Effects of physical activity in women with polycystic ovary syndrome: a systematic review and meta-analysis

Cavalcante, Diana Carvalho Braga; Scandolara, Thalita Basso; Kogure, Gislaine Satyko; Rodrigues, Cainã; Verruma, Carolina Gennari; Moraes Filho, Manoel Odorico de; Reis, Rosana Maria dos; Cavalcante, Marcelo Borges; Furtado, Cristiana Libardi Miranda

doi:10.61622/rbgo/2025rbgo56

person Diana Carvalho Braga Cavalcante

conceived the study and drafted the original version of the article · All authors revised the manuscript’s drafts critically and approved its final version · All authors agree to be accountable for all aspects of the work

schoolUniversidade Federal do Ceará, Fortaleza, CE, Brazil.

0000-0002-7778-2376

person Thalita Basso Scandolara

participated in drafting part of the article and critically revising the paper · All authors revised the manuscript’s drafts critically and approved its final version · All authors agree to be accountable for all aspects of the work

schoolUniversidade Federal do Ceará, Fortaleza, CE, Brazil.

0000-0003-4709-9207

person Gislaine Satyko Kogure

in reviewing and editing the final draft · All authors revised the manuscript’s drafts critically and approved its final version · All authors agree to be accountable for all aspects of the work

schoolFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

0000-0002-2860-846X

person Cainã Rodrigues

participated in the data analyses · All authors revised the manuscript’s drafts critically and approved its final version · All authors agree to be accountable for all aspects of the work

schoolUniversidade Federal do Ceará, Fortaleza, CE, Brazil.schoolFaculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brazil.

0009-0003-1678-3142

person Carolina Gennari Verruma

in reviewing and editing the final draft · All authors revised the manuscript’s drafts critically and approved its final version · All authors agree to be accountable for all aspects of the work

schoolFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

0000-0002-2373-1936

person Manoel Odorico de Moraes Filho

All authors revised the manuscript’s drafts critically and approved its final version · All authors agree to be accountable for all aspects of the work

schoolUniversidade Federal do Ceará, Fortaleza, CE, Brazil.

0000-0003-3378-8722

person Rosana Maria dos Reis

critically revised the paper, participated in the funding acquisition · All authors revised the manuscript’s drafts critically and approved its final version · All authors agree to be accountable for all aspects of the work

schoolFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

0000-0001-9631-4167

person Marcelo Borges Cavalcante

critically supervised the studies selected and analyzed the data · All authors revised the manuscript’s drafts critically and approved its final version · All authors agree to be accountable for all aspects of the work

schoolFaculdade de Medicina, Universidade de Fortaleza, Fortaleza, CE, Brazil.

0000-0001-9943-9731

person Cristiana Libardi Miranda Furtado

conceived the study, supervised the study, participated in the funding acquisition · All authors revised the manuscript’s drafts critically and approved its final version · All authors agree to be accountable for all aspects of the work

schoolUniversidade Federal do Ceará, Fortaleza, CE, Brazil.schoolUniversidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

0000-0002-8711-8225

personCorresponding author: Cristiana Libardi Miranda Furtado E-mail:
clibardim@gmail.com

Conflicts to interest:

none to declare.

Associate Editor:

Marcos Felipe Silva de Sá (https://orcid.org/0000-0002-4813-6404) Universidade de São Paulo, Ribeirão Preto, SP, Brasil

PICOS criteria	Criteria used for eligibility
P	Women of reproductive age diagnosed with PCOS
I	Aerobic or resistance exercise
C	Comparison before and after aerobic or resistance exercise
O	BMI, testosterone, insulin, HDL, LDL, total cholesterol and triglycerides
S	Original articles

