Abstract
PCOS is a complex multigenic condition influenced by significant epigenetic and environmental variables, including nutrition and lifestyle. Insulin resistance IR is found in roughly 80% of obese women with PCOS and 30-40% of lean women. IR is an impairment of insulin to mediate metabolism in skeletal muscle, adipocytes and liver. Following weight gain, the severity of IR in women with PCOS increases. IR affects many PCOS women who are not overweight, and minor weight loss improves clinical results in those with near-normal body weight. The effect of exercise on Insulin sensitivity IS is optimized through glucose transport and metabolism. Exercise is the first-line treatment for PCOS. Moderate intensity (60-70% VO2max; comparable to 75-80% HRmax) and high-intensity aerobic exercise (heart rate >80%) improves IR in women with PCOS. These exercises are performed for at least 30 minutes per session and 3-5 days per week. A single bout of exercise (2-72 hours postexercise) can improve IS immediately. Exercise improves IS and glycemic management as well as helps in lowering the abdominal fat. Therefore, exercise performed on a regular basis can help improve insulin resistance in women with PCOS.
Graphical Abstract
[1]
Escobar-Morreale, H.F. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat. Rev. Endocrinol., 2018, 14(5), 270-284.
[http://dx.doi.org/10.1038/nrendo.2018.24] [PMID: 29569621]
[http://dx.doi.org/10.1038/nrendo.2018.24] [PMID: 29569621]
[2]
Bulsara, J.; Patel, P.; Soni, A.; Acharya, S. A review: Brief insight into polycystic ovarian syndrome. Endocrine. Metabol. Sci., 2021, 3, 100085.
[http://dx.doi.org/10.1016/j.endmts.2021.100085]
[http://dx.doi.org/10.1016/j.endmts.2021.100085]
[3]
Vidya Bharathi, R.; Swetha, S.; Neerajaa, J.; Varsha Madhavica, J.; Janani, D.M.; Rekha, S.N. S, R.; B, U. An epidemiological survey: Effect of predisposing factors for PCOS in Indian urban and rural population. Middle East Fertil. Soc. J., 2017, 22(4), 313-316.
[http://dx.doi.org/10.1016/j.mefs.2017.05.007]
[http://dx.doi.org/10.1016/j.mefs.2017.05.007]
[4]
El Hayek, S.; Bitar, L.; Hamdar, L.H.; Mirza, F.G.; Daoud, G. Poly cystic ovarian syndrome: an updated overview. Front. Physiol., 2016, 7, 124.
[http://dx.doi.org/10.3389/fphys.2016.00124] [PMID: 27092084]
[http://dx.doi.org/10.3389/fphys.2016.00124] [PMID: 27092084]
[5]
Diamanti-Kandarakis, E.; Panidis, D. Unravelling the phenotypic map of polycystic ovary syndrome (PCOS): a prospective study of 634 women with PCOS. Clin. Endocrinol. (Oxf.), 2007, 67(5), 735-742.
[http://dx.doi.org/10.1111/j.1365-2265.2007.02954.x] [PMID: 17760884]
[http://dx.doi.org/10.1111/j.1365-2265.2007.02954.x] [PMID: 17760884]
[6]
Rojas, J.; Chávez, M.; Olivar, L.; Rojas, M.; Morillo, J.; Mejías, J.; Calvo, M.; Bermúdez, V. Polycystic ovary syndrome, insulin resistance, and obesity: navigating the pathophysiologic labyrinth. Int. J. Reprod. Med., 2014, 2014, 719050.
[http://dx.doi.org/10.1155/2014/719050] [PMID: 25763405]
[http://dx.doi.org/10.1155/2014/719050] [PMID: 25763405]
[7]
Dumesic, D.A.; Oberfield, S.E.; Stener-Victorin, E.; Marshall, J.C.; Laven, J.S.; Legro, R.S. Scientific statement on the diagnostic criteria, epidemiology, pathophysiology, and molecular genetics of polycystic ovary syndrome. Endocr. Rev., 2015, 36(5), 487-525.
