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Percy C, Turner A, Orr C. Developing a Novel Web-Based Self-Management Support Intervention for Polycystic Ovary Syndrome: Mixed Methods Study With Patients and Health Care Professionals. JMIR Form Res 2024; 8:e52427. [PMID: 38451567 PMCID: PMC10958350 DOI: 10.2196/52427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 01/10/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) represents a significant global health burden requiring urgent attention. This common chronic endocrine and cardiometabolic condition affects around 1 in 10 women and individuals assigned female at birth, with significant adverse effects on well-being, quality of life, and mental health, as well as serious and complex long-term health consequences. International guidelines for best health care practice recommend the provision of comprehensive cognitive behavioral interventions to support self-management and improve health outcomes for those living with PCOS. Web-based health interventions have the potential to meet this need in an accessible and scalable way. OBJECTIVE We aim to identify barriers to self-management and psychological well-being in women with PCOS and adapt a web-based self-management program to provide a prototype digital support intervention for them. METHODS We adapted an existing support program (HOPE) for PCOS using the antecedent target measure approach. We conducted qualitative interviews with 13 adult women living with PCOS, 3 trustees of a patients with PCOS advocacy charity, and 4 endocrinologists to identify "antecedents" (barriers) to self-management and psychological well-being. Framework analysis was used to identify potentially modifiable antecedents to be targeted by the novel intervention. At a national conference, 58 key stakeholders (patients and health professionals) voted for the antecedents they felt were most important to address. We used research evidence and relevant theory to design a prototype for the PCOS intervention. RESULTS Voting identified 32 potentially modifiable antecedents, relating to knowledge, understanding, emotions, motivation, and behaviors, as priorities to be targeted in the new intervention. A modular, web-based prototype HOPE PCOS intervention was developed to address these, covering six broad topic areas (instilling HOPE for PCOS; managing the stress of PCOS; feeding your mind and body well; body image, intimacy, and close relationships; staying healthy with PCOS; and keeping PCOS in its place). CONCLUSIONS We identified barriers to self-management and psychological well-being in women with PCOS and used these to adapt a web-based self-management program, tailoring it for PCOS, which is a comprehensive group intervention combining education, empowerment, lifestyle management, peer support with cognitive behavioral tools, and goal-setting (to be delivered by peers or codelivered with health care professionals). The modular structure offers flexibility to adapt the program further as new clinical recommendations emerge. The intervention has the potential to be delivered, evaluated for feasibility, and, if effective, integrated into health care services. Self-management interventions are not designed to replace clinical care; rather, they serve as an additional source of support. The HOPE PCOS program conveys this message in its content and activities. Future research should evaluate the prototype intervention using primary outcomes such as measures of psychological well-being, self-management self-efficacy, depression, anxiety, and PCOS-related quality of life. They should also assess the intervention's acceptability, scalability, and cost-effectiveness.
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Affiliation(s)
- Carol Percy
- Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Andrew Turner
- Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Charys Orr
- Harris Church of England Academy, Diocese of Coventry Multi Academy Trust, Coventry, United Kingdom
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2
