Introduction: Polycystic Ovary syndrome (PCOS) is a metabolic disorder associated with increased cardiovascular disease risk. Exercise is an effective treatment strategy to manage symptoms and reduce long-term health risk. High-intensity interval training (HIIT) has been suggested as a more efficient exercise mode in PCOS; however, it is not clear whether HIIT is superior to moderate intensity steady state exercise (MISS).Methods: We synthesized available data through a systematic review and meta-analysis to compare the effectiveness of isolated HIIT and MISS exercise interventions. Our primary outcome measures were cardiorespiratory fitness and insulin resistance, measured using V˙O2max and HOMA-IR respectively.Results: A total of 16 studies were included. Moderate-quality evidence from 16 studies identified significant improvements in V˙O2max following MISS (Δ = 1.081 ml/kg/min, p < 0.001, n = 194), but not HIIT (Δ = 0.641 ml/kg/min, p = 0.128, n = 28). Neither HIIT nor MISS improved HOMA-IR [(Δ = −0.257, p = 0.374, n = 60) and (Δ = −0.341, p = 0.078, n = 159), respectively].Discussion: A significant improvement in V˙O2max was evident following MISS, but not HIIT exercise in women with PCOS. This contrasts with previous literature in healthy and clinical cohorts that report superior benefits of HIIT. Therefore, based on available moderate-quality evidence, HIIT exercise does not provide superior outcomes in V˙O2max compared with MISS, although larger high-quality interventions are needed to fully address this. Additional dietary/pharmacological interventions may be required in conjunction with exercise to improve insulin sensitivity.

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Left ventricular (LV) structural remodeling following athletic training has been evidenced through training-specific changes in wall thickness and geometry. Whether the LV response to changes in hemodynamic load also adapts in a training-specific manner is unknown. Using echocardiography, we examined LV responses of endurance-trained (n=15), resistance-trained (n=14), and non-athletic males (n=13) to (i) 20%, 40%, and 60% one-repetition-maximum (1RM) leg-press exercise, and (ii) intravascular Gelofusine infusion (7ml·kg-1) with passive leg-raise. While resting heart rate was lower in endurance-trained vs. controls (P=0.001), blood pressure was similar between groups. Endurance-trained individuals had lower wall thickness, but greater LV mass relative to body surface area vs. controls, with no difference between resistance-trained and controls. Leg-press evoked a similar increase in blood pressure; however, resistance-trained preserved stroke volume (SV; -3±8%) vs. controls at 60% 1RM (-15±7%, P=0.001). While the maintenance of SV was related to the change in longitudinal strain across all groups (R=0.537; P=0.007), time-to-peak strain was maintained in resistance-trained but delayed in endurance-trained individuals (1% vs. 12% delay; P=0.021). Volume infusion caused a similar increase in end-diastolic volume (EDV) and SV across groups, but leg-raise further increased EDV only in endurance-trained individuals (5±5% to 8±5%; P=0.018). Correlation analysis revealed a relationship between SV and longitudinal strain following infusion and leg-raise (R=0.334, P=0.054), however, we observed no between-group differences in longitudinal myocardial mechanics. In conclusion, resistance-trained individuals better maintained SV during pressure loading, whereas endurance-trained individuals demonstrated greater EDV reserve during volume loading. These data provide novel evidence of training-specific LV functional remodeling.

Neurovascular coupling (NVC) is mediated via nitric oxide signalling, which is independently influenced by sex hormones and exercise training. Whether exercise training differentially modifies NVC pre- vs. post-puberty, where levels of circulating sex hormones will differ greatly within- and between-sexes, remains to be determined. Therefore, we investigated the influence of exercise training-status on resting intra-cranial haemodynamics and NVC at different stages of maturation. Posterior and middle cerebral artery velocities (PCAv and MCAv) and pulsatility index (PCAPI and MCAPI) were assessed via trans-cranial Doppler ultrasound at rest and during visual NVC stimuli. N=121 exercise-trained (males: n=32, females: n=32) and untrained (males: n=28, females: n=29) participants were characterised as pre- (males: n=33, females: n=29) or post- (males: n=27, females: n=32) peak height velocity (PHV). Exercise-trained youth demonstrated higher resting MCAv ( P=0.010). Maturity- and training-status did not affect the ∆PCAv and ∆MCAv during NVC. However, pre-PHV untrained males (19.4±13.5 vs. 6.8±6.0%; P≤0.001) and females (19.3±10.8 vs. 6.4±7.1%; P≤0.001) had a higher ∆PCAPI during NVC than post-PHV untrained counterparts, while the ∆PCAPI was similar in pre- and post-PHV trained youth. Pre-PHV untrained males (19.4±13.5 vs. 7.9±6.0%; P≤0.001) and females (19.3±10.8 vs 11.1±7.3%; P=0.016) also had a larger ∆PCAPI than their pre-PHV trained counterparts during NVC, but the ∆PCAPI was similar in trained and untrained post-PHV youth. Collectively, our data indicate that exercise training elevates regional cerebral blood velocities during youth, but training-mediated adaptations in NVC are only attainable during early stages of adolescence. Therefore, childhood provides a unique opportunity for exercise-mediated adaptations in NVC.

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