Glucose lowering effect Of walking breaks in pregnancy study

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The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide, with current Australian prevalence rates estimated to be between 13-16%. The primary goal of GDM management is to prevent hyperglycaemia, as there is a clear dose-dependent relationship between increased plasma glucose levels during pregnancy and adverse outcomes for both the mother and child. Compliance rates for exercise intervention trials in pregnant women are generally poor (reporting adherence as low as 16-55%). Furthermore, the majority of pregnant women do not reach the recommended levels of physical activity; and overall physical activity levels tend to decrease throughout pregnancy (particularly in caregiving, outdoor, household and recreational activities). The lack of adherence to an exercise regime could be due to feelings of tiredness and increasing immobility as pregnancy progresses, which would limit the ability or motivation for women to maintain exercise efforts for more than 10 min at a time, particularly for women who are not normally active. In light of the fact that brief (2-3 minutes), regular (every 20-30 minutes), light ambulatory activities have been demonstrated to be effective in improving postprandial glucose control in overweight/obese and T2D patients, consideration of the “breaks in sitting” approach may be appropriate for women at risk for or diagnosed with GDM. Given that post-challenge glucose is considered a surrogate for postprandial glycaemia, there is value in examining the effect of breaking up sitting in the context of routine screening for GDM. Based on past studies done within our laboratory, we anticipate that breaking up sitting will lower postprandial glucose responses compared to prolonged sitting without breaks, and may even prevent levels from entering the GDM range. The results of this trial will help inform the design and development of a larger, chronic study looking at breaking up sitting to improve pregnancy outcomes for mothers and offspring. Hypothesis: We hypothesise that regular, light intensity ambulatory breaks in sitting (2 minutes every 20 minutes) will lower post-OGTT glucose and insulin responses in women at risk for developing GDM, compared to sitting-only control. Study Design: A cross-over trial, involving women at risk of GDM, of two laboratory-based interventions undertaken during a standard 75g oral glucose tolerance test. Outcomes: Primary outcomes – postprandial glycaemic response calculated as the incremental area under the curve (iAUC) from half hourly blood sampling over a 4 hour period. Secondary outcomes – postprandial insulin response calculated as iAUC and mean blood pressure.

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