Table 2.
Description of the type of study, intervention, sample, results, conclusions, and year of the selected studies.
| Author—Year | Type of Study | Type of Intervention | Sample Size | Results | Conclusions | Quality |
|---|---|---|---|---|---|---|
| Sklempe et al., 2017 [31] | ECA Randomization method: it is based on the web in two groups (experimental and control) Place: 2 university hospitals in Zagreb (Croatia). Participants were not blinded. Laboratory personnel and doctors were blinded. |
EG: exercises twice a week → 50–55′ session + 30′ walking/day. 20′ aerobic activity (static tape with individualized intensity) + 20–25 resistance exercises (6 exercises in 3 sets of 10 to 15 repetitions with weight and elastic band) + pelvic exercises and stretching + 10’ relaxation. CG: standard care + unsupervised exercise. Program duration: 6 w minimum. Nutrition therapy for women with GDM at the beginning: 1800 kcal per day: 20% protein (90 g), 30% fat (60 g) and 50% carbohydrates (225 g), distributed in three main meals and three snacks. Postprandial and fasting glucose levels were measured 1 or 2 times a month during pregnancy. |
N = 38 (18 EG, 20 CG) Inclusion criteria: pregnant women with GDM between 20 and 40 years. Characteristics: age (EG: 32.78 ± 3.83; CG: 31.95 ± 4.91); upper limit gestational age (30 w); diabetic family history (EG: 7; CG: 8); gestational age of diagnosis (EG: 22.44 ± 6.55; CG: 20.80 ± 6.05); sedentary lifestyle (EG: 25.16 ± 13.2; CG: 24.36 ± 17.09) |
365 exercise sessions. Intensity exercise between 3 and 14 in the Borg rating. 4.42% of maximum heart rate. Walking compliance > 70%. Moderate physical activity and transport levels during the 30th to 36th week of pregnancy > EG. No pharmacological treatment. Average fasting glucose < EG (p = 0.367). Postprandial glucose < EG (p < 0.001) No differences in weight gain or fat mass between both groups. No significant correlation was found between glycemic parameters and the duration of the intervention, adherence to the protocol or the number of assisted exercise sessions. |
Aerobic exercises + resistance exercises → benefits for women with GDM. The EG had lower postprandial glucose levels at the end of pregnancy (p < 0.001). There was no significant difference between groups in the level of fasting glucose at the end of pregnancy. |
10/11 |
| Youngwanichsetha et al., 2014 [35] | ECA Randomization method: computer program and opaque envelopes. Place: tertiary hospital in southern Thailand. |
CG: standard diabetes care. EG: standard diabetes care+ diet+ yoga during 8 w. 2 exercise sessions of 50’. Measures: fasting, postprandial glucose, and HbcA1. |
180 (90 CG; 90 EG) Inclusion criteria: pregnant women with GDM between 24–30 w (no insulin). Pregnant women who have no more complications in their pregnancy. Characteristics: mean age 32.58 (SD = 5.01) CG; 31.24 (SD = 4.54) EG. Plasma glucose after 100g test CG = 89.18 (SD = 12.84) and EG = 89.36 (SD = 13.19). |
Fasting glucose average: EG: 83.39 mg/dL (SD = 17.69). CG: 85.85 mg/dL (SD = 17.94). (p = 0.012) Postprandial glucose average: EG: 105.67 mg/dL (SD = 12.93). CG: 112.36 mg/dL (SD = 13.15). (p = 0.001) HbA1C average: EG: 5.23% (SD = 0.72). CG: 5.68% (SD = 0.68). (p = 0.038) EG < fasting, postprandial glucose, and HbcA1. |
The exercise intervention program is effective in improving glycemic control. | 10/11 |
| Bo et al., 2014 [32] | ECA Randomization method: web (www.epiclin.it) Place: hospital Sant’Anna (Torino) |
Multiple interventions: GD, GB, GBE, GE Diet: carbohydrates 48–50%; protein 18–20%; fat 30–35%; fiber 20–25 g/day, not alcohol. GD → diet. GB: diet + behavior→oral or written recommendations. GBE: diet +exercise → walk 20’/da slightly. GE2: diet +recommendations + exercise → walk 20’ vigorously every day + group b recommendations. Duration: until the end of pregnancy (approx. 16 w). |
