PCOS and Exercise
We all know that exercise is helpful in general, and that is especially true for those living with PCOS. Exercise may improve ovulation, insulin resistance and promote weight loss. Yet, it’s hard to say which type of exercise, the intensity, and how much PCOS-ers should be doing.
Types of Exercise
Resistance training (also known as weight or strength training) requires the body (muscles) to push against force that is practised against it. This includes bodyweight exercises, plyometrics, use of resistance bands, free weights or machine equipment. Resistance training is thought to be beneficial to PCOS-ers because it can improve insulin resistance, glucose metabolism and resting metabolic rate, lowers body fat and increases lean muscle mass.
One study looked at progressive resistance training in women with PCOS. Women in the intervention group exercised for 1 hour per day, 3 times a week for 4 months. Exercises included: bench presses, leg extensions, front lat pull-downs, leg curls, lateral raises, leg presses (45 degrees), triceps pulleys, calf leg presses, arm curls, and abdominal exercises executed in alternating segments. At the end of this study, the women with PCOS experienced weight loss and increased muscle mass, lowered androgen levels, increased reproductive function, but no significant changes to insulin resistance.
The 2015 Almenning study also evaluated strength training compared to HIIT in women with PCOS, and also found that at the end of the study while there was an improvement in body composition, there were not any changes to insulin resistance.
A 2018 study looked at aerobic exercise in women with PCOS. Participants performed 40 minutes of exercise (including 5 minutes of warm up and 5 minutes of cool down), 3 times a week for 16 weeks. The exercise group completed their supervised exercise outside on a track. Interestingly enough, the study does not explicitly state what exercise the control group did, however it may have been unsupervised exercise for 150 minutes per week (this is what I am guessing).
Results demonstrated that there was an improvement in the health-quality of life score, an improved cardiometabolic profile, reduced BMI and waist circumference, and overall positive response doing exercise. However, no changes were seen in fasting glucose or insulin or HOMA-IR values in both control and exercise groups.
High Intensity Interval Training (HIIT)
In men with insulin resistance, studies have shown that HIIT has had a positive impact overall, compared to continuous training (think walking or running).
One study looked at HIIT in women with PCOS. These women participated in a 10-week program where they would do HIIT three times a week. Two sessions were 4×4 minutes of HIIT at 90-95% of their maximum heart rate, separated by 3 minutes of moderate intensity exercise around 70% of their maximum heart rate. The last session was 10×1 minute of maximum intensity HIIT separated by 1 minute of rest or low activity. Mode of exercise was dependent on the individual, but could be the treadmill, outdoor walking/running/cycling. The control group were simply advised to do at least 150 minutes of moderate-intensity exercise per week.
The primary outcome of this study was to measure the change in insulin resistance (via the HOMA-IR value) from baseline to post-intervention. In the group who did HIIT, IR values significantly improved (specifically fasting insulin), as well as overall body composition.
So far the only studies looking at the effect of yoga on PCOS, have been done in adolescent girls. In previous studies, yoga has been studied in men and with poor insulin sensitivity as well as in people with obesity and diabetes.
A 2012 study looked at adolescent girls and the effects of yoga on glucose and insulin levels. Girls were divided into 2 groups – 1 which practiced yoga (1 hour a day for 12 weeks), and the other which practiced conventional physical exercises. At the end of the 12 weeks, there was reduction in fasting blood glucose in the yoga group as well as a drop in the HOMA-IR score of 0.38. The control group actually had an increase in their HOMA-IR score of 0.29.
A 2013 study by the same authors looked at the effects of yoga in adolescent women, but this time specifically looking at endocrine parameters (Anti-mullerian hormone (AMH), luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, prolactin, body–mass index (BMI), hirsutism, and menstrual frequency) before and after 12 weeks. Adolescents in the yoga study practiced for 1 hour per day for 12 weeks, while the other group simply practiced conventional physical exercises. At the end of the 12 weeks, they found that yoga was better at reducing AMH, LH, and testosterone and improving menstrual frequency.
You obviously have your pick when it comes to exercise. I would choose something based on what you like to do (if you hate yoga, don’t do it) and what your goals are. I personally want to decrease my HOMA-IR value, so choosing HIIT and yoga might be the way to go for me.
Something important to keep in mind is that exercise is not the be-all and end-all of treatment. In fact, doing too much exercise may impair your adrenal glands, causing more inflammation, thereby causing more insulin resistance. Sometimes taking it easy is key, and doing gentle exercises (ie. walking, yoga) will your best bet in your path of healing.
Plan exercise with a friend who will not be happy if you don’t show up
If you’re travelling, figure out how you will schedule in some exercise
Keep track of how much you exercise (ie. I put stickers on my recycling calendar)
Pair activities (ie. Watching Netflix? Exercise at the same time)
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KOGURE, G., MIRANDA-FURTADO, C., SILVA, R., MELO, A., FERRIANI, R., DE SÁ, M. and REIS, R. (2016). Resistance Exercise Impacts Lean Muscle Mass in Women with Polycystic Ovary Syndrome. Medicine & Science in Sports & Exercise, 48(4), pp.589-598.
Almenning, I., Rieber-Mohn, A., Lundgren, K., Shetelig Løvvik, T., Garnæs, K. and Moholdt, T. (2015). 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, 10(9), p.e0138793.
COSTA, E., DE SÁ, J., STEPTO, N., COSTA, I., FARIAS-JUNIOR, L., MOREIRA, S., SOARES, E., LEMOS, T., BROWNE, R. and AZEVEDO, G. (2018). Aerobic Training Improves Quality of Life in Women with Polycystic Ovary Syndrome. Medicine & Science in Sports & Exercise, 50(7), pp.1357-1366.
Nidhi, R., Padmalatha, V., Nagarathna, R. and Ram, A. (2012). Effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome. International Journal of Gynecology & Obstetrics, 118(1), pp.37-41.
Nidhi, R., Padmalatha, V., Nagarathna, R. and Amritanshu, R. (2013). Effects of a Holistic Yoga Program on Endocrine Parameters in Adolescents with Polycystic Ovarian Syndrome: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine, 19(2), pp.153-160.