Inclusion criteria:
1.	Original articles;
2.	Randomized controlled trials (RCTs) that compared a PCOS group with supervised aerobic or resistance exercise with a PCOS control group without intervention for meta-analytical analysis;
3.	Intervention lasting at least two weeks with a minimum exercise duration of 30 minutes a day;
4.	Women of reproductive age diagnosed with Polycystic Ovary Syndrome based on the NIH (1990) or Rotterdam ESHRE/ASRM (2003) criteria;
5.	Studies containing primary results of the intervention group and control group of BMI, testosterone, blood glucose, insulin, HDL, LDL, cholesterol and triglycerides and then the secondary results (after the intervention) of the same results;
6.	Studies published in English.
Exclusion criteria:
1.	Systematic reviews, meta-analyses, literature reviews or abstracts;
2.	Studies involving only one high-intensity interval training (HIIT) group, with no other groups involving aerobic or resistance exercise compared to a control group;
3.	Study protocol and/or guidelines;
4.	Research involving any type of diet;
5.	Studies with pregnant women;
6.	Articles with no control group;
7.	Psychological/cognitive-behavioral analysis;
8.	Retrospective studies;
9.	Studies analyzing only medicines;
10.	Research that does not include aerobic or resistance exercise groups;
11.	Observational research;
12.	Case reports;
13.	Analyses of sexual function only;
14.	Research published in languages other than English;
15.	Animal model studies.

