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Review Article

Exercise in polycystic ovarian syndrome: An

evidence-based review
ABSTRACT
Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting female adolescent and adulthood globally. The most annoying
complications of PCOS are obesity and infertility. Exercise is proved to be a best therapeutic and supportive management in PCOS patients
in reducing infertility. Exercise reduces the risk and restores fertility and quality of life in PCOS patients through inducing hormonal changes
of testosterone, androstenedione, combating obesity, metabolic syndrome, reducing inflammatory markers, and increasing immunity. Earlier
systematic reviews and meta‑analyses have proved the effectiveness of exercise in PCOS. This current systematic review will add to the current
evidence of cumulative effects on exercise and shall be an update to the current proof of physical activity in PCOS patients.

Keywords: Depression, exercise, fertility, physical activity, polycystic ovarian syndrome, quality of life, resistance
and endurance training

INTRODUCTION resistance (IR) and its compensatory hyperinsulinemia are

Polycystic ovarian syndrome (PCOS) is a common endocrine
disorder affecting chiefly the women at reproductive
ages (late adolescent and early adulthood). It is caused by the
imbalance of female sex hormones.[1] The prevalence rate is
about 9.13% in Indian adolescents and 3.7% in young women.[2]
A study carried out in an urban population in India showed
a prevalence rate of about 22.5% of Rotterdam classification
and 10.7% by Androgen Excess Society criteria.[3] The clinical
features comprise of reproductive manifestations such as
reduced frequency of ovulation, menstrual irregularity,
reduced fertility, abdominal obesity, sonographic evidence
of ovarian cysts, and high levels of male hormones such as
testosterone and androstenedione.[1]
PCOS is associated with metabolic features including
elevated levels of insulin secretion and resistance, diabetes
and cardiovascular disease risk factors such as abnormal
cholesterol levels and free plasma lipids.[1] The causative
factors behind PCOS are unknown. The probable cause
may be related to the dysregulation in female reproductive
hormones as demonstrated in earlier studies.[1,2] Insulin
proposed as significant etiological factors of PCOS.[4] All these
factors are said to be substantial cause for hyperandrogenism
in PCOS patients.[1] Overweight and obesity worsen these
underlying hormonal imbalances by increasing androgen and
excess blood insulin levels thus making the clinical features
very evident in women with PCOS.[5]
PATHOPHYSIOLOGY OF POLYCYSTIC OVARIAN SYNDROME
The exact etiology of metabolic syndrome is unknown, but
the excessive visceral fat contributes to the development
of clinically significant disorders such as IR, dyslipidemia,
high blood pressure, impaired fibrinolysis, glucose
Disha Shetty, Baskaran Chandrasekaran1,
Arul Watson Singh2, Joseph Oliverraj2
Alva’s College of Physiotherapy and Research Center, 2Department of
Physiotherapy, Alva’s College of Physiotherapy, Moodbidri, Mangalore,
1
Center for Sport Science Medicine and Research, School of Allied
Health Sciences, Manipal University, Manipal, Karnataka, India
Address for correspondence: Mr. Baskaran Chandrasekaran,
Center for Sport Science Medicine and Research, School of Allied
Health Sciences, Manipal University, Manipal, Karnataka, India.
E‑mail: baskaran.c@manipal.edu

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DOI:
How to cite this article: Shetty D, Chandrasekaran B, Singh AW,
10.4103/sjsm.sjsm_10_17 Oliverraj J. Exercise in polycystic ovarian syndrome: An evidence-based
review. Saudi J Sports Med 2017;17:123-8.

