"Effectiveness of Exercise on Physical and Mental Health with Polycystic Ovary Syndrome (PCOS): A Randomized Clinical Trial

Abstract

Polycystic ovary syndrome (PCOS) is a complex hormonal disorder with significant metabolic and reproductive consequences, posing major health and economic challenges. Regular exercise is known to improve clinical outcomes in PCOS, yet the optimal intensity for maximizing benefits remains unclear. High-intensity training (HIT) has gained attention as a promising, well-tolerated approach that addresses barriers to exercise adherence. However, limited research compares its effectiveness to moderate-intensity continuous exercise (MICE) in women with PCOS. This study aimed to evaluate the impact of exercise intensity on physical and mental health, as well as health-related quality of life (HRQoL).

Two systematic reviews, including a meta-analysis, assessed existing exercise interventions in PCOS. Findings confirmed that structured exercise enhances both physical and mental health, with higher-intensity workouts offering additional benefits for cardiovascular fitness, body composition, and insulin resistance. While evidence on exercise intensity and HRQoL was limited, available data suggested that physical activity improved symptom distress, depression, and anxiety in women with PCOS.

A randomized clinical trial was conducted to compare the effects of HIT and MICE on physical, reproductive, and mental health outcomes. The study enrolled 30 overweight women (ages 18-45) diagnosed with PCOS, assigning them to either HIT (high-intensity exercise >90% peak heart rate [HRpeak]) or MICE (moderate-intensity exercise at 60-75% HRpeak). Fifteen participants completed the HIT program, while fifteen completed the MICE program.

For cardio-metabolic outcomes, both groups showed significant improvements in VO2peak (HIT: 21.5 ± 9.8%, P <0.001; MICE: 13.2 ± 8.5%, P <0.001), but HIT resulted in a significantly greater increase (P = 0.005). Insulin sensitivity improved more in the HIT group both from baseline (47.3 ± 36.7%; P = 0.016) and compared to MICE (P = 0.048). The increase in VO2peak was strongly linked to improved insulin sensitivity (P = 0.004, R² = 0.36).

In reproductive health, HIT significantly improved the free androgen index (P = 0.039), free testosterone percentage (P = 0.018), whereas MICE had no significant effects. Free testosterone percentage improved more with HIT (P = 0.006 and P = 0.003, respectively). A strong association was found between insulin sensitivity changes and free testosterone in the HIT group (P = 0.031, adjusted R² = 0.42). Although not statistically significant, menstrual cyclicity improved in 70% of HIT participants compared to 22% in MICE.

Mental health outcomes also favored HIT, with significant reductions in depression (P <0.001) and stress (P = 0.006). Anxiety decreased in both groups, but the reduction was significantly greater in the HIT group (P = 0.019). HIT also improved HRQoL, particularly in emotional well-being, weight concerns, and menstrual symptoms (PCOSQ), along with physical functioning, energy levels, and general health (SF-36).

This study contributes to the existing literature by providing a comparative analysis of HIT and MICE in terms of metabolic, reproductive, and psychological health in women with PCOS. By evaluating key physiological and mental health outcomes, it aims to establish evidence-based recommendations for exercise prescriptions in PCOS management. Given the significant burden of PCOS on women's health, identifying the most effective and feasible exercise strategy is crucial for improving long-term outcomes.

In conclusion, while exercise is widely acknowledged as a beneficial intervention for PCOS, optimizing intensity levels remains a challenge. This study investigates whether HIT offers superior advantages over MICE in addressing the metabolic, reproductive, and psychological aspects of PCOS. The findings will contribute to refining exercise guidelines and improving personalized care for women with this complex disorder.