KatCarney

Exercise Training Program May Be Helpful in Young Women With Polycystic Ovary Syndrome

February 6, 2007 — Women with polycystic ovary syndrome have better cardiopulmonary functional capacity after a 3-month exercise training program, according to the results of a randomized controlled trial reported in the January 30 Ahead of Print issue of the Journal of Clinical Endocrinology & Metabolism.

"Polycystic ovary syndrome (PCOS) is an endocrine disease closely related to several risk factors for cardiovascular disease," write Carlo Vigorito, MD, of the University "Federico II" in Naples, Italy, and colleagues. "An impaired cardiopulmonary functional capacity was previously demonstrated in PCOS women. No data regarding the effects of a structured exercise training (ET) program on cardiopulmonary functional capacity in PCOS women are available."

Ninety young, overweight women with PCOS were randomized to the PCOS-T (trained) group, which underwent a 3-month structured exercise training program, or to the PCOS-UnT (untrained) group (n = 45 in each group). Outcomes included hormonal and metabolic profile and cardiopulmonary and exercise parameters.

After 3 months of the exercise training program, the PCOS-T group had improved maximal oxygen consumption (VO2max; +35.4%), maximal workload (+37.2%), reduction in body mass index
(-4.5%), lower C-reactive protein (-10%), and improvement in insulin sensitivity indexes (P < .001 for all comparisons). During the same period, no changes were observed in PCOS-UnT.

"A three-month structured ET program improves cardiopulmonary functional capacity in young PCOS women," the authors write.

Study limitations include small sample size, lack of generalizability to older women, and limited duration of follow-up.

"Given the strong evidence for a direct role of physical activity in the prevention of IR [insulin resistance], and the fact that ET increases mitochondrial biogenesis and improves glucose tolerance and insulin action in IR subjects, the present work strengthens the recommendation to apply primary defense mechanisms such as exercise in PCOS young women," the authors conclude. "A structured ET program represents a simple therapeutic option which can be safely, routinely and extensively performed for reducing CVR [cardiovascular risk] profile in young PCOS women."

J Clin Endocrinol Metabol. Published online January 30, 2007.

Clinical Context
PCOS affects 5% to 10% of reproductive-aged women and is an important cause of infertility with chronic anovulation, hyperandrogenism, and insulin resistance as main characteristics. Diet and exercise are recommended as first-line treatment for weight loss to reduce metabolic complications, and the current authors previously reported impaired cardiopulmonary capacity related to insulin resistance in women with PCOS, although it is uncertain whether women with PCOS have higher cardiovascular mortality.

The current study is a randomized trial of 90 healthy young women with PCOS to determine the effect of 3 months of structured exercise training compared with no exercise training on cardiopulmonary function and metabolic outcomes.

Study Highlights
Inclusion criteria were healthy women with polycystic ovaries identified by transvaginal ultrasonography, hirsutism by Ferriman-Gallway score, and by the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine criteria for PCOS.
Excluded were women who were pregnant or who had diabetes or other endocrinologic disease, or hepatic, respiratory, or cardiovascular disorder, or who used alcohol.
All women underwent blood sampling and assessment with electrocardiography, exercise test, anthropometric measurements, and completed a leisure-time physical activity questionnaire (LTPA).
Women were advised to take a healthy-balanced meal plan with 50% of calories from carbohydrates, 25% from protein, and 25% from fat.
45 women were randomly assigned to a 3-month structured exercise training program consisting of 3 times per week of supervised aerobic activity with 5-minute warm up and 5-minute cool down with 30 minutes on a bicycle ergometer and electrocardiographic monitoring.
The target was 60% to 70% of maximal oxygen consumption.
45 women assigned to the control group did not receive this training.
Women were not permitted to take any medications during the study.
All women completed a self-reported LTPA, and energy expenditure was calculated in metabolic equivalents per hour and graded as "no LTPA" or "low LTPA," "moderate LTPA," and "high LTPA."
Work-related physical activity was not reported as an outcome.
Mean age was 22 years, body mass index was 29 kg/m2, follicle-stimulating hormone level was 10.5 IU/L and luteinizing hormone level was 24.2 IU/L.
All PCOS patients showed polycystic ovaries and anovulation.
88% had clinical hyperandrogenism, and 63% had biochemical hyperandrogenism.
All patients completed the study, and the total duration of the intervention was 84 days.
There were no adverse events.
Average exercise intensity was 67% of maximal oxygen consumption, averaging 92 minutes per week of training.
After exercise training, 60% of women had normal menstrual cycles.
In the exercise training group, after 3 months, there was a significant improvement in body mass index (-4.5%; P < .001), waist circumference, waist-hip ratio, fasting insulin and area under the curve for insulin (P < .001) vs baseline.
In the exercise training group, improvement in VO2max was significantly correlated to body mass index reduction, waist circumference reduction, waist-hip ratio reduction, and area under the curve for insulin reduction.
There were no significant reductions in total, low-density lipoprotein, or high-density lipoprotein cholesterol, and triglyceride levels.
There were no significant differences between the 2 groups at baseline for hemodynamic or cardiovascular parameters.
After 3 months, the exercise training group showed a significant improvement in VO2max (+35.4%; P < .001), oxygen consumption at anaerobic threshold, and maximal workload.
In the exercise training group, a significant improvement in LTPA was observed while the LTPA level was unchanged in the control group.

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