HIIT'ing or MISS'ing the Optimal Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of High- Versus Moderate-Intensity Exercise Prescription

Abstract

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.

Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment

“…There have been conflicting conclusions regarding the efficacy of the choice of optimal exercise mode in improving insulin sensitivity in women with PCOS. The heterogeneity of PCOS necessitates individualization of treatment options, and it appears that exercise combined with additional dietary/drug intervention is better for improving insulin sensitivity than either intervention alone [149][150][151].…”

Lifestyle management in polycystic ovary syndrome – beyond diet and physical activity

“…These reviews found that vigorous aerobic exercise can improve measures of insulin responsiveness and resistance, including HOMA-IR [ 121 ] and the insulin sensitivity index [ 120 ]; body composition, including WC [ 121 ] and BMI [ 122 ]; and cardiorespiratory fitness (VO 2max ) [ 121 ]. High intensity interval training (HIIT) alone may be effective for improving IR and BMI [ 123 ], however this has not been consistently shown [ 124 ]. Interventions involving a combination of aerobic and resistance exercise [ 122 ] or resistance training only [ 120 ] did not result in improvements in BMI [ 122 ] or weight status [ 120 ].…”

“…↓ WC [ 119 , 121 , 124 ], BMI [ 119 , 122 , 124 ], BF% [ 119 ], HOMA-IR [ 119 , 121 , 122 , 124 ], TC [ 119 , 124 ], FINS [ 119 , 124 ], TAG [ 119 ], LDL-C [ 119 ], RHR [ 119 ]…”

Tai Chi for Overweight/Obese Adolescents and Young Women with Polycystic Ovary Syndrome: A Randomized Controlled Pilot Trial

“…A systematic review compared the effects of high-intensity interval training (HIIT) and moderate-intensity steady-state exercise (MISS) in PCOS patients [37]. e authors reported that neither exercise type improved HOMA-IR, MISS improved the relative maximal oxygen consumption and anthropometric profile, and decreased the TC (moderatequality evidence), and MISS exercise appeared to be more effective in improving cardiorespiratory fitness and BMI in women with PCOS than HIIT [39]. e exercise prescription of Tai chi still needs future investigation, specifically in terms of exercise intensity, frequency, and duration.…”