Diagnosis to Delivery: A Randomized Clinical Trial of Postmeal Walking in Women with Gestational Diabetes

Purpose: The aim of this study was to determine whether advice to perform postmeal walking could be an effective and feasible alternate to standard care continuous walking for the management of gestational diabetes (GDM). Methods: Forty women with GDM were randomized between 28 and 30 wk of gestation into either standard care (CTL; 30-min continuous walking, most days per week) or standard care with advice to PMW (daily 10-min walks after three main meals) for similar to 7 wk. The primary outcome for this randomized controlled trial was postprandial glucose assessed by continuous glucose monitors. Continuous glucose monitor and ActivPAL inclinometers (physical activity parameters) were each worn for 7 d at similar to 28 and similar to 35 wk gestation. Delivery outcomes were also collected. A linear mixed model compared the changes across time between groups. Results: Twenty-six women (PMW: n = 12, CTL: n = 14; age 34 +/- 5 y) completed the trial. Mean 3 h postprandial glucose at dinner was higher in the PMW versus CTL group at baseline and across the intervention (main effect group, P = 0.04). Twenty-four hours, nocturnal, and fasting glucose were similar between groups. The PMW group spent similar to 57 min.d(-1) more time sedentary and similar to 11 min.d(-1) less time stepping versus CTL (main effect group: P = 0.02 and 0.05). Adherence to the prescribed 30 min.d(-1) of physical activity was high, regardless of whether accumulated as 3 x 10-min or one single bout of walking. Conclusions: Distributing activity as 10-min bouts after main meals did not improve postprandial glucose outcomes compared with standard-care control. More research on the optimal duration and intensity of postmeal walks to improve postprandial responses are needed. Strategies that mitigate sedentary time and increase the minutes of physical activity accumulated across the day in pregnancy are also warranted.