Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome

Abstract

Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB. Lowfrequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol 297: R387-R395, 2009. First published June 3, 2009 doi:10.1152/ajpregu.00197.2009We have recently shown that polycystic ovary syndrome (PCOS) is associated with high muscle sympathetic nerve activity (MSNA). Animal studies support the concept that low-frequency electroacupuncture (EA) and physical exercise, via stimulation of ergoreceptors and somatic afferents in the muscles, may modulate the activity of the sympathetic nervous system. The aim of the present study was to investigate the effect of these interventions on sympathetic nerve activity in women with PCOS. In a randomized controlled trial, 20 women with PCOS were randomly allocated to one of three groups: low-frequency EA (n ϭ 9), physical exercise (n ϭ 5), or untreated control (n ϭ 6) during 16 wk. Direct recordings of multiunit efferent postganglionic MSNA in a muscle fascicle of the peroneal nerve before and following 16 wk of treatment. Biometric, hemodynamic, endocrine, and metabolic parameters were measured. Low-frequency EA (P ϭ 0.036) and physical exercise (P ϭ 0.030) decreased MSNA burst frequency compared with the untreated control group. The low-frequency EA group reduced sagittal diameter (P ϭ 0.001), while the physical exercise group reduced body weight (P ϭ 0.004) and body mass index (P ϭ 0.004) compared with the untreated control group. Sagittal diameter was related to MSNA burst frequency (Rs ϭ 0.58, P Ͻ 0.005) in the EA group. No correlation was found for body mass index and MSNA in the exercise group. There were no differences between the groups in hemodynamic, endocrine, and metabolic variables. For the first time we demonstrate that low-frequency EA and physical exercise lowers high sympathetic nerve activity in women with PCOS. Thus, treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS. polycystic ovary syndrome; sympathetic nerve activity; testosterone; insulin resistance; metabolic syndrome; cardiovascular disease POLYCYSTIC OVARY SYNDROME (PCOS) is one of the most common female endocrine disorders affecting ϳ10% of women of reproductive age, and is strongly associated with hyperandrogenism and ovulatory dysfunction (8,46). PCOS increases the risk of metabolic disturbances such as abdominal obesity, hyperinsulinaemia, and insulin resistance, which can lead to type 2 diabetes, and dyslipidemia (8, 46), as well as hypertension which may lead to the development of other cardiovascular diseases (35).Despite extensive research, the primary etiology remains unknown, although both environmental and genetic factors are implicated (17). Existing evidence suggests the ovarian theca cells, the major source of androgen production and secretion (22) to play a key role in the etiology. Also, the hypothalamicpituitary axis (50) and defective insulin a...

Acupuncture for treating polycystic ovary syndrome: guidance for future randomized controlled trials

“…A short description of the studies included in this review was shown in Table 1. Of the 31 included trials, three were performed in Sweden (Stener-Victorin et al, 2009;2013;Jedel et al, 2011;Leonhardt et al, 2014), one in the USA (Pastore et al, 2011;Franasiak et al, 2012), one in Iran (Rashidi et al, 2013), and all other trials were conducted in China. After the studies were divided into four categories according to interventions, five were identified as "acupuncture vs. sham/no intervention," fifteen as "acupuncture+conventional therapy vs. conventional therapy," nine as "acupuncture vs. conventional therapy," and two as "comparison between different groups containing two or more of the above situations.…”