First author (year)	Study Design	Participants and Distribution	Study Duration	Study Criteria and Participant Characteristics	Methods	Clinical and Metabolic Parameters
Aerobic Exercise
Benham et al. (2021)⁽²¹⁾	RCT with 3 groups: CAET Control group HIIT group	47 participants: CAET group (n=14) Control group(n=17) HIIT group (n=16, not considered in the analysis)	26 weeks	Criteria: Rotterdam Age(y): 18 to 40 BMI (mean kg/m²): CAET group: 31,4 Control group: 31,1	CAET participants performed 40 minutes of moderate-intensity aerobic exercise (50% to 60% of HRR) using a Polar H10 HR sensor and Polar A370 watch	BMI, WC, SBP, DBP, VO2 max, Fasting Insulin, Fasting Glucose, HOMA2-IR, Total Cholesterol, HDL-C, LDL-C, TG, ALT, GGT.
Brown et al. (2009)⁽²²⁾	RCT with 2 groups: Exercise group Control group	20 participants: Exercise group (n=8) Control group (n=12)	12 weeks	Criteria: NIH Age(y): 18 to 50 BMI (mean kg/m²): Exercise group: 37,9 Control group: 31,3	Moderate-intensity aerobic exercise on a treadmill (50% VO2 max) using a Polar Electro HR sensor	BMI, CC, SBP, DBP, FG score, TST, VO2 max, HOMA-IR, Glycemia, AUCglu, Insulin, AUCins, HbA1c, HDL, LDL, VLDL, TG.
Jedel et al. (2011)⁽²³⁾	RCT with 3 groups: PCOS group Control group EA group	74 participants: Exercise group (n=30) Control group (n=15) EA group (n=29, not considered in the analysis)	16 weeks	Criteria: Rotterdam Age(y): 18 to 37 BMI (mean kg/m²): Exercise group: 27,7 Control group: 26,8	Regular aerobic exercise 3 days per week, including brisk walking or cycling, self-monitored with an ECG2 HR monitor to maintain a heart rate of ≥ 120 beats/min	BMI, VO2 max, TST, E1-S, E2, DHEA, 17G, SHBG, LH, FSH, FG score.
Lopes et al. (2018)⁽²⁴⁾ Ribeiro et al. (2020)⁽²⁵⁾ Ribeiro et al. (2021)⁽²⁶⁾	RCT with 3 groups: CAT group IAT group Control group	87 participants: CAT group (n=28) IAT group (n=29) Control group (n=30)	16 weeks	Criteria: Rotterdam Age(y): 18 to 39 BMI (mean kg/m²): CAT group: 28,43 IAT group: 28,67 Control group: 29,09	Treadmill aerobic exercise three times per week, progressively increasing from 30min (week 1) to 50 min (week 16). Intensity levels: Light (50-64% HRmax), Moderate (64-77% HRmax), and Vigorous (77-94% HRmax)	BMI, WC, Hip Circumference, WHR, Body weight, Height, SBP, DBP, TST, A4, SHBG, FAI, E2, LH, FSH, Total Cholesterol, TG, HDL, LDL, Fasting Glycemia, Fasting Insulin, HOMA-IR, Homocysteine, CRP.
Stener-Victorin et al. (2009)⁽²⁷⁾	RCT with 3 groups: Exercise group Control group EA group	20 participants: Exercise group (n=5) Control group (n=6) EA group (n=9, not considered in the analysis)	16 weeks	Criteria: Rotterdam Age(y) mean: Exercise group: 30,4 Control group: 31 BMI (mean kg/m²): Exercise group: 26,8 Control group: 28,0	Light to moderate-intensity aerobic exercise (bicycle ergometer, cycling, or brisk walking) for 30 to 45 minutes, 3 days per week.	BMI, WHR, SBP, DBP, HR, LH, FSH, FG score, Total TST, Free TST, SHBG, FAI, DHEA-S, Free T4, TSH, Glucose, Insulin, HOMA-IR, Cholesterol, TG, HDL, LDL.