[http://dx.doi.org/10.1210/er.2015-1018] [PMID: 26426951]
[http://dx.doi.org/10.1210/er.2015-1018] [PMID: 26426951]
[8]
Azziz, R.; Carmina, E.; Chen, Z.; Dunaif, A.; Laven, J.S.E.; Legro, R.S.; Lizneva, D.; Natterson-Horowtiz, B.; Teede, H.J.; Yildiz, B.O. Polycystic ovary syndrome. Nat. Rev. Dis. Primers, 2016, 2(1), 16057.
[http://dx.doi.org/10.1038/nrdp.2016.57] [PMID: 27510637]
[http://dx.doi.org/10.1038/nrdp.2016.57] [PMID: 27510637]
[9]
Qiao, J.; Feng, H.L. Extra- and intra-ovarian factors in polycystic ovary syndrome: impact on oocyte maturation and embryo developmental competence. Hum. Reprod. Update, 2011, 17(1), 17-33.
[http://dx.doi.org/10.1093/humupd/dmq032] [PMID: 20639519]
[http://dx.doi.org/10.1093/humupd/dmq032] [PMID: 20639519]
[10]
Sam, S. Obesity and polycystic ovary syndrome. Obes. Manag., 2007, 3(2), 69-73.
[http://dx.doi.org/10.1089/obe.2007.0019] [PMID: 20436797]
[http://dx.doi.org/10.1089/obe.2007.0019] [PMID: 20436797]
[11]
Shang, Y.; Zhou, H.; He, R.; Lu, W. Dietary modification for reproductive health in women with polycystic ovary syndrome: A systematic review and meta-analysis. Front. Endocrinol., 2021, 12, 735954.
[http://dx.doi.org/10.3389/fendo.2021.735954] [PMID: 34790167]
[http://dx.doi.org/10.3389/fendo.2021.735954] [PMID: 34790167]
[12]
Williams, T.; Mortada, R.; Porter, S. Diagnosis and treatment of polycystic ovary syndrome. Am. Fam. Physician, 2016, 94(2), 106-113.
[PMID: 27419327]
[PMID: 27419327]
[13]
Reyes-Muñoz, E.; Ortega-González, C.; Martínez-Cruz, N.; Arce-Sánchez, L.; Estrada-Gutierrez, G.; Moran, C.; Sánchez-Serrano, A.P.; Higareda-Sánchez, R.; de la Jara-Díaz, J.F. Association of obesity and overweight with the prevalence of insulin resistance, pre-diabetes and clinical-biochemical characteristics among infertile Mexican women with polycystic ovary syndrome: a cross-sectional study. BMJ Open, 2016, 6(7), e012107.
[http://dx.doi.org/10.1136/bmjopen-2016-012107] [PMID: 27449893]
[http://dx.doi.org/10.1136/bmjopen-2016-012107] [PMID: 27449893]
[14]
Marshall, J.C.; Dunaif, A. Should all women with PCOS be treated for insulin resistance? Fertil. Steril., 2012, 97(1), 18-22.
[http://dx.doi.org/10.1016/j.fertnstert.2011.11.036] [PMID: 22192137]
[http://dx.doi.org/10.1016/j.fertnstert.2011.11.036] [PMID: 22192137]
[15]
Dunaif, A.; Segal, K.R.; Shelley, D.R.; Green, G.; Dobrjansky, A.; Licholai, T. Evidence for distinctive and intrinsic defects in insulin action in polycystic ovary syndrome. Diabetes, 1992, 41(10), 1257-1266.
[http://dx.doi.org/10.2337/diab.41.10.1257] [PMID: 1397698]
[http://dx.doi.org/10.2337/diab.41.10.1257] [PMID: 1397698]
[16]
Diamanti-Kandarakis, E.; Dunaif, A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr. Rev., 2012, 33(6), 981-1030.
