Abnormal Postpartum Glucose Tolerance and Gestational Recurrence in Gestational Diabetes. Evid Based Complement Alternat Med. 2021:8470944. https://doi.org/10.1155/2021/8470944\u003c/li\u003e\n\u003cli\u003eBorg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14(5):377-381. https://pubmed.ncbi.nlm.nih.gov/7154893/.\u003c/li\u003e\n\u003cli\u003eVahedi S (2010) World Health Organization Quality-of-Life Scale (WHOQOL-BREF): Analyses of Their Item Response Theory Properties Based on the Graded Responses Model. Iran J Psychiatry 5(4):140-153. https://pubmed.ncbi.nlm.nih.gov/22952508/.\u003c/li\u003e\n\u003cli\u003eBao H, Yu P, Song X, et al (2020) The influence of home-based exercise on gestational diabetes: a meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med 33(13):2300-2305. https://doi.org/10.1080/14767058.2018.1548595.\u003c/li\u003e\n\u003cli\u003eGuelfi KJ, Ong MJ, Crisp NA, et al (2016) Regular Exercise to Prevent the Recurrence of Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstet Gynecol 128(4):819-827. https://doi.org/10.1097/AOG.0000000000001632.\u003c/li\u003e\n\u003cli\u003eDowns DS, Dinallo JM, Birch LL, et al (2017) Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes. Psychol Sport Exerc 30:73-81. https://doi.org/10.1016/j.psychsport.2017.02.003.\u003c/li\u003e\n\u003cli\u003eYu Y, Xie R, Shen C, et al (2018) Effect of exercise during pregnancy to prevent gestational diabetes mellitus: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 31:1632-1637. https://doi.org/10.1080/14767058.2017.1319929.\u003c/li\u003e\n\u003cli\u003eHalse RE, Wallman KE, Dimmock JA, et al (2015) Home-Based Exercise Improves Fitness and Exercise Attitude and Intention in Women with GDM. Med Sci Sports Exerc 47(8):1698-1704. https://doi.org/10.1249/MSS.0000000000000587.\u003c/li\u003e\n\u003cli\u003eBrankston GN, Mitchell BF, Ryan EA, et al (2004) Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus. Am J Obstet Gynecol 190(1):188-193. https://doi.org/10.1016/s0002-9378(03)00951-7.\u003c/li\u003e\n\u003cli\u003eSklempe Kokic I, Ivanisevic M, Kokic T, et al (2018) Acute responses to structured aerobic and resistance exercise in women with gestational diabetes mellitus. Scand J Med Sci Sport 28(7):1793-1800. https://doi.org/10.1111/sms.13076.\u003c/li\u003e\n\u003cli\u003eQazi WA, Babur MN, Malik AN, et al (2020) Effects of structured exercise regime on Glycosylated Hemoglobin and C reactive protein in patients with Gestational Diabetes Mellitus: A randomized controlled trial. Pak J Med Sci 36(7):1449-1453. https://doi.org/10.12669/pjms.36.7.2488.\u003c/li\u003e\n\u003cli\u003eYaping X, Huifen Z, Meijing Z, et al (2021) Effects of Moderate-Intensity Aerobic Exercise on Blood Glucose Levels and Pregnancy Outcomes in Patients With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Diabetes Ther 12(9):2585-2598. https://doi.org/10.1007/s13300-021-01135-6.\u003c/li\u003e\n\u003cli\u003eMenek MY, Budak M (2022) Effect of exercises according to the circadian rhythm in type 2 diabetes: Parallel-group, single-blind, crossover study. Nutr Metab Cardiovasc Dis 32(7):1742-1752. https://doi.org/10.1016/j.numecd.2022.04.017.\u003c/li\u003e\n\u003cli\u003eSklempe Kokic I, Ivanisevic M, Biolo G, et al (2018) Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial. Women Birth 31(4):232-238. https://doi.org/10.1016/j.wombi.2017.10.004.\u003c/li\u003e\n\u003cli\u003eKeating N, Coveney C, McAuliffe FM, et al (2022) Aerobic or Resistance Exercise for Improved Glycaemic Control and Pregnancy Outcomes in Women with Gestational Diabetes Mellitus: A Systematic Review. Int J Environ Res Public Health 19(17):10791. https://doi.org/10.3390/ijerph191710791.\u003c/li\u003e\n\u003cli\u003eXie Y, Zhao H, Zhao M, et al (2022) Effects of resistance exercise on blood glucose level and pregnancy outcome in patients with gestational diabetes mellitus: a randomized controlled trial. BMJ Open Diabetes Res Care 10(2):002622. https://doi.org/10.1136/bmjdrc-2021-002622.\u003c/li\u003e\n\u003cli\u003eBuhary BM, Almohareb O, Aljohani N, et al (2016) Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study. Indian J Endocrinol Metab 20(4):481-90. https://doi.org/10.4103/2230-8210.183478.