Lifestyle Modification Programs in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis
Abstract
Context: Polycystic ovary syndrome (PCOS) is a prevalent disorder that affects women of childbearing age and may be related to obesity and insulin resistance. Objective: The purpose of this systematic review was to appraise the evidence of the impact of lifestyle modification (LSM) interventions on outcomes of women with PCOS. Data Sources: Sources included Ovid Medline, OVID Embase, OVID Cochrane Library, Web of Science, Scopus, PsycINFO, and CINAHL (up to January 2011). Study Selection: We included randomized controlled trials that enrolled woman of any age with PCOS who received LSM and compared them against women who received no intervention, minimal intervention, or metformin. Data Extraction: Two authors performed the data extraction independently. Data Synthesis: We included 9 trials enrolling 583 women with a high loss to follow-up rate, lack of blinding, and short follow-up. Compared with minimal intervention, LSM significantly reduced fasting blood glucose (weighted mean difference, −2.3 mg/dL; 95% confidence interval, −4.5 to −0.1, I2 = 72%, P = .04) and fasting blood insulin (weighted mean difference, −2.1 μU/mL, 95% confidence interval, −3.3 to −1.0, I2 = 0%, P < .001). Changes in body mass index were associated with changes in fasting blood glucose (P < .001). Metformin was not significantly better than LSM in improving blood glucose or insulin levels. We found no significant effect of LSM on pregnancy rate, and the effect on hirsutism was unclear. Conclusions: The available evidence suggests that LSM reduces fasting blood glucose and insulin levels in women with PCOS. Metformin has similar effects. Translation of these short-term effects to patient-important outcomes, beyond diabetes prevention, remains uncertain.
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The more recent previous systematic review reported a small but statistically significant effect on fasting insulin change (MD −2.1 μIU/mL, 95% CI −3.3 to −1.0; 5 trials, I2 = 0%).
“The more recent of these reviews [125] reported a small, but statistically significant effect on FI change (MD − 2.1 μIU/mL, 95% CI − 3.3 to − 1.0; 5 trials, I2 = 0%).”
From Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis (2019) · cites this paper as [125]
The findings on surrogate markers of IR agree with two previous systematic reviews that compared lifestyle interventions to control without distinguishing exercise, diet or their combination.
“These findings agree with those of two previous systematic reviews, which however, did not make the distinction between exercise, diet or their combination, but instead compared lifestyle interventions to control [125, 126].”
From Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis (2019) · cites this paper as [125]
This review located and meta-analysed data from more trials, made a greater number of comparisons, and included a wider range of outcomes than previous systematic reviews.
“We located and meta-analysed data from more trials, made a greater number of comparisons, and included a wider range of outcomes when compared to previous systematic reviews [25, 125, 126, 148].”
From Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis (2019) · cites this paper as [125]
Two systematic reviews of lifestyle interventions in women with PCOS show improvements in weight, hyperandrogenism, and insulin resistance.
“Two systematic reviews of lifestyle interventions in women with PCOS show improvements in weight, hyperandrogenism, and IR [162, 163].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [163]
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- Authors
- Domecq, J. P., Prutsky, G., Mullan, R. J., Hazem, A., Sundaresh, V., Elamin, M. B., Phung, O. J., Wang, A., Hoeger, K., Pasquali, R., Erwin, P., Bodde, A., Montori, V. M., & Murad, M. H.
- Affiliations
- Henry Ford Hospital (US)
- Wayne State University (US)
- University of Minnesota (US)
- University of North Dakota (US)
- Louisiana State University Health Sciences Center Shreveport (US)
- Texas Tech University (US)
- Western University of Health Sciences (US)
- Mayo Clinic (US)
- University of Rochester Medicine (US)
- IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
- Knowledge and Evaluation Research Unit (J.P.D., G.P., R.J.M., A.W., P.E., A.B., V.M.M., M.H.M.), Rochester, Minnesota 55905
- Corresponding author
- Murad, M. Hassan
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2013-12-01
- Volume
- 98
- Issue
- 12
- Pages
- 4655-4663
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2153353583
- Cited by
- 184
- References
- 59
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 9 · 2023: 13 · 2022: 12 · 2021: 14 · 2020: 19 · 2019: 22 · 2018: 13 · 2017: 18 · 2016: 11 · 2015: 23 · 2014: 12 · 2013: 1
- FWCI
- 2.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Keywords
- polycystic ovary syndrome, lifestyle modification, metformin, fasting blood glucose, insulin levels, body mass index, obesity, insulin resistance, hirsutism, pregnancy rate, diabetes prevention
- MeSH terms
- Combined Modality Therapy, Diet, Reducing, Female, Humans, Hyperglycemia, Hyperinsulinism, Life Style, Patient Compliance, Polycystic Ovary Syndrome, Pregnancy, Exercise, Randomized Controlled Trials as Topic, Pregnancy Rate, Evidence-Based Medicine, Overweight, Lost to Follow-Up
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