Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and cause of subfertility in women. The etiology of PCOS has not been fully elucidated; however, insulin resistance has been shown to exacerbate the disease process due to its effect on androgen synthesis. Progressive resistance training (PRT) is an anabolic exercise modality that can improve skeletal muscle size and quality (metabolic capacity), and studies have consistently shown that PRT can increase insulin sensitivity in type 2 diabetes and other cohorts. However, PRT is not currently recommended or routinely prescribed in PCOS. The objective of this article was to provide a rationale for the application of PRT in the management and treatment of PCOS. This will be accomplished by (1) overviewing the pathophysiology of PCOS with emphasis on the etiological role of insulin resistance; (2) summarizing the effectiveness of PRT in treating insulin resistance; (3) presenting evidence that PRT is feasible to prescribe in women with PCOS; and (4) providing general recommendations for PRT to complement existing guidelines for aerobic training in this cohort. We also provide recommendations for future research.
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March WA, Moore VM, Willson KJ, et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reprod. 2010;25(2):544–51.
Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19–25.
Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352(12):1223–36.
Norman RJ, Dewailly D, Legro RS, et al. Polycystic ovary syndrome. Lancet. 2007;370(9588):685–97.
Giudice LC. Endometrium in PCOS: implantation and predisposition to endocrine CA. Best Pract Res Clin Endocrinol Metab. 2006;20(2):235–44.
Gorry A, White DM, Franks S. Infertility in polycystic ovary syndrome. Endocrine. 2006;30(1):27–33.
Bhattacharya SM, Jha A. Prevalence and risk of depressive disorders in women with polycystic ovary syndrome (PCOS). Fertil Steril. 2010;94(1):357–9.
Deeks AA, Gibson-Helm ME, Teede HJ. Anxiety and depression in polycystic ovary syndrome: a comprehensive investigation. Fertil Steril. 2010;93(7):2421–3.
Himelein MJ, Thatcher SS. Depression and body image among women with polycystic ovary syndrome. J Health Psychol. 2006;11(4):613–25.
Barnard L, Ferriday D, Guenther N, et al. Quality of life and psychological well being in polycystic ovary syndrome. Hum Reprod. 2007;22(8):2279–86.
Schmidt J, Landin-Wilhelmsen K, Brännström M, et al. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. J Clin Endocrinol Metab. 2011;96(12):3794–803.
de Groot PC, Dekkers OM, Romijn JA, et al. PCOS, coronary heart disease, stroke and the influence of obesity: a systematic review and meta-analysis. Hum Reprod Update. 2011;17(4):495–500.
Moran LJ, Misso ML, Wild RA, et al. Impaired glucose tolerance, type 2 diabetes and metabolic syndrome in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2010;16(4):347–63.
Chittenden BG, Fullerton G, Maheshwari A, et al. Polycystic ovary syndrome and the risk of gynaecological cancer: a systematic review. Reprod Biomed Online. 2009;19(3):398–405.
Dumesic DA, Lobo RA. Cancer risk and PCOS. Steroids. 2013;78(8):782–5.
Teede HJ, Misso ML, Deeks AA, et al. Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med J Aust. 2011;195(6):S65–112.
Hordern MD, Dunstan DW, Prins JB, et al. Exercise prescription for patients with type 2 diabetes and pre-diabetes: a position statement from Exercise and Sport Science Australia. J Sci Med Sport. 2012;15(1):25–31.
Sharman JE, Stowasser M. Australian Association for Exercise and Sports Science position statement on exercise and hypertension. J Sci Med Sport. 2009;12(2):252–7.
Hayes S, Spence R, Galvao D, et al. Australian Association of Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport. 2009;12:428–34.
Donnelly J, Blair S, Jakicic J, American College of Sports Medicine Position Stand, et al. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459–71.
Selig SE, Levinger I, Williams AD, et al. Exercise & Sports Science Australia Position Statement on exercise training and chronic heart failure. J Sci Med Sport. 2010;13(3):288–94.
Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes Care. 2010;33(12):e147–67.
Kraemer W, Adams K, Cafarelli E, et al. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2002;34(2):364–80.
Ciccolo J, Kraemer WJ. Resistance training for the prevention and treatment of chronic disease. Boca Raton: CRC Press; 2013.
Tresierras M, Balady G. Resistance training in the treatment of diabetes and obesity: mechanisms and outcomes. J Cardiopulm Rehabil Prev. 2009;29(2):67–75.
