A Perspective on A Perspective on ExerciseExercise20 year perspective and journey

Work in the late 1980s

A Perspective on A Perspective on ExerciseExerciseMy work at Sansum vs. my own two kids / pregnancies

Who is at risk?Training throughout pregnancy◦Just “who” can really exercise?

Monitoring in all three trimesters

Modifying workloads – applying real exercise standards to the pregnancy population

GDM in the GDM in the NewsNews

GDM in the GDM in the NewsNews

More than 250,000 women who give birth have diabetes

Harms developing baby – but increases risk of diabetes later in life

Costs are 55% higher for delivery in diabetic women

GDM in the GDM in the NewsNews

High BG numbers for fasting, post prandial, or OGTT now pose greater risks

Gaining weight in first trimester are at higher risk of GDM

Theme for this Theme for this presentationpresentation

What’s changed in exercise programming for pregnancy in general over the past 20 plus years?

How can we apply these types of programs to GDM prevention and therapy?

Goals for ExerciseGoals for ExerciseExercise through entire pregnancyManage glucose and stress hormone levels

Develop a safe weight training program with modifications

Stay with low impact aerobic training

Pilates and Yoga are gaining popularity

Post partum exercise – weight loss, depression, improved fitness, life style habits

Goals of ExerciseGoals of Exercise#1 – Regulate blood sugars – both acute (post exercise), and chronic (lower A1c)

#2 – Regulate body weight gain – good weight vs. excess fat

#3 – Maintain good blood flow – reduce edema, blood pressure increases, etc.

#4 – Maintain or improve lifestyle. Exercise sets the stage for health status of mother and baby

Exercise in the Exercise in the EquationEquationSo how do we integrate exercise into a pregnancy for women at risk for GDM that is safe, effective, and may cause a shift in lifestyle habits that would last after the baby is born?

Recent info on Exercise Recent info on Exercise and Pregnancyand Pregnancy

Amazon shows a lot of books on the subject – so the information is out there.

Exercise and GDMExercise and GDM Tieu, J. Dietary advice in pregnancy for preventing

GDM. Chochrane Database Syst. Rev. 2008.◦ Low GI diets improved baby birthweights◦ One trial used combination of standard exercise (?) with diet

◦ However – results in general were inconclusive deBarros, MC, et al. Resistance exercise and

glycemic control in women with GDM. AJOG – 2010◦ 21% of exercise vs. 56% required insulin, 80% of EX maintained BG levels throughout trial

Tobias, DK – PA before and during pregnancy and risk of GDM. Diabetes Care. 2010. ◦ Pre pregnancy PA in 34,900 participants – OR = .45 of highest / lowest categories. EX in early pregnancy in 4,400 women was protective OR = .76. PA assoc. with sig. reduction in GDM.

Clapp, JF. Effects of diet and exercise on insulin resistance in pregnancy. Met. Synd. Relat. Dis. 2006◦ Decrease in maternal and fetal weight◦ Lowers insulin resistance, lowers blood glucose

Current Info on Exercise and Current Info on Exercise and DiabetesDiabetesExercise must be important – as many web sites are including it as part of the “prevention” formula

Sam’s Club and Sam’s Club and PreventionPrevention What you get: For

$99, buyers of the program get an annual subscription to a web-based program that includes an at-home blood screening test that tracks an individual's cholesterol, blood sugar and hemoglobin levels.

Buyers also get access to a 24/7 nurse line, two health coaching sessions, recommended prevention screenings, schedule and alerts based on age, gender and risks and a physician summary that can be shown to a doctor.

Exercise and GDM Exercise and GDM PreventionPrevention1992 case study on the use of exercise and the prevention of GDM◦Diagnosed in first pregnancy – exercise to reduce symptoms

◦Exercise in first trimester of second pregnancy – less weight gain, higher fitness, and no GDM diagnosis at 24 weeks.

◦Compare first to second pregnancies – clear that exercise had effect on outcome

◦ Eric P. Durak, MSc, Lois Jovanovic, MD, Charles M. Peterson, MD. The Use of Exercise to Prevent Gestational Diabetes Mellitus: A Case Report. Sports Medicine, Training, & Rehab Journal. 3:230, 1992

Exercise and GDM for Exercise and GDM for TodayTodayWhat do we know about exercise and GDM today?Can we prevent diabetes through exercise?Can we prevent GDM through exercise

http://www.gestationaldiabetes.org/Treatment/exercise.html

http://www.livestrong.com/article/112764-exercise-gestational-diabetes/

Exercise in the EquationExercise in the EquationWhat’s missing?◦Comprehensive method of using exercise as part of prevention

◦Numbers are great – but using exercise systematically can reduce numbers even more

◦How can we construct the “perfect” exercise program that can improve on the prevention concept?

