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

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

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 Submission04-Nov-2022
Date of Decision23-Dec-2022
Date of Acceptance24-Dec-2022
Date of Web Publication15-May-2023

Correspondence Address:
S Christy Sopna
No. 51, Pump House Street, Gandhi Thirunallur, Muthiraplayam, Puducherry - 605 009
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjsm.sjsm_25_22

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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 Sep 29];22:94-9. Available from: https://www.sjosm.org/text.asp?2022/22/3/94/377103

  Introduction Top

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 Top

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 Top

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 Top

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 Top

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 Top

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 Top

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.

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Conflicts of interest

There are no conflicts of interest.[28]

  References Top

Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 2018;110:364-79.  Back to cited text no. 1
Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2019;3:CD007506.  Back to cited text no. 2
Bharathi RV, Swetha S, Neerajaa J, Madhavica JV, Janani DM, Rekha SN, et al. An epidemiological survey: Effect of predisposing factors for PCOS in Indian urban and rural population. Middle East Fertility Society J 2017;22:313-6.  Back to cited text no. 3
Joseph N, Reddy AG, Joy D, Patel V, Santhosh P, Das S, et al. Study on the proportion and determinants of polycystic ovarian syndrome among health sciences students in South India. J Nat Sci Biol Med 2016;7:166-72.  Back to cited text no. 4
Roya R, Mohammad Akbar A, Wajeeda T, Avinash B, Humaira M, Avvari B, et al. An Indian Evidence-Based Study of Prevalence, Phenotypic Features, Lifestyle Modifications of Polycystic Ovarian Syndrome Patients. J Gynecol Women's Health 2021:21:556069.  Back to cited text no. 5
Bulsara J, Patel P, Soni A, Acharya S. A review: Brief insight into polycystic ovarian syndrome. Endocrine and Metabolic Sci 2021:3;1,00085.  Back to cited text no. 6
Tal R, Seifer DB, Arici A. The emerging role of angiogenic factor dysregulation in the pathogenesis of polycystic ovarian syndrome. Semin Reprod Med 2015;33:195-207.  Back to cited text no. 7
Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, et al. Diagnosis and treatment of polycystic ovary syndrome: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2013;98:4565-92.  Back to cited text no. 8
Fealy CE, Nieuwoudt S, Foucher JA, Scelsi AR, Malin SK, Pagadala M, et al. Functional high-intensity exercise training ameliorates insulin resistance and cardiometabolic risk factors in type 2 diabetes. Exp Physiol 2018;103:985-94.  Back to cited text no. 9
Harrison CL, Stepto NK, Hutchison SK, Teede HJ. The impact of intensified exercise training on insulin resistance and fitness in overweight and obese women with and without polycystic ovary syndrome. Clin Endocrinol (Oxf) 2012;76:351-7.  Back to cited text no. 10
Douen AG, Ramlal T, Rastogi S, Bilan PJ, Cartee GD, Vranic M, et al. Exercise induces recruitment of the “insulin-responsive glucose transporter”. Evidence for distinct intracellular insulin- and exercise-recruitable transporter pools in skeletal muscle. J Biol Chem 1990;265:13427-30.  Back to cited text no. 11
Corbould A, Kim YB, Youngren JF, Pender C, Kahn BB, Lee A, et al. Insulin resistance in the skeletal muscle of women with PCOS involves intrinsic and acquired defects in insulin signaling. Am J Physiol Endocrinol Metab 2005;288:E1047-54.  Back to cited text no. 12
Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165-74.  Back to cited text no. 13
Hutchison SK, Teede HJ, Rachoń D, Harrison CL, Strauss BJ, Stepto NK. Effect of exercise training on insulin sensitivity, mitochondria and computed tomography muscle attenuation in overweight women with and without polycystic ovary syndrome. Diabetologia 2012;55:1424-34.  Back to cited text no. 14