© 2017 Saudi Journal of Sports Medicine | Published by Wolters Kluwer - Medknow 123
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Shetty, et al.: Evidence of exercise in PCOS
intolerance, and endothelial dysfunction.[6] Pathogenesis
of multiple sclerosis (MS) in PCOS women may be due to
(i) IR, (ii) hyperinsulinemia and (iii) glucose intolerance, which
are caused mainly due to dysregulation of insulin signal
transduction pathways, and (iv) failure in fatty acid uptake
in muscle and liver.[6]
PCOS, Polycystic Ovarian Syndrome (COS) is associated with the
development of cardiovascular disorders and type 2 diabetes.
IR, one of the dynamic components of MS, is observed in
about 50%–80% of women with PCOS.[7] Insulin receptors
are present in significant amount in ovaries and impairment
of insulin signaling in theca cells increases the production
of androgens.[8] IR impairs insulin action in tissues, such as
skeletal muscle, adipocytes, and liver. In skeletal muscle, the
primary effect of insulin is to stimulate glucose uptake and
metabolism. In insulin‑resistant state, the glucose uptake is
markedly reduced in skeletal muscle. Hence, poor exercise
capacity due to reduced muscular efficiency, early fatigue,
and hence exercise tolerance are inevitable in PCOS patients.[9]
Obese individuals exhibit marked skeletal muscle IR as
compared that of lean individuals who are related to higher
body mass index in PCOS women.[10] Weight loss in obese
individuals improves or reverses IR in skeletal muscle of PCOS
women. Obesity tends to aggravate the clinical presentation
of PCOS. Indeed, the incidence of hirsutism and menstrual
irregularity is greater in the obese population as compared
to nonobese PCOS.[11] Owing to the above reasons, quality of
life with PCOS individual might get worse as it progresses.
EXERCISE AND ITS IMPACT ON POLYCYSTIC OVARIAN
SYNDROME PATHOPHYSIOLOGY
Weight reduction may lead to a decrease in glucose intolerance
which in turn may lead to improvement in reproductive and
metabolic derangements in PCOS.[12] Exercise training has
shown significant improvement in irregularity of menstrual
cycles and ovulation in about 50% women diagnosed
with PCOS which improves body composition.[13] Further
weight loss may reduce pulse amplitude of luteinizing
hormone (LH) in turn reducing androgen production.[14] The
key factor responsible for these effects is the reduction of
hyperinsulinemia and IR.
Exercise has shown to modulate insulin sensitivity and lipid
metabolism in skeletal muscle. Exercise improves insulin
sensitivity by increasing intramyocellular triacylglycerol
concentration.[15] Improvement in insulin sensitivity could
be due to more efficient lipid turnover resulting in increased
muscle lipid uptake, transport, utilization, and oxidation.
The literature states the efficacy of exercise training in
124 Saudi Journal of Sports Medicine / Volume 17 / Issue 3 / September-December 2017
combating metabolic syndrome in PCOS patients by marking
improvements in apolipoprotein, adiponectin in the process
of lipid turnover, and uptake in skeletal muscles.[16]
Endurance exercise also increases capillary density,
mitochondrial density, number, hyperplasia of muscle
fibers, neural sensitization, motor learning, and adaptations
thereby increasing exercise capacity and reducing exercise
intolerance in PCOS individual.[17] Improved blood flow
to skeletal muscles, mitochondrial proliferation, and
sensitivity to activity enhance the stability of essential
protein involved in insulin signal transduction in PCOS
patients.[10]
EVIDENCE SEARCH STRATEGY
The literature claiming the effectiveness of exercise in PCOS
is searched through electronic databases such as ProQuest
and Ovid and public databases such as PubMed Central and
Biomed Central. The MeSH items used for searching online
are exercise training AND PCOS, physical activity AND PCOS,
exercise AND fertility OR ovulation. Only full‑text articles
published in English are reviewed. Two authors (DS and AW)
hand searched the articles, and any consensus among the
authors was solved through third author (JO). The research
findings are shown in Table 1.
RECOMMENDATION OF EXERCISE TRAINING IN POLYCYSTIC
OVARIAN SYNDROME
Based on the literature reviewed in Table 1, the dosage of
exercise recommended in PCOS for potential health benefits
may be as follows:
Exercise training session
Warm‑up: At least 5–10 min.
Conditioning phase:
Aerobic training:
• Frequency: 5 days/week for 12–24 weeks
• Intensity: 20–60 min of aerobic (high‑intensity interval
training 70%–70% VO2 peak repetitive exercise bouts
of 10 min, six episodes/session with 15 min of active
pause 55%–60% VO2 peak between the bouts. Continuous
practice sessions 60%–70% heart rate (HR) max inculcating
large muscles such as running or cycling for 30–60 min)
• Time: 30–45 min. Fatigue‑free level
• Mode: Treadmill or bicycle
• Progression: 10% VO2 peak or HR max every 2 weeks.
After 4 weeks, new VO2 peak test to be determined from
maximal or submaximal exercise testing.
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Shetty, et al.: Evidence of exercise in PCOS

