Aerobic exercise in women with polycystic ovary syndrome improves ovarian morphology independent of changes in body composition

Abstract

In a prospective study, 8 women with polycystic ovary syndrome completed 16 weeks of individualized aerobic exercise training. Independent of changes in body weight and adiposity there was a significant increase in aerobic fitness and insulin sensitivity and a significant decrease in the total number of follicles measured by magnetic resonance imaging.Recently and based initially on studies in obesity and type 2 diabetes, lifestyle modification has been adopted as the first line of treatment to manage both the reproductive and metabolic dysfunctions in overweight and obese women with PCOS (1-3). As a result a surge in clinical studies involving dietary restriction alone (4-7) or in combination with physical activity programs have been conducted (8,9). Collectively these studies indicate that a reduction in body weight of at least 5% leads to significant improvements in menstrual cyclicity, ovulation and biochemical hyperandrogenism in terms of the reproductive complaints (4,6-9) and improved glucose tolerance and reduced risk for cardiovascular disease (4,8). One intriguing finding was that in comparison to dietary restriction (800 kcal/ d), aerobic exercise led to a 40% higher rate of ovulation (25% versus 65%, respectively) and greater improvements in SHBG and testosterone despite less weight loss (10). Aerobic exercise resulted in a greater reduction in fasting insulin and insulin resistance (HOMA-IR) suggesting a possible mechanistic link. Exercise-induced changes in visceral fat and ectopic lipid in non-fatty tissues are probably important components however to our knowledge only one recent study using single slice computed tomography measured changes in visceral fat with exercise training in PCOS (11). Studies using magnetic resonance imaging or spectroscopy are seldom no studies have yet quantified the effects of exercise on the polycystic ovarian morphology.As detailed previously (13), eight young (18-30 years), overweight/obese (BMI ≥25 kg/m 2 ) women with PCOS completed a 16-week study of aerobic exercise. Seven normally cycling controls (BMI ≥25 kg/m 2 ) were also enrolled to complete baseline testing only. The Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. All exercise training was performed under supervision at the PBRC Fitness Center five times per week. Exercise was prescribed on an individual basis with the objective to achieve specified exercise energy expenditure (ExEE) per day as previously described (13). Diet was not controlled throughout the exercise intervention however a standardized eucaloric diet (35% fat, 15% protein, 50% carbohydrate) ...

Potential effects of aerobic exercise on the expression of perilipin 3 in the adipose tissue of women with polycystic ovary syndrome: a pilot study

“…Additionally, menstrual cycle improvements have been shown following exercise intervention in women with PCOS 19, 36, 40 . Though some studies show reductions in body weight with exercise 19, 20, 36 , several studies have shown that benefits occur without weight loss 28, 37, 41 and suggest that exercise for PCOS would be recommended even if weight loss were not achieved. Our study showed improvements in insulin resistance as measured by euglycemic-hyperinsulinemic clamps (Table 1) and improvements in menstrual function 28 .…”

“…Though some studies show reductions in body weight with exercise 19, 20, 36 , several studies have shown that benefits occur without weight loss 28, 37, 41 and suggest that exercise for PCOS would be recommended even if weight loss were not achieved. Our study showed improvements in insulin resistance as measured by euglycemic-hyperinsulinemic clamps (Table 1) and improvements in menstrual function 28 . However, despite all these benefits of exercise, few studies have investigated molecular targets in the adipose tissue from women with PCOS.…”

“…With a prospective study design (paired) with a target power of 80% and a significance level set to α=0.05, we can conclude that only 6 subjects would be needed to detect a 20% change in GDR from baseline. The main outcomes of this study were previously reported in Moro et al 24 and in Redman et al 28 The diagnosis of PCOS was assessed by the Rotterdam criteria. 29, 30 Women with PCOS had to possess two of the following criteria: confirmation by medical history of menstrual irregulatiry (oligo- or amenorrhea), presence of more than 10 ovarian follicles 2–9mm in diameter as assessed by MRI, or either clinical (hirsutism score) or serum measures of androgen excess (elevated free androgen index, FAI).…”

“…In order to reduce confounding factors associated with dietary differences and metabolic testing, we provided participants a standard diet of 50% carbohydrate, 35% fat, and 15% protein 2 days prior to testing and throughout the duration of testing. Following an overnight fast, blood and subcutaneous abdominal adipose tissue samples were collected, body composition (percent body fat surmised from all regions of the body) was assessed by dual energy x-ray absorptiometry (DXA, QDR 4500A; Hologics, Bedford, MA), and insulin sensitivity was determined by a hyperinsulinemic-euglycemic clamp (120-minutes at 80mU/min/m 2 ) as previously described 28 . Aerobic capacity (VO 2 max) was measured during a graded treadmill test (TrueMax 2400; ParvoMedics, Salt Lake City, UT).…”

Affect-regulated exercise: an alternative approach for lifestyle modification in overweight/obese women with polycystic ovary syndrome

“…Exercise is a crucial component of lifestyle intervention by promoting several benefits on body composition [2][3][4][5], cardiovascular [2][3][4]6], metabolic [3,[5][6][7][8], reproductive [9][10][11][12] and psychological [13,14] health of women with PCOS. However, the long-term adherence to exercise is a challenge [15].…”