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Exercise Recommendations for Women with Polycystic Ovary Syndrome: Is the Evidence Enough?

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Abstract

In this opinion piece, we summarize, discuss implications of implementation, and critically evaluate our 2018 evidence-based guideline recommendations for exercise and physical activity in women with polycystic ovary syndrome (PCOS). We developed recommendations as part of a larger international guideline development project. The overall guideline scope and priorities were informed by extensive health professional and consumer engagement. The lifestyle guideline development group responsible for the exercise recommendations included experts in endocrinology, exercise physiology, gynecology, dietetics, and obstetrics, alongside consumers. Extensive online communications and two face-to-face meetings addressed five prioritized clinical questions related to lifestyle, including the role of exercise as therapy for women with PCOS. The guideline recommendations were formulated based on one narrative and two evidence-based reviews, before consensus voting within the guideline panel. The development process was in accordance with the Appraisal of Guidelines for Research and Evaluation (AGREE) II, and used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework to assess evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation, and recommendation strength. Given the evidence for exercise as therapy in PCOS being of low quality, a consensus recommendation was made based on current exercise guidelines for the general population. Women with PCOS and clinicians are forced to adopt generic approaches when recommending exercise therapy that perpetuates clinical management with pharmacological solutions. The current status of evidence highlights the need for greater international co-operation between researchers and funding agencies to address key clinical knowledge gaps around exercise therapy in PCOS to generate evidence for appropriate, scalable, and sustainable best practice approaches.

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Acknowledgements

The authors extend many thanks to the Exercise and Sports Science Australia (ESSA) Special Interest Group who provided critical feedback on the recommendation summary.

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Authors and Affiliations

  1. Institute for Health and Sport (iHES), Victoria University, Footscray, PO Box 14428, Melbourne, VIC, 8001, Australia

    Nigel K. Stepto, Rhiannon K. Patten, Russell A. Boyle & Alba Moreno-Asso

  2. Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Monash Health, Melbourne, VIC, Australia

    Nigel K. Stepto, Eliza C. Tassone, Marie L. Misso, Jacqueline Boyle, Cheryce L. Harrison, Mala Thondan, Helena J. Teede & Lisa J. Moran

  3. Australian Institute for Musculoskeletal Science (AIMSS) Victoria University, St Albans, VIC, Australia

    Nigel K. Stepto & Alba Moreno-Asso

  4. Department Medicine Western Health, Faculty of Medicine, Dentistry and Health Sciences, Melbourne University, Melbourne, VIC, Australia

    Nigel K. Stepto

  5. School of Behavioural and Health Sciences, Australian Catholic University, Victoria, Australia

    Leah Brennan

  6. Centre for Eating, Weight and Body Image, Melbourne, VIC, Australia

    Leah Brennan

  7. Department of Women’s and Children’s Health, Department of Gynecology and Reproductive Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Angelica Lindén Hirschberg

  8. Private Practice, Sydney, NSW, Australia

    Kate Marsh

  9. Reproductive Endocrinology and Women’s Health Laboratory, Clinical Sciences Division Pennington Biomedical Research Center, Baton Rouge, LA, USA

    Leanne Redman

  10. Harp Family Medical Centre, Kew East, VIC, Australia

    Mala Thondan

  11. Faculty of Medicine, University of Colombo and De Soyza Hospital for Women Colombo, Colombo, Sri Lanka

    Chandrika Wijeyaratne

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  1. Nigel K. Stepto
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  2. Rhiannon K. Patten
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  14. Chandrika Wijeyaratne
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  15. Helena J. Teede
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  16. Lisa J. Moran
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Corresponding author

Correspondence to Nigel K. Stepto.

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Funding

This work was supported with funding from the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in PCOS (APP1078444), American Society for Reproductive Medicine (ASMR) and European Society of Human Reproduction and Embryology (ESRHE).

Conflict of interest

N Stepto, J. Boyle, L. Moran, and H. Teede were named investigators on the NHMRC Centre for Research Excellence in PCOS (APP1078444) grant, but receive no salary from the grant. J. Boyle is a NHMRC Career Development Fellow. M. Misso was employed as the systematic reviewer and guideline developer for the work that informed this article. R. Patten, E. Tassone, L. Brennan, R. Boyle, C. Harrison, A. Lindén Hirschberg, K. Marsh, A. Moreno-Asso, L. Redman, M. Thondan, and C. Wijeyaratne have no conflicts of interest relevant to this article to declare.

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Stepto, N.K., Patten, R.K., Tassone, E.C. et al. Exercise Recommendations for Women with Polycystic Ovary Syndrome: Is the Evidence Enough?. Sports Med 49, 1143–1157 (2019). https://doi.org/10.1007/s40279-019-01133-6

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