The certainty of the evidence is downgraded by study quality (lack or unclear allocation concealment and blinding).
Lifestyle modification with physical activity and weight loss is recommended for overweight women with polycystic ovary syndrome.
The recommendation attaches a relatively high value on the many beneficial effects of exercise on other outcomes in addition to menstrual regularity and pregnancy rates, and the lack of significant adverse effects.
A meta-analysis 1 included 13 studies. There was no significant difference in the improvements in the menstrual cycles between lifestyle modification (LSM) and metformin alone (weighted mean difference [MD] = 1.62; 4 trials, n=261) and between LSM + metformin and LSM (MD = 1.20; 4 trials, n=230). The pregnancy rates and body mass indices were not significantly different between LSM and metformin alone (MD = 1.44; 2 trials, n=211 and -0.11, 4 trials, n=71, respectively). LSM reduced insulin resistance (MD = -0.52) and increased serum levels of sex hormone-binding globulins (MD = 8.27) compared with metformin.
Another meta-analysis 2 included 18 studies (4 RCTs, 11 randomized comparison trials, 2 non-randomized comparison trials, and 1 single-arm clinical trial). Compared to control group, physical activity showed higher pregnancy rate (RR 2.10, 95% CI 1.32 to 3.35; 3 trials); and live birth rate (RR 2.11, 95% CI 1.02 to 4.39; 2 studies). Pooled analysis showed higher pregnancy rates (RR 1.59, 95% CI 1.06 to 2.38; 5 studies) and live birth rates (RR 2.45, 95% CI 1.24 to 4.83; 2 observations) in the physical activity groups than in the pharmaceutical or dietary treatment groups. Analysis of other outcomes, such as ovulation rates, menstrual regularity, and conception rates, showed no differences between the intervention and comparison groups.
A randomized trial 3 included 68 overweight women with PCOS. At 4 months, the weight loss was significant in the intervention group (-2.1%, P = 0.002) and nonsignificant in the control group (-1.0%). A higher proportion of patients in the intervention group improved menstrual regularity compared to the control group (MD 35%, 95% CI 16 to 60). Logistic regression analysis showed that intervention was the only predictor of improved menstrual function, OR 3.9 (95% CI 1.3 to 11.9). At 12 months, a total of 54% of the women improved menstrual regularity compared to baseline (P = 0.000) and 43% (P = 0.000) had confirmed ovulation. 38% of the women wishing to become pregnant succeeded within 1 year of study completion.
Date of latest search: 2021-11-15
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