Vigorito et al. (2007)⁽²⁸⁾	RCT with 2 groups: Exercise group Control group	90 participants: Exercise group (n=45) Control group (n=45)	13 weeks	Criteria: Rotterdam Age(y) mean: 22 BMI (mean kg/m²): Exercise group: 29,3 Control group: 29,4	Aerobic exercise on a bicycle ergometer for 30 minutes at 60-70% of VO2 max, three times per week.	BMI, WC, WHR, FG score, Hemoglobin, FSH, LH, PRL, E2, P, 17-OHP, TST, A4, SHBG, FAI, DHEA-S, Fasting Glucose, Fasting Insulin, AUCglu, AUCins, AUCglu/AUCins ratio, Total Cholesterol, TG, HDL-C, LDL- C, CRP, VO2 max.
Resistance Exercise
Almenning et al. (2015)⁽²⁹⁾	RCT with 3 groups: Exercise group Control group HIIT group	31 participants: Exercise group (n=11) Control group (n=10) HIIT group (n=10, not considered in the analysis)	10 weeks	Criteria: Rotterdam Age(y) mean: 27,2 BMI (mean kg/m²): Exercise group: 27,4 Control group: 26,5	Resistance training involved eight dynamic strength exercises at 75% of 1RM, with 3 sets of 10 repetitions and one-minute rests between sets, gradually increasing the load. The control group was advised to engage in ≥ 150 minutes of exercise per week without follow-up during the 10-week intervention.	BMI, WC, VO2 max, Glucose, Insulin, HOMA-IR, TST, FAI, AMH, SHBG, DHEA-S, Total Cholesterol, HDL, LDL, TG, Homocysteine, Adiponectin, Leptin.
Vizza et al. (2016)⁽³⁰⁾	RCT with 2 groups: Exercise group Control group	13 participants: 7 in Exercise group 6 in Control group	12 weeks	Criteria: Rotterdam Age(y): 18 to 42 BMI (mean kg/m²): 37,8	Resistance training was performed for 60 minutes on non-consecutive days, with 8 to 12 repetitions per set. Two sets of each exercise were completed in the first two weeks, progressing to three sets from week 3 onward.	BMI, WC, Hip Circumference, WHR, SBP, DBP, Fasting Insulin, Fasting Glucose, TST, SHBG, FAI, HbA1c.

Study (year)	Physical Intervention	Outcomes
Benham et al. (2021)⁽²¹⁾	CAT Control group	CAT: ↓ BMI; ↓WC. Control group: ↓ WC; ↑ insulin.
Brown et al. (2009)⁽²²⁾	Exercise group Control group	Exercise group: ↑ VO2max; ↑ HDL; Improvement in insulin resistance (measured by AUCins); ↓ VLDL; ↓ TG Control group: There were no significant changes in the data.
Jedel et al. (2011)⁽²³⁾	Exercise group Control group	Exercise group: ↓ circulating TST; ↓ E2; ↓ E1-S; ↓ 17G; ↑ VO2max; menstrual frequency increased Control group: Alteration in serum testosterone levels
Lopes et al. (2018)⁽²⁴⁾ Ribeiro et al. (2020)⁽²⁵⁾ Ribeiro et al. (2021)⁽²⁶⁾	CAT IAT Control group	CAT: ↓ Total cholesterol; ↓ WC; ↓ Hip circumference; ↓ LDL; ↓ TST; ↓ cardiac output. IAT: ↓WC; ↓ WHR; ↓ FAI; ↓TST. Control group: ↑ WC; ↑ body fat; ↓ total cholesterol; ↓ LDL.
Stener-Victorin et al. (2009)⁽²⁷⁾	Exercise group Control group	Exercise group: ↓ body weight; ↓ BMI; ↓ insulin; ↑ SHBG; ↑ FAI. Control group: ↓ LH; ↓ FSH; ↓ insulin.
Vigorito et al. (2007)⁽²⁸⁾	Exercise group Control group	Exercise group: Improvement in VO₂max and AUCins; ↓ BMI; ↓ WC; ↓ WHR; ↓ CRP; ↓ fasting insulin; ↑ AUCglu/AUCins ratio Control group: ↑ CRP