[http://dx.doi.org/10.1210/er.2011-1034] [PMID: 23065822]
[http://dx.doi.org/10.1210/er.2011-1034] [PMID: 23065822]
[17]
Moran, A.; Jacobs, D.R., Jr; Steinberger, J.; Hong, C.P.; Prineas, R.; Luepker, R.; Sinaiko, A.R. Insulin resistance during puberty: results from clamp studies in 357 children. Diabetes, 1999, 48(10), 2039-2044.
[http://dx.doi.org/10.2337/diabetes.48.10.2039] [PMID: 10512371]
[http://dx.doi.org/10.2337/diabetes.48.10.2039] [PMID: 10512371]
[18]
Samuel, V.T.; Shulman, G.I. Mechanisms for insulin resistance: common threads and missing links. Cell, 2012, 148(5), 852-871.
[http://dx.doi.org/10.1016/j.cell.2012.02.017] [PMID: 22385956]
[http://dx.doi.org/10.1016/j.cell.2012.02.017] [PMID: 22385956]
[19]
Shi, X.; Xie, X.; Jia, Y.; Li, S. Associations of insulin receptor and insulin receptor substrates genetic polymorphisms with polycystic ovary syndrome: A systematic review and meta-analysis. J. Obstet. Gynaecol. Res., 2016, 42(7), 844-854.
[http://dx.doi.org/10.1111/jog.13002] [PMID: 27098445]
[http://dx.doi.org/10.1111/jog.13002] [PMID: 27098445]
[20]
Laganà, A.S.; Barbaro, L.; Pizzo, A. Evaluation of ovarian function and metabolic factors in women affected by polycystic ovary syndrome after treatment with d-Chiro-Inositol. Arch. Gynecol. Obstet., 2015, 291(5), 1181-1186.
[http://dx.doi.org/10.1007/s00404-014-3552-6] [PMID: 25416201]
[http://dx.doi.org/10.1007/s00404-014-3552-6] [PMID: 25416201]
[21]
Geffner, M.E.; Golde, D.W. Selective insulin action on skin, ovary, and heart in insulin-resistant states. Diabetes Care, 1988, 11(6), 500-505.
[http://dx.doi.org/10.2337/diacare.11.6.500] [PMID: 2969796]
[http://dx.doi.org/10.2337/diacare.11.6.500] [PMID: 2969796]
[22]
Torchen, L.C.; Fogel, N.R.; Brickman, W.J.; Paparodis, R.; Dunaif, A. Persistent apparent pancreatic β-cell defects in premenarchal PCOS relatives. J. Clin. Endocrinol. Metab., 2014, 99(10), 3855-3862.
[http://dx.doi.org/10.1210/jc.2014-1474] [PMID: 25029420]
[http://dx.doi.org/10.1210/jc.2014-1474] [PMID: 25029420]
[23]
Corbould, A. Effects of androgens on insulin action in women: is androgen excess a component of female metabolic syndrome? Diabetes Metab. Res. Rev., 2008, 24(7), 520-532.
[http://dx.doi.org/10.1002/dmrr.872] [PMID: 18615851]
[http://dx.doi.org/10.1002/dmrr.872] [PMID: 18615851]
[24]
Soldani, R.; Cagnacci, A.; Yen, S.S.C. Insulin, insulin-like growth factor I (IGF-I) and IGF-II enhance basal and gonadotrophin-releasing hormone-stimulated luteinizing hormone release from rat anterior pituitary cells in vitro. Eur. J. Endocrinol., 1994, 131(6), 641-645.
[http://dx.doi.org/10.1530/eje.0.1310641] [PMID: 7804448]
[http://dx.doi.org/10.1530/eje.0.1310641] [PMID: 7804448]
[25]
O’Connor, A.; Phelan, N.; Tun, T.K.; Boran, G.; Gibney, J.; Roche, H.M. High-molecular-weight adiponectin is selectively reduced in women with polycystic ovary syndrome independent of body mass index and severity of insulin resistance. J. Clin. Endocrinol. Metab., 2010, 95(3), 1378-1385.
