Polycystic ovary syndrome (PCOS) is a prevalent hormonal disorder affecting an estimated 6% to 21% of women of reproductive age worldwide. Characterized by hyperandrogenism and/or chronic anovulation, PCOS manifests through various symptoms such as hirsutism, acne, oligomenorrhea, and infertility. Beyond reproductive issues, PCOS is associated with increased risks of cardiometabolic diseases, including hypertension, dyslipidemia, insulin resistance (IR), and type 2 diabetes mellitus (T2DM), as well as psychological morbidity, including increased risk of stress, depression, low self-esteem, poor body image, and reduced health-related quality of life.
While there is no cure for PCOS, management focuses on alleviating symptoms and reducing associated health risks through lifestyle modifications, especially diet and exercise. This article explores effective diet and exercise strategies for managing PCOS, drawing on scientific evidence and expert recommendations.
Understanding PCOS and Its Impact
PCOS can lead to a range of health complications, including:
- High blood cholesterol levels
- Sleep apnea
- High blood pressure
- Increased risks for pregnancy complications, such as gestational diabetes and pre-eclampsia
Women with PCOS often experience higher rates of insulin resistance, which impairs the body's ability to use blood sugar for energy, potentially leading to elevated blood sugar levels, weight gain, chronic inflammation, and diabetes. Increased adiposity is considered pivotal and almost 90% of women with PCOS are overweight or obese. Even moderate weight loss (e.g., 5%) may result in clinically meaningful improvements in hyperandrogenism and menstrual regularity.
Exercise Strategies for PCOS Management
Physical exercise offers numerous benefits for women with PCOS, regardless of weight. It can improve metabolic and reproductive symptoms associated with the condition. Exercise helps regulate hormones, lower testosterone levels (easing symptoms like excess hair growth and acne), improve mood, aid weight loss, improve sleep quality (addressing higher risk of sleep apnea), and lower the risk of cardiovascular diseases.
Read also: Guide to PCOS Exercise
Types of Exercise to Consider
A literature review of studies published in the journal Sports Medicine regarding types of exercises, such as strength training and aerobic activity, did not find one specific exercise type was the most beneficial to women with PCOS. The authors did find there are many exercise types that could benefit women with PCOS. The message from these and other studies is that exercise can usually help you when you have PCOS, and the best exercise is what you will do regularly. Here are some exercise types to consider:
Steady-State Cardiovascular Workouts: These activities elevate your heart rate to about 50-70% of your maximum heart rate (calculated by subtracting your age from 220). Examples include walking, cycling, dancing, and aerobics classes. Just 30 minutes a day will help. Cardiovascular exercise increases the body’s sensitivity to insulin and prevents the effects of cholesterol deposition in the arteries that can lead to high blood pressure, heart disease and type-2 diabetes.
High-Intensity Interval Training (HIIT): HIIT involves short bursts of intense exercise followed by rest intervals. Typical exercises include burpees, tuck jumps, and mountain climbers. A study published in the journal PLOS ONE found that women with obesity reported greater enjoyment of HIIT exercises compared to those who engaged in continuous moderate to vigorous exercise. Short cardio bursts in HIIT are fantastic for helping women with PCOS. One study found that HIIT improves insulin resistance and aids fat burn. The HIIT creates an oxygen debt to your muscles which forces your body into excess post-exercise oxygen consumption (EPOC), aka afterburn. Another study specifically looked at women with PCOS and found that HIIT for 10 weeks improved insulin resistance (without weight loss).
Interval Training: This involves exercising at different intensity levels within the same session to keep your heart rate elevated.
Mind-Body Exercises: Practices like yoga, Pilates, and tai chi can reduce stress levels and improve PCOS symptoms while burning calories. Studies show that women with PCOS have an enhanced bodily response to stress and distress, according to an article in the journal Physical Exercise for Human Health.
Read also: PCOS Diet Recipe Guide
Strength Training: Using resistance bands, weights, or body weight to build muscle mass can help maintain a healthy weight and improve metabolic function. Strength training builds muscle by using your own body weight, resistance bands or weights. Research studying the different types of exercise interventions for PCOS investigated resistance training in women with PCOS and found that it was more effective for reducing Free Androgen Index (testosterone levels) than other types of exercise.
Creating an Exercise Plan
The Androgen Excess and PCOS Society recommends at least 30 minutes of moderate to vigorous physical activity daily. Here are some ways to incorporate exercise:
- Create an Interval Training Session: Set up stations with exercises like squats, jumping jacks, lunges, bicep curls, and crunches, performing each for one to two minutes.
- Walk Daily: Aim for 30 to 45 minutes on a treadmill or outdoors.
- Take Aerobics or HIIT Classes: Join classes online or at a gym, including step, dance, boxing, or spinning.
- Practice Yoga, Pilates, or Tai Chi: Attend classes at a studio, gym, or online. Seek guidance from a trainer if you are new to these practices.
To maintain consistency, choose activities you enjoy and consider exercising with a friend for motivation.
Exercise Recommendations
Exercise to improve your PCOS doesn’t have to take hours a week. Studies have found exercise sessions ranging from 30 minutes a day, three times a week, to three total hours per week improved metabolic and reproductive symptoms associated with PCOS.
