The Best Types of Exercise for Patients with PCOS (Now PMOS): Strength Training, HIIT, and More

Does Exercise Help With Weight Loss in PMOS (PCOS)?

Why Exercise Won't Make Your Patients Thin 

Exercise is important to general health as well as for managing PMOS (a syndrome that, until recently, was known as PCOS). And while its role is often overblown with regards to weight loss, exercise still plays an important role in the health of these patients. This article highlights what exercise can and cannot do for your PMOS patients and what are the best types of exercise based on the latest research.

The relationship between exercise and weight loss is far more complicated than "calories in, calories out." A large-scale analysis of over 1,750 adults found that energy compensation by a typical person averages approximately 28%, meaning only about 72% of the extra calories burned from additional activity translates into actual extra calories burned that day.[13] Moreover, the degree of energy compensation varied considerably between people of different body compositions, with individuals who compensate more being more likely to accumulate body fat.[13]

There are a few different reasons for this. First, we assume that metabolic rate remains stable while losing weight, but this is not the case. Both increases and decreases in caloric intake cause the metabolism to shift, negating much of the weight loss benefit of exercise.

Second, exercise-induced increases in appetite are real. A randomized controlled trial (the E-Mechanic trial) of 198 adults with overweight or obesity found that after 24 weeks of supervised exercise, significant weight compensation occurred in both exercise groups, driven primarily by increased energy intake — approximately 91–124 extra kcal/day compared to controls.[14] Participants with higher compensation reported increased appetite ratings and increased cravings for sweet foods.[14]

Third, compensatory reductions in non-exercise physical activity (NEAT) can undermine exercise efforts. Research shows that exercise training can instigate compensatory reductions in energy expenditure through decreases in NEAT, increases in sedentary behavior, or alterations in sleep.[12] In other words, if you go on a hard run, you're less likely to want to do chores around the house afterward, and vice versa.

The point here isn't to discourage your PMOS patients from exercising; it is to give them realistic expectations so they don't become quickly discouraged when the pounds don't melt off, or more importantly, so they can focus on more effective strategies for weight loss, which center chiefly around an insulin-reducing diet.

What Are the Benefits of Exercise for PMOS (PCOS)?

Exercise will help with just about everything else

While exercise is unlikely to produce substantial weight loss on its own, the 2023 International Evidence-Based Guideline for PCOS explicitly states that "there are benefits to a healthy lifestyle even in the absence of weight loss".[7] The beneficial effects of physical activity on insulin sensitivity stem from the activity itself and the avoidance of sedentariness, rather than necessarily resulting from any attendant weight loss.[1] Exercise helps PMOS in several important ways: 

Lowers blood sugar and fasting insulin

A systematic review and meta-analysis of exercise interventions in PCOS found small but meaningful reductions in HOMA-IR (a measure of insulin resistance) of -36.2% with vigorous-intensity exercise. A separate meta-analysis of HIIT trials in PCOS confirmed a significant decrease in HOMA-IR (MD -0.57; 95% CI, -0.98 to -0.16, p = 0.01).[3][5] 

Increases insulin sensitivity

Physical exercise improves insulin sensitivity regardless of PCOS status or degree of insulin resistance. A randomized clinical trial found that HIIT increased the insulin sensitivity index significantly compared to both baseline and moderate-intensity continuous training.[1] [6]

Builds muscle and improves body composition

Both strength training and HIIT significantly decreased fat percentage in women with PCOS, even without changes in body weight.[2] 

Strengthens the heart and improves cardiovascular fitness

A meta-analysis of 33 studies found a moderate increase in VO₂max (24.2%) as a result of vigorous-intensity exercise in women with PCOS.[3] 

Increases HDL cholesterol

HIIT increased HDL cholesterol by 0.2 mmol/L in women with PCOS. More broadly, meta-analyses indicate that exercise training increases HDL cholesterol by 2 to 5 mg/dL.[2][5]