\u003c/li\u003e\n\u003cli\u003eWang C, Guelfi KJ, Yang HX (2016) Exercise and its role in gestational diabetes mellitus. Chronic Dis Transl Med 2(4):208-214. https://doi.org/10.1016/j.cdtm.2016.11.006.\u003c/li\u003e\n\u003cli\u003eAmerican Diabetes Association (2018) 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes Care 41(1):137-143. https://doi.org/10.2337/dc18-S013.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Blood glucose, Gestational diabetes mellitus, Structured exercise, Supervised home exercise","lastPublishedDoi":"10.21203/rs.3.rs-3340855/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3340855/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective \u003c/strong\u003eExercise programs at home are successful in treating gestational diabetes by controlling blood glucose. The aim is to compare the efficacy of the self-directed home exercise program, the standard care alone and the supervised home exercise program in pregnant women with gestational diabetes on blood glucose, quality of life and pregnancy outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eThis randomized, parallel, single-blind study included forty-five pregnant women who were 24-28 weeks of gestation. Participants were randomly divided into the supervised home exercise group (SHEG), home exercise group (HEG) and control group (CG). While the home exercises program was taught and controlled by a physiotherapist in SHEG, the home exercise brochure was given without any training by the gynecologist in HEG. Control group maintained their usual daily care. The home exercise intervention included low to moderate structured exercise performed three days per week for 8 weeks. Their glucose responses, quality of life and pregnancy outcomes were assessed pre- and post intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eFasting glucose and 2 h postprandial glucose levels were improved statistically in SHEG and HEG groups after intervention (p\u0026lt;0.05). Differences in SHEG were statistically higher than HEG (p\u0026lt;0.017). When the HEG and CG were compared, there was no superiority between the two groups in all outcome measures except the physical health. Additionally, there were no statistically significant differences in values of cesarean birth and preterm birth between groups (p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eThis study revealed that pregnant women should be under the supervision of physiotherapists while doing home exercises.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration\u003c/strong\u003e The trial was approved by the registration of ClinicalTrials.gov and registration number: NCT05195333.\u003c/p\u003e","manuscriptTitle":"Comparison of Home Exercise Under Supervision and Self Home Exercise in Pregnant Women with Gestational Diabetes: Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-12 20:33:34","doi":"10.21203/rs.3.rs-3340855/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2023-10-08T08:37:23+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-10-08T06:58:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Archives of Gynecology and Obstetrics","date":"2023-09-20T20:43:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-09-12T11:47:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2023-09-09T16:52:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"922770bc-49a3-4115-a0ff-b667dac29762","owner":[],"postedDate":"October 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-01-08T15:05:20+00:00","versionOfRecord":{"articleIdentity":"rs-3340855","link":"https://doi.org/10.1007/s00404-023-07339-4","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2024-01-06 15:01:54","publishedOnDateReadable":"January 6th, 2024"},"versionCreatedAt":"2023-10-12 20:33:34","video":"","vorDoi":"10.1007/s00404-023-07339-4","vorDoiUrl":"https://doi.org/10.1007/s00404-023-07339-4","workflowStages":[]},"version":"v1","identity":"rs-3340855","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3340855","identity":"rs-3340855","version":["v1"]},"buildId":"omnImTCwR2MFx8CMYfrG7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}