Randomized Face-to-Face vs. Home Exercise Interventions in Pregnant Women with Gestational Diabetes

Abstract

Objectives: Evaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM).

Design: Randomized control trial with two intervention arms and control (standard care).

Method: Participants (N=65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ~20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records.

Results: At the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p's < .05) and significantly higher exercise min and subjective norm than the Home group (p's < .05); these effect sizes were medium-large (η² = .11-.23). There was a medium effect (η² = .13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups.

Conclusion: A theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.

Figure 1

Flow of participants through the study. Face-to-Face = semi-intensive, face-to-face structured exercise program; Home = minimum-contact, home-based exercise program; GDM = gestational diabetes mellitus; Completed = completed protocol and 32-week follow-up assessment.

Figure 2

Mean fasting and postprandial blood glucose levels (mg/dL) for each group at 20, 24, 28, 32, and 36 weeks gestation. Differences were tested using repeated measures ANOVA and follow-up ANCOVAs controlling for 20 week levels. F2F = Face-to-Face; ^a = F2F group has significantly lower mean weekly postprandial blood glucose levels than controls at 36 weeks gestation.