“…In this review, menstrual frequency, hormones, anthropometrics, insulin sensitivity, blood lipids, and fertility were used as the main measurements to assess the effects of acupuncture in treating PCOS. Menstrual frequency and hormones (follicle stimulating hormone (FSH), luteotropic hormone (LH), LH/FSH, and testosterone (T)) were the most common measurements used in evaluating the effect of a therapy on PCOS, and they were available in 25 of the 31 included trials (Zhao et al, 2007;Shi et al, 2009;Stener-Victorin et al, 2009;2013;Lai et al, 2010;Li and Han, 2010;Jedel et al, 2011;Li and Zhang, 2011;Li Y.L. et al, 2011;Pastore et al, 2011;Cui Y. et al, 2012;Franasiak et al, 2012;Liu et al, 2012;Liang et al, 2013a;2013b;Wang and Gu, 2013;Wang and Li, 2013;Zhang, 2013;Zheng et al, 2013;He, 2014;Jin et al, 2014;Leonhardt et al, 2014;Li L. et al, 2014;Lin, 2014;Liang, 2015a;2015b;Qiu et al, 2015;Wang, 2015).…”

“…et al, 2011;Pastore et al, 2011;Cui Y. et al, 2012;Franasiak et al, 2012;Liu et al, 2012;Liang et al, 2013a;2013b;Wang and Gu, 2013;Wang and Li, 2013;Zhang, 2013;Zheng et al, 2013;He, 2014;Jin et al, 2014;Leonhardt et al, 2014;Li L. et al, 2014;Lin, 2014;Liang, 2015a;2015b;Qiu et al, 2015;Wang, 2015). Anthropometric measurements, such as body weight, body mass index (BMI), waist, waist-hip ratio (WHR), and the FerrimanGallwey score were available in 10 of the 31 included trials (Zhao et al, 2007;Stener-Victorin et al, 2009;2013;Lai et al, 2010;Jedel et al, 2011;Liu et al, 2012;Zheng et al, 2013;Jin et al, 2014;Leonhardt et al, 2014;Liang, 2015a;2015b). Measurements about insulin sensitivity including fasting insulin (FINS), fasting plasma glucose (FPG), and homeostasis model assessment for insulin resistance (HOMA-IR) were available in 9 of the 31 trials (Zhao et al, 2007;Stener-Victorin et al, 2009;2013;Lai et al, 2010;Jedel et al, 2011;Liu et al, 2012;Zheng et al, 2013;Leonhardt et al, 2014;Liang, 2015a;…”

“…Anthropometric measurements, such as body weight, body mass index (BMI), waist, waist-hip ratio (WHR), and the FerrimanGallwey score were available in 10 of the 31 included trials (Zhao et al, 2007;Stener-Victorin et al, 2009;2013;Lai et al, 2010;Jedel et al, 2011;Liu et al, 2012;Zheng et al, 2013;Jin et al, 2014;Leonhardt et al, 2014;Liang, 2015a;2015b). Measurements about insulin sensitivity including fasting insulin (FINS), fasting plasma glucose (FPG), and homeostasis model assessment for insulin resistance (HOMA-IR) were available in 9 of the 31 trials (Zhao et al, 2007;Stener-Victorin et al, 2009;2013;Lai et al, 2010;Jedel et al, 2011;Liu et al, 2012;Zheng et al, 2013;Leonhardt et al, 2014;Liang, 2015a;2015b). Measurements about blood lipids including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were available only in four trials (Lai et al, 2010;Jedel et al, 2011;Stener-Victorin et al, 2012;2013;Zheng et al, 2013;Leonhardt et al, 2014).…”

“…Acupuncture was used alone in 14 trials (Yang et al, 2005;Stener-Victorin et al, 2009;2013;Lai et al, 2010;Jedel et al, 2011;Li and Zhang, 2011;Pastore et al, 2011;Cui Y. et al, 2012;Franasiak et al, 2012;Rashidi et al, 2013;Wang and Li, 2013;Zheng et al, 2013;He, 2014;Jin et al, 2014;Leonhardt et al, 2014), and along with pharmacotherapy for ovulation induction, CMH, ECAT or metformin in the other 17 trials. Among the 31 trials reviewed, blinding was only applied in three RCTs (Stener-Victorin et al, 2009;Pastore et al, 2011;Franasiak et al, 2012;. In one trial, researchers failed to find significant differences in the outcomes between true and sham acupuncture (control) (Pastore et al, 2011;Franasiak et al, 2012).…”