Lowers blood pressure

According to the American Heart Association, aerobic training reduces systolic blood pressure by an average of 4 mm Hg and diastolic blood pressure by 3 mm Hg, with even greater reductions in hypertensive patients (5–9 mm Hg systolic).[9] 

Reverses arterial damage

Endothelial function, measured as flow-mediated dilatation of the brachial artery, increased significantly after HIIT in women with PCOS. Exercise also improves endothelial function, reduces arterial stiffness, and has anti-ischemic effects.[2][5] 

Improves reproductive function

Aerobic exercise can improve reproductive function in women with PCOS, including normalized menstrual cyclicity and ovulation. HIIT participants were 7.8 times more likely to report improved menstrual cyclicity than those in a moderate-intensity group.[1][6]

What is the Best Exercise for PMOS (PCOS)?

Some of the best exercises for PMOS include strength training, HIIT (High-Intensity Interval Training), and vigorous-intensity aerobic exercise. These tend to yield the best results in terms of the health benefits listed above — especially when compared to lower-intensity, steady-state cardio.[3][5] 

How Strength Training Benefits Patients with PMOS (PCOS)

Strength training, also known as resistance training, includes a variety of strength-building exercises ranging from free weights like kettlebells or dumbbells, to calisthenics, plyometrics, and sprinting. All of these activities build strength because they are explosive and anaerobic.

This kind of exercise is great for building muscle mass and strength, which has a two-fold benefit for PMOS: it both improves body composition and enhances insulin sensitivity. In the Almenning et al. pilot study, strength training significantly reduced fat percentage and also significantly reduced anti-Müllerian hormone (AMH) by -14.8 pmol/L — a marker often elevated in PCOS — suggesting a favorable hormonal effect.[2]

Resistance training, particularly when done at a high intensity such as sprinting, induces the EPOC (Excess Post-Exercise Oxygen Consumption) effect. A systematic review found that energy expenditure from EPOC is greater following high-intensity interval exercise (average ~136 kJ short-duration, ~289 kJ long-duration) compared with moderate-intensity continuous exercise (average ~101 kJ and ~159 kJ, respectively).[15] Because an oxygen debt is created during anaerobic activity, the body takes in more oxygen for a period after activity, increasing caloric burn beyond the workout itself.[15]

Anaerobic exercise causes the body to burn more sugar than fat (fat is preferentially burned at lower intensities), which aids in glycemic control and insulin sensitivity. Unlike other cells in the body that require insulin for glucose transport, muscle cells can take up glucose without elevation in insulin levels when they contract during exercise. This occurs through insulin-independent translocation of GLUT4 glucose transporters, using distinct calcium signaling pathways from those used by insulin.[1][8] This is why exercise can improve glucose homeostasis even in insulin-resistant individuals.[1]

The more glycogen stored inside muscles — which increases following intense activity that depletes the muscles of their stored glycogen — the less glucose is left to linger in the blood or convert into liver fat, where it induces insulin resistance. With frequent activity, the muscle cells become more adept at drawing in fuels, and exercise-induced peripheral vascular adaptations such as increased arteriole and capillary density allow for increased blood flow that enhances glucose transport and uptake in skeletal muscle.[5] 

Is HIIT Good for PMOS (PCOS)?

High-Intensity Interval Training (HIIT) involves cycling intervals of lower-intensity activity with intervals of very high-intensity activity — such as five minutes of light jogging followed by 30 seconds to 2 minutes of sprinting, then repeating for 4–6 cycles, or five minutes of leisure cycling (10–15 mph) followed by 1 minute of pedaling all out (17–25 mph).

