Exercise Lowers Risk for Type 2 Diabetes in Women With a History of Gestational Diabetes

Written by J. Michael Gonzalez-Campoy, MD, PhD, FACE, Kristin Della Volpe

It is well known that women who have gestational diabetes are at higher risk for developing type 2 diabetes later in life. Now, new research suggests that these women can lower their risk for diabetes by increasing their physical activity level.

“Findings from our study implicate a hopeful message to women with a history of gestational diabetes: although they are at exceptionally high risk for type 2 diabetes, promoting an active lifestyle may lower the risk. Don't give up,” said senior author of the study Cuilin Zhang MD, PhD, Investigator, Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health, Rockville, MD.

This study documents the power of regular physical activity in maintaining health and preventing disease. The study appears in the Journal of the American Medical Association (JAMA) Internal Medicine.

Gestational diabetes mellitus (GDM) is a recognized risk factor for the development of type 2 diabetes later in life.  So are overweight and obesity. This study documents that in women with a past history of GDM, increasing screen time is associated with a higher risk of progression to diabetes. This is a reflection of a sedentary lifestyle, which promotes overweight and obesity. Conversely, increasing levels of physical activity lead to a lower risk of progression to diabetes for women with a past history of GDM.

Study Design

The researchers examined data from 4,554 women with a history of gestational diabetes who were enrolled in a large study known as the Nurses’ Health Study II. The study began in 1989 and is ongoing. Overall, 635 of these women developed type 2 diabetes.

The study showed that 100 minutes per week of moderate-intensity physical activity lowered the risk for type 2 diabetes by 9%. When women increased their activity to 150 minutes per week, they had a 47% lower risk of type 2 diabetes, regardless of their body mass index (a measure of body fat).

In contrast, the more television watched per week the greater the risk for diabetes, with a 28% increased risk with 6 to 10 hours, 41% increased risk with 11 to 20 hours, and 77% increased risk with 20 or more hours per week.

Simple Tips for Staying Active

Dr. Zhang recommended vigorous exercise if possible. For those women who are unable to do high levels of exercise, walking can help too. “I would encourage these women to exercise regularly, at least 30 minutes of walking per day, 5 days a week,” Dr. Zhang said.

For many of us who have overweight or obesity, the initial goal is to mobilize. Physical activity should be built up gently, gradually, over time.  Nothing says that physical activity has to be done fast, or all at once. A two minute walk (one minute walking away, one minute walking back) every hour on the hour ends up being a 30-minute walk at the end of the day.

In our practice we have banned the words ‘diet’ and ‘exercise.’ These are obstacles that get in the way of people doing what they need to do to achieve better health. Rather, we want our patients to learn healthy eating and meal planning, so they can have these skills for life. We also want our patients to incorporate daily physical activity into their lifestyle. It is important that this be physical activity that is realistic for the individual, achievable (so that the person is rewarded accomplishing it), sustainable, and incremental. Examples include parking a block away from where one normally parks, to add a block in and a block back to the daily walking total, or going up and down one flight of stairs at the beginning of a commercial break when watching television.