Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Rhiannon K Patten; Russell A Boyle; Trine Moholdt; Ida Kiel; William G Hopkins; Cheryce L Harrison; Nigel K Stepto

doi:10.3389/fphys.2020.00606

Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Front Physiol. 2020 Jul 7:11:606. doi: 10.3389/fphys.2020.00606. eCollection 2020.

Authors

Rhiannon K Patten¹, Russell A Boyle¹, Trine Moholdt², Ida Kiel², William G Hopkins¹, Cheryce L Harrison³, Nigel K Stepto^{1

2

3

4}

Affiliations

¹ Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
² Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
³ Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, Melbourne, VIC, Australia.

Abstract

Background: Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy with reproductive and metabolic manifestations. Exercise training has consistently been found to result in improved clinical outcomes in women with PCOS, but shortfalls with exercise prescription are evident. The aim of this systematic review and meta-analysis was to identify exercise intervention characteristics that provide favourable outcomes in women with PCOS. Methods: A systematic review of published literature was conducted using EBSCOhost and Ovid Medline up to May 2019. The review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines as per our PROSPERO protocol (CRD42018088367). Randomised controlled trials, non-randomised controlled trials, and uncontrolled trials that evaluated an exercise intervention of at least moderate intensity in women with PCOS were included. Meta-analyses were performed using general linear mixed modelling and Bayesian inferences about effect magnitudes. Results: Thirty-three articles were identified for systematic review of which 19 were meta-analysed. Intervention duration ranged from 6 to 26 weeks. A total number of 777 women were included in the meta-analysis. The meta-analysis found that improvements in health outcomes are more dependent on exercise intensity rather than dose. Fixed effects analysis reported a moderate increase in VO_2peak (24.2%; 90% CL, 18.5-30.1), and small reductions in HOMA-IR (-36.2%; 90% CL, -55.3 to -9.0), and waist circumference (-4.2%; 90% CL -6.0 to -2.3) as a result of vigorous intensity exercise. These results are confirmed in the predicted analysis which reported the greatest improvements in VO_2peak, BMI, and waist circumference after vigorous intensity exercise alone or when combined with diet, particularly for women with clinically adverse baseline values. Conclusions: Exercise training in the management of PCOS is becoming more common. Results from our analysis support the use of exercise and suggest that vigorous intensity exercise may have the greatest impact on cardiorespiratory fitness, body composition, and insulin resistance. Our results indicate that, a minimum of 120 min of vigorous intensity per week is needed to provide favourable health outcomes for women with PCOS with studies of longer duration required to evaluate outcomes with sustained exercise.

Keywords: cardiorespiratory fitness; exercise intensity; high-intensity interval training; insulin resistance; lifestyle intervention; metabolic health; physical activity; resistance training.

Publication types

Systematic Review