The effectiveness of exercise in the treatment of polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive-aged women. The clinical and biochemical characteristics of PCOS typically include cystic ovaries, ovulatory dysfunction, and hyperandrogenaemia. PCOS is also associated with metabolic and psychological morbidity. Typically, management of PCOS focusses upon weight loss through positive lifestyle changes, namely caloric restriction and increasing physical activity (PA). Exercise is an effective treatment for a range of populations; despite its recommendation in PCOS, little is known about its effectiveness at improving health in this population. Accordingly, three studies were completed to investigate the effect of PA in the management of PCOS. Studies of women with PCOS that compared exercise (and diet) interventions to control conditions were meta-analysed in a systematic review. Exercise interventions improved insulin resistance, lipids, and cardiorespiratory fitness. However, the magnitude of these changes was small and the certainty of the evidence was graded as low or very low. A need for rigorously designed and sufficiently powered studies that address this question was highlighted. In study 2, despite no differences in PA, women with PCOS were found to be more overweight, and have poorer self-esteem and quality of life (QoL) than women without PCOS. Self-esteem, BMI and a PCOS diagnosis impaired QoL, whereas PA appeared to have no effect. Study 3 also reported less-favourable health, independent of BMI, in women with PCOS compared to controls. Cluster analysis was completed, and a larger proportion of women with PCOS were assigned to the poorer health cluster; this cluster was also less active. Furthermore, women who were more active, and spent less time sitting, had more favourable health. In conclusion, this PhD highlights a lack of high-quality studies to investigate the role of PA in women with PCOS; this should be a research priority. However, women with PCOS who are more active, and spend less time sitting have reduced cardiovascular risk, which supports current treatment recommendations.