 day with strength training three times per week, and adults should get 150 minutes per week of moderate-intensity activity or 75 minutes of vigorous activity (or a combination of both) and two non-consecutive days of strength training activities. The international guideline for PCOS suggests activity be performed in 10-minute or longer bouts and that patients and clients take 10,000 steps per day. Recommendations for those aiming for modest weight loss or focusing on weight regain prevention are 250 minutes per week of moderate-intensity activity or 150 minutes of vigorous activity (or a combination of both) and two non-consecutive days of strengthening activities.
In a systematic review and meta-analysis about exercise for managing PCOS, effects from exercise included statistically significant benefits to fasting insulin, insulin resistance markers, total and low-density lipoprotein cholesterol and triglycerides. The greatest improvements were seen in study participants with overweight or obesity. However, the authors cautioned about interpreting the findings due to study limitations including low-quality evidence.
One systematic review and meta-analysis found that when assessing exercise duration (ranging from six to 26 weeks), exercise intensity mattered more than quantity for health outcomes, including increases in V02 peak (used to assess a person’s physical activity limits, this is the highest value of oxygen rate attained during a high-intensity exercise test), reduced insulin resistance markers and reduced waist circumference. The greatest benefit was seen in vigorous-intensity exercise either alone or combined with a dietary plan, advice or guidance.
A review of evidence included in the new international guideline for PCOS indicated behavioral interventions yielded better outcomes in weight management for adolescents than compared to a placebo group, as well as when used in combination with dietary and exercise interventions. One study showed that adolescents who received behavioral interventions from a multidisciplinary care team with an RDN, health psychologist, gynecologist and endocrinologist experienced enhanced weight loss when combined with dietary consultations.
There are proven benefits to people with PCOS receiving early access to an RDN. While studies show a multidisciplinary approach to PCOS treatment yields the best outcomes, they also highlight barriers to including RDNs in the care team, including insurance reimbursement and financial limitations for patients and clients, lack of referrals for nutrition education and lack of knowledge of PCOS and the potential benefit of lifestyle interventions. Studies show knowledge gaps in health care professionals can lead to delays in diagnosing and caring for people with PCOS and to patients and clients seeking less qualified or low-quality information online for support. RDNs working with populations at risk for PCOS should stay abreast of current research.
Abdalla M, Deshmukh H, Atkin S, Sathyapalan T. A review of therapeutic options for managing the metabolic aspects of polycystic ovary syndrome. Therap Advance Endocrine Metab. 2020;11:2042018820938305.
Dapas M, Lin FT, Nadkarni GN, et al. Distinct subtypes of polycystic ovary syndrome with novel genetic associations: An unsupervised, phenotypic clustering analysis. PLoS medicine. 2020;17(6):e1003132.
Dokras A, Stener-Victorin E, Yildiz B, et al. Androgen Excess-Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Sterile. 2018;109(5):888-99.
Garad RM, Teede HJ. Polycystic Ovary Syndrome: Improving policies, awareness and clinical care. Current Opinion in Endocrine and Metabolic Research. 2020.
Geier L, Bekx M, Connor E. Factors contributing to initial weight loss among adolescents with polycystic ovary syndrome. J Ped Adolescent Gyn. 2012;25(6):367-70.
Goodman N, Cobin R, Futterweit W, Glueck J, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and androgen excess and PCOS society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 1. Endocrine Practice. 2015;21(11):1291-300.
Goodman N, Cobin R, Futterweit W, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society disease state clinical review: guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 2. Endocrine Practice. 2015;21(12):1415-26.
Goss AM, Chandler-Laney PC, Ovalle F, et al. Effects of a eucaloric reduced-carbohydrate diet on body composition and fat distribution in women with PCOS. Metabolism. 2014;63(10):1257-64.
Gower BA, Chandler‐Laney PC, Ovalle F, et al. Favourable metabolic effects of a eucaloric lower‐carbohydrate diet in women with PCOS. Clinic Endocrine. 2013;79(4):550-7.
Ibáñez L, Oberfield SE, Witchel S, et al. An International Consortium update: pathophysiology, diagnosis, and treatment of polycystic ovarian syndrome in adolescence. Horm Res Paediatr. 2017;88(6):371–395.
Jarrett BY, Lin AW, Lujan ME. A commentary on the new evidence-based lifestyle recommendations for patients with polycystic ovary syndrome and potential barriers to their implementation in the United States. J Acad Nutr Diet. 2019;119(2):205-10.
Kite C, Lahart IM, Afzal I, et al. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Syst Rev. 2019;8(1):51.
Lin A, Dollahite J, Sobal J, Lujan M. Health-related knowledge, beliefs and self-efficacy in women with polycystic ovary syndrome. Hum Reprod. 2018;33(1):91–100.
Mavropoulos J, Yancy W, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nut Metab. 2005;2(1):1-5.
McGrice M, Porter J. The effect of low carbohydrate diets on fertility hormones and outcomes in overweight and obese women: A systematic review. Nutrients. 2017;9(3):204.
Moran LJ, Ko H, Misso M, et al. Dietary Composition in the Treatment of Polycystic Ovary Syndrome: A Systematic Review to Inform Evidence-Based Guidelines. J Acad Nutr Diet. 2013;113(4):520–545.
Moran LJ, Tassone C, Boyle J, et al. Evidence summaries and recommendations from the international evidence‐based guideline for the assessment and management of polycystic ovary syndrome: Lifestyle management. Obesity Rev. 2020;21(10):e13046.
Paganini C, Peterson G, Stavropoulos V, Krug I. The overlap between binge eating behaviors and polycystic ovarian syndrome: an etiological integrative model. Curr. Pharm. Des. 2018;24(9):999-1006.
Patten R, Boyle R, Moholdt T, et al. Exercise interventions in polycystic ovary syndrome: a systematic review and meta-analysis. Front physiol. 2020;11:606.
Pirotta S, Barillaro M, Brennan L, et al. Disordered Eating Behaviours and Eating Disorders in Women in Australia with and Without Polycystic Ovary Syndrome: A Cross-Sectional Study. J Clin Med. 2019;8(10):1682.
Rodgers RJ, Avery JC, Moore VM, Det al. Complex diseases and co-morbidities: polycystic ovary syndrome and type 2 diabetes mellitus. Endocrine Connect. 2019;8(3):R71-5.
Schroeder B. ACOG releases guidelines on diagnosis and management of polycystic ovary syndrome. AFP. 2003;67(7):1619.
Shang Y, Zhou H, Hu M, Feng H. Effect of diet on insulin resistance in polycystic ovary syndrome. J Clin Endocrine Metab. 2020 Oct;105(10):3346-60.
Teede HJ, Misso ML, Boyle JA, et al. Translation and implementation of the Australian‐led PCOS guideline: clinical summary and translation resources from the International Evidence‐based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Med J Aus. 2018;209:S3-8.
Teede HJ, Misso ML, Costello MF, et al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. NHMRC. 2018:1-98.
Trent M, Gordon CM. Diagnosis and management of polycystic ovary syndrome in adolescents. Pediatrics. 2020;145(Supplement 2):S210-8.
What are Menstrual Irregularities? National Institutes of Health website. Reviewed January 31, 2017. Accessed August 18, 2021.
Wolf W, Wattick R, Murray P, et al. Future Implications of Using Registered Dietitians in Multidisciplinary Polycystic Ovary Syndrome Treatment. Healthcare. 2018;6(4):144.<issue_start><issue_comment>Title: build_visit: hdf4 building