Table 1: The current evidence behind effects of exercise on Polycystic Ovarian Syndrome women
Source Study design Participants Method Exercise intervention Inference Evidence
Intensity Duration Freq uency grade
Aerobic exercise training on PCOS
Almenning Pilot three-arm 31 PCOS Assigned to HITT - 4 sessions of 10 week 3 days/week Insulin resistance 1b
et al., 2015[18] parallel RCT patients high-intensity 4 min. With 90% HR Control group: reduced and improved
interval training, maximum: 3 min of >150 min of flow-mediated
traditional 70% HR calisthenics vasodilatation
strength training, Resistance training:
and control 8 exercise/three
sets/10 reps
Kong et al., Parallel RCT 31 PCOS HITT compared HITT - 8 s cycle: HITT - 20:40 min Both 4 days/ No difference in body 1b
2016[19] patients to moderate 12 s rest. Continuous rest week for weight reduction
to vigorous, exercise 60%-80% 5 weeks Testosterone and
continuous VO2 peak estradiol reduced in
exercise HITT
Physical enjoyment
more in HITT and less
time
Miri et al., Animal RCT 30 PCOS rats Relation between Moderate (70%-75%) 60 min Six sessions/ Higher testosterone 2b
2014[20] versus ten exercise and sex and low (50%-55% week, and androstenedione
controls hormones in rats VO2 peak) 8 weeks in PCOS rate
No difference in body
weight
Hutchison Dual-arm RCT 44 individualsMitochondrial Moderate (70%) or 60 min Six 5 min Significant 3b
et al., 2012[16] (16 PCOS, biogenesis vigorous (90%-95% intervals with improvement in
13 non-PCOS and lipid after VO2 max) 2 min insulin resistance
overweight) exercise in whereas no change
overweight PCOS in mitochondrial
and normal biogenesis and lipids
Brown et al., Two-arm RCT 37 PCOS Individualized 50% VO2 peak in 60 min/session 12 weeks Decreased large VLDL 2b
2009[21] (exercise patients exercise treadmill chylomicrons
compared with prescription from Improvement in HDL
usual care) STRRIDE study Improvement in insulin
versus usual care resistance
group
Abazar et al., Case-control 24 PCOS Compared with 60%-70% HR 60 min 3 weeks for Reduced body 3b
2015[22] patients aerobic exercise maximum 12 weeks composition and lipid
and usual care profile in PCOS
Benrick Case controlled Not specified Compared Ran on treadmill Not available 5 days/week Exercise decrease 4
et al., 2013[23] animal trial PCOS-induced resveratrol 1-1.5 km/day and 5 weeks adipose and insulin
rats alone and with resistance than
exercise revertol
Both did not reduce
the bone mass loss in
PCOS individuals
Covington Case–control 16 individuals Effect of aerobic 55% VO 2 max 16 weeks 5 days/week Improved lipolysis 2c
et al., 2015[24] (8 PCOS and (8 PCOS and exercise on (progressive energy and lipid uptake
eight control) eight control) lipolysis expenditure) regulation
Improved insulin
sensitivity
Resistance exercise training on PCOS
Vizza et al., Two-arm parallel 15 PCOS Assigned to Not specified 60 min for Four Increased BMI, lean 2b
2016[25] pilot RCT patients progressive 12 weeks sessions/ body mass, and
resistance week reduced HbA1C
exercise and no Reduction in
exercise (usual depression
care)
Cheema et Nonsystematic 108 PCOS Relation to 60% 1 RM (15 reps) 2-3 Two sets of PRT improves insulin 2a
al., 2014[26] review exercise, progress to 70%-85% nonconsecutive 5-8 types sensitivity
hormones, and 1 RM (8-12 reps) days/week of 3 sets for Regulates weight and
insulin resistance 12 weeks fertility

Contd...