[http://dx.doi.org/10.1210/jc.2009-1557] [PMID: 20080859]
[http://dx.doi.org/10.1210/jc.2009-1557] [PMID: 20080859]
[26]
Farshchi, H.; Rane, A.; Love, A.; Kennedy, R.L. Diet and nutrition in Polycystic Ovary Syndrome (PCOS): Pointers for nutritional management. J. Obstet. Gynaecol., 2007, 27(8), 762-773.
[http://dx.doi.org/10.1080/01443610701667338] [PMID: 18097891]
[http://dx.doi.org/10.1080/01443610701667338] [PMID: 18097891]
[27]
Khatlani, K.; Njike, V.; Costales, V.C. Effect of lifestyle intervention on cardiometabolic risk factors in overweight and obese women with polycystic ovary syndrome: a systematic review and meta-analysis. Metab. Syndr. Relat. Disord., 2019, 17(10), 473-485.
[http://dx.doi.org/10.1089/met.2019.0049] [PMID: 31513475]
[http://dx.doi.org/10.1089/met.2019.0049] [PMID: 31513475]
[28]
Tabassum, F.; Jyoti, C.; Sinha, H.H.; Dhar, K.; Akhtar, M.S. Impact of polycystic ovary syndrome on quality of life of women in correlation to age, basal metabolic index, education and marriage. PLoS One, 2021, 16(3), e0247486.
[http://dx.doi.org/10.1371/journal.pone.0247486] [PMID: 33690645]
[http://dx.doi.org/10.1371/journal.pone.0247486] [PMID: 33690645]
[29]
Barber, T.M.; McCarthy, M.I.; Wass, J.A.H.; Franks, S. Obesity and polycystic ovary syndrome. Clin. Endocrinol., 2006, 65(2), 137-145.
[http://dx.doi.org/10.1111/j.1365-2265.2006.02587.x] [PMID: 16886951]
[http://dx.doi.org/10.1111/j.1365-2265.2006.02587.x] [PMID: 16886951]
[30]
Anwar, S.; Shikalgar, N. Prevention of type 2 diabetes mellitus in polycystic ovary syndrome: A review. Diabetes Metab. Syndr., 2017, 11(S2), S913-S917.
[http://dx.doi.org/10.1016/j.dsx.2017.07.015] [PMID: 28711517]
[http://dx.doi.org/10.1016/j.dsx.2017.07.015] [PMID: 28711517]
[31]
Parker, L.; Shaw, C.S.; Stepto, N.K.; Levinger, I. Exercise and glycemic control: focus on redox homeostasis and redox-sensitive protein signaling. Front. Endocrinol., 2017, 8, 87.
[http://dx.doi.org/10.3389/fendo.2017.00087] [PMID: 28529499]
[http://dx.doi.org/10.3389/fendo.2017.00087] [PMID: 28529499]
[32]
Bird, S.R.; Hawley, J.A. Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport Exerc. Med., 2017, 2(1), e000143.
[http://dx.doi.org/10.1136/bmjsem-2016-000143] [PMID: 28879026]
[http://dx.doi.org/10.1136/bmjsem-2016-000143] [PMID: 28879026]
[33]
Borghouts, L.B.; Keizer, H.A. Exercise and insulin sensitivity: a review. Int. J. Sports Med., 2000, 21(1), 1-12.
[http://dx.doi.org/10.1055/s-2000-8847] [PMID: 10683091]
[http://dx.doi.org/10.1055/s-2000-8847] [PMID: 10683091]
[34]
Giallauria, F.; Palomba, S.; Maresca, L.; Vuolo, L.; Tafuri, D.; Lombardi, G.; Colao, A.; Vigorito, C.; Francesco, O. Exercise training improves autonomic function and inflammatory pattern in women with Polycystic Ovary Syndrome (PCOS). Clin. Endocrinol., 2008, 69(5), 792-798.
