Z Geburtshilfe Neonatol 2023; 227(03): 186-196
DOI: 10.1055/a-2004-0740
Original Article

Effects of Exercise Intervention Based on Self-efficacy Theory on Pregnant Women with Gestational Diabetes Mellitus

Yingyao Tan
1   Nursing school, Guangdong Pharmaceutical University, Guangzhou, China
Fangying Huang
2   Department of Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
Yan Wang
3   Nursing school, Macao Polytechnic University, Macau, China
Yutao Lan
1   Nursing school, Guangdong Pharmaceutical University, Guangzhou, China
Shu Cai
1   Nursing school, Guangdong Pharmaceutical University, Guangzhou, China
› Author Affiliations
Funding Information 2018 Research Project of Guangdong Nursing Association — gdhlxueh2019zx037; Construction Project of Teaching Quality and Teaching Reform in undergraduate universities of Guangdong Province- Nursing teaching Team[yue jiao gao han[2018] No.179] —


Background During pregnancy, gestational diabetes mellitus (GDM)is a common complication. Although some exercise programs have been recommended clinically, many pregnant women have low exercise compliance, making it difficult to effectively control blood sugar. Therefore, this study constructed an exercise intervention plan based on self-efficacy theory and explored the effect of the program on blood glucose and pregnancy outcomes in patients with gestational diabetes mellitus.

Methods A randomized controlled trial was conducted. A usual exercise program was implemented for the participants in the control group, and the participants in the intervention group received an exercise program on the basis of the control group and combined with the self-efficacy theory. Participants were assessed based on exercise self-efficacy, blood glucose, weight gain, exercise compliance, and pregnancy outcomes at week 4, week 8 and week 12.

Results One hundred three gestational diabetes mellitus patients were recruited at baseline, 53 in the intervention group and 50 in the control group. After the intervention, the exercise self-efficacy score and exercise compliance of the intervention group were higher than those of the control group (P<0.05). Fasting blood glucose, 2-h post-prandial plasma glucose, weight gain during the intervention period, incidence of neonatal hypoglycemia, and incidence of gestational hypertension were lower than those in the control group (P<0.05).

Conclusion Implementing an exercise intervention based on self-efficacy theory for gestational diabetes mellitus patients can improve exercise self-efficacy and exercise compliance, effectively control blood glucose and weight gain, improve pregnancy outcomes, and promote maternal and infant safety.

