(132) A Randomized Controlled Trial of Postprandial Ambulation Among Individuals with Gestational Diabetes Mellitus

While low to moderate intensity exercise is recommended for the management of Gestational Diabetes Mellitus (GDM), the optimal timing of exercise in relation to eating remains debated. This study aimed to investigate glycemic, obstetric and neonatal outcomes of timed ambulation in the 2-hour postprandial period compared to unscheduled ambulation.


Study Design:
A single-center RCT was conducted from Oct 2022 to Oct 2024. Individuals with newly diagnosed GDM were recruited from a tertiary maternal center. After written informed consent was obtained, participants were randomized to guided counseling for either 1) postprandial ambulation (walk for 15-20 minutes within 2 hours of 2 meals a day) or 2) unscheduled 30-40 minutes once a day (routine counseling). Participants were instructed to wear a study-provided Fitbit Inspire activity monitor during all waking hours until delivery. Demographic characteristics, medical history, and pregnancy management and outcomes were abstracted from the medical chart. We estimated that 46 participants will provide 80% power to detect a 15% difference in the primary outcome of neonatal birthweight percentile.

Results:
A total of 46 individuals were enrolled with 23 randomized to postprandial ambulation. Characteristics of the study sample are described in Table 1. Compliance with Fitbit monitor usage was similar between groups. There was no significant difference in the primary outcome of neonatal birthweight percentile with routine counseling compared to postprandial ambulation counseling (49.7% vs 53.7%, p=0.69). Similarly, there were no differences in other measures of glycemic control, obstetric or neonatal outcomes (Table 2).

Conclusion:
In this pilot, receiving counseling to ambulate within 2 hours after meals compared to unscheduled ambulation did not significantly affect glycemic, obstetric, and neonatal outcomes among individuals with GDM. Further study is needed to determine whether the lack of observed effects reflects limited adherence or a true absence of benefit from postprandial ambulation timing.