While the mantra ‘exercise is medicine’ or that ‘being physically active throughout your life is generally better than any pill a doctor can prescribe’ is applicable to the general population, it is especially true for women with PCOS. These statements are not new and are well recognised even at the emergence of modern medicine as seen in Hippocrates early writings. They are also clearly articulated in current evidence-based guideline recommendations for the management and treatment of PCOS where lifestyle therapy that includes diet, exercise and behaviour change coaching are first-line. However, the guideline recommendations do not provide clinicians, allied health professionals or women with PCOS any clear guidance on optimal exercise programs to assist in managing the clinical symptoms of PCOS. Associate Professor Nigel Stepto explains.
Physical activity (any bodily movement produced by skeletal muscles that requires energy expenditure) and structured exercise (an activity requiring physical effort, carried out to sustain or improve health and fitness) deliver cardio-metabolic, reproductive and mental benefits, whether alone or combined with diet changes. Both aerobic exercise and resistance exercise are proven beneficial to reduce cardio-metabolic risk factors but intensity of and/or combined training, seems to be most efficient. It is estimated that the health impacts of formal exercise therapy can reduce long-term cost to any healthcare system by ~$1900 (AUD) per pre-diabetic person annually (Deloitte Access Economics for ESSA.)
Despite these well-established benefits of exercise for prevention of chronic disease, maintenance of health and therapeutic benefits in women with PCOS, they tend to remain inactive. This disengagement from physical activity and formal exercise is likely due to general and PCOS-specific barriers to physical activity and formal exercise. To overcome reduced exercise participation, we need to address the general (time limitations) and PCOS specific (lack of confidence about maintaining physical activity, fear of injury, physical limitations) barriers by finding not only effective formal exercise activities, but also ones that are enjoyable and likely sustainable beyond formal therapeutic intervention periods.
As with pharmacological treatments, our preliminary work found that exercise has significant health benefits for women with PCOS, but it does not normalise insulin resistance, promote significant weight loss, nor completely ameliorate syndrome features. This begs the question of how can we optimise exercise therapy and what are the biological factors that are limiting the impact of exercise in women with PCOS. New evidence is emerging that an exercise ‘dose’ of specific intensity may be an important determinant of health impact of exercise in PCOS, and that increased exercise doses may be required to overcome epigenetic programming and/or excessive tissue fibrosis in metabolically important tissues like muscle and fat. While there is a clear role for exercise in management and treatment of PCOS, either alone or within a lifestyle program, there is an urgent need to:
- Determine appropriate exercise ‘doses’, types and regimes that are most efficacious for improving clinical features of PCOS while enhancing engagement and long-term sustainability in therapeutic exercise interventions.
- Understand at the molecular level (i.e. epigenetic signatures and tissue fibrosis) in muscle, fat and blood cells, why exercise is not as effective in women with PCOS compared to those without PCOS, to possible identify new drug targets for adjunct therapy.
Our small team (myself and early career researchers andPhD students), in collaboration with colleagues at Monash University, NovoNordisk Foundation of Basic Metabolic Research (University of Copenhagen) and the Universities of Adelaide, Queensland and New South Wales, are undertaking a number of studies to answer these two highly relevant and important questions.
Currently we are recruiting for the clinical exercise trial ‘iHIT-PCOS’ (ANZCTR12615000242527) which is exploring the role of vigorous exercise training in the form of high intensity intermittent training (HIT) as a therapeutic strategy in PCOS. The trial is currently recruiting in the west of Melbourne and planning to expand the trial across Melbourne and nationally in 2018 (pending funding).
If you would like to know more about the trial or participate please email me.