A top doctor shares the dos and don'ts of exercise if you suffer with PCOS
PCOS exercise (polycystic ovary syndrome) is anything but binary – there’s no ‘right’ or ‘wrong’ way to do it, but there are certain kinds that could ease your symptoms. Many of the millions of women affected by the condition (1 in 10 in the UK) who have reaped the rewards for themselves have taken to TikTok to share what they've found are the best types for them.
To date, ‘PCOS workouts’ have had 52.5million views on the platform, and so many glowing testimonials on the impact of exercising on PCOS prove just how effective it can be. So, to mark PCOS Awareness Month, we wanted to get the scoop from the experts: what really warrants the 'best' and 'worst' kinds of PCOS exercise? How often should you exercise with PCOS? And when should you avoid it? Here’s the 411.
What is PCOS?
Dr Rebecca Robinson, a consultant in Sports and Exercise Medicine, tells us: ‘Polycystic ovary syndrome is a condition in which a woman’s ovaries have multiple cysts on a scan. The syndrome itself is defined by an imbalance in your hormones – an excess in androgen (testosterone is one type of androgen).’
PCOS symptoms
Dr Robinson pinpoints the following symptoms:
Irregular, less frequent periods with lower levels of ovulation
Infertility issues
Heavy periods
Weight gain
Hair growth
Skin issues
Does PCOS improve with exercise?
It's likely, yes. Dr Robinson explains: ‘PCOS can mean that you have a tendency to find losing weight harder and you can have a higher risk of diabetes or central obesity, as one of the hallmarks of the condition is insulin resistance [which the NHS cites as the main cause of diabetes]. This means that your body finds it harder to metabolise glucose and use it as energy, which means your body ends up producing more insulin and your blood sugar levels increase.
‘So, physical activity in combination with good nutrition is one of the best, medically-advised ways of managing PCOS, because it enhances your metabolism and can therefore help with weight loss.
‘It can also help regulate your hormones and lower the increase you have in testosterone, which will soothe symptoms such as acne and hair growth – both of which are rooted in higher testosterone.’
How can PCOS affect exercise?
Good news – Dr Robinson affirms that PCOS shouldn’t hinder your exercise performance too much, but there’s one symptom that might become a barrier: period pains. ‘PCOS can cause painful cramps,’ she explains. ‘And because they’re also likely to be irregular it can be hard to track your cycle and manage any symptoms before they set in.’ Confusingly, it can actually be exercise itself that helps nix this kind of pain, but Dr Robinson adds that the contraceptive pill could also help.
Remember, the contraceptive pill isn't for everyone. Always consult a GP or medical professional.
The 'best' forms of exercise for PCOS
Dr Robinson tells us that cardio workouts, HIIT and strength training all have their merits, so a combination of all three would – generally (disparities from one case to the next are inevitable, and if you’re dealing with severe symptoms, it’s always best to seek advice from a GP or professional) – be wise.
Cardio for PCOS
‘Cardiovascular exercise can help keep your heart healthy and deter long-term effects of cholesterol deposition in the arteries that can lead to heart disease and high-blood pressure, which women with PCOS can be at a higher risk of due to insulin resistance and weight gain,’ says Dr Robinson.
In fact, a meta-analysis of 16 studies on women with PCOS published in the journal, Frontiers of Psychology, showed that aerobic (a.k.a. cardio) activity of 'vigorous' intensity had a positive impact on both BMI (Body Mass Index) and insulin resistance (+17%), more so than 'moderately intense' aerobic activity. The analysis also found that 120 minutes of this kind of cardio exercise per week is needed for these positive effects to come into fruition (roughly 20 minutes per day), but these effects came about without any changes to the participants' diets.
HIIT for PCOS
Short cardio bursts in HIIT can work wonders for women with PCOS. One PLoS One study found that when two groups of women with PCOS did either HIIT or strength training three times a week, after 10 weeks, the women who did HIIT had experienced the most significant improvements in insulin resistance. Dr Robinson credits this to an improvement in metabolic rate which works to ‘regulate weight’. The study explains that a lot of this is down to the EPOC effect - the process of Excess Post-exercise Oxygen Consumption.
HIIT initially works by burning through fat, but it also creates an oxygen debt to your muscles which forces your body into EPOC mode. So, after your session, your body has to continue to work hard to repair the muscle tears, so it continues to burn fat to generate the energy needed to restore a normal level of oxygenation. The upshot? Your body burns more fat - the study found that fat percentage actually decreased 'significantly' in participants.