Strasser B, Schobersberger W. Evidence for resistance training as a treatment therapy in obesity. J Obes 2011. doi:10.1155/2011/482564.
Strasser B, Siebert U, Schobersberger W. Resistance training in the treatment of the metabolic syndrome. Sports Med. 2010;40(5):397–415.
Sigal R, Kenny G, Boulé N, et al. Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes. Ann Intern Med. 2007;147:357–69.
Diamanti-Kandarakis E, Christakou C. Insulin resistance in PCOS. In: Farid N, Diamanti-Kandarakis E, editors. Diagnosis and management of polycystic ovary syndrome. New York: Springer; 2009. p. 35–61.
Stepto NK, Cassar S, Joham AE, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Hum Reprod. 2013;28(3):777–84.
Aubuchon M, Laughbaum N, Poetker A, et al. Supervised short-term nutrition and exercise promotes weight loss in overweight and obese patients with polycystic ovary syndrome. Fertil Steril. 2009;91(4):1336–8.
Bruner B, Chad K, Chizen D. Effects of exercise and nutritional counseling in women with polycystic ovary syndrome. Appl Physiol Nutr Metab. 2006;31(4):384–91.
Thomson RL, Buckley JD, Lim SS, et al. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome. Fertil Steril. 2010;94(5):1812–6.
Thomson RL, Buckley JD, Noakes M, et al. The effect of a hypocaloric diet with and without exercise training on body composition, cardiometabolic risk profile, and reproductive function in overweight and obese women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2008;93(9):3373–80.
Mahoney D. Lifestyle modification intervention among infertile overweight and obese women with polycystic ovary syndrome. J Am Assoc Nurse Pract 2013. doi:10.1002/2327-6924.12073.
Boyle J, Teede HJ. Polycystic ovary syndrome: an update. Aust Fam Physician. 2012;41(10):752–6.
National Institutes of Health. Evidence-based methodology workshop on polycystic ovary syndrome, 3–5 December 2012. Executive summary. Final report. National Institutes of Health; 2012. Available from: https://prevention.nih.gov/docs/programs/pcos/FinalReport.pdf.
Tsilchorozidou T, Overton C, Conway GS. The pathophysiology of polycystic ovary syndrome. Clin Endocrinol. 2003;60(1):1–17.
Amato P, Simpson JL. The genetics of polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol. 2004;18(5):707–18.
Urbanek M. The genetics of the polycystic ovary syndrome. Nat Clin Pract Endocrinol Metab. 2007;3(2):103–11.
Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG. 2006;113(10):1148–59.
Lim SS, Davies MJ, Norman RJ, et al. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(6):618–37.
Teede HJ, Joham AE, Paul E, et al. Longitudinal weight gain in women identified with polycystic ovary syndrome: results of an observational study in young women. Obesity. 2013;21(8):1526–32.
Toprak S, Yonem A, Cakir B, et al. Insulin resistance in nonobese patients with polycystic ovary syndrome. Horm Res. 2001;55(2):65–70.
Cascella T, Palomba S, De Sio I, et al. Visceral fat is associated with cardiovascular risk in women with polycystic ovary syndrome. Hum Reprod. 2008;23(1):153–9.
Carmina E, Bucchieri S, Esposito A, et al. Abdominal fat quantity and distribution in women with polycystic ovary syndrome and extent of its relation to insulin resistance. J Clin Endocrinol Metab. 2007;92(7):2500–5.
Kirchengast S, Huber J. Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Hum Reprod. 2001;16(6):1255–60.
Yildirim B, Sabir N, Kaleli B. Relation of intra-abdominal fat distribution to metabolic disorders in nonobese patients with polycystic ovary syndrome. Fertil Steril. 2003;79(6):1358–64.
Hutchison SK, Stepto NK, Harrison CL, et al. Effects of exercise on insulin resistance and body composition in overweight and obese women with and without polycystic ovary syndrome. J Clin Endocrinol Metab. 2011;96(1):E48–56.
Amati F, Pennant M, Azuma K, et al. Lower thigh subcutaneous and higher visceral abdominal adipose tissue content both contribute to insulin resistance. Obesity. 2012;20(5):1115–7.
Moran LJ, Ranasinha S, Zoungas S, et al. The contribution of diet, physical activity and sedentary behaviour to body mass index in women with and without polycystic ovary syndrome. Hum Reprod. 2013;28(8):2276–83.
Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012;33(6):981–1030.
Welt CK, Taylor AE, Fox J, et al. Follicular arrest in polycystic ovary syndrome is associated with deficient inhibin A and B biosynthesis. J Clin Endocrinol Metab. 2005;90(10):5582–7.
Jonard S, Dewailly D. The follicular excess in polycystic ovaries, due to intra-ovarian hyperandrogenism, may be the main culprit for the follicular arrest. Hum Reprod Update. 2004;10(2):107–17.
Lovejoy J, Bray G, Bourgeois M, et al. Exogenous androgens influence body composition and regional body fat distribution in obese postmenopausal women: a clinical research center study. Clin Endocrinol Metab. 1996;81(6):2198–203.
Livingstone C, Collison M. Sex steroids and insulin resistance. Clin Sci. 2002;102(2):151–66.
Corbould A. Insulin resistance in skeletal muscle and adipose tissue in polycystic ovary syndrome: are the molecular mechanisms distinct from type 2 diabetes? Panminerva Med. 2008;50(4):279–94.
Dantas WS, Gualano B, Rocha MP, et al. Metabolic disturbance in PCOS: clinical and molecular effects on skeletal muscle tissue. Scientific World J 2013. doi:10.1155/2013/178364.
Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444(7121):840–6.
Dunaif A, Wu X, Lee A, et al. Defects in insulin receptor signaling in vivo in the polycystic ovary syndrome (PCOS). Am J Physiol Endocrinol Metab. 2001;281(2):E392–9.
Skov V, Glintborg D, Knudsen S, et al. Reduced expression of nuclear-encoded genes involved in mitochondrial oxidative metabolism in skeletal muscle of insulin-resistant women with polycystic ovary syndrome. Diabetes. 2007;56(9):2349–55.
Patti ME, Butte AJ, Crunkhorn S, et al. Coordinated reduction of genes of oxidative metabolism in humans with insulin resistance and diabetes: potential role of PGC1 and NRF1. Proc Natl Acad Sci U S A. 2003;100(14):8466–71.
Mootha VK, Lindgren CM, Eriksson K-F, et al. PGC-1α-responsive genes involved in oxidative phosphorylation are coordinately downregulated in human diabetes. Nat Genet. 2003;34(3):267–73.
Puder JJ, Varga S, Kraenzlin M, et al. Central fat excess in polycystic ovary syndrome: relation to low-grade inflammation and insulin resistance. J Clin Endocrinol Metab. 2005;90(11):6014–21.
Corbould A, Kim YB, Youngren JF, et al. Insulin resistance in the skeletal muscle of women with PCOS involves intrinsic and acquired defects in insulin signaling. Am J Physiol Endocrinol Metab. 2005;288(5):E1047–54.
Holte J. Polycystic ovary syndrome and insulin resistance: thrifty genes struggling with over-feeding and sedentary life style? J Endocrinol Invest. 1998;21(9):589–601.
Busfield F, Duffy DL, Kesting JB, et al. A genomewide search for type 2 diabetes: susceptibility genes in indigenous Australians. Am J Hum Genet. 2002;70(2):349–57.
Sukala W, Page R, Cheema B. Targeting the type 2 diabetes epidemic in Polynesia: historical perspective and rationale for exercise intervention trials. Ethn Dis. 2012;22(2):123–8.
Chakravarthy MV, Booth FW. Eating, exercise, and “thrifty” genotypes: connecting the dots toward an evolutionary understanding of modern chronic diseases. J Appl Physiol. 2004;96(1):3–10.
Hutchison S, Teede H, Rachoń D, et al. Effect of exercise training on insulin sensitivity, mitochondria and computed tomography muscle attenuation in overweight women with and without polycystic ovary syndrome. Diabetologia. 2012;55(5):1424–34.
Stannard S, Johnson N. Insulin resistance and elevated triglyceride in muscle: more important for survival than ‘thrifty’ genes? J Physiol. 2003;554(3):595–607.
Cooney GJ, Thompson AL, Furler SM, et al. Muscle long-chain Acyl CoA Esters and insulin resistance. Ann N Y Acad Sci. 2002;967(1):196–207.
Amati F, Dube JJ, Alvarez-Carnero E, et al. Skeletal muscle triglycerides, diacylglycerols, and ceramides in insulin resistance: another paradox in endurance-trained athletes? Diabetes. 2011;60(10):2588–97.
