The Best Types of Exercise for Patients with PCOS

by Krista Russ

Exercise is important to general health as well as for managing 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 PCOS patients and what are the best types of exercise for patients with PCOS based on the latest research.  

Why Exercise Won’t Make Your Patients Thin

Dr. Jason Fung states in his book The Obesity Code, “Exercise is like brushing your teeth. It is good for you and should be done every day. Just don’t expect to lose [much] weight [1].”  

And he’s right. With regards to weight loss, a therapeutic tool often recommended for PCOS, the results are modest at best. In most well-controlled studies on exercise, weight loss averages about 30 percent of the expected result [1]. For instance,  a controlled study on people found that exercising five days per week which amounted to burning an extra 600 calories a day, produced a weight loss of about ten pounds over ten months–far less than the thirty-five pounds expected [1].  

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 at all. Both increases and decreases in caloric intake cause the metabolism to shift dramatically–either decreasing by up to 40 percent with lower intakes or increasing by 50 percent with higher intake [1]. This negates much of the weight loss benefit of exercise.  

Second, everyone knows exercise is a great way to work up an appetite. Hyperphagia is real, and a hard run will definitely bring it on. Third, several studies show that people tend to decrease their other activities after exercise–and it goes both ways. So if you’re on your feet all day, you’re less likely to go on that run after work, and if you go on a run, you’re less likely to want to do chores around the house, etc.  

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

Exercise Will Help just About Everything Else

While it’s unlikely to produce substantial weight loss, exercise does help PCOS in several other ways like: 

• Lowering blood sugar and fasting insulin [2] 

• Increasing insulin sensitivity [2] 
• Building muscle, which increases the metabolic rate [3]  
• Strengthening the heart [3]  
• Increasing HDL Cholesterol [4]  
• Lowering blood pressure [4]  

• Reversing arterial damage [3]  
• Small but clinically significant decrease in body weight over time (probably on the order of 5-10 pounds) [1]  

Some of the best exercises for PCOS include strength training, HITT (High Intensity Interval Training, and vigorous-intensity aerobic exercise–the last to be discussed in a future article [5]. These tend to yield the best results in terms of the health benefits aforementioned, including weight loss–especially when compared to lower intensity, steady-state cardio.  

Strength Training For PCOS

Strength training, also known as resistance training, includes a variety of strength-building exercises ranging from free weights like kettlebells or dumbbells, 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 PCOS; it both increases the metabolic rate and improves insulin sensitivity. Resistance training, particularly when done at a high intensity such as sprinting, induces the EPOC (Excess Post Oxygen Consumption) effect [5]. Because an oxygen debt is created during anaerobic activity, the lungs take in more oxygen for several hours after activity, increasing caloric burn long after the workout [5]. 

Lastly, 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 transport, the muscle cells are unique in that they can soak up glucose without elevation in insulin levels when they contract during exercise, acting as a sort of reservoir for glucose storage [6]. And the more glycogen stored inside muscles–which increases following intense activity that depletes the muscles of their stored glycogen–the less of it is left to linger in the blood, or convert into toxic liver fat, where it induces insulin resistance. With frequent activity, the muscle cells not only become more adept at drawing in fuels, but the mitochondria within them multiply and use more fuels at rest, increasing the metabolic rate further [7].  

What is HITT?

High Intensity Interval Training also known as HITT 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-2 minutes of sprinting and 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).   

HITT combines aerobic with anaerobic/strength exercise, reaping the best of both worlds. Because these workouts are tough, they are usually short, ranging from 15-30 minutes, but effective. For example, a PLoS one study found that after ten weeks, women who did HITT experienced a greater decrease in insulin resistance than women who performed strength training [5].  

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.  

The Bottom Line

Consistency is more important than doing a crazy workout that’s unsustainable, so counsel your patients to start slow, with gradual increases over time. 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, as sitting has become the new smoking [8], [9], [10].  

For maximal benefit, encourage patients to exercise in their target heart rate zone [11], meaning at a moderate to vigorous intensity [12] for 150 minutes or more per week (at least 75 minutes if vigorous). This ensures they 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 read our EBook: Your Ultimate PCOS Toolkit

References 

1. Fung J. Chapter 4: The Exercise Myth. In: van Emden E, ed. (Why your body’s own insulin is the key to controlling your weight)The Obesity Code. Unlocking The Secrets of Weight Loss: Greystone Books; 2016: 53-56.   
2. Bird SR, Hawley JA. Update on the effects of physical activity on insulin sensitivity in humans. BMJ Open Sport Exerc Med. 2017 Mar 1;2(1):e000143. doi: 10.1136/bmjsem-2016-000143. PMID: 28879026; PMCID: PMC5569266. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569266/#:~:text=Exercise%20improved%20HOMA%2DIR%2C%20fasting,glucose%2C%20insulin%20levels%20and%20IR  
3. Experience Life Staff. How Exercise Heals. Experience Life by Life Time. October 1, 2020. Accessed August 14, 2023. https://experiencelife.lifetime.life/article/how-exercise-heals/ 
4. American Heart Association News. Doctors should ‘prescribe’ exercise for adults with slightly high blood pressure, cholesterol. The American Heart Association. June 2, 2021. Accessed August 14, 2023. https://www.heart.org/en/news/2021/06/02/doctors-should-prescribe-exercise-for-adults-with-slightly-high-blood-pressure-cholesterol 
5. Wilkins B. Exercise for PCOS: the ‘best’ and ‘worst’ kinds to improve symptoms. Women’s Health. Updated September 12, 2022. Accessed August 14, 2023.  https://www.womenshealthmag.com/uk/fitness/workouts/a40036309/exercise-for-pcos/  
6. Bikman B. Chapter 14: The Importance of Physical Activity. In: Schulz C, Fraleigh J, O’Brien K, Zarkos A, eds. (The Hidden Epidemic at the Root of Most Chronic Disease–and How to Fight It) Why We Get Sick: BenBella Books Inc; 2020: 134-138. 
7. The Effect of Mitochondrial Density on Athletic Performance. MOXY Muscle Oxygen Monitor. Accessed August 14, 2023.  https://my.moxymonitor.com/blog/bid/326925/The-Effect-of-Mitochondrial-Density-on-Athletic-Performance#:~:text=When%20you%20increase%20the%20size,or%20compete%20faster%20and%20longer.  
8. Time To Move. University of Michigan Human Resources. Accessed August 14, 2023.  https://hr.umich.edu/benefits-wellness/health-well-being/mhealthy/faculty-staff-well-being/physical-activity/time-move 
9. Reynolds G. Move for 3 minutes, every half-hour, to counter the ill effects of sitting, new study finds. The Seattle Times. Updated September 8, 2021. Accessed August 11, 2023.   https://www.seattletimes.com/nation-world/move-for-3-minutes-every-half-hour-to-counter-the-ill-effects-of-sitting-new-study-finds/  
10. The dangers of sitting: why sitting is the new smoking. Better Health Channel. Last reviewed on April 7, 2022. Accessed August 14, 2023.   https://www.betterhealth.vic.gov.au/health/healthyliving/the-dangers-of-sitting  
11. Target Heart Rate and Estimated Maximum Heart Rate. Centers for Disease Control and Prevention. Last reviewed on June 3, 2022. Accessed August 10, 2023. https://www.cdc.gov/physicalactivity/basics/measuring/heartrate.htm 
12. How much physical activity do adults need? Centers for Disease Control and Prevention. Last reviewed on June 2, 2022. Accessed August 10, 2023. https://www.cdc.gov/physicalactivity/basics/adults/index.htm