INVESTIGATING THE EFFECTS OF EXERCISE REGIMENS ON INSULIN SENSITIVITY AND OVULATORY FUNCTION IN WOMEN WITH PCOS

Abstract

Background

Polycystic ovary syndrome (PCOS) is a leading endocrine disorder in reproductive-aged women, strongly linked with insulin resistance and ovulatory dysfunction. Although exercise is widely recommended as first-line management, evidence comparing aerobic and resistance training for both metabolic and reproductive outcomes remains limited, particularly in South Asian clinical settings.

Objective

To evaluate and compare the effects of aerobic training versus resistance training on insulin sensitivity and ovulatory function in women with PCOS managed at a tertiary hospital in central Punjab, Pakistan.

Methods

A parallel-group randomized controlled trial was conducted over 12 weeks at a tertiary care hospital in central Punjab. Eighty women aged 18–35 years with PCOS diagnosed by Rotterdam criteria were randomized (1:1) to either:

1. Aerobic training (moderate-intensity cardiovascular exercise), or
2. Resistance training (progressive strength-based exercise targeting major muscle groups).

Both interventions were delivered three sessions per week under supervision. Primary outcomes were change in insulin resistance (HOMA-IR) and ovulatory function, assessed through menstrual tracking and biochemical confirmation where feasible. Secondary outcomes included BMI, waist circumference, fasting insulin, fasting glucose, total testosterone, and sex hormone-binding globulin (SHBG). Data were analyzed using between- and within-group comparisons with significance set at p < 0.05.

Study Type: Randomized Controlled Trial (RCT)

Results

Both exercise regimens produced clinically meaningful metabolic and reproductive improvements. HOMA-IR decreased in both groups, with a slightly larger reduction in the aerobic arm (Aerobic: 4.11 ± 0.97 to 2.91 ± 0.91; Resistance: 4.06 ± 0.90 to 3.11 ± 0.85). Fasting insulin also declined (Aerobic: 19.41 ± 3.59 to 15.17 ± 3.57 µIU/mL; Resistance: 18.80 ± 3.91 to 15.39 ± 3.79 µIU/mL). Waist circumference reduced in both groups (Aerobic: −4.82 ± 3.18 cm; Resistance: −3.92 ± 2.96 cm), while BMI decreased modestly (Aerobic: −1.10 ± 0.92 kg/m²; Resistance: −0.81 ± 0.80 kg/m²).

Endocrine markers improved, with reduced total testosterone and increased SHBG in both arms. Evidence of ovulatory restoration was observed in approximately half of participants (Aerobic: 55%; Resistance: 50%). Attendance remained high, supporting intervention feasibility in the local tertiary-care setting.

Conclusion

In women with PCOS in central Punjab, Pakistan, both aerobic and resistance training significantly improved insulin sensitivity and endocrine profiles, with meaningful ovulatory recovery in nearly half of participants. Aerobic training demonstrated slightly greater reductions in insulin resistance and central adiposity, while resistance training achieved comparable hormonal and ovulatory outcomes. These findings support integrating structured exercise prescriptions into routine PCOS management and suggest that both modalities can be effectively tailored to patient preference and feasibility in South Asian clinical settings.