But, according to the study, the main positive to come from HIIT was an increase in insulin resistance, and insulin resistance is a major driver of many PCOS symptoms. There's a lot to why this is, but several studies have linked high insulin to an increase in testosterone (causing things like acne and hair growth) and impaired ovulation (leading to things like infrequent or heavy periods).
Strength training for PCOS
The same study published in the Frontiers of Psychology that proved the pros of cardio activity, also looked into resistance training for PCOS. They found that resistance training in women with PCOS was most effective for reducing Free Androgen Index (a fancy way of saying testosterone levels - testosterone is a type of androgen) than anything else. For strength training, both 'moderate' and 'vigorous' intensities brought about positive effects (on average, the participants who did 30 hours of resistance training had 15% lower levels of testosterone).
Much like the analysis found with cardio, the more frequently you do strength training the better - the participants who strength trained for 50 hours (between 6 and 26 weeks - the analysis looked at 16 studies of varying lengths), had a greater decrease in FAI, than those who did 30 hours.
Other research also preaches the pros of strength training for PCOS. One study in 2016 that looked into progressive resistance training reported decreases in FAI of 0.82%. Another study comparing a 10-week intervention of either resistance training or high intensity interval training, reported the largest decrease in FAI in the strength training group, with a decrease of −0.7% from baseline values.
The 'worst' forms of exercise for PCOS
There’s no one ‘worst’ form of exercise. Rather, one study in Baltimore's Medicine Journal found that overdoing any kind could make your menstrual cycle even more irregular. This is mainly down to a spike in cortisol levels (that can stick around and become chronic if you continue to overtrain on a long-term basis), which puts your hormones out of whack.
Dr Robinson highlights the importance of not falling into the habit of overtraining in a bid to tackle PCOS-induced weight gain. ‘Many women may mistake weight gain with not training hard enough, but overdoing it could cause the loss of periods due to a negative energy balance, or worsen symptoms by throwing your hormones further off balance. The focus should be on a sustainable exercise plan and whole foods – including low glycemic-index carbohydrates, minimal sugar and healthy fats.’
How regularly should you exercise with PCOS?
A minimum of two to three workouts per week - ideally five - is Dr Robinson’s advice. ‘This is the best way to sustainably improve metabolic health,’ she says. ‘Include cardio, HIIT, and strength training, and even if you’re not working out – try to be active every day. Even a short 20-minute walk is worth it.’
What's more, studies have shown that just 30 minutes a day, three times a week, to three total hours per week can improve metabolic and reproductive symptoms associated with PCOS.
When should you avoid exercise with PCOS?
One lesser-known symptom of PCOS is pelvic pain, and it’s when this gets unusually bad that you might want to ease off exercise. ‘Try having a rest or lower intensity exercise day, then seek medical support if it’s ongoing,’ says Dr Robinson.
4 tips for exercising with PCOS
1. Fuel up
'In order to prepare for exercise, particularly intense exercise, nutrition and hydration are key,’ says GP Dr Helen Evans-Howells. 'Start an exercise session fully hydrated and having fuelled your body with a balanced meal or snack 1-2 hours before.’ Foods high in carbohydrates, such as bread, bananas and pasta, are great for preparing your body for a workout. 'Keep hydrated during exercise and afterwards to promote recovery and minimise injury,’ Dr Evans-Howells says.
2. Warm up and cool down appropriately
Always bookend your workout with a warm-up and cool-down, to ensure you get the most out of your session and minimise the risk of injury. 'If exercise is new to you, then taking professional advice and pacing yourself to prevent an injury at the beginning is crucial to consistency,’ says Dr Evans-Howells.
3. Be patient and consistent
'Change takes time, so pacing yourself and building up the exercise intensity over weeks or months will be the key to creating a sustainable change which will bring health benefits that last a lifetime,’ Dr Evans-Howells says. Consider easing yourself in with a couple of low-impact sessions a week, and gradually adjusting the variables (quantity of workouts per week, exercise intensity, and so on) with the support of a trainer, if possible, as you progress to continue challenging yourself.
4. Stick to your own timeline
As we always say, what works for you may not work for someone else, so it's important to pay attention to what your body needs and move at your own pace. Go hell-for-leather from the get-go and you could pay for it with more acute symptoms, but if you start slowly and give your body a chance to adapt, you’ll be able to notice any flare-ups and make any changes you need to before it's too late.
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