400 participants Inclusion criteria: pregnant women with GDM between 18–50 years and 24–26 w of gestation. |
Weight, BMI, insulin, and dietary values (triglycerides and CPR concentration) → < in all groups. Postprandial glucose (p < 0.001) and HbA1c (p < 0.001) → < in the E/BE groups. Groups that do exercise (n = 101): Fasting glucose: 72.4 ± 10.3. Postprandial glucose: 106.1 ± 19.0. HbAc1: 4.6 ± 0.5. Groups that do not exercise (n = 99): Fasting glucose: 74.1 ± 10.7 Postprandial glucose: 117.2 ± 16.5 HbAc1: 4.9 ± 0.4. Groups that do exercise + diet + not recommendations (n = 101): Fasting glucose: 73.3 ± 10.1 Postprandial glucose: 113.0 ± 20.0 HbAc1: 4.8 ± 0.5 Groups that do exercise + diet + recommendations (n = 99): Fasting glucose: 73.2 ± 11.0 Postprandial glucose: 110.2 ± 17.1 HbAc1: 4.8 ± 0.4 |
Exercise → ↓ postprandial glucose, triglycerides and CRP concentrations. Exercise + recommendations→ no significance (p > 0.3). Group D → > maternal/neonatal complications. Exercise + diet → ↓ maternal/neonatal complications. Recommendations or recommendations + exercise→ no ↓ maternal/neonatal complications. |
10/11 |
| Halse et al., 2014 [36] | ECNA Place: King Edward Memorial Hospital, Perth, Western Australia |
Analyze fasting, postprandial glucose levels, HbA1c and glucose and insulin response to an oral glucose load of 75 g. Conventional care based on glycemic control 2 h after breakfast, lunch and dinner + educator advice + dietitian + food and beverage daily in the 1st and last. GE → 3 sessions of supervised exercise (exercise bike at home: 5’ low intensity 55-65% warm-up + 20–30’ pedalling of > intensity with intervals between 15–60’ higher intensity every 2’. The intensity was individualized for each woman The duration of the session was increased up to 45’ in the last + 5–10’ of low intensity and gentle stretching) + 2 sessions without the supervision of 30’ until s 34 + conventional care. Supervision: TA, pre and post-exercise glucose and intake of the last meal before exercise. GC→ 35 ± 8, → walking (52%), exercise bike (40%), water exercise (5%) and yoga (3%) + conventional care. |
40 participants (20 EG; 20 CG) Inclusion criteria: women with GDM, between 26–30 w of gestation, who had had an exploration of the normal anatomy in w 18, with a BMI < 45, non-smokers and not enrolled in any exercise program and who could perform physical activity. Characteristics: age (32 ± 3 → CG; 34 ± 5 → EG). |
W 34 → glucose measurement and insulin response at 30, 60, 90, 120’ fasting according to GTT, HbcA1, physical activity level and nutritional status. EG → glucose response to exercise was 6.3 ± 08.mM pre-exercise at 4.9 ± 0.7mM post-exercise (p < 0.001). 62% of participants → capillary glucose was 1.0 mM pre to post. Half cc fasting blood glucose EG → more than the CG (p = 0.083) → No significance. CC postprandial glucose < in EG than in CG (p = 0.046). Glucose after breakfast < EG (p = 0.036); dinner (p = 0.054); lunch (p = 0.312) Post-intervention glucose not significant differences between EG and CG, insulin response CG (4.2 ± 2.3) and EG (5.0 ± 3.0) →(p > 0.05). HbcA1 → % > in post-intervention values in CG than in EG (p = 0.012) compared with pre-intervention values, without differences between groups (p > 0.05). Physical activity → EG > number of hours/w vs. CG. Feeding → CG > protein intake in the 1st s (p = 0.033) and last w (p = 0.009). HC > intake in EG in the last w (p = 0.035). |
Cycling at home helps control postprandial glucose levels in women with GDM along with a proper diet. Supervision helps > adherence to exercise and change the lifestyle of these women. + research with + population and + exercise variety |
8/11 |
| De Barros et al., 2010 [33] |
ECA Randomization method: web and opaque envelopes. Place: obstetric clinic, the university hospital of Sao Paulo (Brazil). |