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Weng Y, Zhang Y, Wang D, Wang R, Xiang Z, Shen S, Wang H, Wu X, Wen Y, Wang Y. Exercise-induced irisin improves follicular dysfunction by inhibiting IRE1α-TXNIP/ROS-NLRP3 pathway in PCOS. J Ovarian Res 2023; 16:151. [PMID: 37525261 PMCID: PMC10388501 DOI: 10.1186/s13048-023-01242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Excessive production of androgen drives oxidative stress (OS) and inflammasome activation in ovarian granulosa cells (GCs). Therefore, the induced follicular developmental disorder is the major cause of infertility in women with polycystic ovary syndrome (PCOS). Exercise-induced upregulation of irisin is capable of regulating metabolism by reducing OS and inflammation. Exercise has been shown to alleviate a range of PCOS symptoms, including maintaining a normal menstrual cycle, in several clinical trials. METHODS Female Sprague-Dawley (SD) rats and primary ovarian cells were treated with two different androgens, dehydroepiandrosterone (DHEA) and dihydrotestosterone (DHT), to simulate a hyperandrogenic environment, followed by eight weeks of exercise training and irisin intervention. The levels of reactive oxygen species (ROS), tissue inflammation and fibrosis were examined using hematoxylin and eosin (H&E) staining, western blot, quantitative real-time PCR (qRT-PCR), dichlorofluorescein diacetate (DCF-DA) probe detection, immunofluorescence staining, immunohistochemistry, and Sirius red staining. RESULTS Exercise for eight weeks improved polycystic ovarian morphology and decreased the levels of inflammation, OS, and fibrosis in PCOS rats. Hyperandrogen increased ROS production in ovarian cells by inducing endoplasmic reticulum stress (ERS) and activating the inositol-requiring enzyme 1α (IRE1α)-thioredoxin-interacting protein (TXNIP)/ROS-NOD-like receptor family pyrin domain containing 3 (NLRP3) signaling pathway, further enhancing the levels of inflammation. Irisin suppressed the expression of IRE1α and its downstream targets, thus improving the ovarian dysfunction of PCOS rats induced by hyperandrogen. CONCLUSION Exercise can alleviate various phenotypes of PCOS rats induced by DHEA, and its therapeutic effect may be mediated by secreting beneficial myokines. IRE1α may be an important target of irisin for reducing OS and inflammation, thereby improving ovarian fibrosis.
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Affiliation(s)
- Yajing Weng
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China
| | - Yaling Zhang
- School of Medicine, Jiaxing University, Jiaxing, 314001, China
| | - Daojuan Wang
- Department of Pain, Medical School, The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, 210008, China
| | - Rong Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China
| | - Zou Xiang
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, 999077, China
| | - Shanmei Shen
- Department of Endocrinology, Medical School, The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, 210093, China
| | - Hongwei Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China
| | - Xiaoke Wu
- Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, 150040, China.
| | - Yanting Wen
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China.
| | - Yong Wang
- State Key Laboratory of Analytical Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, 210093, China.
- Nanjing University (Suzhou) High-Tech Institute, Suzhou, 215123, China.
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Rajkumar E, Ardra A, Prabhu G, Pandey V, Sundaramoorthy J, Manzoor R, Sooraj KV, Manikandaprabu M, Badiger T. Polycystic ovary syndrome: An exploration of unmarried women's knowledge and attitudes. Heliyon 2022; 8:e09835. [PMID: 35832347 PMCID: PMC9272350 DOI: 10.1016/j.heliyon.2022.e09835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/13/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022] Open
Abstract
Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder among women of reproductive age and a chief cause of subfertility attributed to ovulation. Besides, lack of knowledge about PCOS, its treatment, and lifestyle changes influence the prognosis. The present qualitative inquiry investigates the knowledge and attitudes of unmarried women towards the syndrome, associated treatment, and necessary lifestyle changes in the fight against the same. A total of 15 participants with PCOS were selected using purposive sampling (n from southern parts of India viz. Kerala and Tamil Nadu states. The telephonic interviews were conducted in late November and early December 2020. He conventional content analysis emerged with six major themes. The themes capsulated women’s knowledge, causes, complications and risk factors, treatment of PCOS their perceived importance of health promotive behaviours such as physical activity, sleep patterns, and perceived support from society. The importance of diet, exercise and a healthy lifestyle were additional relevant factors stressed by the respondents. Although the medicines helped participants attain regular menstrual cycles, they also had side effects reported in the discussion. Few respondents reported that they lacked the necessary awareness of PCOS when diagnosed at a younger age. The study enhances the understanding of PCOS from a qualitative approach that has cultural relevance apart from pertinent clinical and lifestyle implications.
