Physical Exercise and Sports Research Group, Manuela Beltrán University, Bogotá, Colombia.
J Physiother. 2012;58(3):198. doi: 10.1016/S1836-9553(12)70112-1.
Does a 12-week exercise program prevent gestational diabetes and improve insulin resistance in healthy pregnant women with normal body mass index (BMI)?
Randomised, controlled trial with concealed allocation and blinded outcome assessment.
Two University hospitals in Norway.
White adult women with a single fetus. High-risk pregnancies or diseases that would interfere with participation were exclusion criteria. Randomisation of 855 participants allocated 429 to the exercise group and 426 to a control group.
Both groups received written advice on pelvic floor muscle exercises, diet, and lumbo-pelvic pain. In addition, the intervention group participated in a standardised group exercise program led by a physiotherapist, once a week for 12 weeks, between 20 and 36 weeks gestation. The program included 30-35 minutes low impact aerobics, 20-25 minutes of strength exercises using body weight as resistance and 5-10 minutes of stretching, breathing, and relaxation exercises. They were also encouraged to follow a 45-minute home exercise program at least twice a week. The control group received standard antenatal care and the customary information given by their midwife or general practitioner.
The primary outcomes were the prevalence of gestational diabetes, insulin resistance estimated by the homeostasis model assessment method (HOMA-IR), and fasting insulin and oral glucose tolerance tests at baseline and at the end of the training period. Fasting and 2-hour glucose levels were measured in serum by the routine methods. Gestational diabetes was diagnosed as fasting glucose level 2-hour value ≥7.8mmol/L. Secondary outcome measures were weight, BMI, and pregnancy complications and outcomes.
702 participants completed the study. At the end of the 12-week program, there was no difference in the prevalence of gestational diabetes (25 (7%) of intervention group compared with 18 (6%) of control group), HOMA-IR (-0.15, 95% CI -0.33 to 0.03), or oral glucose tolerance tests at 2 hours (-0.13mmol/L, 95% CI -0.28 to 0.03) between the groups. Fasting insulin was significantly lower in the intervention group by 1.0 international units/mL (95% CI -0.1 to -1.9). The groups did not differ significantly on any of the secondary outcomes. Adherence to the exercise protocol in the intervention group was 55%. A per protocol analysis of 217 women in the intervention group who adhered to the exercise program demonstrated similar results with no difference in prevalence of diabetes.
A 12-week exercise program undertaken during the second trimester of pregnancy did not reduce the prevalence of gestational diabetes in pregnant women with BMI in the normal range.
12 周的运动方案能否预防正常体重指数（BMI）的健康孕妇发生妊娠糖尿病并改善胰岛素抵抗？
随机对照试验，设隐匿分组，结果评估设盲。
挪威的两家大学医院。
白人单胎妊娠的成年女性。高风险妊娠或可能影响参与的疾病为排除标准。对 855 名参与者进行随机分组，429 人分入运动组，426 人分入对照组。
两组均接受书面的骨盆底肌肉运动、饮食和腰背疼痛建议。此外，干预组在妊娠 20-36 周时每周参加一次由物理治疗师主导的标准化小组运动，持续 12 周。方案包括 30-35 分钟低强度有氧运动、20-25 分钟使用体重作为阻力的力量练习，以及 5-10 分钟的伸展、呼吸和放松练习。还鼓励她们每周至少进行两次在家中进行 45 分钟的运动方案。对照组接受常规产前护理和常规的由助产士或全科医生提供的信息。
主要结局为妊娠糖尿病的发生率、用稳态模型评估法（HOMA-IR）估计的胰岛素抵抗，以及基线和训练期末的空腹胰岛素和口服葡萄糖耐量试验。用常规方法检测血清中的空腹和 2 小时血糖。诊断妊娠糖尿病的标准为空腹血糖水平 2 小时值≥7.8mmol/L。次要结局为体重、BMI 和妊娠并发症及结局。
702 名参与者完成了研究。在 12 周方案结束时，干预组的妊娠糖尿病发生率（25（7%）与对照组（18（6%））、HOMA-IR（-0.15，95%CI-0.33 至 0.03）或 2 小时口服葡萄糖耐量试验（-0.13mmol/L，95%CI-0.28 至 0.03）均无差异。干预组的空腹胰岛素水平显著降低 1.0 国际单位/毫升（95%CI-0.1 至-1.9）。两组在任何次要结局上均无显著差异。干预组的运动方案依从率为 55%。对 217 名遵守运动方案的干预组女性进行方案分析，结果类似，糖尿病发生率无差异。
在 BMI 处于正常范围内的孕妇妊娠中期进行 12 周的运动方案并未降低妊娠糖尿病的发生率。