Diet: 7 servings → 35 cal/Kg per day + 300 Kcal/day in the day 2nd and 3rd quarter. CG → usual care. EG → wait for 90’ after eating and perform blood glucose. Exercise: resistance circuit of 8 exercises with an elastic band with 15 repetitions each exercise with a minimum of 30’ of rest and a maximum of 1’. 2nd quarter → 2 series of the circuit and 3rd quarter → 3 series. 3 times in w (1 under supervision). Moderate Intensity Glycemic profile every w. Insulin if > 30% glucose measurements > recommended value, hyperglycemia or baby weight > 75th percentile. |
64 participants (32 CG; 32 EG) Inclusion criteria: women with GDM, non-smokers, sedentary between 18–45 years, without the disease, gestational age between 24–34 w. Characteristics: age CG → 32.4 ± 5.40; EG → 31.81 ± 4.87. |
Insulin requirement: CG → 18 (56,3%) EG→ 7 (21.9%) Amount of insulin required IU/kg: CG → 0.49 ± 0.14 EG → 0.44 ± 0.11 Average glucose levels: CG → 102.89 ± 7.88 EG→ 100.30 ± 9.37 |
The resistenace exercise program with elastic band was effective in reducing the number of patients requiring insulin and to control glucose levels in women with GDM | 11/11 |
| Davenport et al., 2008 [34] |
Case-control study Place: London. |
2 groups were established: CG: conventional treatment: nutritionist advice every 2 w. Objectives: 2000 Kcal/day. 200 g CH in 3 meals and 3 drinks + glucose measurement + regular monitoring with your doctor. EG: hike (3–4 times at w increasing from 2’ to reach 40’ the last w. Duration: 6 w) + conventional treatment. Inclusion criteria: women with GDM, without pathology in pregnancy, and with follow-up from their doctor. |
30 women → 10 EG and 20 CG. Characteristics: age → CG: 33.3 ± 5.3; EG: 33.48 ± 7.1. BMI before pregnancy → CG: 32.8 ± 5.9; EG: 32.92 ± 7.1.; Weight gained during pregnancy → CG: 12.7 ± 8.4. EG: 12.0 ± 9.7 |
Participants that require insulin: CG: 70%. EG: 70%. Glucose values at treatment: EG: < at the end of pregnancy tan the CG. CG capillary glucose 1 h after dinner increased at the end of the arm compared to the beginning. Amount of insulin: EG: 0.16 ± 0.13 U/kg → required less frequently. CG: 0.5 ± 0.37 U/kg. |
Glucose concentration can be improved, as well as reducing the amount and frequency of insulin injection in women with GDM who walk. | 7/9 |
| Daniel et al., 2014 [37] | ECA Randomization method: random assignment to the GE/GC. Place: Owerri, Nigeria. |
EG: dance exercises for 8 w. Warm-up (low-intensity aerobic exercises) and 5–10’ stretching + Dance: 10–20’ cardio-respiratory exercises (low-moderate intensity) such as fast walking. The duration increased from 40 to 60’ after 4 w + strengthening exercises (pelvic floor and abdominal muscle exercise)+ stretching and cooling 5–10’. CG: no exercise program. Fasting glucose level at the beginning. 4 and 8 w. |
30 participants (15 EG; 15 CG) Inclusion criteria: women with > 24 w of gestation diagnosed with GDM suitable for exercise. Charactristics: age → EG 32 ± 3.42; CG 32.93 ± 4.61. Gestational age (weeks) → EG: 26.8 ± 0.94; CG 26.33 ± 0.98. |
Fasting glucose: Start: EG(144.53; SD: 6.96); CG (145.07; SD: 8.19), (p = 0.85). S 4: EG (118.63; SD:10.73); CG (142.73; SD: 6.96) (p = 0.001) S 8: EG (87.67; SD: 11.84); CG (141.53; SD: 6.82) (p = 0.001) |
Significant effect of the exercise program. Exercises 3 times per w between 40–60’ per session at moderate intensity reduces blood glucose. |
8/11 |
RCT: randomized controlled study; w: week; GDM: gestational diabetes mellitus; EG: experimental group; CG: control group; BMI: body mass index; CRP: c-reactive protein; ECNA: non-randomized controlled study; GTT: glucose tolerance test; tto: treatment; cc: concentration; n: number; HbcA1: glycosylated haemoglobin; SD: standard deviation; p: a measure of statistical significance; g: grams; GD: group D; GB: group B; GBE: BE group; GE2: group E; <: minor; >: major; ′: minute; HC: carbohydrate.