A sample program would include a mid morning walk of 1 to 1.5 miles with a couple "up hill" challenges. An afternoon walk would include a pre-planned route that also included some small hills, but that is not too congested with traffic.

Walking at the local track will offer women a planned distance, as all tracks are a quarter mile in length. They also have soft surfaces for shock absorption, and usually are not crowded until track practice at 3-4 p.m.

Walking with a partner (perhaps one who is also pregnant) may help in keeping motivation levels high during pregnancy. With a diagnosis of GDM, and a growing belly, many women feel that they are to big to begin with, let alone trying to keep up with those who may not wish to keep their pace.

Good walking shoes are a must. Many women gain enough weight in the second trimester to warrant purchase of a new pair. This may help in case there are any minor swelling problems in the feet, and newer shoes are more stable. To date, there is not specific shoe for pregnancy, but there may be a market for them, with the advent of the new "baby boom".

One aspect of good diabetes control is that of self-blood sugar monitoring, as highlighted above. Self monitoring lets any diabetic person know where their sugar levels are at any time of the day. In exercise, it sets the limits of conditioning, as higher levels may dictate more prolonged exercise programs to "burn off" more sugar, and lower levels may dictate the ingestion of a carbohydrate to prevent hypoglycemia (low blood sugar) reactions after exercise has finished. None the less, having a home monitor (usually reimbursed by insurance upon physician prescription) plays an important part of the diabetic exercise regimen, and should be used by any GDM women who wishes to perform walking programs (or any exercise) to keep in good metabolic control during her pregnancy.

It should always be remembered that any exercise program should be built up in terms of intensity and duration, including walking. There are many women who would not think of walking for 30 minutes two or three times a day, because of swelling, morning sickness, backache, or headaches. Consultation with your obstetrician should provide proper guidelines for any medical considerations needed to perform exercise safely, and within individual limits.

Then, working with an instructor, or on your own, exercise up to your perceived limits, and stay in those limits as you build endurance over a couple of weeks. It is possible to increase fitness levels during pregnancy, if they are done systematically. Walk for 5 minutes as a brisk pace, and gradually increase. If the goal is blood sugar control, compare walking times with post walking sugar checks. Over time there should be a consistent pattern.

Summary
Exercise not only has been touted as a good therapeutic treatment for diabetes, but recent epidemiology studies also shows a strong association between exercises levels, and the reduction of diabetes in general. This is known as primary prevention. Those persons who exercised the most had the least occurrence of the disease. This types of studies have given tremendous support to the advent of exercise in the diabetic population.

One case report highlighted a previously diagnosed GDM women in her first pregnancy who exercised throughout her second. The glucose tolerance test was normal - essentially preventing the occurrence of the disease in the second pregnancy. These are powerful reasons for pregnant women to inquire about exercise, and for doctors to prescribe it more often.