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Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations

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Abstract

Objective

Τo summarize and present the main guidelines for exercise during normal pregnancy and pregnancy complicated by gestational diabetes mellitus (GDM).

Methods

Relevant guidelines were retrieved through the electronic databases PubMed (MEDLINE), CENTRAL (Cochrane), and Embase; reference sections of the retrieved publications; proceedings of the main congresses in the field; and websites of relevant organizations published during the years 2000–2018.

Results

All guidelines recommend aerobic training from 60 to 150 min/week, with an upper limit of 30 min/day. Exercise is safe, even on a daily basis. Resistance exercise is suggested by five national guidelines (Australia, Canada, Denmark, Norway, and the UK). Discrepancies exist regarding the recommended intensity of exercise. Canada, Japan, Spain, and the UK use both objective (heart rate and maximum oxygen consumption) and subjective criteria (Borg’s Scale and talk test) to determine the effectiveness and safety of exercise. Only Canada provides specific recommendations, according to the woman’s age and level of physical condition. Women with GDM on no insulin treatment do not need to take extra precautions during exercise. However, due to their condition of hyperglycemia, they must comply with the recommendation issued for type 2 diabetes. The prescription and supervision of exercise should be carried out in a similar way as for uncomplicated pregnancies. Finally, women with GDM on insulin treatment need to follow the same recommendations as for those for pregnant women with type 1 diabetes.

Conclusion

Health professionals must be informed about the correct planning and execution of physical exercise programs so as to safely achieve the maximum effectiveness of exercise-induced health-related benefits in pregnant women.

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Abbreviations

ACOG:

American College of Obstetricians and Gynecologists

ACSM:

American College of Sport Medicine

ADA :

American Diabetes Association

APSS:

Adult Pre-Exercise Screening System

BMI:

Body mass index

bpm:

Beats per minute

CSEP:

Canadian Society for Exercise Physiology

ESSA:

Exercise and Sport Science Australia

FITT:

Frequency (F), intensity (I), time (T), and type (T)

GDM:

Gestation diabetes mellitus

GLUT4:

Glucose transporter type 4

HRR:

Heart rate reserve

MET:

Metabolic equivalent of task

NELIP:

Nutrition and Exercise Lifestyle Intervention Program

PARmed-x:

Physical Activity Readiness Medical Examination

SOGC:

Society of Obstetricians and Gynecologists of Canada

VO2max :

Maximum consumption of oxygen

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Authors and Affiliations

  1. School of Physical Education and Sports Science, Democritus University of Thrace, 69100, Komotini, Greece

    Dimitra Savvaki, Helen Douda & Savvas P. Tokmakidis

  2. Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Dimitra Savvaki, Eleftheria Taousani, Dimitrios G. Goulis, Efrosini Tsirou & Evangelia Voziki

  3. Department of Midwifery, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece

    Eleftheria Taousani

  4. Physiology Laboratory, Medical School, Democritus University of Thrace, Alexandroupolis, Greece

    Nikolaos Nikolettos

Authors
  1. Dimitra Savvaki
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  2. Eleftheria Taousani
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  3. Dimitrios G. Goulis
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  4. Efrosini Tsirou
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  5. Evangelia Voziki
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  6. Helen Douda
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  8. Savvas P. Tokmakidis
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Contributions

D.S. wrote the first draft and edited the manuscript; E.Ta. wrote up the precautions required before initiation of an exercise program; D.G.G. (Endocrinology - Gestational diabetes), E.Ts. (Diet - Gestational diabetes), and S.T. (Clinical Ergophysiology and Exercise) made significant contributions in their areas of expertise and edited the first draft. E.V., H.D., and N.N. edited and revised the manuscript for the intellectual content.

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Correspondence to Dimitra Savvaki.

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Savvaki, D., Taousani, E., Goulis, D.G. et al. Guidelines for exercise during normal pregnancy and gestational diabetes: a review of international recommendations. Hormones 17, 521–529 (2018). https://doi.org/10.1007/s42000-018-0085-6

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