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Shetty, et al.: Evidence of exercise in PCOS

Table 1: Contd...
Source Study design Participants Method Exercise intervention Inference Evidence
Intensity Duration Freq uency grade
Lara et al., Case-control 43 PCOS Evaluated 70%-90% (1 RM) for Three 16 weeks Increases sexual 3a
2015[27] study women resistance 8-15 reps nonconsecutive excitement,
exercise over days lubrication, and
sexual function emotional status
and emotional regulation
status
Ramos et al., Case-control 43 PCOS Quality of Life 60% 1 RM with 5% Not specified 16 weeks Improved functional 3a
2016[28] study versus 51 after resistance every week 3 series capacity domain of
healthy exercise training of 10 reps/set SF36
females for 16 weeks
Physical activity and lifestyle modifications on PCOS
Thomson Three 41 overweight/ Assigned to one Walking/jogging, 25 min 5 days/week Diet with aerobic or 2b
et al., 2016[29] randomized obese PCOS of three groups: resistance training combined aerobic and
parallel group patients Diet, combined (not specified) resistance exercise
trial diet and aerobic is better than diet
exercise, alone in reducing
combined diet, depression, improved
aerobic and exercise barriers
resistance
exercise
Conte et al., Systematic 456 PCOS Exercise Not available Not available Not available Of 73 studies initially 3a
2015[30] review patients compared with recruited, only
usual care seven studies were
included. Though
training seemed to
be antidepressive,
inconclusive evidence
exists
Ennour-Idrissi Meta-analysis of 18 RCTS (1994 Physical activity Not available Not available Not available Significant 1a
et al., 2015[31] RCTS PCOS) with no physical reduction in sex
activity hormones (estradiol,
testosterone,
androstenedione) after
physical activity in
PCOS patients
Stener- Two-arm RCT 72 PCOS Individual effects Self-paced brisk 30 min Three days/ Anxiety and 2b
Victorin et al., of acupuncture walk, cycle faster week for depression reduced
2013[32] and exercise than normal walk 16 weeks across all the group
over usual care >120 beats/min Fertility domain
improved with
exercise group
Banting et al., Cross-sectional 217 women Relation between Not available Not available Not available PCOS women are 2c
2014[33] (154 PCOS) physical activity better in physical
and mental activity but more
health in PCOS anxious than non-
patients PCOS
Costa et al., Single time 14 obese Ef fect of ARE Warm-up - 5 min 40 min 1 day GPS and HR monitor 2c
2015[34] observational PCOS in aerobic Pleasurable intensity with affective words
trial individuals capacit y. GPS - 40 min through phones
and HR monitors Cool down - 5 min improved physical
were used to activity intensity and
gauge physical joy in PCOS patients
activity
ARE=Affect regulated exercise, PCOS=Polycystic ovarian syndrome, RCT=Randomized controlled trial, HR=Heart rate, RM=Repetition maximum, Reps=Repetition, GPS=Global positioning system,
HITT=High intensity interval training, VLDL=Very low density lipoprotein, HDL=High-density lipoprotein, BMI=Body mass index, HbA1C=Glycated hemoglobin, PRT=Progressive resistance training

Resistance exercise training: and triceps curl, abdominal curl ups, split squats, leg
• Frequency: 2–3 days/week for 12–24 weeks curls, and extensions). 2–3 sets of 8–12 repetition/set.
• Intensity: Initial 60%–70% of 1 repetition maximum 1 min rest between set. Avoid Valsalva maneuver during
comprising three sets of 8–10 resistance stations lifting
(lateral pull down, military press, chest press, biceps • Time: 30–45 min. Fatigue‑free level

