Exercise for PCOS?
Workout & Exercise Strategies that Actually Work for PCOS

Written by: Dr. Ashley Eskew, MD, MSCI

Edited by: Dr. Will Haas, MD, MBA

Last updated: September 16th, 2021

Sporty woman thinking about the best exercise for PCOS

Spinning classes cause PCOS…

Don’t lift weights if you have PCOS… it will make your hair growth worse

You need to exercise more and eat less…

The topic of exercise and polycystic ovary syndrome (PCOS) is a maze of myths and misinformation. 

Some of you may already know how ridiculous these statements are, while others are just starting to explore how exercise can help manage PCOS and might be wondering if they’re really true. 

And no matter where you are on your PCOS journey, this post will help deepen your understanding of how exercise can help you manage your PCOS successfully

Here’s a quick overview of what you’ll discover:

Why Exercise is So Important for Women with PCOS

Here’s where you’ll learn all the wonderful things exercise can do to help with your PCOS symptoms…

But before we jump into all the benefits, it’s important to note that studies have consistently shown that dietary changes alone OR dietary changes plus exercise produce better outcomes than JUST exercise alone (1).

As much as you can, try not to get yourself in the rut of overeating or eating filler foods… only to punish yourself later with exercise. We’ve all been there, and truth be told, there’s no amount of exercise that can make up for poor dietary choices on the regular.

So if you’re just starting out or you’re feeling a little overwhelmed, take a deep breath, start slow, and optimize your diet first

Of course, we’ve also got you covered with some tips for getting started with exercise in the next section, so don’t just skip to the summary 🙂

Infographic about the benefits of exercise for PCOS

Improved body composition 

We know that we said it’s not just about weight loss, but even small amounts of weight loss (5-10% of your body weight) can make a difference in PCOS outcomes (1). 

With that said, keep in mind that the number on the scale might not budge while you are achieving positive changes in your body composition because the fact is, muscle weighs more than fat.  

So even if you’re not seeing immediate improvements on the scale, you’re still taking steps to improve your symptoms and overall health by engaging in exercise on a regular basis. Pay more attention to how your clothes fit you and how you feel. That’s far more valuable than any number on the scale.

Increased insulin sensitivity 

Many women with PCOS, including lean women, have insulin resistance or hyperinsulinemia (too much insulin in the blood.) 

As we discussed previously, high insulin levels can cause your ovaries to increase the production of testosterone while also decreasing the protein that binds up free-floating testosterone. This combination of things can then disrupt your menstrual cycle and ovulation, cause acne, and result in hirsutism.

Exercise, especially strength training, increases insulin sensitivity in both healthy women and women who have polycystic ovarian syndrome which can help mitigate this vicious cycle. 

Reduced inflammation

Even though it’s not part of the official diagnostic criteria for PCOS, research indicates that women with PCOS suffer from chronic inflammation (2). 

The good news is that regular exercise improves markers of inflammation (3). This is especially important because chronic inflammation is also a driving force for insulin resistance (4). 

Once again, even if you’re not seeing the benefits of your exercise right away, rest assured that positive things are happening in your body!

Decreased risk for heart disease

We know that heart disease is probably not top of mind compared to your reproductive health, but it’s the number one killer of women. And if that didn’t catch your attention, women with PCOS have a higher risk for developing cardiovascular disease (5, 6). 

The good news is that regular exercise can help improve many of the risk factors contributing to heart disease including things like type 2 diabetes, hypertension, and high cholesterol.

Elevated mood

It’s not talked about as often as it should, but women with PCOS are more likely to develop symptoms of depression and anxiety (7). 

Luckily, when you exercise, your body releases endorphins – a special type of chemical messenger released in the brain that promotes feelings of wellness. 

Who doesn’t want that?

Tips for Overcoming Exercise Challenges

Getting started or even continuing with an exercise program is tough…

Even as the endorphin-junkies that we are, we encounter roadblocks that can get in the way of workouts… lack of time and motivation are two that come to mind. 

We thought it might be helpful to break down some common exercise challenges we have experienced ourselves and encounter with our patients most often with some tips to get started with a plan that works for YOU.

Infographic with 4 tips for overcoming exercise with PCOS

Ditch the all-or-nothing mindset

Following an unrealistic workout program can be so destructive… 

In fact, nothing can derail your progress faster than falling short of unreasonable expectations. And even though exercising 3-5 days a week is recommended, it doesn’t mean that you have to start there or stick with that schedule. 

Any day you exercise gets you one step closer to your goals! 

So start with what’s realistic and build from there.

Choose a workout plan that feels good 

It might sound obvious, but seek out activities and environments that make you feel good and bring you joy. 

If joining a gym gives you anxiety… then workout at home (we promise, you don’t need that fancy equipment to make significant gains). If you hate running but love to spin… hop on a stationary bike. If you enjoy brisk walking most… then do that! Have you been wanting to give yoga a try? Then start there! 

Exercise will hopefully become a part of your life for years to come, so you have plenty of time to explore new methods.