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Affiliation(s)
- Eslavath Rajkumar
- Department of Psychology, Central University of Karnataka, Kalaburagi, India
| | - A Ardra
- Department of Psychology, Central University of Karnataka, Kalaburagi, India
| | - G Prabhu
- Department of Psychology, Central University of Karnataka, Kalaburagi, India
| | - Vijyendra Pandey
- Department of Psychology, Central University of Karnataka, Kalaburagi, India
| | | | - Rameez Manzoor
- Department of Social Work, University of Science and Technology, Meghalaya, India
| | - K V Sooraj
- Children and Police, State Resource Centre Social Policing, Directorate of Kerala Police, Trivandrum, India
| | - M Manikandaprabu
- Department of Psychology, Christ (Deemed to be University) Bannerughatta, Bengaluru, India
| | - Tukaram Badiger
- Department of Social Work, Central University of Karnataka, Kalaburagi, India
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Song Y, Wang H, Zhu Z, Huang H. Effects of Metformin and Exercise in Polycystic Ovary Syndrome: Systematic Review and Meta-Analysis. Horm Metab Res 2021; 53:738-745. [PMID: 34740275 DOI: 10.1055/a-1666-8979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Metformin is introduced for treatment of women with PCOS, and the beneficial effects of exercise in women with PCOS are found for a range of outcomes. Our aim is to compare the effects of metformin plus exercise with exercise intervention in PCOS on clinical, anthropometric, metabolic, and psychological parameters. MEDLINE, EMBASE, Web of Science and China National Knowledge Infrastructure were searched for studies. Nine studies were considered eligible for inclusion. The meta-analysis reveals that metformin offers additive benefits to exercise, leading to modest improvements in menstrual cycles, hyperandrogenism, and abdominal fat.
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Affiliation(s)
- Yu Song
- Department of Obstetrics and Gynecology, The Third Hospital of Wuhan, HuBei, China
| | - Huimin Wang
- Department of Obstetrics and Gynecology, The Third Hospital of Wuhan, HuBei, China
| | - Zhengyan Zhu
- Department of Obstetrics and Gynecology, The Third Hospital of Wuhan, HuBei, China
| | - Hongli Huang
- Department of Obstetrics and Gynecology, The Third Hospital of Wuhan, HuBei, China
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5
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Barber TM, Franks S. Obesity and polycystic ovary syndrome. Clin Endocrinol (Oxf) 2021; 95:531-541. [PMID: 33460482 DOI: 10.1111/cen.14421] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/02/2020] [Accepted: 01/14/2021] [Indexed: 02/06/2023]
Abstract
The increased global prevalence of obesity over the last 40-years has driven a rise in prevalence of obesity-related co-morbidities, including polycystic ovary syndrome (PCOS). On a background of genetic susceptibility, PCOS often becomes clinically manifest following weight gain, commonly during adolescence. A common endocrinopathy affecting between 6%-10% of reproductive-age women, PCOS presents with the cardinal features of hyperandrogenism, reproductive and metabolic dysfunction. PCOS associates with insulin resistance, independently of (but amplified by) obesity. Insulin resistance in PCOS is characterized by abnormal post-receptor signalling within the phosphatidylinositol-kinase (PI3-K) pathway. Multiple factors (including most notably, weight gain) contribute towards the severity of insulin resistance in PCOS. Compensatory hyperinsulinaemia ensues, resulting in over-stimulation of the (intact) post-receptor mitogen-activated protein kinase (MAP-K) insulin pathway, with consequent implications for steroidogenesis and ovarian function. In this concise review, we explore the effects of weight gain and obesity on the pathogenesis of PCOS from the perspective of its three cardinal features of hyperandrogenism, reproductive and metabolic dysfunction, with a focus on the central mediating role of the insulin pathway. We also consider key lifestyle strategies for the effective management of obese and overweight women with PCOS.
