MATERIALS AND METHODS
Study Design: A randomised control trial was carried out in the Illawarra Shoalhaven Local Health District (ISLHD) and greater Sydney area, NSW, Australia from September 2018 to March 2022. Study recruitment and data collection were paused from March 2020 to October 2021 due to the coronavirus pandemic restrictions. A Consolidated Standards of Reporting Trials (CONSORT) flow diagram indicating recruitment and enrolment during these periods is provided as Figure 1. Women were randomised 1:1, via a third-party computer generator, to standard-care which includes advice to perform 30 minutes of physical activity daily (Control (CTL)) or standard-care with intervention advice to perform three 10-min bouts of postmeal walking (PMW: 30 minutes broken up into 10 min walking, within 60 minutes of breakfast, lunch, and dinner) (Figure 1). To understand the real-world impact and future translation, the intervention for this pragmatic pilot trial was delivered alongside standard-care and undertaken in free-living habitual conditions with minimal contact by researchers. Concurrently, using continuous glucose monitors (CGM) and inclinometers for physical activity, we were able to assess the glycaemic impact and adherence to our physical activity prescriptions in the free-living environment. This study was approved by the joint University of Wollongong and ISLHD ethics committee (HREC: 2018/318; ACTRN12618001355268) with written informed consent provided by all women at the first meeting with researchers.
Participants: Women with GDM were recruited via social media callouts (in the greater Sydney area) and group education sessions at the Illawarra Shoalhaven Local Health District Diabetes Service. Participants were eligible for this study with a diagnosis of GDM according to the International Association of Diabetes in Pregnancy Study Group criteria [4], were aged > 18 years, and were <30 weeks’ gestation. Exclusion criteria included <18 years, high-risk pregnancies, women with prescriptions for metformin or corticosteroids, contraindications to performing physical activity, or women on pre-existing medications for conditions such as hypertension, cardiac disease, renal disease, thyroid disease, or psychosis.