HIIT combines aerobic with anaerobic/strength exercise, reaping the best of both worlds. Because these workouts are tough, they are usually short — ranging from 15 to 30 minutes — but effective. The training intensity is typically performed between 90% and 95% of maximum heart rate, three times a week.[1]

The evidence for HIIT in PCOS is compelling: 

• A PLoS ONE pilot study found that after ten weeks, women who did HIIT experienced a 17% improvement in insulin resistance (HOMA-IR), while strength training alone did not significantly change HOMA-IR.[2] 
• A randomized clinical trial published in Human Reproduction found that HIIT offered greater improvements in aerobic capacity, insulin sensitivity, and menstrual cyclicity, and larger reductions in hyperandrogenism compared to moderate-intensity continuous training (MICT). HIIT participants were 7.8 times more likely to report improved menstrual cyclicity.[6] 
• A 2021 meta-analysis of seven randomized controlled trials (n = 423) confirmed that HIIT alone is effective for reducing HOMA-IR and BMI in women with PCOS.[5] 
• A 2026 study found that 12 weeks of HIIT reduced fasting glucose levels and improved whole-body insulin sensitivity in women with PCOS, with gene ontology analysis revealing a reduction in oxidative stress and low-grade chronic inflammation.[4] 
• A meta-analysis of 33 studies concluded that improvements in health outcomes in PCOS are more dependent on exercise intensity rather than dose, and that a minimum of 120 minutes of vigorous-intensity exercise per week is needed to provide favorable health outcomes.[3] 

One word of caution: Ensure your patient has a solid foundation in fitness before recommending this kind of intense workout and counsel them to always warm up and stretch beforehand to prevent serious injuries like muscle strains or tears. It is also worth noting that exercise for more than 60 minutes per day in women with PCOS can actually increase the risk of anovulation, whereas 30–60 minutes per day reduces the risk of anovulatory infertility.[1] 

Recommendations for PCOS (PMOS) Patient Exercise

Consistency is more important than doing a crazy workout that's unsustainable, so counsel your patients to start slow, with gradual increases over time. The 2023 International Evidence-Based Guideline for PCOS recommends advising "sustainable physical activity based on individual preferences and goals".[7] Remind them that any movement is better than none.

Even getting up to stretch for a few minutes every hour while working can improve health and lower the risk for chronic diseases. Sedentary behavior is independently associated with increased risks of metabolic syndrome, cardiovascular disease, type 2 diabetes, and all-cause mortality — even after adjusting for physical activity levels.[10] A dose-response meta-analysis found that sitting for more than 6–8 hours per day significantly increases the risk of all-cause and cardiovascular mortality.[17] However, replacing just 30 minutes of sitting with walking reduced all-cause mortality risk by 3.5%, and the protective effects became more pronounced as exercise intensity increased.[16]

For maximal benefit, encourage patients to exercise in their target heart rate zone, meaning at a moderate to vigorous intensity. Current guidelines from the U.S. Department of Health and Human Services and the WHO recommend at least 150 to 300 minutes per week of moderate-intensity aerobic activity, or 75 to 150 minutes per week of vigorous-intensity aerobic activity, plus muscle-strengthening activities on 2 or more days per week.[18] For modest weight loss and prevention of weight regain, the PCOS-specific guidelines recommend a minimum of 250 minutes per week of moderate-intensity or 150 minutes per week of vigorous-intensity activity.[7]

This ensures patients are creating enough stress on the heart, lungs, and muscles for them to adapt and become stronger, producing the health benefits previously mentioned. You should also encourage your patients to try using a continuous glucose monitor (CGM) to see the impact that exercise has on their blood sugar levels both during and after exercise.

For more on exercise and other helpful tools for managing PCOS like helpful biometrics and labs, as well as intriguing, real-life case studies, be sure to take our Navigating Hormone Complexities course, course two in the Optimal Medicine Training Series.