[http://dx.doi.org/10.1111/j.1365-2265.2008.03305.x] [PMID: 18505468]
[http://dx.doi.org/10.1111/j.1365-2265.2008.03305.x] [PMID: 18505468]
[35]
Palomba, S.; Giallauria, F.; Falbo, A.; Russo, T.; Oppedisano, R.; Tolino, A.; Colao, A.; Vigorito, C.; Zullo, F.; Orio, F. Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Hum. Reprod., 2008, 23(3), 642-650.
[http://dx.doi.org/10.1093/humrep/dem391] [PMID: 18158291]
[http://dx.doi.org/10.1093/humrep/dem391] [PMID: 18158291]
[36]
Thomson, R.L.; Buckley, J.D.; Noakes, M.; Clifton, P.M.; Norman, R.J.; Brinkworth, G.D. The effect of a hypocaloric diet with and without exercise training on body composition, cardiometabolic risk profile, and reproductive function in overweight and obese women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab., 2008, 93(9), 3373-3380.
[http://dx.doi.org/10.1210/jc.2008-0751] [PMID: 18583464]
[http://dx.doi.org/10.1210/jc.2008-0751] [PMID: 18583464]
[37]
Harrison, C.L.; Stepto, N.K.; Hutchison, S.K.; Teede, H.J. The impact of intensified exercise training on insulin resistance and fitness in overweight and obese women with and without polycystic ovary syndrome. Clin. Endocrinol., 2012, 76(3), 351-357.
[http://dx.doi.org/10.1111/j.1365-2265.2011.04160.x] [PMID: 21711376]
[http://dx.doi.org/10.1111/j.1365-2265.2011.04160.x] [PMID: 21711376]
[38]
Thomson, R.L.; Buckley, J.D.; Brinkworth, G.D. Perceived exercise barriers are reduced and benefits are improved with lifestyle modification in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial. BMC Womens Health, 2016, 16(1), 14.
[http://dx.doi.org/10.1186/s12905-016-0292-8] [PMID: 26960762]
[http://dx.doi.org/10.1186/s12905-016-0292-8] [PMID: 26960762]
[39]
Almenning, I.; Rieber-Mohn, A.; Lundgren, K.M.; Shetelig Løvvik, T.; Garnæs, K.K.; Moholdt, T. Effects of high intensity interval training and strength training on metabolic, cardiovascular and hormonal outcomes in women with polycystic ovary syndrome: a pilot study. PLoS One, 2015, 10(9), e0138793.
[http://dx.doi.org/10.1371/journal.pone.0138793] [PMID: 26406234]
[http://dx.doi.org/10.1371/journal.pone.0138793] [PMID: 26406234]
[40]
Kogure, G.S.; Miranda-Furtado, C.L.; Silva, R.C.; Melo, A.S.; Ferriani, R.A.; De Sá, M.F.S.; Reis, R.M.D. Resistance exercise impacts lean muscle mass in women with polycystic ovary syndrome. Med. Sci. Sports Exerc., 2016, 48(4), 589-598.
[http://dx.doi.org/10.1249/MSS.0000000000000822] [PMID: 26587847]
[http://dx.doi.org/10.1249/MSS.0000000000000822] [PMID: 26587847]
[41]
Bambaeichi, E.; Samadi, Z.; Valiani, M.; Shahshahan, Z. Evaluation of changes in levels of hyperandrogenism, hirsutism and menstrual regulation after a period of aquatic high intensity interval training in women with polycystic ovary syndrome. Int. J. Prev. Med., 2019, 10(1), 187.