Study

Outcomes

Almenning et al. (2015)⁽²⁹⁾

Exercise group:
↓ Fat percentage;
↓FAI;
↑ fat-free mass;
↓ Anti-Müllarian Hormone

Control group:
There were no significant changes in this group

Vizza et al. (2016)⁽³⁰⁾

- Exercise group:
↑ weight (resulting from muscle hypertrophy);
↑ BMI;
↑ lean mass;
↑ fat-free mass;
↑ fasting glucose;
↓ WC;
↓ HbA1c

Control group:
There were no significant changes in this group.

Study	Year	Study duration (weeks)	Outcome	Control Group*					Aerobic Training
					Before		After			Before		After
				n	Mean	SD	Mean	SD	n	Mean	SD	Mean	SD
Benham et al.⁽²¹⁾	2021	13	BMI (Kg/m²)	17	31,1	2,2	31,1	2,2	14,0	31,4	2,6	31,0	2,5
Ribeiro et al.⁽²⁵⁾	2020a	16	BMI (Kg/m²)	30	29,1	5,2	29,3	5,4	28,0	28,4	5,6	28,2	5,7
Stener-Victorin et al.⁽²⁷⁾	2009	16	BMI (Kg/m²)	6	28,0	6,2	28,5	6,2	5,0	26,8	4,8	26,4	4,8
Vigorito et al.⁽²⁸⁾	2007	13	BMI (Kg/m²)	45	29,4	3,5	29,3	3,2	45,0	29,3	2,9	28,0	2,9
Ribeiro et al.⁽²⁵⁾	2020b	16	BMI (Kg/m²)	45	29,4	3,5	29,3	3,2	29	28,7	4,8	28,5	4,8
Benham et al.⁽²¹⁾	2021	13	No data
Ribeiro et al.⁽²⁵⁾	2020a	16	Testosterone (ng/dl)	30	86,0	37,0	100,0	46,0	28,0	117,0	50,0	93,0	38,0
Stener-Victorin et al.⁽²⁷⁾	2009	16	Testosterone (ng/dl)	6	60,5	23,0	57,6	20,1	5,0	57,6	25,9	57,6	8,6
Vigorito et al.⁽²⁸⁾	2007	13	Testosterone (ng/dl)	45	72,0	14,4	69,1	11,5	45,0	66,2	20,1	60,5	17,2
Ribeiro et al.⁽²⁵⁾	2020b	16	Testosterone (ng/dl)	45	29,4	3,5	29,3	3,2	29	108	52	88	54
Benham et al.⁽²¹⁾	2021	13	Insulin (mIU/L)	17	99,5	15,4	114,0	17,6	14,0	83,4	17,8	86,4	19,8
Ribeiro et al.⁽²⁵⁾	2020a	16	Insulin (mIU/L)	30	12,8	8,5	12,4	9,8	28,0	11,3	8,1	11,2	8,3
Stener-Victorin et al.⁽²⁷⁾	2009	16	Insulin (mIU/L)	6	9,2	6,7	7,8	3,1	5,0	8,0	4,5	6,4	2,8
Vigorito et al.⁽²⁸⁾	2007	13	Insulin (mIU/L)	45	20,2	3,8	20,4	3,6	45,0	20,1	3,5	18,3	3,0
Ribeiro et al.⁽²⁵⁾	2020b	16	Insulin (mIU/L)	45	29,4	3,5	29,3	3,2	29	9,5	7,2	10,4	7
Benham et al.⁽²¹⁾	2021	13	HDL (mg/dL)	17	50,3	3,9	46,4	3,9	14,0	42,5	3,9	42,5	3,9
Ribeiro et al.⁽²⁵⁾	2020a	16	HDL (mg/dL)	30	50,0	13,0	48,0	13,0	28,0	46,0	9,0	44,0	10,0
Stener-Victorin et al.⁽²⁷⁾	2009	16	HDL (mg/dL)	6	65,7	11,6	58,0	15,5	5,0	54,1	11,6	54,1	7,7
Vigorito et al.⁽²⁸⁾	2007	13	HDL (mg/dL)	45	59,0	19,0	58,0	16,0	45,0	53,8	11,6	55,2	12,9
Ribeiro et al.⁽²⁵⁾	2020b	16	HDL (mg/dL)	45	29,4	3,5	29,3	3,2	29	49	11	47	10
Benham et al.⁽²¹⁾	2021	13	LDL (mg/dL)	17	100,5	7,7	112,1	7,7	14,0	96,7	7,7	100,5	7,7
Ribeiro et al.⁽²⁵⁾	2020a	16	LDL (mg/dL)	30	116,0	32,0	108,0	27,0	28,0	112,0	24,0	102,0	23,0
Stener-Victorin et al.⁽²⁷⁾	2009	16	LDL (mg/dL)	6	85,1	11,6	85,1	19,3	5,0	88,9	19,3	85,1	23,2
Vigorito et al.⁽²⁸⁾	2007	13	LDL (mg/dL)	45	72,5	21,6	75,9	24,9	45,0	76,3	18,3	73,2	23,8
Ribeiro et al.⁽²⁵⁾	2020b	16	LDL (mg/dL)	45	29,4	3,5	29,3	3,2	29	112	23	106	23
Benham et al.⁽²¹⁾	2021	13	Cholesterol (mg/dL)	17	174,0	7,7	181,8	7,7	14,0	158,6	7,7	162,4	7,7
Ribeiro et al.⁽²⁵⁾	2020a	16	Cholesterol (mg/dL)	30	188,0	34,0	178,0	24,0	28,0	185,0	30,0	171,0	28,0
Stener-Victorin et al.⁽²⁷⁾	2009	16	Cholesterol (mg/dL)	6	158,5	11,6	154,7	27,1	5,0	154,7	23,2	154,7	19,3
Vigorito et al.⁽²⁸⁾	2007	13	Cholesterol (mg/dL)	45	154,0	16,0	156,0	17,0	45,0	153,0	18,1	151,0	16,4
Ribeiro et al.⁽²⁵⁾	2020b	16	Cholesterol (mg/dL)	45	29,4	3,5	29,3	3,2	29	179	29	174	27
Benham et al.⁽²¹⁾	2021	13	Triglycerides (mg/dL)	17	115,2	17,7	115,2	17,7	14,0	97,4	17,7	88,6	17,7
Ribeiro et al.⁽²⁵⁾	2020a	16	Triglycerides (mg/dL)	30	112,0	56,0	103,0	59,0	28,0	151,0	172,0	144,0	139,0
Stener-Victorin et al.⁽²⁷⁾	2009	16	Triglycerides (mg/dL)	6	62,0	17,7	70,9	35,4	5,0	62,0	26,6	62,0	8,9
Vigorito et al.⁽²⁸⁾	2007	13	Triglycerides (mg/dL)	45	112,0	21,0	111,0	23,0	45,0	114,6	20,3	113,3	23,3
Ribeiro et al.⁽²⁵⁾	2020b	16	Triglycerides (mg/dL)	45	29,4	3,5	29,3	3,2	29	99	54	107	61

[TFN1] P: population; I: intervention; C: comparison; O: outcomes; S: study; PCOS: polycystic ovary syndrome; BMI: body mass index; HDL: high-density lipoprotein; LDL: low-density lipoprotein.