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Table 4 Summary of findings for primary outcomes: exercise versus control

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

Exercise compared to usual care for women with PCOS
Patient or population: women with PCOS
Setting:
Intervention: exercise
Comparison: usual care
Outcomes Anticipated absolute effects* (95% CI) Relative effect(95% CI) № of participants (studies) Certainty of the evidence(GRADE) Comments
Risk with usual care Risk with exercise
Systolic blood pressure (change from baseline) follow-up: range 8 weeks to 16 weeks The mean systolic blood pressure (change from baseline) ranged from − 2.5 to 1.1 mmHg The mean systolic blood pressure (change from baseline) in the intervention group was 2.93 mmHg lower (7.06 lower to 1.2 higher) 158 (4 RCTs) LOW a,b Exercise may result in little to no difference in systolic blood pressure (change from baseline).
Diastolic blood pressure (change from baseline)follow-up: range 8 weeks to 16 weeks The mean diastolic blood pressure (change from baseline) ranged from −3.1 to 2.9 mmHg The mean diastolic blood pressure (change from baseline) in the intervention group was 2.19 mmHg lower (5.23 lower to 0.85 higher) 158 (4 RCTs) LOW a,b Exercise may result in little to no difference in diastolic blood pressure (change from baseline).
Fasting blood glucose (change from baseline)follow-up: range 8 weeks to 16 weeks The mean fasting blood glucose (change from baseline) ranged from − 1.3 to 2.6 mg/dL The mean fasting blood glucose (change from baseline) in the intervention group was 1.08 mg/dL lower (2.47 lower to 0.3 higher) 263 (9 RCTs) LOW c,d Exercise may result in little to no difference in fasting blood glucose (change from baseline).
Fasting insulin (change from baseline) follow-up: range 8 weeks to 16 weeks The mean fasting insulin (change from baseline) ranged from −4.1 to 2.5 μU/ml The mean fasting insulin (change from baseline) in the intervention group was 2.44 μU/ml lower (4.42 lower to 0.64 lower) 263 (9 RCTs) VERY LOW e,f,g Exercise may reduce fasting insulin (change from baseline) but we are very uncertain.
HOMA-IR (change from baseline)follow-up: range 8 weeks to 16 weeks The mean HOMA-IR (change from baseline) ranged from − 0.4 to 0.7 The mean HOMA-IR (change from baseline) in the intervention group was 0.57 lower (0.99 lower to 0.14 lower) 173 (8 RCTs) VERY LOW d,e,h Exercise may reduce HOMA-IR (change from baseline) but we are very uncertain.
Total cholesterol (change from baseline) follow-up: range 8 weeks to 16 weeks The mean total cholesterol (change from baseline) ranged from −8.85 to 6.85 mg/dL The mean total cholesterol (change from baseline) in the intervention group was 6.48 mg/dL lower (10.5 lower to 2.45 lower) 225 (7 RCTs) LOW g,i Exercise may reduce total cholesterol (change from baseline) slightly.
LDL-C (change from baseline) follow-up: range 8 weeks to 16 weeks The mean LDL-C (change from baseline) ranged from − 17.7 to 7.03 mg/dL The mean LDL-C (change from baseline) in the intervention group was 7.51 mg/dL lower (10.01 lower to 5.02 lower) 225 (7 RCTs) LOW g,i Exercise may reduce LDL-C (change from baseline) slightly.
HDL-C (change from baseline) follow-up: range 8 weeks to 16 weeks The mean HDL-C (change from baseline) ranged from − 17.7 to 3.5 mg/dL The mean HDL-C (change from baseline) in the intervention group was 0.01 mg/dL lower (1.91 lower to 1.89 higher) 225 (7 RCTs) LOW d,i Exercise may result in little to no difference in HDL-C (change from baseline).
Triglycerides (change from baseline) follow-up: range 8 weeks to 16 weeks The mean triglycerides (change from baseline) ranged from − 1.0 to 8.9 mg/dL The mean triglycerides (change from baseline) in the intervention group was 4.78 mg/dL lower (7.52 lower to 2.05 lower) 225 (7 RCTs) LOW g,i Exercise likely results in a small effect that may not be an important (or unimportant) reduction in triglycerides (change from baseline).
  1. *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
  2. CI confidence interval, MD mean difference
  3. GRADE Working Group grades of evidence
  4. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
  5. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
  6. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
  7. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
  8. Explanations
  9. aThree of the four trials had a high or unclear risk of selection bias, detection bias, and reporting bias; all were at high risk of performance bias; two were at high or unclear risk of attrition bias; and all were at a high or unclear risk of contamination. Therefore we downgraded by one level
  10. bSmall number of participants, wide confidence intervals for three of the four trials, and null/negligible effect and appreciable benefit included in the confidence interval for the mean difference. Therefore, we downgraded by one level
  11. cMost trials were at an unclear or high risk of selection bias, detection bias, and reporting bias; and all trials were at a high or unclear risk of contamination and low adherence. Therefore, we downgraded by one level
  12. dSmall number of participants and null/negligible effect and appreciable benefit included in the confidence interval for the mean difference. Therefore, we downgraded by one level
  13. eMost trials were at an unclear or high risk of selection bias, detection bias, attrition bias, and reporting bias; and most trials were at a high or unclear risk of contamination and low adherence. Therefore, we downgraded by one level
  14. fConsiderable heterogeneity was observed. Therefore, we downgraded by one level
  15. gSmall number of participants and wide confidence intervals in the included trials. Therefore, we downgraded by one level
  16. hConsiderable heterogeneity was observed and there was minimal or no overlap of confidence intervals. Therefore, we downgraded by one level
  17. iMost trials were at an unclear or high risk of selection bias, detection bias, and reporting bias; and all trials were at a high or unclear risk of contamination. Therefore, we downgraded by one level