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Affiliation(s)
- Thomas M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Stephen Franks
- Institute of Reproductive & Developmental Biology, Department of Metabolism, Digestion & Reproduction, Imperial College London, London, UK
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Pirotta S, Joham A, Grieger JA, Tay CT, Bahri-Khomami M, Lujan M, Lim SS, Moran LJ. Obesity and the Risk of Infertility, Gestational Diabetes, and Type 2 Diabetes in Polycystic Ovary Syndrome. Semin Reprod Med 2021; 38:342-351. [PMID: 33873233 DOI: 10.1055/s-0041-1726866] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review describes the relationship between obesity and the most common reproductive (infertility) and metabolic (gestational diabetes mellitus [GDM] and type 2 diabetes mellitus [T2DM]) consequences in polycystic ovary syndrome (PCOS). It also describes the vital role of lifestyle management for PCOS. PCOS is a heterogeneous endocrine disorder common in reproductive-age women. Consensus on the exact etiological mechanisms of PCOS is unreached. Overweight or obesity is present in at least 60% of the PCOS population, but the condition occurs irrespective of BMI, with excess BMI increasing both the prevalence and severity of clinical features. Use of lifestyle therapies (nutrition, physical activity, and/or behavioral) for the prevention and management of excess weight gain, infertility, GDM, and T2DM is a vital component of best-practice PCOS care. Lifestyle management is recommended for all women with PCOS as the first-line treatment with or without medications. Due to a lack of high-quality trials demonstrating the efficacy of specific lifestyle approaches, PCOS lifestyle recommendations are as those for the general population. This review summarizes current knowledge relating to obesity and its impact on fertility, GDM, and T2DM. It also summarizes the lifestyle recommendations to best manage these conditions in women with PCOS and obesity.
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Affiliation(s)
- Stephanie Pirotta
- Health and Social Care Unit, SPHPM, Monash University, Victoria, Australia
| | - Anju Joham
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia.,Department of Diabetes and Vascular Medicine, Monash Health, Victoria, Australia
| | - Jessica A Grieger
- Adelaide Medical School, University of Adelaide, South Australia, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Chau Tien Tay
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Mahnaz Bahri-Khomami
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Marla Lujan
- Division of Nutritional Sciences, Cornell University, New York
| | - Siew S Lim
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Victoria, Australia
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7
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Alkoudsi KT, Al-Qudah R, Basheti IA. Assessing the effectiveness of a pharmaceutical care service on the quality of life of women with polycystic ovarian syndrome living in war and non-war countries. J Eval Clin Pract 2020; 26:1467-1477. [PMID: 31701623 DOI: 10.1111/jep.13310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Polycystic ovarian syndrome (PCOS) is a serious health problem that affects women of all ages worldwide, including their quality of life (QOL). Interventions on lifestyle modification can be a suitable therapy. This study aimed to evaluate the effect of a PCOS pharmaceutical care service on QOL for women diagnosed with PCOS living in Syria (a country affected by war) and Jordan (non-war-zone country). METHODS PCOS women from both Syria and Jordan with age above 16 years were recruited in the study. Women randomly allocated into active group received an educational intervention by the pharmacist (via oral and written educational module) with special focus on diet and exercise. Women allocated to the control group did not receive the educational intervention. Both groups were followed for 4 months. Women in both groups completed the QOL questionnaire at both baseline and end of study. Multiple-regression analysis was performed to identify factors associated with change in QOL scores across the study. RESULTS PCOS women (n = 118) from both Syria (n = 60) and Jordan (n = 58) were recruited. Unlike control group patients, QOL was significantly improved in the active group at the end of the study for Syrian (102.75 vs 118.50, P < 0.001) and Jordanian women (95.31 vs 112.67, P < 0.001). Study group (active versus control) and difference in anxiety scores across the study were the only independent variables that showed association with the dependent variable, difference in QOL mean scores across the study period. CONCLUSION A pharmacist led intervention on lifestyle modification delivered to PCOS women led to positive effects on QOL scores. The intervention was successful in Syria and Jordan. This highlights the significant role that pharmacists can play in improving the life of women with PCOS whether living in war or non-war-zone countries.
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Affiliation(s)
- Kinda T Alkoudsi
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Raja'a Al-Qudah
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Iman A Basheti
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
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Jena SK, Mishra L, Naik SS, Khan S. Awareness and opinion about polycystic ovarian syndrome (PCOS) among young women: a developing country perspective. Int J Adolesc Med Health 2020; 33:123-126. [PMID: 32549137 DOI: 10.1515/ijamh-2018-0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/02/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the perception on PCOS and its prevalence among adolescent and young women. METHODS The study was conducted over 2 year period in a tertiary care teaching hospital from Eastern India. A pre-formed, validated questionnaire was used to record the details. Descriptive statistics was used to report the findings. RESULTS Of 965 young patients with mean (SD) age 20.64 (2.1) years, 27 (2.79 %) were aware of an entity called PCOS. Awareness among adolescents with PCOS was 25.9 % (7/27). All aware patients belonged to the urban sector with professionals constituting around 48%, of which 11% were students. The major source of information among aware patients was from doctors (40.7%), and friends and Internet (25.9%); rest being from books, newspapers, and teachers. Majority (70%) were aware that diet restriction and exercise were the primary modalities of treatment, whereas, only 3.7% knew about the role of contraceptive pills in PCOS. CONCLUSIONS Awareness regarding PCOS among the young women is very low mainly in the rural set up. Doctors and health staffs should play a major role in spreading awareness of the entity to prevent long term complications.
