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Table 5 Summary of findings for primary outcomes: exercise and diet versus diet

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

Exercise and diet compared to Diet for women with PCOS
Patient or population: women with PCOS
Setting:
Intervention: exercise and diet
Comparison: Diet
Outcomes Anticipated absolute effects* (95% CI) Relative effect (95% CI) № of participants (studies) Certainty of the evidence (GRADE) Comments
Risk with Diet Risk with exercise and diet
Fasting blood glucose (change from baseline) follow-up: range 16 weeks to 20 weeks The mean fasting blood glucose (change from baseline) ranged from − 7.0 to − 3.2 mg/dL The mean fasting blood glucose (change from baseline) in the intervention group was 2.92 mg/dL higher (0.4 lower to 6.23 higher) 78 (2 RCTs) VERY LOW a,b We are uncertain about the effect of exercise and diet on fasting blood glucose (change from baseline).
Fasting insulin (change from baseline) follow-up: range 12 weeks to 20 weeks The mean fasting insulin (change from baseline) ranged from − 2.9 to − 18.54 μU/ml The mean fasting insulin (change from baseline) in the intervention group was 2.22 μU/ml higher (3.7 lower to 8.14 higher) 90 (3 RCTs) VERY LOW a,c,d We are uncertain about the effect of exercise and diet on fasting insulin (change from baseline).
HOMA-IR (change from baseline) follow-up: range 16 weeks to 20 weeks The mean HOMA-IR (change from baseline) ranged from − 0.74 to − 0.56 The mean HOMA-IR (change from baseline) in the intervention group was 0.01 lower (0.45 lower to 0.43 higher) 78 (2 RCTs) VERY LOW a,b We are uncertain about the effect of exercise and diet on HOMA-IR (change from baseline).
*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). CI: Confidence interval; MD: Mean difference
GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
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
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
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
  1. Explanations
  2. aAll trials were at an unclear risk of selection bias, reporting bias, contamination, and adherence issues. All trials were at a high risk of detection bias and attrition bias. Therefore, we downgraded by one level
  3. bSmall number of participants, only two trials, and wide confidence intervals in the included trials. Therefore, we downgraded by two levels
  4. cSubstantial heterogeneity was observed. Therefore, we downgraded by one level
  5. dSmall number of participants and trials, wide confidence intervals, and null/negligible effect and appreciable benefit included in the confidence interval for the mean difference. Therefore, we downgraded by two levels