Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes?

Secondary analysis of a cluster randomized NELLI study in Finland


Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women. The purpose of the intervention was to examine whether intensified physical activity counseling in Finnish maternity care is feasible and effective in promoting leisure-time physical activity among pregnant women at risk of gestational diabetes.


Fourteen municipalities were randomized to intervention and usual care group. Nurses in intervention integrated five physical activity counseling sessions into routine maternity visits and offered monthly group meetings on physical activity instructed by physiotherapists. In usual care group conventional practices were continued.

Feasibility evaluation included:

  • safety (incidence of physical activity -related adverse events; questionnaire)
  • realization (timing and duration of sessions, number of sessions missed, attendance at group meetings; systematic record-keeping of the nurses and physiotherapists)
  • applicability (nurses’ views; telephone interview).

Effectiveness outcomes were:

  • weekly frequency and duration of total leisure-time physical activity
  • weekly frequency and duration of intensity-specific leisure-time physical activity
  • meeting physical activity recommendation for health self-reported at 8–12 (baseline), 26–28 and 36–37 weeks’ gestation.

Multilevel analysis with adjustments was used in testing for between-group differences in physical activity changes.


The decrease in the weekly days of total and moderate-to-vigorous-intensity leisure-time physical activity was smaller in intervention (N=219) than in usual care group (N=180) from baseline to the first follow-up. A similar trend was seen in meeting the physical activity recommendation.

Intervention did not experience more adverse events classified as warning signs to terminate exercise than usual care group. Counseling was implemented as planned and viewed positively by the nurses.


Intensified counseling had no effects on the duration of total or intensity-specific weekly leisure-time physical activity. However, it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity leisure-time physical activity from baseline to the end of second trimester and was feasibly embedded into routine practices.





Minna Aittasalo, Researcher



For publications (international and Finnish) of this research see the Finnish description.
To find the list of publications (Julkaisuja), scroll the page down.

Last Modified: 27.11.2014


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