Aktaş HŞ, Uzun YE, Kutlu O, Pençe HH, Özçelik F, Çil EÖ, et al. The effects of high intensity-interval training on vaspin, adiponectin and leptin levels in women with polycystic ovary syndrome. Arch Physiol Biochem 2022;128:37-42.  Back to cited text no. 15
Almenning I, Rieber-Mohn A, Lundgren KM, Shetelig Løvvik T, Garnæs KK, Moholdt T. Effects of high intensity interval training and strength training on metabolic, cardiovascular and hormonal outcomes in women with polycystic ovary syndrome: A pilot study. PLoS One 2015;10:e0138793.  Back to cited text no. 16
Faryadian B, Tadibi V, Behpour N. Effect of 12-week high intensity interval training program on C-reactive protein and insulin resistance in women with polycystic ovary syndrome. J Clin Diagn Res 2019;13:CC01-4. [doi: 10.7860/JCDR/2019/41203.13106].  Back to cited text no. 17
Lopes IP, Ribeiro VB, Reis RM, Silva RC, Dutra de Souza HC, Kogure GS, et al. Comparison of the effect of intermittent and continuous aerobic physical training on sexual function of women with polycystic ovary syndrome: Randomized controlled trial. J Sex Med 2018;15:1609-19.  Back to cited text no. 18
Ribeiro VB, Lopes IP, Dos Reis RM, Silva RC, Mendes MC, Melo AS, et al. Continuous versus intermittent aerobic exercise in the improvement of quality of life for women with polycystic ovary syndrome: A randomized controlled trial. J Health Psychol 2021;26:1307-17.  Back to cited text no. 19
Ribeiro VB, Kogure GS, Lopes IP, Silva RC, Pedroso DC, de Melo AS, et al. Effects of continuous and intermittent aerobic physical training on hormonal and metabolic profile, and body composition in women with polycystic ovary syndrome: A randomized controlled trial. Clin Endocrinol (Oxf) 2020;93:173-86.  Back to cited text no. 20
Samadi Z, Bambaeichi E, Valiani M, Shahshahan Z. Evaluation of changes in levels of hyperandrogenism, hirsutism and menstrual regulation after a period of aquatic high intensity interval training in women with polycystic ovary syndrome. Int J Prev Med 2019;10:187.  Back to cited text no. 21
[PUBMED]  [Full text]  
Benham JL, Booth JE, Corenblum B, Doucette S, Friedenreich CM, Rabi DM, et al. Exercise training and reproductive outcomes in women with polycystic ovary syndrome: A pilot randomized controlled trial. Clin Endocrinol (Oxf) 2021;95:332-43.  Back to cited text no. 22
Roessler KK, Birkebaek C, Ravn P, Andersen MS, Glintborg D. Effects of exercise and group counselling on body composition and VO2 max in overweight women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2013;92:272-7.  Back to cited text no. 23
Hiam D, Patten R, Gibson-Helm M, Moreno-Asso A, McIlvenna L, Levinger I, et al. The effectiveness of high intensity intermittent training on metabolic, reproductive and mental health in women with polycystic ovary syndrome: Study protocol for the iHIT – Randomised controlled trial. Trials 2019;20:221.  Back to cited text no. 24
Kiel IA, Lundgren KM, Mørkved S, Kjøtrød SB, Salvesen Ø, Romundstad LB, et al. Women undergoing assisted fertilisation and high-intensity interval training: A pilot randomised controlled trial. BMJ Open Sport Exerc Med 2018;4:e000387.  Back to cited text no. 25
Kiel IA, Lionett S, Parr EB, Jones H, Røset MA, Salvesen Ø, et al. Improving reproductive function in women with polycystic ovary syndrome with high-intensity interval training (IMPROV-IT): Study protocol for a two-Centre, three-armed randomised controlled trial. BMJ Open 2020;10:e034733.  Back to cited text no. 26
Patten RK, McIlvenna LC, Levinger I, Garnham AP, Shorakae S, Parker AG, et al. High-intensity training elicits greater improvements in cardio-metabolic and reproductive outcomes than moderate-intensity training in women with polycystic ovary syndrome: A randomized clinical trial. Hum Reprod 2022;37:1018-29.  Back to cited text no. 27
Pawar S, Mahajan A. Comparison of effects of high intensity interval training and circuit training on hormonal imbalance and cardiopulmonary fitness in women with polycystic ovarian syndrome. Int J Res Soc Sci 2019;9:437-53.  Back to cited text no. 28


  [Table 1], [Table 2], [Table 3]


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