Exploring the effectiveness of physical activity interventions in women with previous gestational diabetes: A systematic review of quantitative and qualitative studies

Abstract

Women with previous Gestational Diabetes Mellitus (GDM) have seven times the risk of Type 2 diabetes later in life compared to women without GDM. Physical activity can reduce this risk and most women with previous GDM are not physically active. Aims To explore: (1) effectiveness of physical activity interventions for women with previous GDM; (2) factors that women with previous GDM perceive influence their physical activity; (3) how these factors are addressed by the interventions. Methods A systematic review of quantitative (aim 1) and qualitative (aim 2) studies with a mixed-methods synthesis (aim 3) was conducted in October 2017 following Cochrane methodology. Of 8101 articles identified, twenty-eight studies were included in total: 18 in Review 1 and 10 in Review 2. Results Four interventions significantly increased physical activity and 14 had either mixed effectiveness or no changes in physical activity. Reporting of intervention components and study quality varied greatly. Relevant qualitative factors included accounting for childcare issues, social support and cultural sensitivities. Interventions that incorporated these factors were associated with effectiveness. Education about how to reduce future risk of Type 2 diabetes and using pedometers in interventions were not associated with intervention effectiveness. Other factors that future interventions should address consist of ‘putting others before yourself’; ‘putting off lifestyle change’; ‘lack of support from healthcare professionals’ and ‘being a healthy role model for families’. Conclusion Combining the results of qualitative and quantitative studies can provide a nuanced understanding of the effectiveness of physical activity and lifestyle interventions.

Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

“…Because of the strong influence of the family on women's lifestyle choices and the reliance on family for social support, lifestyle interventions for postpartum women should take a family‐focused approach 49,64 . Considering that the child's health and well‐being is a priority for postpartum mothers, proposing the need to be role models for their children may be an effective strategy to facilitate long‐term lifestyle change 17,65 . Changes at the community and policy level such as provision of childcare at exercise facilities and safe walking paths for mothers with pram may also be effective in promoting physical activity 66…”

Beliefs, Benefits and Barriers Associated with Physical Activity: Impact of These Factors on Physical Activity in Patients With Type II Diabetes Mellitus

“…positive beliefs about physical activity (Buelo et al, 2019). These issues deserve further research.…”

Protocol for a randomised controlled trial of a co-produced, complex, health promotion intervention for women with prior gestational diabetes and their families: the Face-it study

“…Gilbert et al argue that the integration of psychosocial wellbeing (e.g., social support) in interventions seeking to reduce the adverse impacts of GDM is important given the documented interaction with physical activity and dietary choice [62]. Likewise, in their recent systematic review, Buelo and colleagues highlight the importance of psychosocial factors, such as social and community support, and addressing everyday barriers (e.g., having time to exercise) for physical activity interventions for women with prior GDM to be effective [63]. Consequently, we expect the Face-it intervention to be a better 'fit' for the target group, increasing the likelihood of engagement and behaviour change compared to previous interventions.…”