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Table 2 Characteristics of studies included in this systematic review

From: Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis

Study (design) N randomised/analysed Intervention duration (assessment points) Participant characteristics (PCOS diagnostic criteria) Intervention Outcome measures
Almenning et al. [32]
(RCT)
HIIT: 10/8
RT: 11/8
CON: 10/9
10 wks (baseline, 10 wks) Age: 27.2 ± 5.5 y
BMI: 26.7 ± 6.0 kg/m2
(Rotterdam)
HIIT frequency: 3 times/wk
HIIT intensity: 2 d/wk, 4 × 4 mins 90–95% HRmax/3 × 3 mins ~ 70% HRmax. 1 d/wk, 10 × 1 min ‘all-out’/10 × 1 min rest.
RT frequency: 3 times/wk
RT sets × reps: 3 × 10
RT load: 75% 1-RM
HOMA-IR, FBG, FI, TG, TC, LDL-C, HDL-C VO2 max, RHR, BW, BMI, WC, BF%, FM, FFM, T, SHBG, FAI, hsCRP
Brown et al. [97]
(RCT)
EX: 21/8
CON: 16/12
20–24 wks due to varying length of ramp-up phase
(baseline, immediately post)
Age: 32.3 ± ns y
BMI: 33.0 kg/m2
(NIH)
Exercise: 12-wk moderate-intensity intervention preceded by 8–12-wk ramp-up.
Aerobic duration: ~ 228 min/wk (≤ 60 bouts)
Aerobic intensity: 40–60% VO2 max
FBG, FI, HOMA-IR, TG, LDL-C, HDL-C, VO2 max, BW, BMI, WC, FT, SBP, DBP
Bruner et al. [98]
(RCT)
EX + DIET: 7/7
DIET: 5/5
12 wks
(baseline, 12 weeks)
Age: 30.7 ± 4.6 y
BMI: 36.6 ± 6.0 kg/m2
(Rotterdam)
Exercise frequency: 3 times/wk
Aerobic intensity: 70–85% HRmax
Aerobic duration: 30 mins (+ 10-min warm-up)
RT sets × reps: 2–3 × 10–15
RT load: not specified
Diet: 1 h/wk of nutritional counselling
FI, QUICKI, VO2 max, BW, BMI, WC, T, SHBG, FAI
Guzick et al. [99]
(RCT)
EX + DIET: 6/6
CON: 6/6
12 wks
(baseline, 12 weeks)
Age: 31.7 ± 10.0 y
BMI: ns
(NIH)
Exercise frequency: 5 times/wk
Exercise intensity: 1050–4200 kJ/wk
Diet: VLCD (8 wks) with calories increased over final 4 wks (4200–5040 kJ/d).
‘Optifast’ used to supplement diet
FBG, FI, BW, WHR, T, SHBG, FT, LH, FSH
Hoeger et al. [100]
(RCT)
LS + PLA: 11/6
PLA: 9/7
LS + MF: 9/5
MF: 9/5
48 wks
(baseline, 24 wks, 48 wks)
Age: 28.5 ± 5.2 y
BMI: 39.0 ± 6.1 kg/m2
(NIH)
Exercise programme: Individualised to achieve 150 min per week
Diet: Individualised healthy balanced meal plan to achieve 500–1000 kcal deficit per day
Metformin: 850 mg 2 times/day
BW, T, SHBG, FAI
Konopka et al. [102]
(RCT)
EX: 12/12
CON: 13/13
12 wks
(baseline, 12 wks)
Age: 35 ± 5.0 y
BMI: 33.0 ± 5.0 kg/m2
(Rotterdam)
Exercise frequency: 5 times/wk
Exercise intensity: 65% VO2 peak
Exercise duration: 60 min
FBG, FI, HOMA-IR, BMI, BW, FM, FFM, E2
Nasrekani et al. [104]
(RCT)
EX: 10/10
CON: 10/10
12 wks
(baseline, 12 wks)
Age: 30.4 ± 5.9 y
BMI: 28.3 ± 6.2 kg/m2
(Rotterdam)
Exercise frequency: 3 times/wk
Exercise intensity: 40–65% HRmax
Exercise duration: 25–30 min
VO2 max, BW, BMI, FSH, LH
Nybacka et al. [105, 106]
(RCT)
EX: 19/17
EX + DIET: 19/12
DIET: 19/14
4 months
(baseline, 4 months)
Age: 30.8 ± 5.2 y
BMI: 36.0 ± 6.2 kg/m2
(Rotterdam)
Exercise programme: Individualised to meet individuals’ capacity, goals and interest.
