Can Walking Help Manage High Blood Sugar During Pregnancy?

Summary:

In pregnant individuals diagnosed with hyperglycemia during pregnancy (N=20) enrolled in a randomized controlled pilot trial, a 5-week behavioral physical activity intervention focusing on unsupervised walking or stepping delivered remotely via weekly 10-20 minute coaching sessions significantly maintained self-reported moderate-intensity physical activity levels (walking/running: +0.22 MET h/week vs -0.70 in controls) with promising improvements in neonatal birthweight-for-gestational age and subscapular skinfold compared to a general wellness control group receiving remote counseling without physical activity, diet, or metabolism guidance, though it was associated with no adverse events and excellent participant ratings (100% rating as excellent or very good).

Clinical Context

Gestational diabetes and pregnancy hyperglycemia affect approximately 15-20% of pregnancies and are associated with adverse outcomes for both mother and infant, including macrosomia, birth complications, and long-term metabolic programming effects. Physical activity is a cornerstone of gestational diabetes management, improving insulin sensitivity and glucose control while reducing excessive weight gain and neonatal adiposity.

However, physical activity typically declines during pregnancy, particularly in the third trimester, due to physical discomfort, fatigue, and perceived safety concerns. Women with gestational diabetes face additional barriers including medical appointments consuming time and energy, and uncertainty about appropriate exercise intensity. Behavioral interventions that support activity maintenance could provide substantial benefit.

This pilot trial tested a pragmatic, scalable approach: brief weekly remote coaching focused on walking—the most accessible form of exercise—delivered via phone or video. The remote delivery model addresses access barriers and may be particularly relevant given increasing telehealth adoption. The 5-week duration targets the critical late-pregnancy period when activity decline is most pronounced.

Clinical Pearls

1. Intervention Prevented Activity Decline: While the control group showed typical late-pregnancy activity decline (-0.70 MET h/week), the intervention group slightly increased activity (+0.22 MET h/week). Maintaining activity levels when the natural trajectory is decline represents meaningful behavioral change.

2. High Acceptability Supports Feasibility: 100% of participants rated the intervention as excellent or very good, indicating the coaching approach, session duration, and remote delivery format were well-received. High acceptability is essential for real-world implementation and suggests the intervention could be scaled.

3. Promising Neonatal Outcomes: Improvements in birthweight-for-gestational-age Z-score and subscapular skinfold (a measure of neonatal adiposity) suggest potential benefits for offspring metabolic health. While the pilot study was not powered for clinical outcomes, these signals are encouraging for larger trials.

4. Brief Coaching Is Sufficient: The 10-20 minute weekly sessions represent minimal resource investment while achieving meaningful effects. This intensity is realistic for integration into routine prenatal care and could potentially be delivered by various trained personnel.

Practical Application

For pregnant patients with gestational diabetes or pregnancy hyperglycemia, consider implementing brief behavioral coaching focused on walking or stepping. The remote delivery format via phone or video fits into existing telehealth infrastructure and accommodates patients’ busy schedules. Weekly check-ins of 10-20 minutes provide accountability without excessive burden.

Key coaching elements likely include goal-setting for daily steps or walking duration, problem-solving barriers (timing, comfort, safety concerns), self-monitoring with pedometers or smartphone apps, and progressive adjustment based on pregnancy stage and symptoms. Emphasize that the goal is maintaining activity rather than increasing intensity.

Reassure patients that walking is safe and beneficial during pregnancy with hyperglycemia, assuming no obstetric contraindications. Address common concerns about exercise safety, and provide guidance on warning signs that should prompt stopping and seeking evaluation. Coordinate with obstetric providers to ensure consistent messaging.

Broader Evidence Context

This pilot adds to evidence supporting physical activity interventions in gestational diabetes. Meta-analyses have demonstrated that exercise improves glycemic control and reduces insulin requirements in gestational diabetes, though many studies tested supervised exercise programs that are difficult to implement at scale. The remote, unsupervised walking-focused approach tested here offers a more pragmatic model.

Current gestational diabetes guidelines recommend regular physical activity but often lack specific implementation guidance. Studies like this help translate general recommendations into actionable intervention protocols that can be tested and refined.

Study Limitations

Small pilot sample (N=20) limits statistical power and generalizability. Self-reported physical activity may be subject to recall bias and social desirability effects. The 5-week intervention period may not capture effects on delivery outcomes or long-term behavior. The control group received active wellness counseling, making this a conservative comparison. Specific glycemic outcomes were not detailed in the summary.

Bottom Line

A brief, remotely delivered behavioral walking intervention successfully prevents the typical late-pregnancy decline in physical activity among individuals with pregnancy hyperglycemia, showing excellent acceptability and promising effects on neonatal body composition, supporting further testing of this scalable approach.

Source: Ehrlich, Samantha F., et al. “A Randomized Controlled Pilot Trial of a Behavioral Physical Activity Intervention for Pregnancy Hyperglycemia.” Read article