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Diet, exercise equally effective for reproductive function in obese women with PCOS
Nybacka A. Fertil Steril. 2011;96:1508-1513.
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Overweight and obese women with polycystic ovary syndrome benefit equally from dietary management and exercise for improved reproductive function, according to researchers from Sweden.
Diet and exercise — alone and in combination — improved BMI, menstrual pattern and ovulation in 57 overweight/obese women with PCOS. Patients were randomly assigned to diet alone, exercise alone or diet and exercise combined. Forty-three patients completed the trial.
In all three arms, 24-hour caloric intake at 4 months was significantly reduced (P<.001 for diet, P<.01 for diet and exercise, and P<.05 for exercise alone).
Dietary management, as supervised by a dietician, reduced BMI by 6%; exercise, as supervised by a physical therapist, reduced BMI by 3%; and both diet and exercise reduced BMI by 5%. In the diet groups, lower body fat and lean body mass were significantly lowered; in the exercise-alone group, upper body fat was lowered and lean body mass was maintained.
Improved menstrual pattern occurred among 69% of patients, and ovulation was confirmed in 34%. After intervention, a high serum level of insulin-like growth factor-binding protein 1 (IGFBP-1) was the strongest predictor of resumed ovulation.
Free testosterone was decreased, but was only significant in the diet group (P<.01). There was a general lowering of testosterone–sex hormone-binding globulin ratio (P<.01), which was associated with significant decreases for both the diet and combined groups (P<.01 and P<.05). In all patients combined, mean serum IGF-I and IGFBP-1 levels rose (P=.08 for both), although the diet group had significant elevations (P<.05 for both).
Half of the patients were followed for a median of 2.8 years. According to the researchers, weight reduction and improved menstrual pattern were maintained during this time.
“The underlying mechanism(s) appears to involve enhanced insulin sensitivity, as reflected in the high serum level of IGFBP-1 in the ovulatory women,” the researchers wrote. “Lifestyle modification is suggested as the first line of treatment to improve reproductive and metabolic health in overweight or obese patients with PCOS, and the supportive individualized dietary and exercise programs used here may have long-term beneficial effects.”
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