Diet: ≥ 600 kcal/day reduction maintaining 55–60% CHO, 25–30% fat and 10–15% protein.
FBG, FI, HOMA-IR, BW, BMI, WHR, BF%, FFM, T, SHBG, FT, E2, FSH, LH
Petranyi et al. [107]
(QRCT)
LS + MF: 29/29
MF: 27/27
6 months
(baseline, 6 months)
Age: 29 ± ns y
BMI: 27.2 ± 6.9 kg/m2
(Rotterdam)
Exercise programme: recommendation to increase physical activity levels. Specifics unclear.
Diet: low glycaemic index diet with caloric restriction for those who are obese.
Metformin: 500 mg 3 times/day
BMI, WHR
Roessler et al. [34]
(Randomised crossover)
EX: 8/7
CON: 9/7
16 wks
(baseline, 8 wks, 16 wks)
Age: 31.7 ± 7.9 y
BMI: 36.3 ± 7.2 kg/m2
(Rotterdam)
Exercise frequency: 3 times/wk (2 × cycle, 1 × walk)
Exercise intensity: following 2-week ramp, cycling 20–180 s 80–100% HRmax/rest 25–180 s 45–65% HRmax. Walking 3–5 min 80–90% HRmax/1 min 50–60% HRmax.
Exercise duration: 45 min (+ 10 min warm-up).
Control: Group counselling sessions (2 h, 1 time/wk) focussing on barriers and motivation.
VO2 max, BW, BMI, WC
Sa et al. [36, 108]
(RCT)
EX: 15/14
CON: 15/13
16 wks
(baseline, 16 wks)
Age: 26.0 ± 5.0 y
BMI: 32.8 ± 4.6 kg/m2
(Rotterdam)
Exercise frequency: 3 times/wk
Exercise intensity: 60–85% HRmax
Exercise duration: 40 min (+ 5 min)
SBP, DBP, FI, BMI, RHR, VO2 max, T, FSH, LH
Saremi et al. [109]
(RCT)
EX: 11/11
CON: 11/11
8 wks
(baseline, 8 wks)
Age: 35.2 ± 4.4 y
BMI: 28.3 ± 4.3 kg/m2
(Rotterdam)
Exercise frequency: 3 times/wk
Exercise intensity: 40–65% HRmax
Exercise duration: 30 min
FBG, FI, HOMA-IR, TG, TC, LDL-C, HDL-C, VO2 peak, BW, BMI, BF%, WC, WHR
Saremi et al. [110]
(RCT)
EX + PLA: 10/10
CON: 10/10
EX + CAL: 10/10
8 wks
(baseline, 8 wks)
Age: 27.1 ± 5.1 y
BMI: 25.5 ± 2.7 kg/m2
(Rotterdam)
Exercise frequency: 3 times/wk
RT sets x reps: 1–2 × 15–20
RT load: 40–60% 1-RM
FBG, FI, HOMA-IR, TG, TC, LDL-C, HDL-C, BW, BMI
Stener-Victorin et al. [101, 103, 111,112,113]
(RCT)
EX: 34/22
CON: 17/13
ACU: 33/24
16 wks
(baseline, 16 wks, 32 wks)
Age: 30 ± 4.4 y
BMI: 28.1 ± 7.3 kg/m2
(Rotterdam)
Exercise frequency: 3 times/wk
Exercise intensity: HR ≥ 120 BPM
Exercise duration: 30–45 min
Low-frequency electroacupuncture: 14 × 30 min treatments over 16 wks
SBP, DBP, FBG, FI, HOMA-IR, TG, TC, LDL-C, HDL-C, BMI, WHR, T, FT, SHBG, FAI, LH, FSH,
VO2 max, BMI, E2
Thomson et al. [33, 114,115,116]
(RCT)
AET + DIET: 31/18
AET + RT + DIET: 33/20
DIET: 30/14
20 weeks (baseline, 10 wks, 20 wks) Age: 29.3 ± 6.8 y
BMI: 36.1 ± 4.8 kg/m2
(Rotterdam)
Exercise frequency: 5 times/wk (3 × aerobic, 2 × RT in combined exercise group)
Aerobic intensity: 60–65% HRmax progressed to 75–80% HRmax by study end
Aerobic duration: 25–30 min progressed to 45 mins by study end
RT sets × reps: 3 × 12
RT load: 50–60% 1-RM progressed to 65–75% 1-RM after 2 wks
Diet: energy restricted high protein diet (5000–6000 kJ/day)
SBP, DBP, FBG, FI, HOMA-IR, TG, TC, LDL-C, HDL-C, BW, BF%, FM, FFM, WC, T, SHBG, FAI, PCOS-Q
Turan et al. [117]
(RCT)
EX: 16/14
CON: 16/16
8 wks
(baseline, 8 wks)
Age: 24.5 ± 2.8 y
BMI: 21.9 ± 3.5 kg/m2
(Rotterdam)
Exercise frequency: 3 times/wk
