High-intensity interval training in polycystic ovarian syndrome: An evidence-based review

S Christy Sopna; D Beulah Jebakani; P Sabita

doi:10.4103/sjsm.sjsm_25_22

REVIEW ARTICLE

Year : 2022 | Volume : 22 | Issue : 3 | Page : 94-99

High-intensity interval training in polycystic ovarian syndrome: An evidence-based review

S Christy Sopna¹, D Beulah Jebakani¹, P Sabita²
¹ Department of Obstetrics and Gynaecology Physiotherapy, Mother Theresa Postgraduate and Research Institute of Health Sciences, Puducherry, India
² Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Puducherry, India

Date of Submission	04-Nov-2022
Date of Decision	23-Dec-2022
Date of Acceptance	24-Dec-2022
Date of Web Publication	15-May-2023

Correspondence Address:
S Christy Sopna
No. 51, Pump House Street, Gandhi Thirunallur, Muthiraplayam, Puducherry - 605 009
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/sjsm.sjsm_25_22

Abstract

Polycystic ovarian syndrome is an endocrine disorder affecting women of reproductive age group leading to anovulation and infertility. Lifestyle modification is the first line of treatment for polycystic ovary syndrome (PCOS). High-intensity interval training (HIIT) is an aerobic type with high and low tempo cycles of exercise. This review is based on current evidences on High intensity interval training among PCOS women and cumulative dosage of high intensity interval training to enable a maximum therapeutic effect. The current dosage of high intensity interval training has shown effective to augment the reproductive, mental, physical changes reducing the cardiovascular risks and improving the quality of life among PCOS women.

Keywords: High-intensity interval training, insulin resistance, polycystic ovarian syndrome

How to cite this article:
Sopna S C, Jebakani D B, Sabita P. High-intensity interval training in polycystic ovarian syndrome: An evidence-based review. Saudi J Sports Med 2022;22:94-9

How to cite this URL:
Sopna S C, Jebakani D B, Sabita P. High-intensity interval training in polycystic ovarian syndrome: An evidence-based review. Saudi J Sports Med [serial online] 2022 [cited 2023 Jun 5];22:94-9. Available from: https://www.sjosm.org/text.asp?2022/22/3/94/377103

Introduction

Polycystic ovarian syndrome is a common endocrine disorder affecting women of reproductive age group leading to anovulation and infertility. Stein and Leventhal were the first to describe polycystic ovary syndrome (PCOS) more elaborately in 1935. PCOS is manifested by the presence of ovarian cyst, anovulation or oligoovulation (reduced ovulation), irregular menstrual cycles, biochemical hyperandrogenism (elevated hormones or androgens), clinical hyperandrogenism (hirsutism), and infertility.^[1],[2] According to the WHO, the global burden of PCOS is estimated to be over 116 million (3.4%) worldwide.^[3] The rate of prevalence in Indian adolescents is about 91.13% and 3.7% in young women.^[4] 71% of women with PCOS reside in an urban region while 29% in a rural region.^[5] PCOS is diagnosed based on different diagnosed criteria; among those, the commonly used is Rotterdam criteria.^[6] The metabolic features of PCOS are elevated levels of insulin resistance, diabetes mellitus, and cardiovascular risk factors such as abnormal cholesterol levels and free plasma lipids; women with PCOS have an increased level of insulin resistance (IR) and hyperinsulinemia, dyslipidemia, and low-grade inflammation.^[7] Hormone imbalances are worsened by overweight and obesity worsen by increasing the androgen and hyperinsulinemia.^[8]

High-intensity interval training (HIIT) typically involves repeated, short intervals of running, walking (indoor treadmill or outdoor), or cycling performed at 85%–95% of peak heart rate interspersed with periods of rest or low-intensity exercise. HIIT is an aerobic-type exercise which includes continuous, intermittent, low-volume, and high-volume high-intensity training.^[9]

Effect of High-Intensity Interval Training on Pathophysiology Of Polycystic Ovarian Syndrome

Lifestyle changes are the first line of management in PCOS. HIIT is an aerobic-type exercise with high and low tempo cycles. In the literature, there are numerous studies stating that HIIT reduces the risk of mortality due to diseases such as obesity and type 2 diabetes mellitus and improves the quality of life. The gold standard euglycemic hyperinsulinemia clamps confirm that PCOS women are more insulin resistant than non-PCOS women of similar weight. The high-intensity exercise has an ability to alleviate insulin resistance in PCOS.^[9],[10] Exercise assists glucose intake without insulin signaling pathway by inducing the translocation of glucose transporter-4 to the plasma membrane. Exercise acts similarly to insulin.^[11] The exercise-induced improvement is due to the glucose uptake by the skeletal muscle during exercise, but the insulin sensitivity and the defect in insulin signaling pathway are not restored.^[12],[13] High intensity interval training increases the transport and utilization of lipid by the skeletal muscle leading to increased lipid uptake and improved insulin sensitivity. There are numerous literature stating the efficacy of exercise training in overcoming the metabolic symptoms in PCOS by making improvement in apoprotein and adiponectin as a process of lipid turnover and uptake in skeletal muscle. HIIT improves the maximum oxygen consumption VO2 max, a well-established marker of cardiopulmonary health.^[14]

Need of the Study

The need for the study is to review the current evidences of HIIT on PCOS women and to provide an cumulative recommended dosage and progression of HIIT to provide a maximum therapeutic effect to improve the physical, psychological, reproductive, metabolic, cardiopulmonary and quality of life.

Inclusion, Eligibility, and Interventions

The review included females between the ages of 18 and 50 years who had been diagnosed with PCOS using any established criteria. They should have received high-intensity training as an isolated intervention without concurrent treatment such as dietary changes or drug interventions. The study included every full-text randomized controlled trial published in English. Articles published in languages other than English and articles with concurrent treatment were excluded from the study.

Methodology for Evidence Search

The randomized controlled trials on the effectiveness of HIIT in PCOS were searched through electronic databases such as PubMed, Scopus, EBSCO, Ovid MEDLINE, and Cochrane databases. The MeSH items used for searching online were HIIT AND PCOS, physical activity AND PCOS, Exercise, and PCOS. Only full-text randomized controlled trials published in English were reviewed; we had selected only the randomized controlled trial because it had a high level of evidence and it would be efficient to give the exercise prescription based on the trials. The articles were hand searched by two authors, and any consensus that arose between the two authors was solved through the third author. The research findings are placed in [Table 1].

Table 1: The current evidence behind the effects of high-intensity interval training on polycystic ovarian syndrome

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Recommendation of High-Intensity Interval Training in Polycystic Ovarian Syndrome

Based on the recent literature, reviewed in [Table 1], the dosage of exercise recommended in PCOS for potential health benefits may be as in [Table 2] and the progression of exercise in [Table 3].

Table 2: Recommendation for prescription of high-intensity interval training

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Table 3: Recommendation for progression of high-intensity interval training

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Conclusion

High intensity interval training from the current evidences shows there is an improvement in the anthropometric measurements such as body mass index, waist-hip ratio also on metabolic parameters such as HOMA-IR, total cholestrol and lipid profile. HIIT has an extensive role in the improvement of reproductive outcomes such as levels of free androgen index, Female Sexual Function Index, menstrual bleeding, menstruation frequency, anxiety, depression, and quality of life. The recommended dosage and progression of exercise in the literature review showed potential health benefit and maximum therapeutic effect.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.[28]

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