Lifestyle Management – Barriers and Enablers

It is well known that weight management through lifestyle – diet, exercise and behavioural strategies – is recommended as first-line treatment in PCOS, however, the effect of these guidelines on actual dietary and physical activity prescription by health professionals is not known. Monash Centre for Health Research and Implementation’s Associate Professor Lisa Moran is part of an international collaboration that aims to help identify gaps in existing knowledge on lifestyle for women with PCOS.

 In 2016, a Partnership Grant was submitted to NHMRC titled ‘Polycystic Ovary Syndrome: Implementation Research using the Experiences and Perspectives of Women and Health Professionals to Internationally Translate Guidelines and Evidence into Practice’. Work has commenced on individual components of this grant and I am involved with the project titled ‘Attitudes and barriers to a healthy lifestyle in PCOS’.

Weight management through lifestyle (diet, exercise and behavioural strategies) is recommended as first-line treatment by Cochrane reviews, international statement and 2011 guidelines performed by our group. We know that dietary and physical activity advice are key components of weight management programs and current evidence-based Australian guidelines outline the principles of dietary and physical activity management for PCOS. However, the effect of these guidelines on actual dietary and physical activity prescription by health professionals is not known. Only 25% of 357 European endocrinologists chose lifestyle management as the first option for treatment.

The provision of lifestyle advice also varies across specialities with 85% vs 40% of US endocrinologists and gynaecologists recommending lifestyle changes to adolescents with PCOS which are often broad, variable and unstructured. Only half of clinicians provide specific advice on optimal dietary intake or duration/frequency of exercise and less than a third refer patients to a dietitian.

The translation of this knowledge to actual dietary and physical activity practices by women with PCOS is also unclear. Women are dissatisfied with information received from clinicians with the majority (60%) not provided or not referred to information sources at diagnosis and half of those receiving information feeling it was inadequate. In the absence of health professional referred resources, women with PCOS may seek non evidence-based information on lifestyle management.  The effect of this on actual dietary intake and physical activity is not known. Furthermore, despite the Australian PCOS guidelines being the only international evidence-based guidelines for lifestyle management in PCOS, their relative uptake in Australia compared to other countries is not known.

We are undertaking a survey examining barriers and enablers to lifestyle management in women with PCOS with international collaborators across the US (Dr Lynn Monahan, Ms Angela Grassi) and the UK (Dr Yvonne Jeanes) and consumer partners POSAA, PCOS Challenge and Verity. It will assess the knowledge of women with PCOS of physical activity and diet recommendations, sources of this knowledge, guideline awareness and other enablers and barriers for weight management to inform the lifestyle content of our clinical models of care and resources.

I will be conducting this research over 2017 with CRE-affiliated PhD student and dietitian Stephanie Pirotta and our international collaborators and we will commence recruitment in Australia soon. This research will benefit both women with PCOS and health professionals. It will help in identifying gaps in existing knowledge on lifestyle for women with PCOS and relative contribution of evidence-based and non-evidence based sources to this knowledge.

If you would like to know more about Lisa’s research, please contact her at: lisa.moran@monash.edu