Exercise guidelines for gestational diabetes mellitus

Table 1 Diagnostic criterion for gestational diabetes mellitus (WHO 2013) and diabetes mellitus in pregnancy (WHO 2006)[5]

	Gestational diabetes mellitus	Diabetes mellitus in pregnancy
Fasting plasma glucose level	≥ 5.1-6.9 mmol/L	≥ 7.0 mmol/ L
	OR	OR
75 g oral glucose tolerance test levels	1 h: ≥ 10.0 mmol/K	1: Not required
	2 h: ≥ 8.5-11.0 mmol/L	2 h: ≥ 11.1 mmol/L
Random plasma glucose level	Not required	≥ 11.0 mmol/L

Table 2 Absolute and relative contraindications for exercise during pregnancy[75,82]

Absolute contraindications	Relative contraindications (aerobic exercise)
Restrictive lung disease	Heavy smoking
Ruptures membranes	History of extremely sedentary lifestyle
Preeclampsia	Orthopaedic limitations
Pregnancy-induced hypertension	Poorly controlled hypertension
Premature labour during current pregnancy	Extreme morbid obesity
Persistent bleeding (second or third trimester)	Extremely underweight (BMI < 12 kg/m2)
Incomplete cervix or cerclage	Poorly controlled type 1 diabetes
Placenta previa (placental implanting into lower uterus) after 26 wk of gestation	Chronic bronchitis
Hemodynamically significant heart disease	Severe anaemia
High order multiple gestation (≥ triplets)	Unevaluated maternal cardiac arrhythmia
	Intrauterine growth restriction in current pregnancy Poorly controlled seizure disorder Poorly controlled hyperthyroidism Previous spontaneous abortion Anaemia (hb < 100 g/L) Twin pregnancy after 28 wk Malnutrition or eating disorder

BMI: Body mass index.

Table 3 Benefits of maternal exercise for the foetus and the child

Benefits to the foetus[100-104]	Benefits to the foetus[1,58,73,104,105]
Lower heart rate response to acute maternal exercise	Lower birth weights
Increased amniotic fluids	Increased gestational ages (lower risk of preterm birth)
Increased in placenta viability and volume	Improved neurodevelopment and lower body fat percentage
Increase in vascular function	Infants have higher behaviour regulatory ability and orientation
Faster placental growth and greater villous tissue	At the age of five children have less body fat, higher general language intelligence and oral language
Higher tolerance to labour

Table 4 Modified heart rate target zone for aerobic exercise in pregnancy[82,95]

Maternal age	Heart rate target zone (beats/min)	Heart rate target zone (beats/10 s)	Heart rate target zone (beats/min) (SOwt/SOb)
< 20	140-155	23-26	-
20-29	135-150	22-25	102-124
30-39	130-145	21-24	101-120
≥ 40	125-140	20-30	-

SOwt: Sedentary overweight; Sob: Sedentary obese.

Table 5 Exercise guidelines for gestational diabetes mellitus

Type of exercise	Intensity	Duration	Frequency
Aerobic (large muscle activities in a rhythmic manner) e.g., walking, running, swimming and cycling	Moderate 60%-90% of APHRM RPE 12-14 Previously sedentary Owt/Ob should begin training at 20%-30% of APVO2R RPE 12-14 Vigorous RPE 14-16	≤ 30 min continuously (up to 45 min if self-paced)	No more than two consecutive days without exercising
Resistance (multi joint exercises, large muscle groups) e.g., dumbbells, resistance band and pregnancy Pilates	Moderate 50% 1RM 5-10 exercises 8-15 repetitions 1-2 sets	60 min	At least 2 but ideally 3 times a week

APHRM: Age predicted heart rate maximum; RPE: Rate of perceived exertion; Owt: Overweight; Ob: Obese; APVO₂R: Age predicted VO₂ reserve; RM: Repetition maximum.