Comparative cardiometabolic effects of high, moderate, and low intensity exercise in polycystic ovary syndrome: a systematic review and network meta-analysis of randomized controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and network meta-analysis of randomized controlled trials
PubMed 41668109 · doi:10.1186/s12905-025-04201-4
What was done
A systematic review and random-effects network meta-analysis of 23 randomized controlled trials compared high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), low-intensity training (LIT), and no exercise in women with polycystic ovary syndrome (PCOS). Primary outcomes assessed were body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR), and maximal oxygen uptake (VO2max). Secondary outcomes included fasting insulin, lipid profile, fasting glucose, HbA1c, and blood pressure. Surface under the cumulative ranking curve (SUCRA) metrics were calculated to identify the most effective interventions.
What was found
Across 23 trials comprising 1,192 participants, MICT significantly reduced HOMA-IR (mean difference [MD] -0.25, 95% CI -0.42 to -0.08; SUCRA 0.89), whereas HIIT did not (MD -0.18, 95% CI -0.42 to 0.05). HIIT significantly increased VO2max (MD 5.56, 95% CI 3.54 to 7.58; I² = 68.8%; SUCRA 0.84). Both HIIT and MICT significantly reduced fasting insulin (HIIT: MD -1.89, 95% CI -2.70 to -1.08, SUCRA 0.99; MICT: MD -0.92, 95% CI -1.46 to -0.37) and LDL cholesterol (HIIT: MD -6.92, 95% CI -10.81 to -3.02, SUCRA 0.87; MICT: MD -5.42, 95% CI -8.05 to -2.79). Neither modality produced significant effects on BMI, HDL cholesterol, triglycerides, glucose, HbA1c, or blood pressure.
Why it matters
These findings indicate that different exercise modalities elicit distinct metabolic adaptations in women with PCOS, suggesting exercise prescriptions can be tailored specifically toward improving insulin resistance via MICT or enhancing cardiorespiratory fitness and lipids via HIIT.
Limits
The certainty of evidence was graded only as low to moderate across outcomes. The average trial size was modest (~52 participants per study), and VO2max outcomes displayed substantial statistical heterogeneity (I² = 68.8%). Quantitative results for low-intensity training, protocol adherence, and long-term clinical endpoints were not provided in the abstract.
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