Publication History

Received: 18 August 2022

Accepted after revision: 26 November 2022

Article published online:
24 January 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Chiefari E, Arcidiacono B, Foti D. et al. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest 2017; 40: 899-909 DOI: 10.1007/s40618-016-0607-5.
  • 2 American College of Obstetricians and Gynecologists Practice Bulletin No. 180 Summary: Gestational Diabetes Mellitus. Obstet Gynecol 2017; 130: 244-246 DOI: 10.1097/AOG.0000000000002152.
  • 3 Sklempe Kokic I, Ivanisevic M, Biolo G. et al. Combination of a structured aerobic and resistance exercise improves glycaemic control in pregnant women diagnosed with gestational diabetes mellitus. A randomised controlled trial. Women Birth 2018; 31: e232-e238 DOI: 10.1016/j.wombi.2017.10.004.
  • 4 Laine MK, Kautiainen H, Gissler M. et al. Gestational diabetes in primiparous women-impact of age and adiposity: a register-based cohort study. Acta Obstet Gynecol Scand 2018; 97: 187-194 DOI: 10.1111/aogs.13271.
  • 5 American Diabetes Association. 13 Management of diabetes in pregnancy: standards of medical care in diabetes-2018. Diabetes Care 2018; 41: S137-S143 DOI: 10.2337/dc18-S013.
  • 6 Johns EC, Denison FC, Norman JE. et al. Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends Endocrinol Metab 2018; 29: 743-754 DOI: 10.1016/j.tem.2018.09.004.
  • 7 Billionnet C, Mitanchez D, Weill A. et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 2017; 60: 636-644 DOI: 10.1007/s00125-017-4206-6.
  • 8 Damm P, Houshmand-Oeregaard A, Kelstrup L. et al. Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark. Diabetologia 2016; 59: 1396-1399 DOI: 10.1007/s00125-016-3985-5.
  • 9 Wang YY, Liu Y, Li C. et al. Frequency and risk factors for recurrent gestational diabetes mellitus in primiparous women: a case control study. BMC Endocr Disord 2019; 19: 22 DOI: 10.1186/s12902-019-0349-4.
  • 10 Koivusalo SB, Rönö K, Klemetti MM. et al. Gestational diabetes mellitus can be prevented by lifestyle intervention: the Finnish Gestational Diabetes Prevention Study (RADIEL): a randomized controlled trial. Diabetes Care 2016; 39: 24-30 DOI: 10.2337/dc15-0511.
  • 11 Wang C, Wei Y, Zhang X. et al. Effect of regular exercise commenced in early pregnancy on the incidence of gestational diabetes mellitus in overweight and obese pregnant women: a randomized controlled trial. Diabetes Care 2016; 39: e163-e164 DOI: 10.2337/dc16-1320.
  • 12 Evenson KR, Barakat R, Brown WJ. et al. Guidelines for physical activity during pregnancy: comparisons from around the world. Am J Lifestyle Med 2014; 8: 102-121 DOI: 10.1177/1559827613498204.
  • 13 American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care 2011; 34: S62-S69 DOI: 10.2337/dc11-S062.
  • 14 Cheng A, Barnes T. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Introduction. Can J Diabetes 2013; 37: S4 DOI: 10.1016/j.jcjd.2013.01.010.
  • 15 Wang C, Guelfi KJ, Yang HX. Exercise and its role in gestational diabetes mellitus. Chronic Dis Transl Med 2016; 2: 208-214 DOI: 10.1016/j.cdtm.2016.11.006.
  • 16 Meander L, Lindqvist M, Mogren I. et al. Physical activity and sedentary time during pregnancy and associations with maternal and fetal health outcomes: an epidemiological study. BMC Pregnancy Childbirth 2021; 21: 166 DOI: 10.1186/s12884-021-03627-6.
  • 17 Yan Z, Xiang H, Li C et al. Correlation between physical activity status and perinatal outcomes of pregnant women in urban areas of Tianjin. Maternal and Child Health Care of China 2016; 31: 3492–3496. CNKI: SUN: ZFYB. 0.2016-17-025
  • 18 Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev 1977; 84: 191-215 DOI: 10.1037//0033-295x.84.2.191.
  • 19 Bandura A. Self-efficacy mechanism in human agency. Am Psychol 1982; 37: 122 DOI: 10.1037/0003-066X.37.2.122.
  • 20 Ahmad Sharoni SK, Abdul Rahman H, Minhat HS. et al. The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia. PLoS One 2018; 13: e0192417 DOI: 10.1371/journal.pone.0192417.
  • 21 You H, Lei A, Xiang J. et al. Effects of breastfeeding education based on the self-efficacy theory on women with gestational diabetes mellitus: A CONSORT-compliant randomized controlled trial. Medicine (Baltimore) 2020; 99: e19643 DOI: 10.1097/MD.0000000000019643.
  • 22 Kim J, Oh EG, Choi M. et al. Development and evaluation of myofunctional therapy support program (MTSP) based on self-efficacy theory for patients with obstructive sleep apnea. Sleep Breath 2020; 24: 1051-1058 DOI: 10.1007/s11325-019-01957-6.
  • 23 Mohammadi F, Kohan S, Farzi S. et al. The effect of pregnancy training classes based on bandura self-efficacy theory on postpartum depression and anxiety and type of delivery. J Educ Health Promot 2021; 10: 273 DOI: 10.4103/jehp.jehp_105_21.