Zierath JR, Krook A, Wallberg-Henriksson H. Insulin action and insulin resistance in human skeletal muscle. Diabetologia. 2000;43(7):821–35.
Peppa M, Koliaki C, Nikolopoulos P, et al. Skeletal muscle insulin resistance in endocrine disease. J Biomed Biotechnol 2010. doi:10.1155/2010/527850.
Gordon B, Benson A, Bird S, et al. Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract. 2009;83:157–75.
Ibanez J, Izquierdo M, Arguelles I, et al. Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes. Diabetes Care. 2005;28:662–7.
Shaibi G, Cruz M, Ball G, et al. Effects of resistance training on insulin sensitivity in overweight latino adolescent males. Med Sci Sports Exerc. 2006;38(7):1208–15.
Ishii T, Yamakita T, Sato T, et al. Resistance training improves insulin sensitivity in NIDDM subjects without altering maximal oxygen uptake. Diabetes Care. 1998;21(8):1353–5.
Poehlman E, Dvorak R, DeNino W, et al. Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial. J Clin Endocrinol Metab. 2000;85:2463–8.
Hawley J, Lessard S. Exercise training-induced improvements in insulin action. Acta Physiol. 2008;192:127–35.
Holten M, Zacho M, Gaster M, et al. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscles in patients with type 2 diabetes. Diabetes. 2004;53:294–305.
Jorge MLMP, de Oliveira VN, Resende NM, et al. The effects of aerobic, resistance, and combined exercise on metabolic control, inflammatory markers, adipocytokines, and muscle insulin signaling in patients with type 2 diabetes mellitus. Metabolism. 2011;60(9):1244–52.
Jubrias SA, Esselman PC, Price LB, et al. Large energetic adaptations of elderly muscle to resistance and endurance training. J Appl Physiol. 2001;90(5):1663–70.
Moran LJ, Hutchison SK, Norman RJ, et al. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2011;(2):CD007506.
Harrison CL, Lombard CB, Moran LJ, et al. Exercise therapy in polycystic ovary syndrome: a systematic review. Hum Reprod Update. 2011;17(2):171–83.
Thomson RL, Buckley JD, Brinkworth GD. Exercise for the treatment and management of overweight women with polycystic ovary syndrome: a review of the literature. Obes Rev. 2011;12(5):e202–10.
Giallauria F, Palomba S, Maresca L, et al. Exercise training improves autonomic function and inflammatory pattern in women with polycystic ovary syndrome (PCOS). Clin Endocrinol. 2008;69(5):792–8.
Harrison CL, Stepto NK, Hutchison SK, et al. The impact of intensified exercise training on insulin resistance and fitness in overweight and obese women with and without polycystic ovary syndrome. Clin Endocrinol. 2012;76(3):351–7.
Palomba S, Giallauria F, Falbo A, et al. Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Hum Reprod. 2008;23(3):642–50.
Randeva HS, Lewandowski KC, Drzewoski J, et al. Exercise decreases plasma total homocysteine in overweight young women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2002;87(10):4496–501.
Brown AJ, Setji TL, Sanders LL, et al. Effects of exercise on lipoprotein particles in women with polycystic ovary syndrome. Med Sci Sports Exerc. 2009;41(3):497–504.
Stener-Victorin E, Jedel E, Janson PO, et al. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol. 2009;297(2):R387–95.
Vigorito C, Giallauria F, Palomba S, et al. Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2007;92(4):1379–84.
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Trials. 2010;11:32. doi:10.1186/1745-6215-11-32.
Cheema B, Robergs R, Askew C. Exercise physiologists emerge as allied healthcare professionals in the era of non-communicable disease pandemics: a report from Australia, 2006–2012. Sports Med. Epub 25 Mar 2014. http://www.ncbi.nlm.nih.gov/pubmed/24664532.
Birinder S. Cheema is guarantor of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article. All authors have contributed to the preparation of the manuscript and have approved and read the final article. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. All authors declare they have no competing interests.
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Cheema, B.S., Vizza, L. & Swaraj, S. Progressive Resistance Training in Polycystic Ovary Syndrome: Can Pumping Iron Improve Clinical Outcomes?. Sports Med 44, 1197–1207 (2014). https://doi.org/10.1007/s40279-014-0206-6