Physical Therapy in Gestational Diabetes Mellitus By Dr. Akshita Goel

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GDM (gestational diabetes mellitus) is a variant of glucose intolerance involving potentially serious consequences that develops during pregnancy and is diagnosed through a laboratory test termed as an oral glucose tolerance test. It has a prevalence ranging 3.5 to 12 percent and is becoming more prominent. The mother developing hypertension and pre-eclampsia, along with birth trauma from macrosomia, the probability of GDM recurrence in subsequent pregnancies, with a seven-fold heightened risk of type 2 diabetes mellitus, cardiovascular disease, and leukaemia, are all short-term negative repercussions. For these reasons, the rising prevalence of GDM has public health ramifications.

In effort to avert the deleterious repercussions of poorly controlled GDM, glycemic management is essential. Dietary modifications, regular self-monitoring of postprandial acute capillary blood glucose levels, and insulin therapy are typically used to treat GDM. Exercise, notably systematic aerobic and/or resistance training, is a beneficial adjunctive therapy in the management of type 2 diabetes mellitus since this increases glucose uptake and improves insulin sensitivity, improves glucose transportation, and improves glucose tolerance. Exercise is attributed to a diminution in glycated hemoglobin levels (HbA1c) also.

Exercise as a therapeutic adjunct for optimizing postprandial glycaemia stabilization in women with GDM has a plausible physiological basis. Although dietary modification is the cornerstone of standard GDM management for sustaining postprandial glycaemic levels and optimising maternal and foetal consequences, in as many as 39 percent of women with GDM, postprandial control of glycaemia is not sustained with diet therapy singly, and insulin administration does not resolve insulin resistance per se. Both activation of intracellular glucose transporters and the utilisation of intracellular fatty acids augment insulin action during an acute bout of exercise. It also modulates the expression of muscle proteins that are essential in insulin sensitivity.

The lack of consistency in exercise prescription among trials makes it difficult to identify an ideal exercise regime. However, the research suggests that a plan of either aerobic exercise or resistance training appears to be equally effective, as long as it is accomplished for 20 to 30 minutes, three to four times a week, at a moderate intensity or higher, to provide a reiterated impulse that encourages enhanced blood glucose uptake and induces increases in insulin sensitivity. As a corollary, implementing exercise in the management of gestational diabetes mellitus lowers postprandial blood glucose, fasting blood glucose, and glycated haemoglobin levels. In gestational diabetes mellitus, exercise is safe and may diminishes maternal and neonatal complications. The resistance training programme minimizes the level of insulin required and improves capillary glycaemic control. Insulin sensitivity advantages after aerobic exercise and weight loss have also been associated with older women with a history of gestational diabetes and type 2 diabetes mellitus. Research also confirms the efficacy of proprioceptive training on dynamic postural balance during pregnancy.

There are several other evidences on the influence of an aquatic physical activity programme on glycaemic control and perinatal outcomes in women with gestational diabetes. Women’s physical activity levels decline during pregnancy, especially in the latter trimester. Physical activity in the water is more comfortable and may be more beneficial for pregnant women. The current literature certainly illustrates that physical activity during leisure time before and/or during pregnancy prevents against the emergence of GDM and pre-eclampsia. Additionally, calorie restriction and exercise induce reduced weight increase in obese GDM patients, reduced macrosomic newborns, and no deleterious pregnancy outcomes.

Pregnancy is an excellent opportunity for behavioral changes, and this intervention may also aid in the long-term adoption of healthy lifestyle changes. This is relevant to translation into a person-centered model of care. This would permit exercise regimens to be tailored to a person’s inclinations, potentially improving adherence.

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