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Affiliation(s)
| | - Lipsa Mishra
- Department of Obstetrics and Gynecology, AIIMS, Bhubaneswar, India
| | | | - Shahnawaz Khan
- Department of Obstetrics and Gynecology, AIIMS, Bhubaneswar, India
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9
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Kiel IA, Lionett S, Parr EB, Jones H, Røset MAH, Salvesen Ø, Vanky E, Moholdt T. Improving reproductive function in women with polycystic ovary syndrome with high-intensity interval training (IMPROV-IT): study protocol for a two-centre, three-armed randomised controlled trial. BMJ Open 2020; 10:e034733. [PMID: 32086359 PMCID: PMC7044845 DOI: 10.1136/bmjopen-2019-034733] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/15/2020] [Accepted: 02/04/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age and the leading cause of anovulatory infertility. Women with PCOS have a 15-fold higher prevalence of infertility, compared with women without PCOS, independent of body mass index (BMI). A healthy lifestyle is recommended to improve overall health and fertility in PCOS but there is limited evidence on the isolated effects of exercise, especially for reproductive outcomes. Previous findings indicate superior metabolic health benefits after vigorous compared with moderate-intensity exercise. Our primary aim is to determine the effect of high-intensity interval training (HIT) on menstrual frequency, as a proxy of reproductive function, in women with PCOS. METHODS AND ANALYSIS The study is a two-centre, randomised, controlled trial with three parallel groups. Women (n=64) from Trondheim (Norway) and Melbourne (Australia) with PCOS according to the Rotterdam criteria will be randomly allocated (1:1:1) to high-volume HIT, low-volume HIT or a control group with no exercise after stratifying for BMI < or ≥ 27 kg/m2 and study centre. Measurements for study end points will be undertaken at baseline, after a 16 week exercise intervention and at 12 months following baseline assessments. The primary outcome measure is menstruation frequency, measured as the number of self-reported menstrual bleedings divided by the number of expected menstrual bleedings during a 12-month period. Secondary outcome measurements include markers of cardiovascular, metabolic and reproductive health, as well as quality of life and adherence to and enjoyment of exercise. ETHICS AND DISSEMINATION The Regional Committee Medical Research Ethics, Norway, and The Australian Catholic University Human Research Ethics Committee, Australia, have approved the trial protocol. This trial will provide new insight regarding the impact of exercise on fertility in PCOS. We expect this trial to contribute to new therapeutic exercise strategies as part of clinical care for women with PCOS. TRIAL REGISTRATION NUMBER Clinical trial gov NCT02419482.
