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Journal of Endocrinological Investigation

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01-05-2017 | Review

Is cardiorespiratory fitness impaired in PCOS women? A review of the literature

Authors: S. Donà, E. Bacchi, P. Moghetti

Published in: Journal of Endocrinological Investigation | Issue 5/2017

Abstract

Purpose

Polycystic ovary syndrome (PCOS) is a common and heterogeneous endocrine disorder, affecting 8–12% of reproductive-aged women. Insulin resistance and body fat excess are common features in these subjects. Increased physical activity and diet modifications are the first recommended approach in the management of these women, at least in overweight/obese subjects. Evaluation of cardiorespiratory fitness (CRF) is important in assessing exercise performance and in monitoring the effects of physical exercise interventions. Several studies have shown that CRF may be impaired in metabolic and endocrine disorders. However, there are little data on this issue in PCOS women. The aim of this narrative review is to critically evaluate whether aerobic capacity is altered in PCOS women, focusing on maximal oxygen uptake.

Methods

An updated search of the literature was performed, identifying papers with maximal oxygen consumption measurements in women with PCOS compared to healthy controls.

Results

We have identified six studies on this specific topic: four of them showed an alteration of maximal oxygen consumption in PCOS women, whereas two did not. However, taken together these studies suggest that CRF may be strikingly impaired in both normal-weight and overweight/obese subjects with this condition.

Conclusions

Women with PCOS appear to be characterized by a reduced cardiopulmonary fitness. However, further research on this topic is needed. This information may hopefully help clinicians and exercise specialist in planning individualized exercise programs aimed at improving the metabolic and endocrine outcomes in these women.

Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF, Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society (2009) The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 91:456–488CrossRefPubMed

Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 19:41–47CrossRef

Zawadski JK, Dunaif A (1992) Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In: Dunaif A, Givens JR, Haseltine FP, Merriam GR (eds) polycystic ovary syndrome. Blackwell Scientific Publications, Boston, pp 377–384

Moghetti P, Tosi F, Bonin C, Di Sarra D, Fiers T, Kaufman JM, Giagulli VA, Signori C, Zambotti F, Dall’Alda M, Spiazzi G, Zanolin ME, Bonora E (2013) Divergences in insulin resistance between the different phenotypes of the polycystic ovary syndrome. J Clin Endocrinol Metab 98:E628–E637CrossRefPubMed

Diamanti-Kandarakis E, Dunaif A (2012) Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 33:981–1030CrossRefPubMed

Tosi F, Di Sarra D, Kaufman JM, Bonin C, Moretta R, Bonora E, Zanolin E, Moghetti P (2015) Total body fat and central fat mass independently predict insulin resistance but not hyperandrogenemia in women with polycystic ovary syndrome. J Clin Endocrinol Metab 100:661–669CrossRefPubMed

Escobar-Morreale HF, Luque-Ramírez M, González F (2011) Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis. Fertil Steril 95(3):1048–1058CrossRefPubMed

Murri M, Luque-Ramírez M, Insenser M, Ojeda-Ojeda M, Escobar-Morreale HF (2013) Circulating markers of oxidative stress and polycystic ovary syndrome (PCOS): a systematic review and meta-analysis. Hum Reprod Update 19(3):268–288CrossRefPubMed

Spritzer PM, Lecke SB, Satler F, Morsch DM (2015) Adipose tissue dysfunction, adipokines, and low-grade chronic inflammation in polycystic ovary syndrome. Reproduction 149(5):R219–R227CrossRefPubMed

10.

Karakose M, Demircan K, Tutal E, Demirci T, Arslan MS, Sahin M, Celik HT, Kazanci F, Karakaya J, Cakal E, Delibasi T (2016) Clinical significance of ADAMTS1, ADAMTS5, ADAMTS9 aggrecanases and IL-17A, IL-23, IL-33 cytokines in polycystic ovary syndrome. J Endocrinol Invest 39(11):1269–1275CrossRefPubMed

11.

Shorakae S, Teede H, de Courten B, Lambert G, Boyle J, Moran LJ (2015) The emerging role of chronic low-grade inflammation in the pathophysiology of polycystic ovary syndrome. Semin Reprod Med 33(4):257–269CrossRefPubMed

12.

Phelan N, O’Connor A, Kyaw Tun T, Correia N, Boran G, Roche HM, Gibney J (2013) Leucocytosis in women with polycystic ovary syndrome (PCOS) is incompletely explained by obesity and insulin resistance. Clin Endocrinol (Oxf) 78(1):107–113CrossRef

13.

Yilmaz MA, Duran C, Basaran M (2016) The mean platelet volume and neutrophil to lymphocyte ratio in obese and lean patients with polycystic ovary syndrome. J Endocrinol Invest 39(1):45–53CrossRefPubMed

14.

Moran LJ, Hutchison SK, Norman RJ, Teede HJ (2011) Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 6:7

15.

Conway G, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Franks S, Gambineri A, Kelestimur F, Macut D, Micic D, Pasquali R, Pfeifer M, Pignatelli D, Pugeat M, Yildiz BO, ESE PCOS Special Interest Group (2014) The polycystic ovary syndrome: a position statement from the European Society of Endocrinology. Eur J Endocrinol 171:P1–P29CrossRefPubMed

16.

Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK (2013) Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 98:4565–4592CrossRefPubMed

17.

Moghetti P, Carmina E, De Leo V, Lanzone A, Orio F, Pasquali R, Toscano V (2015) How to manage the reproductive issues of PCOS: a 2015 integrated endocrinological and gynecological consensus statement of the Italian Society of Endocrinology. J Endocrinol Invest 38:1025–1037CrossRefPubMed

18.

Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA (2010) Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 95:2038–2049CrossRefPubMed

19.

Domecq JP, Prutsky G, Mullan RJ, Hazem A, Sundaresh V, Elamin MB, Phung OJ, Wang A, Hoeger K, Pasquali R, Erwin P, Bodde A, Montori VM, Murad MH (2013) Lifestyle modification programs in polycystic ovary syndrome: systematic review and meta-analysis. J Clin Endocrinol Metab 98:4655–4663CrossRefPubMed

20.

Kiddy DS, Hamilton-Fairley D, Bush A, Short F, Anyaoku V, Reed MJ, Franks S (1992) Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 36:105–111CrossRef

21.

Pasquali R, Gambineri A, Cavazza C, Ibarra Gasparini D, Ciampaglia W, Cognigni GE, Pagotto U (2011) Heterogeneity in the responsiveness to long-term lifestyle intervention and predictability in obese women with polycystic ovary syndrome. Eur J Endocrinol 164:53–60CrossRefPubMed

22.

Kuchenbecker WK, Groen H, van Asselt SJ, Bolster JH, Zwerver J, Slart RH, Vd Jagt EJ, Muller Kobold AC, Wolffenbuttel BH, Land JA, Hoek A (2011) In women with polycystic ovary syndrome and obesity, loss of intra-abdominal fat is associated with resumption of ovulation. Hum Reprod 26:2505–2512CrossRefPubMed

23.

Carroll S, Dudfield M (2004) What is the relationship between exercise and metabolic abnormalities? A review of the metabolic syndrome. Sports Med 34:371–418CrossRefPubMed

24.

Haqq L, McFarlane J, Dieberg G, Smart N (2015) The effect of lifestyle intervention on body composition, glycemic control, and cardiorespiratory fitness in polycystic ovarian syndrome: a systematic review and meta-analysis. Int J Sport Nutr Exerc Metab 25:533–540CrossRefPubMed

25.

Harrison CL, Lombard CB, Moran LJ, Teede HJ (2011) Exercise therapy in polycystic ovary syndrome: a systematic review. Hum Reprod Update 17:171–183CrossRefPubMed

26.

Brown AJ, Setji TL, Sanders LL, Lowry KP, Otvos JD, Kraus WE, Svetkey PL (2009) Effects of exercise on lipoprotein particles in women with polycystic ovary syndrome. Med Sci Sports Exerc 41:497–504CrossRefPubMedPubMedCentral

27.

Giallauria F, Palomba S, Manguso F, Vitelli A, Maresca L, Tafuri D, Lombardi G, Colao A, Vigorito C, Orio F (2008) Abnormal heart rate recovery after maximal cardiopulmonary exercise stress testing in young overweight women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 68:88–93CrossRef

28.

Palomba S, Giallauria F, Falbo A, Russo T, Oppedisano R, Tolino A, Colao A, Vigorito C, Zullo F, Orio F (2008) Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Hum Reprod 23:642–650CrossRefPubMed

29.

Randeva HS, Lewandowski KC, Drzewoski J, Brooke-Wavell K, O’Callaghan C, Czupryniak L, Hillhouse EW, Prelevic GM (2002) Exercise decreases plasma total homocysteine in overweight young women with polycystic ovary syndrome. J Clin Endocrinol Metab 87:4496–4501CrossRefPubMed

30.

Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB (2009) Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol 297:R387–R395CrossRefPubMed

31.

Vigorito C, Giallauria F, Palomba S, Cascella T, Manguso F, Lucci R, De Lorenzo A, Tafuri D, Lombardi G, Colao A, Orio F (2007) Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 92:1379–1384CrossRefPubMed

32.

Thomson RL, Buckley JD, Noakes M, Clifton PM, Norman RJ, Brinkworth GD (2008) The effect of a hypocaloric diet with and without exercise training on body composition, cardiometabolic risk profile, and reproductive function in overweight and obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 93:3373–3380CrossRefPubMed

33.

Bruner B, Chad K, Chizen D (2006) Effects of exercise and nutritional counseling in women with polycystic ovary syndrome. Appl Physiol Nutr Metab 31:384–391CrossRefPubMed

34.

Nybacka Å, Carlström K, Fabri F, Hellström PM, Hirschberg AL (2013) Serum antimüllerian hormone in response to dietary management and/or physical exercise in overweight/obese women with polycystic ovary syndrome: secondary analysis of a randomized controlled trial. Fertil Steril 100:1096–1102CrossRefPubMed

35.