◦Who’s qualified to conduct exercise programs for “at risk” diabetic or pre-diabetic pregnant women?

Exercise in the Exercise in the EquationEquationCurrent thoughts on exercise for pregnancy◦Upper body ergometry is still a standard

◦Many types to chose in health club setting

Other forms of Other forms of ExerciseExerciseIn the Home◦Walking program◦Swimming◦Strength training and stretching

At work◦Walking / machine work

With friends◦Small group fitness program through pregnancy

An Exercise An Exercise PrescriptionPrescriptionExercising based on HR and PREExercising multiple times per dayTraining for BG controlTime of day to best exercise Biomechanics and balance issues Type of aerobic machineWeight lifting for pregnancy◦Functional performance training for two

An Exercise An Exercise PrescriptionPrescription

Times per week = 3-5◦Work up from 1-2 times at start◦May walk 2X per day for BG control◦Monitor BG levels post exercise

Training Type◦Breathing and imagery training (BG response)

◦Linear movement patterns (front/ back, side to side)

◦Light to moderate stretching Yoga programs Standing Pilates

Strength through Strength through PregnancyPregnancy

Weight lifting for pregnancy◦Functional performance training for two

◦Small muscle group exercise◦Sets and reps◦Rest period◦Hydration / rehydration◦Tubing, medicine ball, balance

◦ http://www.youtube.com/watch?v=mPzSniJZv4Y&feature=related - Exercise

◦ with Dr. Kathy

Strength in PregnancyStrength in PregnancyModifying range of motion in exercise (squat), and even picking up weights.

Strength in PregnancyStrength in PregnancyUse of rubber tubing training

Use of body weight exercises◦Wall push ups◦Body weight fitness ball squats

Yoga for PregnancyYoga for PregnancyOne of the best types of exercises for increased oxygen, range of motion, pain reduction, and relaxation

Yoga and PregnancyYoga and PregnancyWorking on range of motion while keeping a wide stance for balance

Pilates and PregnancyPilates and PregnancyPregnancy exercises for upper body strengthening that do not affect the abdominal area

Pilates and PregnancyPilates and PregnancyPost partum core training exercises

Pilates instructor KarenaLineback

ContraindicationsContraindicationsContraindication Solution

Toxemia / high blood pressure

Breathing exercises , stretches, ITP type exercise program

Ketones / excess proteins MD recommendations

Edema / pain in feet Water exercise / foot (general) massage

Low back pain / lordosis Posture exercises, stretches, Pilates training, massage

Joint laxity Water training, slow rhythmic exercises, walking program, aerobic machines

Cost of exercise Cost of exercise programprogram3 pairs of neopreme dumb bells ◦5 lb, 8 lb, 10 lb. $50-55.00

Yoga Mat $25.003 rubber tubing cords $18.0045-55 CM fitness ball $25.001-2 exercise videos$20.00

Good pair of shoes $55.00◦TOTAL $150-200.00

Is exercise part of the Is exercise part of the “standard of prenatal “standard of prenatal care”? care”? Referrals / information from doctors

Oncologists need a listing of qualified instructors from health clubs, Pilates studios, and private practice trainers

Work with physical therapist and pre natal nurses in terms of medical issues

Diet and GDMDiet and GDMWhat about diet – what is critical in terms of changing metabolism?

Movement to Ornish / vegetarian

ADA general recommendations for diet to manage diabetes

Hidden sugars – substitutes and HFCS

Facebook – diet and Facebook – diet and pregnancypregnancy

Holistic medicine and Holistic medicine and GDMGDMHolistic medicine – is there a place for GDM prevention?◦Stress reduction techniques

◦Use of pre-natal supplements

◦Organic foods

Self care – self Self care – self managementmanagement

How about self care – what can women do to improve their odds of prevention?

◦Daily food logs◦Visits to RD in first trimester

◦Develop a life-long exercise program

◦ Learning to avoid diabetes-related risks

Working with the Working with the Exercise CommunityExercise Community

What about the diabetes community – how can they incorporate exercise?       Work with local health clubs and YMCAs to provide programs

Computer based outcomes for glucose / body weight / A1c / lipids, etc.

Follow ups after pregnancy

Fitness for the long Fitness for the long haulhaulLong term health consequences of regular exercise◦Develop all exercise plans in first trimester

◦Have initial instruction and supervision as needed

◦Write down fitness and diabetes outcomes!

◦Monitoring of BG pre and post exercise – see trends over weeks (see graph next slide)

BG monitoring over BG monitoring over timetime

Future GDM and Future GDM and Wellness IssuesWellness IssuesFuture thoughts and action plan for exercise and GDM◦Health club referrals◦Bi-lingual education programs for exercise

◦Information packet / referral pad in OB-GYN offices

Questions ? ? ? ? ? ? Questions ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?