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Shetty, et al.: Evidence of exercise in PCOS
• Mode: Dumbbell, barbell, thera tubes, and weighted uptodate in the management of polycystic ovary syndrome. Eur J Obstet
pulley machines
• Progression: Repetitions or sets can be increased based
on the rating of perceived exertion or maximal voluntary
contraction using the weights.
Cool down: Calisthenics 5–10 min, active recovery.
CONCLUSION
Exercise training and physical activity in PCOS have shown
to have a good impact on improving the anthropometric
measurements such as body mass index, waist circumference,
and metabolic parameters such as total cholesterol, IR, and
lipid profile thus reducing metabolic syndrome and other
risk factors associated with PCOS. Exercise training should be
included in the routine medical management to augment the
benefits of ovulation chances, reducing cardiovascular risks
and improving the quality of life in PCOS women.
Acknowledgments
The author Baskaran Chandrasekaran would like to thank
Dr. Fiddy Davis Ph.D., Associate Professor/Head, Center
for Sport Science Medicine and Research for the valuable
suggestion and passion toward research in the field of health
promotion and physical activity.
Financial support and sponsorship
Nil.
Conlicts of interest
There are no conflicts of interest.
REFERENCES
1. Tal R, Seifer DB, Arici A. The emerging role of angiogenic factor
dysregulation in the pathogenesis of polycystic ovarian syndrome. Semin
Reprod Med 2015;33:195‑207.
2. Joseph N, Reddy AG, Joy D, Patel V, Santhosh P, Das S, et al. Study
on the proportion and determinants of polycystic ovarian syndrome
among health sciences students in South India. J Nat Sci Biol Med
2016;7:166‑72.
3. Joshi B, Mukherjee S, Patil A, Purandare A, Chauhan S, Vaidya R.
A cross‑sectional study of polycystic ovarian syndrome among adolescent
and young girls in Mumbai, India. Indian J Endocrinol Metab
2014;18:317‑24.
4. Stepto NK, Cassar S, Joham AE, Hutchison SK, Harrison CL,
Goldstein RF, et al. Women with polycystic ovary syndrome have
intrinsic insulin resistance on euglycaemic‑hyperinsulaemic clamp.
Hum Reprod 2013;28:777‑84.
5. Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH,
Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome:
An Endocrine Society clinical practice guideline. J Clin Endocrinol
Metab 2013;98:4565‑92.
6. Orio F, Muscogiuri G, Nese C, Palomba S, Savastano S, Tafuri D, et al.
Obesity, type 2 diabetes mellitus and cardiovascular disease risk: An
Saudi Journal of Sports Medicine / Volume 17 / Issue 3 / September-December 2017
Gynecol Reprod Biol 2016;207:214‑9.
7. Shabir I, Ganie MA, Zargar MA, Bhat D, Mir MM, Jan A, et al.
Prevalence of metabolic syndrome in the family members of women
with polycystic ovary syndrome from North India. Indian J Endocrinol
Metab 2014;18:364‑9.
8. Dupont J, Scaramuzzi RJ. Insulin signalling and glucose transport in
the ovary and ovarian function during the ovarian cycle. Biochem J
2016;473:1483‑501.
9. Dantas WS, Marcondes JA, Shinjo SK, Perandini LA, Zambelli VO,
Neves WD, et al. GLUT4 translocation is not impaired after acute
exercise in skeletal muscle of women with obesity and polycystic ovary
syndrome. Obesity (Silver Spring) 2015;23:2207‑15.
10. Jung UJ, Choi MS. Obesity and its metabolic complications: The role of
adipokines and the relationship between obesity, inlammation, insulin
resistance, dyslipidemia and nonalcoholic fatty liver disease. Int J Mol
Sci 2014;15:6184‑223.
11. Ramanand SJ, Ghongane BB, Ramanand JB, Patwardhan MH,
Ghanghas RR, Jain SS. Clinical characteristics of polycystic ovary
syndrome in Indian women. Indian J Endocrinol Metab 2013;17:138‑45.
12. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of
polycystic ovary syndrome. Clin Epidemiol 2013;6:1‑13.
13. Harrison CL, Lombard CB, Moran LJ, Teede HJ. Exercise therapy in
polycystic ovary syndrome: A systematic review. Hum Reprod Update
2011;17:171‑83.
14. Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E;
American Association of Clinical Endocrinologists (AACE); American
College of Endocrinology (ACE); Androgen Excess and PCOS Society.
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. Endocr Pract
2015;21:1415‑26.
15. Li Y, Xu S, Zhang X, Yi Z, Cichello S. Skeletal intramyocellular lipid
metabolism and insulin resistance. Biophys Rep 2015;1:90‑8.
16. Hutchison SK, Teede HJ, Rachon D, Harrison CL, Strauss BJ, Stepto NK.
Effect of exercise training on insulin sensitivity, mitochondria and
computed tomography muscle attenuation in overweight women with
and without polycystic ovary syndrome. Diabetologia 2012;55:1424‑34.
17. Harrison CL, Stepto NK, Hutchison SK, Teede HJ. The impact
of intensiied exercise training on insulin resistance and itness in
overweight and obese women with and without polycystic ovary
syndrome. Clin Endocrinol (Oxf) 2012;76:351‑7.
18. Almenning I, Rieber‑Mohn A, Lundgren KM, Shetelig Løvvik T,
Garnæs KK, Moholdt T. Effects of high intensity interval training and
strength training on metabolic, cardiovascular and hormonal outcomes
in women with polycystic ovary syndrome: A pilot study. PLoS One
2015;10:e0138793.
19. Kong Z, Fan X, Sun S, Song L, Shi Q, Nie J. Comparison of high‑intensity
interval training and moderate‑to‑vigorous continuous training for
cardiometabolic health and exercise enjoyment in obese young women:
A randomized controlled trial. PLoS One 2016;11:e0158589.
20. Miri M, Karimi Jashni H, Alipour F. Effect of exercise intensity on weight
changes and sexual hormones (androstenedione and free testosterone)
in female rats with estradiol valerate‑induced PCOS. J Ovarian Res
2014;7:37.
21. Brown AJ, Setji TL, Sanders LL, Lowry KP, Otvos JD, Kraus WE, et al.
Effects of exercise on lipoprotein particles in women with polycystic
ovary syndrome. Med Sci Sports Exerc 2009;41:497‑504.
22. Abazar E, Taghian F, Mardanian F, Forozandeh D. Effects of aerobic
exercise on plasma lipoproteins in overweight and obese women with
polycystic ovary syndrome. Adv Biomed Res 2015;4:68.
23. Benrick A, Maliqueo M, Miao S, Villanueva JA, Feng Y,
Ohlsson C, et al. Resveratrol is not as effective as physical exercise
for improving reproductive and metabolic functions in rats with
127
[Downloaded free from http://www.sjosm.org on Tuesday, October 17, 2017, IP: 1.186.28.220]