  • 24 Offerman MP, Schroevers MJ, van der Velden LA. et al. Goal processes & self-efficacy related to psychological distress in head & neck cancer patients and their partners. Eur J Oncol Nurs 2010; 14: 231-237 DOI: 10.1016/j.ejon.2010.01.022.
  • 25 Wang L, Chen CM, Liao WC. et al. Evaluating a community-based stroke nursing education and rehabilitation programme for patients with mild stroke. Int J Nurs Pract 2013; 19: 249-256 DOI: 10.1111/ijn.12064.
  • 26 Moher D, Hopewell S, Schulz KF. et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg 2012; 10: 28-55 DOI: 10.1016/j.ijsu.2011.10.001.
  • 27 Chinese Diabetes Society Guidelines for the prevention and control of type 2 diabetes in China (2017 Edition). Chinese Journal of Practical Internal Medicine 2018; 38: 292-344 DOI: 10.19538/j. nk2018040108.
  • 28 Li C, Meiling H, Yingtao L et al. Implementation of the health education coordinated by medical staff and volunteers based on online- to- offline conception for patients with gestational diabetes mellitus. J Nursing Sci 2019; 34: 80–83. CNKI: SUN: HLXZ.0.2019-09-028
  • 29 Leng J, Shao P, Zhang C. et al. Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women: a prospective population-based study in Tianjin, China. PLoS One 2015; 10: e0121029 DOI: 10.1371/journal.pone.0121029.
  • 30 Mottola MF, Davenport MH, Ruchat SM. et al. 2019 Canadian guideline for physical activity throughout pregnancy. Br J Sports Med 2018; 52: 1339-1346 DOI: 10.1136/bjsports-2018-100056.
  • 31 Hongmei Y, Yongfang D, Lingling G. Reliability and validity of the Chinese version of the Pregnancy Exercise Self-Efficacy Scale. Chinese Journal of Nursing 2017; 52: 632-636 CNKI:SUN:ZHHL.0.2017-05-039
  • 32 Xuefang W. Effects of integrated health management on exercise compliance and body weight of pregnant women during pregnancy. Laboratory Medicine and Clinic 2016; 13: 2174-2176 CNKI:SUN:JYYL.0.2016-15-038
  • 33 Mei L. Study on the application of nursing intervention scheme based on self- efficacy theory in the compliance of postoperative functional exercise in breast cancer patients. Qingdao University 2019; DOI: 10.27262/d.cnki.gqdau.2019.000978.
  • 34 Ping X. Effects of self-efficacy and educational intervention on motor performance and balance function in patients with Parkinson’s disease. Chinese. Journal of Gerontology 2018; 38: 3682-3684 CNKI:SUN:ZLXZ.0.2018-15-043
  • 35 Hongjie L, Hongmei S, Lili X. et al. Long-term effect of peer support model on the self-efficacy, self-management and blood glucose control in type 2 diabetes patients. Chin Gen Prac 2018; 21: 861-866 CNKI:SUN:QKYX.0.2018-07-02
  • 36 Zhilan Y, Jianping S, Zihong S. et al. The effect of self-efficacy intervention on the compliance of pelvic floor muscle exercise in elderly female patients with urinary incontinence. Chinese Journal of Gerontology 2013; 33: 4061-4063 CNKI:SUN:ZLXZ.0.2013-16-134
  • 37 Jie S. The effects of nursing intervention based on self-efficacy theory in weight management of overweight/obese infertility patients. Lanzhou University 2021; DOI: 10.27204/d.cnki.glzhu.2021.001933.
  • 38 Haiyun Z, Meirong G, Fang W. et al. Influence of nursing intervention based on self-efficacy theory on blood glucose, quality of life and negative emotions of patients with type 2 diabetes mellitus. Chinese Nursing Research 2018; 32: 1878-1881 DOI: 10.12102/j.issn .100993.2018.12.014.
  • 39 Coll CV, Domingues MR, Gonçalves H. et al. Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence. J Sci Med Sport 2017; 20: 17-25 DOI: 10.1016/j.jsams.2016.06.007.
  • 40 Dou H, Xiaoyun W. Application of exercise intervention program based on smart phone APP in prediabetic patients. Chinese. Nursing Research 2022; 36: 128-132 CNKI:SUN:SXHZ.0.2022-01-025
  • 41 Yan H. A case-control study of risk factors for gestational diabetes mellitus. Anhui Medical University 2016; DOI: 10.7666/d.D01026231.
  • 42 Miao D. Correlation analysis of body mass index, weight gain and serum thyroid-stimulating hormone level with metabolic syndrome during pregnancy. Maternal and Child Health Care of China 2016; 31: 4149-4151 DOI: 10.7620/zgfybj.j.issn.1001-4411.2016.20.19.
  • 43 Voormolen DN, de Wit L, van Rijn BB. et al. Neonatal hypoglycemia following diet-controlled and insulin-treated gestational diabetes mellitus. Diabetes Care 2018; 41: 1385-1390 DOI: 10.2337/dc18-0048.
  • 44 Yang Y, Dejian W. Self-efficacy theory and its application in sports. Journal of Beijing Sport University 2007; 1: 137-138 DOI: 10.19582/j.cnki.11-3785/g8.2007.s1.070.