PCOS & EXERCISE Bob Tygenhof, MA, CPT Director, Center for Active Lifestyle Medicine Integrative Medical Group of Irvine

Speaker Disclosure None

Learning Objectives Current exercise recommendations for PCOS patients Latest research impacting these recommendations How to incorporate exercise into a PCOS treatment plan How to write an exercise prescription

Benefits Of Exercise Long-term benefits Short-term benefits - you feel better NOW! Premature MortalityMetabolic Syndrome CVD/CADObesity HypertensionColon Cancer StrokeBreast Cancer OsteoporosisDepression Type 2 DMCognitive Function

PCOS Exercise Recommendations “Hence, lifestyle management is useful for targeting weight loss and prevention of weight gain, and is first-line treatment for a large proportion of women with PCOS. Lifestyle management may also improve PCOS independent of weight loss, with exercise intervention improving metabolic risk factors associated with PCOS, including hypertension, IR and elevated blood glucose levels, even when no weight loss occurs.”

PCOS Exercise Recommendations “However, it is difficult to be certain about the effectiveness of lifestyle interventions in women with PCOS, because available information is based on small uncontrolled trials that address different outcomes in different subgroups of women, and specific recommendations remain unclear.”

Section 5. Lifestyle Management In PCOS 5.1a Lifestyle management (single or combined approaches of diet, exercise and/or behavioral interventions) for weight loss, prevention of weight gain, or for general health benefits should be recommended in women with polycystic ovary syndrome. — level B 5.2a Lifestyle management targeting weight loss (in women with a body mass index ≥25kg/m2 [overweight]) and prevention of weight gain (in women with a body mass index < 25 kg/m2 [lean]) should include both reduced dietary energy (caloric) intake and exercise and should be first-line therapy for all women with polycystic ovary syndrome. — level C 5.5a Exercise participation of at least 150 minutes per week should be recommended to all women with polycystic ovary syndrome, especially those with a body mass index ≥25 kg/m2 (overweight), given the metabolic risks of polycystic ovary syndrome and the long-term metabolic benefits of exercise. Of this, 90 minutes per week should be aerobic activity at moderate to high intensity (60%–90% of maximum heart rate) to optimize clinical outcomes. — level D Treatment Focus: Reduce insulin resistance Improve metabolic features Improve reproductive function Improve body image and mood

Research Findings Since 2011 Improved body composition Restored insulin sensitivity Enhanced adipose tissue lipolysis Improved depression

Improved Body Composition 24 women with PCOS – 12 in aerobic exercise group, 12 in control group Intervention: 12 weeks of moderate level (60 to 70% of maximum heart rate) aerobic exercise for 60 min., 3 times/week Results: significant improvements in body composition measures - BMI, WHR, body fat percentage, body fat mass

Restored Insulin Sensitivity Control and PCOS rats were treated with vehicle or resveratrol, while another group of PCOS rats were allowed to exercise freely for 5 weeks “We have shown that 5-6 weeks of resveratrol treatment did not improve insulin sensitivity in DHT-induced PCOS rats, but exercise restored insulin sensitivity to a similar level as in control rats.” “Physical exercise also had beneficial effects on fat mass, adipocyte size, and estrus cyclicity.”

Enhanced Adipose Tissue Lipolysis 8 women with PCOS and 8 normal- cycle women matched for BMI, age, and percent body fat Intervention: 16-week progressive moderate intensity (55% VO2max) aerobic exercise-training program “Alterations were seen in the gene expression in the adipose tissue following exercise” “Lipase expression is increased following exercise training with no decreases in circulating concentrations of total testosterone or free androgen index, perhaps indicating that aerobic exercise can increase adipose tissue lipolysis despite altering testosterone expression.”

Improved Depression 153 women with PCOS and 64 women without PCOS aged years Completed a questionnaire including the Hospital Anxiety and Depression Scale and a survey regarding levels of physical activity, physical activity barriers, motivators and supports “Physical activity is associated with lower depression in women with PCOS”

Incorporating Exercise Into The PCOS Treatment Plan 3 Major Barriers 1.Too many options 2.Adding a behavior, not replacing one 3.Exercise is punishment, right?

Too Many “Good” Options A lifestyle program may include diet and nutrition, supplementation, exercise, stress management, sleep management, eating disorders, addictive behaviors, acupuncture, counselling, massage therapy, skincare aesthetics, meditation, on and on. All take time and money Exercise must be prioritized near the top of the list

Adding, Not Replacing Many of the elements in a lifestyle program – diet and nutrition, supplementation, stress management, sleep management, eating disorders, addictive behaviors, skincare aesthetics – involve activities that are already being done. Changing, not expanding, behaviors. Exercise replaces something – this must be openly addressed

Exercise As Punishment Long-term adherence is based on enjoyment Patient should never be sore or in pain But she should be challenged A challenge is engaging and rewarding; it increases enjoyment Start low and go slow

Writing the Exercise Prescription FITT-VP Frequency Intensity Type Time Volume Progression

Writing The Exercise Prescription FITT-VP Frequency Intensity Type: aerobic exercise Time Volume Progression

Writing The Exercise Prescription FITT-VP Frequency: 5 days a week Intensity Type: aerobic exercise Time Volume Progression

Writing The Exercise Prescription FITT-VP Frequency: 5 days a week Intensity Type: aerobic exercise Time: 30 minutes/day Volume Progression

Writing The Exercise Prescription FITT-VP Frequency: 5 days a week Intensity: moderate Type: aerobic exercise Time: 30 minutes/day Volume Progression

Writing The Exercise Prescription FITT-VP Frequency: 5 days a week Intensity: moderate Type: aerobic exercise Time: 30 minutes/day Volume: F x I x T = 150 minutes/week, moderate intensity Progression

Writing The Exercise Prescription FITT-VP Frequency: 5 days a week Intensity: moderate Type: aerobic exercise Time: 30 minutes/day Volume: F x I x T = 150 minutes/week, moderate intensity Progression: start low, go slow

Thank You! Bob Tygenhof, MA, CPT (949)