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The purpose of this study was to determine whether postmeal walking (breaking up exercise into short bouts after meals) is an effective and feasible alternate to continuous walking for the management of gestational diabetes. Forty-one women with gestational diabetes were randomised between wk 28-30 gestation to either standard-care (30-min continuous exercise) or standard-care with postmeal walking (10-min of walking after breakfast, lunch and dinner). Continuous glucose and activity monitors were worn to measure glycaemic control and adherence during three-days of standard-care (baseline) followed by three-days of postmeal or continuous walking. A linear mixed model analysed the changes from baseline between postmeal and continuous walking, as an average of the three-day periods. Thirty-two women (postmeal walking n=17: control n=15, 33±5 y, body mass index 25±4 kg.m2) completed the trial. Postprandial and overnight glucose concentrations were similar between postmeal walking and control, both interventions improved from baseline. There was no difference in adherence between groups, however postmeal walking completed more minutes of prescribed physical activity across baseline and intervention days compared to the continuous walking standard-care group. Preliminary findings from this proof-of-concept study suggest postmeal walking could be a promising alternative to, and work interchangeably with, traditional advice to perform continuous moderate-intensity physical activity, in women with gestational diabetes. Novelty bullets -Three ten-minute postmeal walks may be comparable to thirty minutes continuous walking for glucose control in women with gestational diabetes - Accumulating activity in short bouts after meals is a feasible alternate to continuous exercise for women with gestational diabetes

Background: Gestational diabetes mellitus (GDM) affects approximately one in six pregnancies, causing a significant burden on maternal and infant health. Lifestyle interventions are first-line therapies to manage blood glucose levels (BGLs) and prevent future cardiometabolic complications. However, women with GDM experience considerable barriers to lifestyle interventions; thus, the aim of this study was to determine how women with GDM manage their condition and to identify the primary supports and barriers to lifestyle intervention participation. Methods: An online cross-sectional survey of women in Australia with a history of GDM was conducted. Questions included participant demographics, strategies used to manage BGLs, physical activity and dietary habits, and barriers and supports to lifestyle interventions. Results: A total of 665 individuals consented and responded to the advertisement, of which 564 were eligible and provided partial or complete responses to the survey questions. Most respondents were between 35 and 39 years of age (35.5%), not pregnant (75.4%), working part-time (26.7%), university-educated (58.0%), and had only one child (40.1%). Most respondents managed their BGLs through diet (88.3%), with “low-carbohydrate” diets being the most popular (72.3%), and 46.2% of respondents were undertaking insulin therapy. Only 42.2% and 19.8% of respondents reported meeting the aerobic and strengthening exercise recommendations, respectively. Women with one child or currently pregnant expecting their first child were 1.51 times more likely (95% CI, 1.02, 2.25) to meet the aerobic exercise recommendations than those with two or more children. The most common reported barriers to lifestyle intervention participation were “lack of time” (71.4%) and “childcare” commitments (57.7%). Lifestyle interventions delivered between 6 and 12 months postpartum (59.0%), involving an exercise program (82.6%), and delivered one-on-one were the most popular (64.9%). Conclusion: Most women report managing their GDM with lifestyle strategies. The most common strategies reported involve approaches not currently included in the clinical practice guidelines such as reducing carbohydrate consumption. Furthermore, despite being willing to participate in lifestyle interventions, respondents report significant barriers, including lack of time and childcare commitments, whereas mentioned supports included having an online format. Lifestyle interventions for women with a history of GDM should be designed in a manner that is both tailored to the individual and considerate of existing barriers and supports to participation.