Sprung VS, Cuthbertson DJ, Pugh CJ, Aziz N, Kemp GJ, Daousi C, Green DJ, Cable NT, Jones H (2013) Exercise training in polycystic ovarian syndrome enhances flow-mediated dilation in the absence of changes in fatness. Med Sci Sports Exerc 45:2234–2242CrossRefPubMed

36.

Hutchinson SK, Stepto NK, Harrison CL, Moran LJ, Strauss BJ, Teede HJ (2011) Effects of exercise on insulin resistance and body composition in overweight and obese women with and without polycystic ovary syndrome. J Clin Endocrinol Metab 96:E48–E56CrossRef

37.

Kogure GS, Miranda-Furtado CL, Silva RC, Melo AS, Ferriani RA, De Sá MF, Dos Reis RM (2016) Resistance exercise impacts lean muscle mass in women with polycystic ovary syndrome. Med Sci Sports Exerc 48:589–598CrossRefPubMed

38.

Mario FM, Graff SK, Spritzer PM (2016) Habitual physical activity is associated with improved anthropometric and androgenic profile in PCOS: a cross-sectional study. J Endocrinol Invest. Oct 22 [Epub ahead of print]

39.

American College of Sports Medicine (2014) Guidelines for exercise testing and prescription, 9th edn. Lippincott Williams & Wilkins, Baltimore, pp 72–94

40.

Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H (2009) Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 301:2024–2035CrossRefPubMed

41.

Bertoli A, Di Daniele N, Ceccobelli M, Ficara A, Girasoli C, De Lorenzo A (2003) Lipid profile, BMI, body fat distribution, and aerobic fitness in men with metabolic syndrome. Acta Diabetol 40:S130–S133CrossRefPubMed

42.

Ugur-Altun B, Altun A, Tatli E, Arikan E, Tugrul A (2004) Relationship between insulin resistance assessed by HOMA-IR and exercise test variables in asymptomatic middle-aged patients with type 2 diabetes. J Endocrinol Invest 27:455–461CrossRefPubMed

43.

Bacchi E, Negri C, Di Sarra D, Tosi F, Tarperi C, Moretta R, Schena F, Bonora E, Kaufman JM, Moghetti P (2015) Serum testosterone predicts cardiorespiratory fitness impairment in normal-weight women with polycystic ovary syndrome. Clin Endocrinol 83:895–901CrossRef

44.

Cosar E, Köken G, Sahin FK, Akgün L, Uçok K, Genç A, Yilmazer M (2008) Resting metabolic rate and exercise capacity in women with polycystic ovary syndrome. Int J Gynecol Obstet 101:31–34CrossRef

45.

Orio F Jr, Giallauria F, Palomba S, Cascella T, Manguso F, Vuolo L, Russo T, Tolino A, Lombardi G, Colao A, Vigorito C (2006) Cardiopulmonary impairment in young women with polycystic ovary syndrome. J Clin Endocrinol Metab 91:2967–2971CrossRefPubMed

46.

Rissanen AP, Koskela-Koivisto T, Hägglund H, Koponen AS, Aho JM, Pöyhönen-Alho M, Tiitinen A, Tikkanen HO, Peltonen JE (2016) Altered cardiorespiratory response to exercise in overweight and obese women with polycystic ovary syndrome. Physiol Rep 4:e12719CrossRefPubMedPubMedCentral

47.

Thomson RL, Buckley JD, Moran LJ, Noakes M, Clifton PM, Norman RJ, Brinkworth GD (2009) Comparison of aerobic exercise capacity and muscle strength in overweight women with and without polycystic ovary syndrome. BJOG 116:1242–1250CrossRefPubMed

48.

Tosi F, Fiers T, Kaufman J-M, Dall’Alda M, Moretta R, Giagulli VA, Bonora E, Moghetti P (2016) Implications of androgen assay accuracy in the phenotyping of women with polycystic ovary syndrome. J Clin Endocrinol Metab 101:610–618CrossRefPubMed

49.

Taieb J, Mathian B, Millot F, Patricot MC, Mathieu E, Queyrel N, Lacroix I, Somma-Delpero C, Boudou P (2003) Testosterone measured by 10 immunoassays and by isotope-dilution gas chromatography-mass spectrometry in sera from 116 men, women, and children. Clin Chem 49:1381–1395CrossRefPubMed

50.

Buchanan TA, Watanabe RM, Xiang AH (2010) Limitations in surrogate measures of insulin resistance. J Clin Endocrinol Metab 95:4874–4876CrossRefPubMedPubMedCentral

51.

Polak K, Czyzyk A, Simoncini T, Meczekalski B (2016) New markers of insulin resistance in polycystic ovary syndrome. J Endocrinol Invest. Jul 29 [Epub ahead of print]

Title: Is cardiorespiratory fitness impaired in PCOS women? A review of the literature
Authors: S. Donà
E. Bacchi
P. Moghetti
Publication date: 01-05-2017
Publisher: Springer International Publishing
Published in: Journal of Endocrinological Investigation / Issue 5/2017
Electronic ISSN: 1720-8386
DOI: https://doi.org/10.1007/s40618-016-0599-1

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