Exercise duration: 50–60 min
Aerobic intensity: 65–70% HRmax
RT sets x reps: 1 × 15
RT load: 5–6 on RPE for RT scale
SBP, DBP, FBG, HOMA-IR, FI, TG, TC, HDL-C, LDL-C, BMI, WC, RHR, VO2 max, T, FT, E2, LH, FSH
Vigorito et al. [118]
(RCT)
EX: 45/45
CON: 45/45
3 months
(baseline, 3 months)
Age: 21.8 ± 2.1 y
BMI: 29.4 ± 3.2 kg/m2
(Rotterdam)
Exercise frequency: 3 times/wk
Exercise intensity: 60–70% VO2 max
Exercise duration: 30 min
SBP, DBP, FBG, FI, TG, TC, LDL-C, HDL-C, VO2 max, RHR, BMI, WC, E2, T, FT, SHBG, FAI, LH, FSH, CRP
Vizza et al. [119]
(RCT)
EX: 8/7
CON: 7/6
12 wks
(baseline, 12 wks)
Age: 27 ± 5.0 y
BMI: 37.8 ± 11.4 kg/m2
Exercise frequency: 4 times/wk (2 × RT, 2 home-based)
RT sets × reps: 2–3 × 8–12
RT load: Progressed with strength gains
Home-based: Callisthenics, 3 sets of 10 reps
FBG, FI, HOMA-IR, BW, BMI, WC, FM, FFM, BF%, hsCRP, T, SHBG, FAI, PCOS-Q, SF-36
  1. Studies presented by lead author and year of publication. Design; RCT randomised controlled trial, QRCT quasi-randomised controlled trial. N randomised the number of participants randomised into each study arm at the study initiation, analysed is the number of participants included within the analysis, HIIT high-intensity interval training, RT resistance training, CON control group, EX exercise group, DIET dietary intervention, LS lifestyle, PLA placebo, MF metformin, ACU acupuncture, AET aerobic exercise training, CAL calcium supplementation. Intervention duration length of the duration, assessment points the time-points at which researchers have assessed outcome measures. Participant characteristics presented as mean ± standard deviation (SD) or median in one study [97] for age (in years, y) and BMI (kg/m2) at study entry, ns not specified. Diagnostic criteria the specific criteria used to confirm a PCOS diagnosis, NIH National Institute of Health (1990) diagnostic criteria, Rotterdam European Society for Human Reproductive and Embryology/American Society for Reproductive Medicine (2003). Outcome measures refers to the outcomes from each study that are relevant to this systematic review. VO2 max maximum oxygen uptake, RHR resting heart rate, HDL-C high-density lipoprotein cholesterol, LDL-C low-density lipoprotein cholesterol, TC total cholesterol, TG triglycerides, FBG fasting blood glucose, FI fasting insulin, HOMA-IR homeostatic assessment of insulin resistance, QUICKI quantitative insulin sensitivity check index, FM fat mass, FFM fat-free mass, BF% body fat percentage, BW body weight, BMI body mass index, WC waist circumference, WHR waist-to-hip ratio, SHBG sex hormone binding globulin, FAI free androgen index, T testosterone, FT free testosterone, E2 oestradiol, LH luteinising hormone, FSH follicle stimulating hormone, SBP systolic blood pressure, DBP diastolic blood pressure, hsCRP high-sensitivity C-reactive protein, d day, mins minutes, wk week, reps repetitions, RM maximum number of repetitions, HRmax maximum heart rate, PCOS-Q PCOS health-related questionnaire, SF-36 Optum36-item Short Form Survey, VLCD very low calorie diet, CHO carbohydrate