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Background <p>Polycystic ovary syndrome (PCOS) is a complex condition affecting women across the lifespan, and exercise is often recommended as a first line treatment strategy. However, treatment guidelines and previous reviews did not provide clear and consistent recommendations about exercise modalities for women with PCOS. This study aimed to determine the optimal exercise modes for improving anthropometric, metabolic, reproductive, and psychological outcomes in women with PCOS.</p> Methods <p>A systematic search was conducted across PubMed, EMBASE, the Cochrane Library, Web of Science, CINAHL, and ClinicalTrials.gov from inception to March 20, 2025. We included randomized controlled trials (RCTs) evaluating exercise interventions in women diagnosed with PCOS. Two reviewers independently conducted study screening, risk of bias assessment using version 2 of the Cochrane Risk of Bias (RoB 2) tool, and data extraction. We performed a Bayesian network meta-analysis, pooling effect sizes as mean difference (MD) or standardized mean difference (SMD) with 95% credible interval (CrI). Surface under the cumulative ranking curve (SUCRA) values were calculated to rank exercise efficacy for each outcome. The certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework.</p> Results <p>A total of 29 studies involving 884 participants were included in the network meta-analysis. Compared with no exercise, the following modalities emerged as the highest-ranked interventions in the relevant outcomes: aerobic exercise for body mass index (BMI) (SUCRA = 82.39%; MD: -1.29; 95% CrI: -2.39, -0.21), combined aerobic and resistance exercise for fasting insulin (SUCRA = 94.30%; SMD:-1.68; 95% CrI: -3.45, -0.30), and mind-body exercise for fasting blood glucose (SUCRA = 94.27%; SMD: -1.09; 95% CrI: -1.98, -0.23) and homeostatic model assessment of insulin resistance (SUCRA: 98.09%; MD: -0.94; 95% CrI: -1.64, -0.08). Aerobic exercise also ranked highest for progesterone (SUCRA = 98.90%; SMD: -0.51; 95% CrI: -0.95, -0.07). Meta-regression showed results were not significantly modified by age, baseline BMI, risk of bias, intervention length or duration. The certainty of evidence was rated as low or very low across outcomes.</p> Conclusions <p>While the specific exercise modalities show potential advantages for improving PCOS-related outcomes, the findings should be interpreted with caution as preliminary insights due to the low or very low certainty of the overall evidence. Further large-scale, rigorously designed studies are required to confirm the comparative effectiveness of different exercise modalities.</p> Trial registration <p>PROSPERO, CRD42024614113.</p>

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Ranking exercise interventions by their effectiveness in the management of polycystic ovary syndrome: a systematic review and network meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月29日

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  • Sijie Hu,
  • Quan Shen,
  • Ziyan Li,
  • Tan He,
  • Yao Luo,
  • Ping Tu,
  • Chunli Yan,
  • Jun Lei

摘要

Background

Polycystic ovary syndrome (PCOS) is a complex condition affecting women across the lifespan, and exercise is often recommended as a first line treatment strategy. However, treatment guidelines and previous reviews did not provide clear and consistent recommendations about exercise modalities for women with PCOS. This study aimed to determine the optimal exercise modes for improving anthropometric, metabolic, reproductive, and psychological outcomes in women with PCOS.

Methods

A systematic search was conducted across PubMed, EMBASE, the Cochrane Library, Web of Science, CINAHL, and ClinicalTrials.gov from inception to March 20, 2025. We included randomized controlled trials (RCTs) evaluating exercise interventions in women diagnosed with PCOS. Two reviewers independently conducted study screening, risk of bias assessment using version 2 of the Cochrane Risk of Bias (RoB 2) tool, and data extraction. We performed a Bayesian network meta-analysis, pooling effect sizes as mean difference (MD) or standardized mean difference (SMD) with 95% credible interval (CrI). Surface under the cumulative ranking curve (SUCRA) values were calculated to rank exercise efficacy for each outcome. The certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework.

Results

A total of 29 studies involving 884 participants were included in the network meta-analysis. Compared with no exercise, the following modalities emerged as the highest-ranked interventions in the relevant outcomes: aerobic exercise for body mass index (BMI) (SUCRA = 82.39%; MD: -1.29; 95% CrI: -2.39, -0.21), combined aerobic and resistance exercise for fasting insulin (SUCRA = 94.30%; SMD:-1.68; 95% CrI: -3.45, -0.30), and mind-body exercise for fasting blood glucose (SUCRA = 94.27%; SMD: -1.09; 95% CrI: -1.98, -0.23) and homeostatic model assessment of insulin resistance (SUCRA: 98.09%; MD: -0.94; 95% CrI: -1.64, -0.08). Aerobic exercise also ranked highest for progesterone (SUCRA = 98.90%; SMD: -0.51; 95% CrI: -0.95, -0.07). Meta-regression showed results were not significantly modified by age, baseline BMI, risk of bias, intervention length or duration. The certainty of evidence was rated as low or very low across outcomes.

Conclusions

While the specific exercise modalities show potential advantages for improving PCOS-related outcomes, the findings should be interpreted with caution as preliminary insights due to the low or very low certainty of the overall evidence. Further large-scale, rigorously designed studies are required to confirm the comparative effectiveness of different exercise modalities.

Trial registration

PROSPERO, CRD42024614113.