Shetty, et al.: Evidence of exercise in PCOS

dihydrotestosterone‑induced polycystic ovary syndrome. Evid Based
Complement Alternat Med 2013;2013:964070.
24. Covington JD, Bajpeyi S, Moro C, Tchoukalova YD, Ebenezer
PJ, Burk DH, et al. Potential effects of aerobic exercise on the
expression of perilipin 3 in the adipose tissue of women with
polycystic ovary syndrome: A pilot study. Eur J Endocrinol
2015;172:47‑58.
25. Vizza L, Smith CA, Swaraj S, Agho K, Cheema BS. The feasibility
of progressive resistance training in women with polycystic ovary
syndrome: A pilot randomized controlled trial. BMC Sports Sci Med
Rehabil 2016;8:14.
26. Cheema BS, Vizza L, Swaraj S. Progressive resistance training in
polycystic ovary syndrome: Can pumping iron improve clinical
outcomes? Sports Med 2014;44:1197‑207.
27. Lara LA, Ramos FK, Kogure GS, Costa RS, Silva de Sá MF,
Ferriani RA, et al. Impact of physical resistance training on the sexual
function of women with polycystic ovary syndrome. J Sex Med
2015;12:1584‑90.
28. Ramos FK, Lara LA, Kogure GS, Silva RC, Ferriani RA, Silva de Sá MF,
et al. Quality of life in women with polycystic ovary syndrome after
a program of resistance exercise training. Rev Bras Ginecol Obstet
2016;38:340‑7.
29. Thomson RL, Brinkworth GD, Noakes M, Clifton PM, Norman RJ,
Buckley JD. The effect of diet and exercise on markers of endothelial
function in overweight and obese women with polycystic ovary
syndrome. Hum Reprod 2012;27:2169‑76.
30. Conte F, Banting L, Teede HJ, Stepto NK. Mental health and physical
activity in women with polycystic ovary syndrome: A brief review.
Sports Med 2015;45:497‑504.
31. Ennour‑Idrissi K, Maunsell E, Diorio C. Effect of physical activity on
sex hormones in women: A systematic review and meta‑analysis of
randomized controlled trials. Breast Cancer Res 2015;17:139.
32. Stener‑Victorin E, Holm G, Janson PO, Gustafson D, Waern M.
Acupuncture and physical exercise for affective symptoms and
health‑related quality of life in polycystic ovary syndrome: Secondary
analysis from a randomized controlled trial. BMC Complement Altern
Med 2013;13:131.
33. Banting LK, Gibson‑Helm M, Polman R, Teede HJ, Stepto NK. Physical
activity and mental health in women with polycystic ovary syndrome.
BMC Womens Health 2014;14:51.
34. Costa EC, de Sá JC, Costa IB, Meireles Rda S, Lemos TM,
Elsangedy HM, et al. Affect‑regulated exercise: An alternative approach
for lifestyle modiication in overweight/obese women with polycystic
ovary syndrome. Gynecol Endocrinol 2015;31:971‑5.

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