And remember, consistency is what leads to results, so never feel pressured into a form of exercise intervention that feels like a chore or you won’t stick to it. Mix and match so you don’t get bored and do what you LOVE.

Connect with a coach

It’s easy to feel overwhelmed with the amount of information out there these days… 

… and going to the gym with no plan (or even the wrong plan), can leave you feeling lost or frustrated, especially if you don’t get the results you want. 

We’re big fans of having a coach. Even though Dr. Haas holds advanced certifications as a strength coach, he always works with a  coach to develop and guide his own workout plans. 

Make sure to connect with a few coaches before settling into a routine. 

Just because someone is a fitness expert does not mean that you will connect with them. More importantly, you should work with someone you trust and who is willing to customize your program for the unique needs of someone with PCOS. 

Start where you are

Don’t be ashamed, embarrassed, or discouraged by your current fitness level… 

Where you are today will not be your final destination.  

And even if you’ve been exercising for some time, do what you can at the moment. You will continue to improve and advance your exercise ability over time. 

Remember, it’s always better to start small… and if you feel like doing more, let it be because you enjoy your workout, not because of any preconceived expectations or external pressures.

What Type of Exercise is Best for PCOS?

Now is a good time to dispel a common myth about physical exercise and PCOS… 

No one type of exercise is going to cure, cause, or worsen your PCOS symptoms. 

That means lifting weights and doing squats won’t automatically drive up your testosterone levels and flare your hyperandrogenic symptoms… 

Similarly, sticking to cardio or high-intensity interval training (HIIT) won’t cause you to gain weight and store body fat.

As with most things, there’s not a one size fits all approach here. Our goal in this section is to present the evidence so you can modify your exercise plan to suit your individual circumstances.

So, let’s dive in…

A meta-analysis of 10 randomized control trials including 533 women with PCOS concluded that aerobic exercise alone was effective in reducing body mass index (BMI). It’s also interesting to note that neither aerobic exercise nor aerobic exercise combined with resistance training appeared to have a dramatic effect on testosterone levels (8). 

Although this same study didn’t assess quality of life measures, other small studies have shown that aerobic training for as little as 150 minutes per week (30 minutes, 5 days per week) not only improves cardiometabolic outcomes but also improves mental health-related quality of life (9). 

And as an added benefit, aerobic exercise has also been shown to improve insulin sensitivity and PCOS morphology (10).

Now if aerobic activity isn’t your thing, then you can consider taking up resistance training.

Progressive resistance training alone for 1 hr per day, 3 times per week for 4 months in women with PCOS (11) has been shown to increase lean muscle mass, while:

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    Decreasing androgen levels

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    Decreasing fasting glucose levels

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    Decreasing waist circumference

So please don’t be afraid of lifting weights!

Unfortunately for our fellow yogis, the data on yoga or other forms of flexibility training in women with PCOS is sparse. With that being said, yoga is an excellent complement to any lifestyle modification and is another great way to help improve your overall quality of life.

As you can see a variety of different types of exercise have shown clinical benefits in PCOS so there’s no one right way to go about it.

How Much Exercise is Enough?

The question of how much exercise is enough is definitely an important one. 

Not only do you want to make sure that you’re not wasting your time, but you want to make sure that you’re not overdoing it too! 

The ‘right’ amount of training will vary according to your unique needs and circumstances, but there are some general recommendations that apply well to most women with PCOS. 

According to the Department of Health and Human Services (DHHS) (12), to achieve substantial health benefits from exercise: 

“Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity.”

So that could look like: 30 – 60 minutes of moderate exercise 5 days per week OR 15 – 30 minutes of vigorous activity 5 days per week.

These recommendations are actually in line with the findings in a meta-analysis of 19 studies that indicated 120 min of vigorous activity per week was needed to provide favorable health outcomes for women with PCOS (13). 

And in case you are wondering, vigorous physical activity is defined as “activities that take hard physical effort and make you breathe much harder than normal,” which include things like heavy lifting, aerobics, and fast cycling.

One recent study in Fertility & Sterility has suggested that vigorous exercise may be associated with improved metabolic profiles in women with PCOS independent of total exercise output (14). 

In fact, when compared to those who were inactive or those who engaged in moderate physical activity only, those who engaged in vigorous exercise had a lower BMI, improved insulin sensitivity and lipids. What’s even more exciting is that for every hour of vigorous exercise, a woman’s odds of metabolic syndrome were reduced by 22% (14).

Ultimately, we think the important message here is that you get enough cumulative exercise throughout the week without overdoing it. 

And that last point is important… 

Over-training can definitely undo the progress and benefits you’ve worked so hard to achieve.

Woman with PCOS exhausted from exercise

This is a good place to briefly talk about cortisol as we see this topic come up a lot. Too often we see claims that long bouts of aerobic exercise drives up cortisol levels and results in weight gain and increased body fat.

Cortisol is a stress hormone that does many things in your body, including raising blood sugar in the short term and storing fat in the long term. Obviously, if your body is already struggling with insulin resistance, additional increases in blood sugar or body fat are not good for your PCOS. 