[http://dx.doi.org/10.4103/ijpvm.IJPVM_360_18] [PMID: 31807257]
[http://dx.doi.org/10.4103/ijpvm.IJPVM_360_18] [PMID: 31807257]
[42]
Aktaş, H.Ş.; Uzun, Y.E.; Kutlu, O.; Pençe, H.H.; Özçelik, F.; Çil, E.Ö.; Irak, L.; Altun, Ö.; Özcan, M.; Özsoy, N.; Aydın Yoldemir, Ş; Kalyon, S.; Arman, Y.; Tükek, T. The effects of high intensity-interval training on vaspin, adiponectin and leptin levels in women with polycystic ovary syndrome. Arch. Physiol. Biochem., 2022, 128(1), 37-42.
[http://dx.doi.org/10.1080/13813455.2019.1662450] [PMID: 31516017]
[http://dx.doi.org/10.1080/13813455.2019.1662450] [PMID: 31516017]
[43]
Orio, F.; Muscogiuri, G.; Giallauria, F.; Savastano, S.; Bottiglieri, P.; Tafuri, D.; Predotti, P.; Colarieti, G.; Colao, A.; Palomba, S. Oral contraceptives versus physical exercise on cardiovascular and metabolic risk factors in women with polycystic ovary syndrome: a randomized controlled trial. Clin. Endocrinol., 2016, 85(5), 764-771.
[http://dx.doi.org/10.1111/cen.13112] [PMID: 27219465]
[http://dx.doi.org/10.1111/cen.13112] [PMID: 27219465]
[44]
Turan, V.; Mutlu, E.K.; Solmaz, U.; Ekin, A.; Tosun, O.; Tosun, G.; Mat, E.; Gezer, C.; Malkoc, M. Benefits of short-term structured exercise in non-overweight women with polycystic ovary syndrome: a prospective randomized controlled study. J. Phys. Ther. Sci., 2015, 27(7), 2293-2297.
[http://dx.doi.org/10.1589/jpts.27.2293] [PMID: 26311969]
[http://dx.doi.org/10.1589/jpts.27.2293] [PMID: 26311969]
[45]
Hutchison, S.K.; Teede, H.J.; Rachoń, D.; Harrison, C.L.; Strauss, B.J.; Stepto, N.K. Effect of exercise training on insulin sensitivity, mitochondria and computed tomography muscle attenuation in overweight women with and without polycystic ovary syndrome. Diabetologia, 2012, 55(5), 1424-1434.
[http://dx.doi.org/10.1007/s00125-011-2442-8] [PMID: 22246378]
[http://dx.doi.org/10.1007/s00125-011-2442-8] [PMID: 22246378]
[46]
Thomson, R.L.; Brinkworth, G.D.; Noakes, M.; Clifton, P.M.; Norman, R.J.; Buckley, J.D. The effect of diet and exercise on markers of endothelial function in overweight and obese women with polycystic ovary syndrome. Hum. Reprod., 2012, 27(7), 2169-2176.
[http://dx.doi.org/10.1093/humrep/des138] [PMID: 22552687]
[http://dx.doi.org/10.1093/humrep/des138] [PMID: 22552687]
[47]
Hutchison, S.K.; Stepto, N.K.; Harrison, C.L.; Moran, L.J.; Strauss, B.J.; Teede, H.J. Effects of exercise on insulin resistance and body composition in overweight and obese women with and without polycystic ovary syndrome. J. Clin. Endocrinol. Metab., 2011, 96(1), E48-E56.
[http://dx.doi.org/10.1210/jc.2010-0828] [PMID: 20926534]
[http://dx.doi.org/10.1210/jc.2010-0828] [PMID: 20926534]
[48]
Moran, L.; Harrison, C.; Hutchison, S.; Stepto, N.; Strauss, B.; Teede, H. Exercise decreases anti-müllerian hormone in anovulatory overweight women with polycystic ovary syndrome: a pilot study. Horm. Metab. Res., 2011, 43(13), 977-979.
[http://dx.doi.org/10.1055/s-0031-1291208] [PMID: 21989557]
[http://dx.doi.org/10.1055/s-0031-1291208] [PMID: 21989557]