1. Obesity and polycystic ovary syndrome. Barber TM, Franks S. Clinical Endocrinology. 2021;95(4):531-541. doi:10.1111/cen.14421.
2. Effects of High Intensity Interval Training and Strength Training on Metabolic, Cardiovascular and Hormonal Outcomes in Women With Polycystic Ovary Syndrome: A Pilot Study. Almenning I, Rieber-Mohn A, Lundgren KM, et al. PloS One. 2015;10(9):e0138793. doi:10.1371/journal.pone.0138793.
3. Exercise Interventions in Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Patten RK, Boyle RA, Moholdt T, et al. Frontiers in Physiology. 2020;11:606. doi:10.3389/fphys.2020.00606.
4. Dissociation Between Metabolic Improvements and Mitochondrial Transcriptional Changes Following Exercise Training in Women With Polycystic Ovary Syndrome. Moreno-Asso A, Altıntaş A, Voisin S, et al. American Journal of Physiology. Endocrinology and Metabolism. 2026;330(5):E747-E757. doi:10.1152/ajpendo.00211.2024.
5. Effect of High-Intensity Interval Training on Metabolic Parameters in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Santos IKD, Nunes FASS, Queiros VS, et al. PloS One. 2021;16(1):e0245023. doi:10.1371/journal.pone.0245023.
6. 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. Patten RK, McIlvenna LC, Levinger I, et al. Human Reproduction (Oxford, England). 2022;37(5):1018-1029. doi:10.1093/humrep/deac047.
7. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Teede HJ, Tay CT, Laven JJE, et al. The Journal of Clinical Endocrinology and Metabolism. 2023;108(10):2447-2469. doi:10.1210/clinem/dgad463.
8. Polycystic Ovary Syndrome. Joham AE, Norman RJ, Stener-Victorin E, et al. The Lancet. Diabetes & Endocrinology. 2022;10(9):668-680. doi:10.1016/S2213-8587(22)00163-2.
9. Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association. Paluch AE, Boyer WR, Franklin BA, et al. Circulation. 2024;149(3):e217-e231. doi:10.1161/CIR.0000000000001189.
10. From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management. Pani A, Gironi I, Di Vieste G, et al. International Journal of Endocrinology. 2020;2020:6276187. doi:10.1155/2020/6276187.
11. Recommendations From the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome†. Teede HJ, Tay CT, Laven J, et al. Human Reproduction (Oxford, England). 2023;38(9):1655-1679. doi:10.1093/humrep/dead156.
12. Altered Motivation States for Physical Activity and 'Appetite' for Movement as Compensatory Mechanisms Limiting the Efficacy of Exercise Training for Weight Loss. Flack KD, Stults-Kolehmainen MA, Creasy SA, et al. Frontiers in Psychology. 2023;14:1098394. doi:10.3389/fpsyg.2023.1098394.
13. Energy compensation and adiposity in humans. Careau V, et al. Current Biology. 2021.
14. Effect of different doses of supervised exercise on food intake, metabolism, and non-exercise physical activity: The E-MECHANIC randomized controlled trial. Martin CK, et al. American Journal of Clinical Nutrition. 2019;110(3):583–592.
15. Magnitude and duration of excess of post-exercise oxygen consumption between high-intensity interval and moderate-intensity continuous exercise: A systematic review. Panissa VLG, et al. Obesity Reviews. 2021;22:e13099.
16. Replacement of sedentary behavior with various physical activities and the risk of all-cause and cause-specific mortality. Chang Q, Zhu Y, Liu Z, et al. BMC Medicine. 2024;22(1):385. doi:10.1186/s12916-024-03599-2.
17. Sedentary Behaviour and Risk of All-Cause, Cardiovascular and Cancer Mortality, and Incident Type 2 Diabetes: A Systematic Review and Dose Response Meta-Analysis. Patterson R, McNamara E, Tainio M, et al. European Journal of Epidemiology. 2018;33(9):811-829. doi:10.1007/s10654-018-0380-1.
18. Physical Activity Guidelines for Americans, 2nd Edition. U.S. Department of Health and Human Services. Washington, DC: U.S. Department of Health and Human Services; 2018.