Some of the ways you can incorporate exercise in your life include the following:
Read also: Natural Ways to Reduce PCOS Facial Hair
- Create your own interval training session, where you set up about six stations and exercise at each for about one to two minutes at a time. Examples could include:squatsjumping jackslungesbicep curlscrunches
- Walk for 30 to 45 minutes a day on a treadmill or outdoors.
- Take an aerobics class online or at a gym. Examples include step, dance, boxing, or spinning.
- Take a HIIT class at a gym or using online resources. YouTube offers many workout videos that you can complete at home. Just ensure the routine is from a reputable provider.
- Practice yoga, Pilates, or tai chi at a studio, gym, or using an online class. If you have not practiced before, you may wish to seek the guidance of a trainer to evaluate your form and safety.
- If boredom is a factor in your commitment to an exercise routine, utilize a combination of these exercise types, such as completing a different exercise session type three times a week.
Dietary Strategies for PCOS Management
Nutrition plays a crucial role in managing PCOS symptoms, particularly insulin resistance. A balanced diet can help control blood glucose levels, affecting insulin and androgen levels. Nutrition for PCOS is similar to nutrition for people with diabetes. The two most important factors are the types of foods you eat and the times of day you eat.
General Dietary Guidelines
The Androgen Excess and PCOS Society provides the following dietary recommendations:
- Calorie Reduction: If overweight, reduce calorie intake by 500 to 1,000 calories per day.
- Fat Intake: Limit total fat to less than 30% of your total daily calories. Reduce saturated fats (high-fat beef, butter, cheese, full-fat dairy) to less than 10% of total calories. Avoid trans fats.
- Fiber Intake: Incorporate an additional 5 to 10 grams of fiber daily.
- Cholesterol Intake: Eat less than 200 milligrams of cholesterol a day.
Healthy Eating Habits
Focus on incorporating these habits into each meal and snack:
- Lean Proteins: Include servings of skinless chicken, fish, or tofu.
- Healthful Fats: Cook with olive oil.
- Vegetables: Add broccoli, kale, spinach, and peppers.
- Beans, Nuts, and Lentils: Incorporate a serving of these.
- Brightly Colored Fruits: Choose red grapes, blueberries, oranges, and cherries.
- Whole Grains: Opt for whole-grain bread and pasta.
Specific Dietary Recommendations
- Prioritize Whole, Fresh Foods: Limit ultra-processed foods.
- Pair Carbs and Sugars with Protein and Fiber: This slows glucose release into the bloodstream.
- Eat Small, Healthy Meals Throughout the Day: Distribute meals to coincide with active periods. Eat your largest meals just before your more active times of day.
- Avoid Fad Diets, Intermittent Fasting, and Binge Eating: These can disrupt metabolic balance.
Mediterranean Diet
There is good evidence to support adding in whole plant-based foods, such as those suggested on a Mediterranean diet plan or DASH diet. Mediterranean meals are built around vegetables, beans and whole grains, with fish or poultry for protein. Olive oil is used instead of butter for preparing food and fruit is served for dessert. Olive oil is the primary source of fat and provides monounsaturated fat, which lowers total cholesterol. Try vegetables with hummus or yogurt-based dips rather than chips and processed packaged snacks. Consume fruits with nuts or nut butters.
Additional Tips
- Embrace Food as Fuel: Recognize that food provides nutrients for body and mind function, rather than eating out of boredom or stress.
- Address Emotional Eating: Seek therapy to develop a healthy relationship with food.
Considerations for Adolescents with PCOS
Adolescents with PCOS face unique challenges, including limited control over food choices and navigating social settings involving food. It is hard to avoid pizza if all your friends are socializing at a pizzeria. It’s important to manage this process so you don’t develop obesity and diabetes. Replacing highly processed foods with fresh fruit, vegetables, low-fat dairy, healthy fats, lean protein and whole grains will help with the excess insulin production.
Scientific Evidence Supporting Exercise and Diet
A systematic review and meta-analysis of 18 trials involving women with PCOS found that exercise had a statistically significant effect on improving several key health markers:
- Fasting Insulin: Reduced by -2.44 μIU/mL
- HOMA-IR: Reduced by -0.57
- Total Cholesterol: Reduced by -5.88 mg/dL
- LDL Cholesterol: Reduced by -7.39 mg/dL
- Triglycerides: Reduced by -4.78 mg/dL
- VO2 Max: Improved by 3.84 ml/kg/min
- Waist Circumference: Reduced by -2.62 cm
- Body Fat Percentage: Reduced by -1.39%
The review also found statistically lower BMI (− 1.02 kg/m2) and resting heart rate (− 3.26 beats/min) in post-intervention analysis. Subgroup analyses revealed the greatest improvements in overweight/obese participants, and more outcomes improved when interventions were supervised, aerobic in nature, or of a shorter duration.
Important Considerations and Precautions
Before starting any new diet or exercise plan, consult with your doctor, especially if you have other medical conditions, such as arthritis or heart-related issues. A registered dietitian and personal trainer can provide personalized guidance.
It is also important to avoid over-exercising, as it can disrupt hormone levels and menstrual cycles.