Which exercise works best to manage PCOS symptoms?
According to the 2023 International Evidence-Based Guidelines for the Assessment and Management of PCOS, whilst there are benefits to losing weight, there is a lack of significant clinical evidence on the effectiveness of specific lifestyle interventions within the PCOS population.
There is a plethora of well-meaning and sometimes contradictory advice around managing PCOS symptoms with exercise. In this article we explore the link between PCOS and Exercise.
For those seeking to manage their PCOS condition with exercise it is important to recognize that:
In general, evidence on the benefits of specific exercise programs for a general population may not be applicable to a specific individual with PCOS and, in some cases, may focus inherently on short-term gains rather than sustained improvements in health;
The best form of exercise is often one that you enjoy and are therefore motivated to participate in consistently; and
Excessive exercise can be problematic for physical health (e.g., hormonal dysregulation due to stress on body)[1] and mental health (e.g., obsessive behaviors similar to disordered eating).[2]
Before starting a new activity, it is recommended that you consult a healthcare professional, especially if you have health conditions or are taking medication, to ensure the exercise program is safe and appropriate for you.
Whilst there are many different ways of staying active, exercise generally falls into one of five main categories:[3]
Cardio/aerobic: activities focused on making your heart beat faster with benefit to heart health and lung capacity, typically involving the large muscle groups;
Muscle strengthening: activities focused on building muscle mass;
Bone strengthening: activities focused on building bone mass;
Flexibility: activities focused on increasing your flexibility, typically involving stretching; and
Balance: activities focused on improving your balance, typically involving core muscles and muscles in the legs.
Within cardio/aerobic activity, the American Heart Association further classifies intensity of exercise as:[4]
Moderate: 50-70% of maximum heart rate (208 less 0.7 x age), typically with increase in breathing rate but still able to continue a conversation; and
Vigorous: 70-85% of maximum heart rate, typically where you can’t say more than a few words without pausing for breath.
As per the general exercise guidelines, the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS recommended that individuals with PCOS aim to undertake 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic activity per week.[5] A review of studies on PCOS and exercise concluded that improvements in health outcomes were more dependent on the intensity than duration of exercise.[6]
In addition, it is recommended that individuals undertake muscle/bone strengthening activities three times per week.[7] However, the 2023 guidelines also recognized that there is no evidence for the benefits of any particular type or intensity of exercise in this population.[8]
Depending on your priorities, you may choose to adapt your activities to reflect your specific health goals, for example:
Weight management: a combination of aerobic exercise to burn calories, muscle strengthening activities to increase metabolism[9] and a calorie-restricted diet;[10]
Cardiovascular health: a combination of aerobic exercise to reduce blood pressure and cholesterol, muscle strengthening to reduce strain on your heart and flexibility and balance exercises to avoid injury;[11]
Bone health: a variety of muscle-strengthening and bone-strengthening (weight bearing) exercises with higher impact to improve bone density if you do not have prior injuries;[12]
Mental health: any form of exercise has benefits for mental health and consider including activities outside with friends and family for the most benefit;[13] and
Reproductive health: as per weight management and cardiovascular health to prepare for a healthy pregnancy and flexibility/strength training to prepare for a healthy labor and delivery.[14]
Sources
[1] https://my.clevelandclinic.org/health/diseases/24431-hypothalamic-amenorrhea
[2] https://www.columbiapsychiatry.org/news/when-exercise-becomes-too-much-good-thing
[3] https://www.nhlbi.nih.gov/health/heart/physical-activity/types
[4] https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887
[5] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.monash.edu/__data/assets/pdf_file/0003/3379521/Evidence-Based-Guidelines-2023.pdf
[6] https://pmc.ncbi.nlm.nih.gov/articles/PMC7358428/
[7] https://www.sciencedirect.com/science/article/pii/S1440244024002081
[8] chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.monash.edu/__data/assets/pdf_file/0003/3379521/Evidence-Based-Guidelines-2023.pdf
[9] https://www.bhf.org.uk/informationsupport/heart-matters-magazine/activity/best-exercise-to-lose-belly-fat
[10] https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/exercise/art-20050999
[11] https://www.bhf.org.uk/informationsupport/heart-matters-magazine/activity/exercises-heart-health
[12] https://theros.org.uk/information-and-support/bone-health/exercise-for-bones/
[13] https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/be-active-for-your-mental-health/
[14] https://www.nct.org.uk/information/pregnancy/body-pregnancy/it-safe-exercise-during-pregnancy
