Exercise & PCOS

PCOS is a chronic condition which commonly presents with prominent reproductive features, however PCOS has the potential for major metabolic consequences including obesity, insulin resistance, type 2 diabetes and cardiovascular disease, all currently national health priority areas. ^[1]

Obesity is the primary cause of chronic disease in Australian women with adverse effects such as Type 2 Diabetes and Cardiovascular Disease. ^[2] Obesity also has a negative impact on women’s reproductive systems. Obesity increases insulin resistance and hyperandrogenism which exacerbates the prevalence and severity of PCOS, infertility, pregnancy complications, gestational diabetes and fetal pregnancy complications. ^[3]

PCOS also significantly impacts the mental health status of women, ^[4,5] and 40% of women diagnosed with PCOS are affected by anxiety and depression. Due to the known link between obesity and depression, a reduction in weight is extremely beneficial in order to manage emotional disturbances associated with PCOS. ^[6]

Major implication for exercise and lifestyle intervention.

Lifestyle modifications such as healthy diet, smoking cessation, regular exercise and weight loss (if overweight), is highly recommended as the initial phase of treatment for women with PCOS. ^[1,7]

Evidence has shown a reduction of 5 to 10% of body fat has reduced insulin, improved menstrual cycle function, reduced testosterone levels, improved hirsutism and acne, improved ovulation and fertility, and improved psychological outcomes. ^[1,8]

Evidence has also found that after completing 3 months of aerobic training women with PCOS and not ovulating, were able to restore normal menstrual cycle. ^[9] Improvements in hormone markers as a result of exercise meant an increase in pregnancy rates and ovulation.

Due to the high level of metabolic risk of PCOS and long term metabolic benefits of exercise it is recommended that women with PCOS participate in a combination of aerobic and resistance training for at least 150 minutes of exercise per week. To optimise clinical outcomes, it is important for women to complete 90 minutes per week of moderate-high (60-90% max heart rate) intensity aerobic exercise. Healthy coaching principles with appropriate education and patient driven goal setting may assist with motivation and support in behavioural changes. ^[1,10]

Women with PCOS face greater barriers to physical activity such as reduced confidence, increased fear of injury, body image, depression and anxiety. An Accredited Exercise Physiologist is a specialist in the design and delivery of individualised exercise prescription for people with chronic and complex diseases including PCOS. At Advanced Physiotherapy we have both male and female Exercise Physiologists that will work with the client to determine suitable goals and plan optimal exercise prescription. Our state of the art facilities are available to all clients whilst under our care.

References

1. Alliance, P. A. (2011). Evidence-based guideline for the assessment and management of polycystic ovary syndrome. Jean Hailes Foundation.
2. Moran, L., & Teede, H. (2009). Metabolic features of the reproductive phenotypes of polycystic ovary syndrome. Human reproduction update.
3. Haffner, S., The insulin resistance syndrome revisited. Diabetes Care, 1996. 19: p. 275.
4. Deeks, A. A., Gibson-Helm, M. E., & Teede, H. J. (2010). Anxiety and depression in polycystic ovary syndrome: a comprehensive investigation. Fertility and sterility, 93(7), 2421-2423.
5. Moran, L., Gibson-Helm, M., Teede, H., & Deeks, A. (2010). Polycystic ovary syndrome: a biopsychosocial understanding in young women to improve knowledge and treatment options. Journal of Psychosomatic Obstetrics & Gynecology, 31(1), 24
6. Farrell, K., & Antoni, M. H. (2010). Insulin resistance, obesity, inflammation, and depression in polycystic ovary syndrome: biobehavioral mechanisms and interventions. Fertility and sterility, 94(5), 1565-1574.
7. Moran, L. J., Brinkworth, G., Noakes, M., & Norman, R. J. (2006). Effects of lifestyle modification in polycystic ovarian syndrome. Reproductive biomedicine online, 12(5), 569-578.
8. Teede, H. J., Misso, M. L., Deeks, A. A., Moran, L. J., Stuckey, B. G., Wong, J. L., ... & Guideline, D. G. (2011). Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. The Medical Journal of Australia, 195(6), S65.
9. Vigorito, C., Giallauria, F., Palomba, S., Cascella, T., Manguso, F., Lucci, R., ... & Orio, F. (2007). Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome. The Journal of Clinical Endocrinology & Metabolism, 92(4), 1379-1384.
10. Cuff, D. J., Meneilly, G. S., Martin, A., Ignaszewski, A., Tildesley, H. D., & Frohlich, J. J. (2003). Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes care, 26(11), 2977-2982.