Dharshini Chittybabu
KMCH College of Physiotherapy, Coimbatore, Tamil nadu, India
Abstract Title:
Gestational Diabetes Mellitus: Bridging The Gap Between Prescription And Practice
Research Interests:
Gestational Diabetes Mellitus (GDM) is a condition where glucose intolerance is first recognized during pregnancy. It usually develops in the 2nd or 3rd trimester due to hormonal changes causing insulin resistance.
Why Physiotherapy is Important in GDM
Physiotherapy plays a major non-pharmacological role in managing GDM by improving insulin sensitivity and overall maternal health.
Key Benefits
• Improves glucose uptake by muscles
• Reduces insulin resistance
• Controls excess weight gain
• Improves circulation and cardiovascular fitness
• Reduces risk of:
o Macrosomia (large baby)
o Pre-eclampsia
o Cesarean delivery
EXERCISE PRESCRIPTION:
Parameter Recommendation
Start time After medical clearance
Best time After meals (improves postprandial glucose)
Position Avoid prolonged supine (after 1st trimester)
Hydration Maintain adequate fluid intake
Monitoring Watch for dizziness, pain, contractions
Core Framework of an Adherence-Based Model
1. Behavioral Foundation (Theory-Driven)
Use established behavior models:
• Health Belief Model
• Social Cognitive Theory
• Transtheoretical Model
Patient-Centered Exercise Prescription
Instead of rigid protocols:
• Customize based on:
o Trimester
o BMI
o Glucose levels
o Lifestyle (urban vs rural)
Example:
• Sedentary patient → start with 10 min walking
• Active patient → progress to combined aerobic + resistance
Adherence Enhancement Strategies
A. Education + Counseling
• Explain “why exercise works” in simple terms
• Use fetal benefit as motivation (very effective in GDM)
Goal Setting (SMART Goals)
• Specific: “Walk 20 min after lunch”
• Measurable: 5 days/week
• Achievable & realistic
C. Self-Monitoring
• Exercise diary
• Step counter / mobile apps
Useful apps:
• Google Fit
• MyFitnessPal
D. Supervision Model
• Hybrid approach works best:
o 1–2 supervised sessions/week
o Home program for rest
E. Social Support
• Family involvement (important in Indian context)
• Group antenatal exercise classes
F. Motivational Interviewing
• Address fear: “Is exercise safe?”
• Reinforce small wins
• Avoid authoritative tone → collaborative approach
Outcome Measures
Maternal:
• Fasting blood glucose
• HbA1c
• Weight gain
Fetal:
• Birth weight
• APGAR score
Behavioral:
• Adherence %
• Dropout rate
