Polycystic ovary syndrome (PCOS): Targeting a potential root cause with exercise.

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age. It is characterized by the presence of multiple cysts on the ovaries, as well as a range of other symptoms such as irregular menstrual cycles, excess hair growth, and weight gain.

One of the most significant and common symptoms of PCOS is insulin resistance and compensatory hyperinsulinemia [1-3]. Insulin resistance is a condition in which the body’s cells are less sensitive to the effects of insulin, which results in excess insulin production. Insulin resistance and compensatory hyperinsulinemia are present in 65–95% of women with PCOS, including most overweight and obese women and more than half of women of normal weight [1].

Insulin resistance and compensatory hyperinsulinemia are considered major drivers of PCOS and are involved in the development of hyperandrogenaemia and reproductive dysfunction by various mechanisms [1, 4]. It is often that women with PCOS will be prescribed with an insulin sensitizing medication like metformin. It is important to know that exercise is also a potent insulin sensitizing tool. Different types of exercise are more potent others when targeting insulin sensitivity.

Resistance training and high intensity interval training (HIIT) have both been shown to improve insulin sensitivity, glucose metabolism and hormonal profiles of women with PCOS [5-8]. It is important to know that 80% of our glucose metabolism (and most of our insulin receptors) are in our muscle tissue. Compared to other types of exercise, high intensity resistance training and HIIT uses lots of glucose for fuel and once you complete a session your muscles are reduced of glucose stores, this causes your body to burn more fat for fuel after the session is completed, which can aid in weight loss. It also stimulates an increase in glucose transporters and insulin receptors in the muscle tissue, making your muscles more sensitive to insulin. Overtime an increase in muscle quality will allow for further increases in insulin receptors, glucose transporters and more room to store glucose, therefore reducing high insulin levels which can alleviate PCOS.

High intensity exercise also stimulates certain hormones (myokines) which result in fat loss or fat redistribution from the abdominal and visceral area [9-11]. This helps clear our “toxic” abdominal fat which can alleviate inflammation, insulin resistance and PCOS. Although HIIT and high intensity-resistance training offer similar benefits explained above, they also offer unique advantageous (but this is for a different blog).

In addition to these benefits, resistance training and HIIT have been shown to improve body composition, cardiovascular fitness, and overall health in women with PCOS. These exercises can also help to reduce stress and improve mood, which can be particularly beneficial for women with PCOS who may be experiencing a range of emotional and psychological symptoms.

Other types of exercise like walking or running are also effective methods which will also benefit PCOS, although the most insulin sensitizing types of exercise are HIIT and resistance training. HIIT and resistance training are also time-efficient, and the methods used at Sydney Exercise Medicine are the safest and most effective methods.

In addition, low carbohydrate and ketogenic diets have been shown to reverse type 2 diabetes, insulin resistance and PCOS [12, 13].

In conclusion, resistance training and HIIT can be beneficial for women with PCOS and insulin resistance. These types of exercises can improve insulin sensitivity, glucose metabolism, body composition, cardiovascular fitness, and overall health. It is important to note that before starting any exercise program, it is always best to consult with a healthcare provider or an exercise physiologist to ensure that the program is safe and appropriate for the individual needs. Also, it is important to keep in mind that, although exercise can be beneficial for managing PCOS and insulin resistance, it is only one part of a comprehensive treatment plan. A healthy diet, weight management, and medication, if needed, should also be part of the treatment plan.

Sources:

1. Zhao, H., et al., Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment. Journal of Ovarian Research, 2023. 16(1): p. 9.

2. Marshall, J.C. and A. Dunaif, Should all women with PCOS be treated for insulin resistance? Fertil Steril, 2012. 97(1): p. 18-22.

3. Zhang, H., et al., Relationship between body composition, insulin resistance, and hormonal profiles in women with polycystic ovary syndrome. Front Endocrinol (Lausanne), 2022. 13: p. 1085656.

4. Cassar, S., et al., Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic–hyperinsulinaemic clamp studies. Human Reproduction, 2016. 31(11): p. 2619-2631.

5. Wright, P.J., et al., Resistance Training as Therapeutic Management in Women with PCOS: What is the Evidence? Int J Exerc Sci, 2021. 14(3): p. 840-854.

6. Niemann, M.J., et al., Strength Training and Insulin Resistance: The Mediating Role of Body Composition. J Diabetes Res, 2020. 2020: p. 7694825.

7. Wang, B., et al., Effect of resistance exercise on insulin sensitivity of skeletal muscle. World Journal of Meta-Analysis, 2021. 9(2): p. 101-107.

8. Santos, I.K.d., et al., Effect of high-intensity interval training on metabolic parameters in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE, 2021. 16(1): p. e0245023.

9. Wedell-Neergaard, A.S., et al., Exercise-Induced Changes in Visceral Adipose Tissue Mass Are Regulated by IL-6 Signaling: A Randomized Controlled Trial. Cell Metab, 2019. 29(4): p. 844-855.e3.

10. Zhang, H., et al., Exercise training-induced visceral fat loss in obese women: The role of training intensity and modality. Scandinavian Journal of Medicine & Science in Sports, 2021. 31(1): p. 30-43.

11. Kolnes, K.J., et al., Effect of Exercise Training on Fat Loss—Energetic Perspectives and the Role of Improved Adipose Tissue Function and Body Fat Distribution. Frontiers in Physiology, 2021. 12.

12. Hallberg, S.J., et al., Reversing Type 2 Diabetes: A Narrative Review of the Evidence. Nutrients, 2019. 11(4).

13. Zhang, X., et al., The Effect of Low Carbohydrate Diet on Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials. Int J Endocrinol, 2019. 2019: p. 4386401.