But here’s the thing… 

Cortisol production is elicited at exercise intensities between 80% – 90% of your VO2 max, which doesn’t describe your typical bout of cardio (15). This is also an acute response, meaning if you’re not exercising to the point of near exhaustion on a regular basis, then cortisol levels should not become persistently elevated. 

With that said, if you start doing two workouts a day or spend 2 hours grinding it out on the elliptical machine every day, then cortisol levels can become chronically elevated… and under these conditions, exercise can contribute to fat storage. 

So just remember, chronic cortisol production is less about the type of exercise and more about the amount and intensity. 

Bottom line… more isn’t always better, regardless of the type of exercise you choose – so don’t overdo it! And as with most things in life, balance is key.

Keep Your Goals in Mind (Not Just Your Weight)

Before you jump feet first into your exercise plan, we always suggest you stop and set some goals. 

Yes, we know… 

Goal-setting, snooze. But…

It’s so easy to lose motivation if you don’t know what you’re working toward, especially on those days that you just don’t have the motivation or you’re completely stressed out. 

So take the time to get clear about your PCOS goals!

Every woman has different goals, which is exactly the way it should be. 

Improved menstrual regularity? 

Weight loss? 

Better blood sugar? 

Stress relief? 

Healthy pregnancy?

And just one more thing about goal-setting… As women, we must look beyond the unrealistic expectations marketed to us about the effects of exercise. We must remember that each of us is unique and that we are each beautiful in our own way. 

That means remembering most of us are not genetically programmed to get 6-pack abs in 6-weeks, no matter what the flashy magazine covers promise. 

Your exercise plan is about so much more than appearances… It’s about improving quality of life, enhancing fertility, and decreasing cardiometabolic risk... and not just for the next 3 months or until we get pregnant, but for the rest of your life.

Final Thoughts

So where does all this talk about exercise leave us? 

For the average woman trying to manage PCOS, here are some basic guidelines:

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    Choose the form of exercise that best suits you

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    Try to mix and match different types of exercise (i.e., strength, flexibility, and cardio)

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    Shoot for 120-150 minutes of vigorous exercise per week

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    Don’t overtrain your body, regardless of the form of exercise

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    Set your goals and don’t judge your progress or self-worth by the numbers

Most importantly, forget what you saw that other person doing on social media, avoid the comparison trap, and do what feels right for YOU!

Remember, the food you eat is one of the most important factors that you can control along your reproductive journey.
With Love & Empowerment,
Dr. Ashley Eskew & Dr. Will Haas

References:

  1. Nybacka A, Carlstrom K, Stahle A, Nyren S, Hellstrom PM, Hirschberg AL. Randomized comparison of the influence of dietary management and/or physical exercise on ovarian function and metabolic parameters in overweight women with polycystic ovary syndrome. Fertil Steril. 2011;96(6):1508-13.

  2. Riley JK, Jungheim ES. Is there a role for diet in ameliorating the reproductive sequelae associated with chronic low-grade inflammation in polycystic ovary syndrome and obesity? Fertil Steril. 2016;106(3):520-7.

  3. Giallauria F, Palomba S, Maresca L, et al. Exercise training improve autonomic functions and inflammatory pattern in women with polycystic ovary syndrome (PCOS). Clin Endocrinol (Oxf).2008;69:792-8.

  4. Dadona P, Aljada A, Bandyopadhyay A. Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol. 2004;25:4-7.

  5. https://www.cdc.gov/heartdisease/women.html.

  6. 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(3):364-79.

  7. Cooney LG, Lee I, Sammel MD, Dokras A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod. 2017;32:1075-1091.

  8. Dos Santos IK, Ashe MC, Cobucci RN et al. The effect of exercise as an intervention for women with polycystic ovary syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2020;99:e19644.

  9. Costa EC, DE Sa JCF, Stepto NK. Aerobic training improves quality of life in women with polycystic ovary syndrome. 2018;50(7):1357-1366.

  10. Redman LM, Elkind-Hirsch K, Ravussin E. Aerobic exercise in women with polycystic ovary syndrome improves ovarian morphology independent of changes in body composition. Fertil Steril.  2011;95:2696-2699.

  11. Kogure GS, Mirando-Furtado CL, Silva RC et al. Resistance exercise impacts lean muscle mass in women with polycystic ovary syndrome. Med Sci Sports Exerc. 2016;48:589-98.

  12. https://health.gov/our-work/nutrition-physical-activity/presidents-council

  13. Patten RK, Boyle RA, Moholdt T et al. Exercise interventions in polycystic ovary syndrome: a systematic review and meta-analysis. Front Physiol. 2020;11:606.

  14. Greenwood EA, Noel MW, Kao CN. et al. Vigorous exercise is associated with superior metabolic profiles in polycystic ovary syndrome independent of total exercise expenditure. Fertil Steril. 2016;105:486-93.

  15. Hill EE, Zack E, Battaglini C, et al. Exercise and circulating cortisol levels: the intensity threshold effect. J Endocrinol Invest. 2008;31:587-91.

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