Exercise as it relates to Disease/Gestational Diabetes Mellitus (GDM) in Indigenous Australians

What is GDM?

 * Elevated fasting glucose levels attained during pregnancy
 * Usually diagnosed between 24 and 28 weeks
 * According to US data occurrence in 5-9% of pregnancies

Women who have GDM generally do not experience any symptoms, but they may experience the following: tiredness, excessive thirst, frequent urination or blurred vision.

Risk factors for developing GDM
[1]
 * Glycosuria (glucose present in the urine; usually caused by excess carbohydrate intake or the kidney tubules' inability to reabsorb.)
 * Diabetes in a first degree relative
 * Aged over 30 years
 * A history of glucose intolerance
 * Marked obesity or BMI (Body Mass Index) greater than 25
 * A previous infant with macrosomia (enlarged birthweight)
 * Ethnicity (Aboriginal, Hispanic, South Asian, Asian or African Desert descent)

Indigenous at Risk
It is important to specifically target these populations as the Aboriginal community is 20% more likely to be diagnosed with GDM. [3]

This may be due to individual factors such as[4]:


 * Poor diet; consuming energy dense foods
 * Increase in sedentary behaviours
 * Higher number of indigenous smokers
 * Obesity; 57% of Australian Aboriginals are classed as overweight or obese in 15 years and up.[5]
 * High rates of alcohol consumption

Or community factors such as[4]:


 * Impact of historical and political events
 * Low socio-economical status
 * Decrease of health service due to rural setting or cultural beliefs
 * Increase in daily stress

Research has shown that many indigenous Australians view diabetes as a low priority and subsequently act too late in prevention and management of the disease. Approximately 50% of women with GDM will develop Type II diabetes within 5–10 years[1]. Particularly in Indigenous women the impact of prevention and optimal treatment is an important area of focus for them and their offspring's health.

To minimize the risk of contracting Type II diabetes women should:


 * Breastfeed
 * Exercise for 150min per week at a moderate intensity
 * Maintain a healthy diet before, during and post pregnancy

Physical Activity and GDM
Physical activity greatly increases the body's sensitivity to insulin and the insulin in use will last for longer. This has great effects on reducing the blood glucose levels in the body and decreases the need for pharmacological interventions such as insulin injections.[2]

If a person is physically active pre-pregnancy the chance of developing GDM is greatly reduced. Indigenous women are more prone to sedentary behaviour. To increase exercise initiation and adherence, women should consult their health care professionals on their exercise beliefs. That is: advantages, social influences, and perceived barriers to exercise, as a framework for designing effective GDM treatment and prevention programs.[4]

Physical Activity Guidelines
In the Aboriginal community, due to urbanisation and a shift from the hunter-gatherer lifestyle to a more westernised lifestyle, there has been a reduction in physical activity. Physical activity, as mentioned also has social and community connotations for Aboriginal people; the social aspect of physical activity is an important factor in working out interventions aimed at increasing exercise. Thus, a program that is aimed at early detection and primary intervention with a better understanding of indigenous culture can have a better therapeutic outcome than one usually designed for the general population. [3][4]

There are currently limited exercise guidelines that specifically target the Indigenous women. It is important to target this population so that Indigenous Australians may be appropriately educated on what resources are potentially available. The frequency, type, duration and intensity of the exercise program should be tailored to each individual’s needs.

General guidelines are:

10 minutes of arm exercises after every meal has also been shown to decrease blood glucose levels along with the implementation of a resistance program; resistance exercise training may help to avoid insulin therapy for overweight women with gestational diabetes. [7] Exercise intervention along with diet modification has a much greater effect on the prevention and treatment of GDM than diet alone. [7]
 * 30 minutes of brisk organised activity a day[3][6][7]

Diet
A large proportion of the Aboriginal community consumes energy dense food and do not have easy access to fresh fruits and vegetables. This problem is worse for isolated or rural communities due to lack of grocery stores selling fresh fruits and vegetables and being able to afford the high cost of fresh food.

Several studies have found links between the dietary intake of Aboriginal people and diabetes and this risk is reduced with the consumption of bush meats, reduction of processed meat consumption and removing the fat from meat before cooking.[3][4]

Further information
Aboriginal people and Diabetes website GDM Background information General exercise and pregnancy guidelines
 * http://www.dontignorediabetes.com.au/Aboriginal_People_and_Diabetes
 * http://www.babycenter.com.au/pregnancy/complications/diabetes/
 * http://www.csep.ca/CMFiles/publications/parq/parmed-xpreg.pdf