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Affiliation(s)
- Ida Almenning Kiel
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Sofie Lionett
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Exercise and Nutrition Research Programme, Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Evelyn Bridget Parr
- Exercise and Nutrition Research Programme, Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Helen Jones
- Research Institute for Sport and Exercise Science (RISES), Liverpool John Moores University, Liverpool, UK
| | - Maria Aurora Hernandez Røset
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Unit of Applied Clinical Research, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eszter Vanky
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Barber TM, Hanson P, Weickert MO, Franks S. Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. CLINICAL MEDICINE INSIGHTS. REPRODUCTIVE HEALTH 2019; 13:1179558119874042. [PMID: 31523137 PMCID: PMC6734597 DOI: 10.1177/1179558119874042] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/05/2019] [Indexed: 01/06/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a common female condition typified by reproductive, hyperandrogenic, and metabolic features. Polycystic ovary syndrome is a genetic condition, exacerbated by obesity. There is a close link between obesity and PCOS based on epidemiological data, and more recently corroborated through genetic studies. There are many mechanisms mediating the effects of weight-gain and obesity on the development of PCOS. The metabolic effects of insulin resistance and steroidogenic and reproductive effects of hyperinsulinaemia are important mechanisms. Adipokine production by subcutaneous and visceral fat appears to play a part in metabolic function. However, given the complexity of PCOS pathogenesis, it is important also to consider possible effects of PCOS on further weight-gain, or at least on hampering attempts at weight-loss and maintenance through lifestyle changes. Possible mediators of these effects include changes in energy expenditure, mental ill health, or physical inactivity. In this brief review, we discuss the main mechanisms that underlie the association between obesity and PCOS, from divergent perspectives of weight-gain contributing to development of PCOS and vice versa. We also consider novel management options for women with obesity and PCOS.
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Affiliation(s)
- Thomas M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Petra Hanson
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin O Weickert
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK.,Centre of Applied Biological and Exercise Sciences, Coventry University, Coventry, UK
| | - Stephen Franks
- Institute of Reproductive Medicine, Imperial College London, London, UK
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11
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Prevalence of anxiety and depression among women with Polycystic Ovary Syndrome living in war versus non-war zone countries: A randomized controlled trial assessing a pharmacist intervention. Res Social Adm Pharm 2019; 16:689-698. [PMID: 31420190 DOI: 10.1016/j.sapharm.2019.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 07/22/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is a serious health problem. In women experiencing PCOS, there are myriad physical and mental health consequences; anxiety/depression are commonly associated with this condition. Community pharmacists are in a pivotal position to identify and help women diagnosed with PCOS. OBJECTIVES To investigate the prevalence/severity of anxiety/depression among females diagnosed with PCOS living in Syria (a war-zone country) and Jordan (a non-war zone country). Secondly, to evaluate the impact of a pharmaceutical care service delivered by a clinical pharmacist on participants' anxiety/depression severity. METHODS Females, diagnosed with PCOS above the age of 16, were recruited into the study and randomly allocated into either the active or the control group. The active group participants received a PCOS pharmaceutical care service. This service involved the provision of verbal and written educational materials, with a special focus on diet and exercise. The control group participants received only standard counseling. Both groups were followed up for four months. All participants completed the Beck Anxiety Inventory and the Beck Depression Inventory at baseline and follow-up. RESULTS Data from study participants (n = 118) from both Syria (n = 60) and Jordan (n = 58) highlighted a high prevalence of anxiety (Syria = 95% vs. Jordan = 98%) and depression (Syria = 83% vs. Jordan = 65%). At follow-up, active group participants, from both countries, showed significant improvements in anxiety and depression mean scores (anxiety: Syria = 34.97 ± 14.8 vs. 30.47 ± 14.3, p < 0.001; Jordan = 26.93 ± 13.7 vs. 23.37 ± 15.2, p < 0.001; depression: Syria = 26.53 ± 12.6 vs. 22.93 ± 12.2, p < 0.001; Jordan = 17.70 ± 11.0 vs. 15.76 ± 11.1, p = 0.049). No significant improvements were evident for control group participants from either countries. CONCLUSION Prevalence of anxiety/depression for females with PCOS living in Syria and in Jordan is high and calls for special attention by healthcare specialists and policymakers in both countries. Females, who received the PCOS pharmaceutical care service, showed significant improvements in anxiety/depression scores. Improvements were similar in both countries.
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The Effect of Resistance Training in Water and Land with Vitamin D Supplementation on Anti-Mullerian Hormone in Women with Polycystic Ovary Syndrome. WOMEN’S HEALTH BULLETIN 2019. [DOI: 10.5812/whb.84882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Rofey DL, El Nokali NE, Jackson Foster LJ, Seiler E, McCauley HL, Miller E. Weight Loss Trajectories and Adverse Childhood Experience among Obese Adolescents with Polycystic Ovary Syndrome. J Pediatr Adolesc Gynecol 2018. [PMID: 29526815 DOI: 10.1016/j.jpag.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE To examine the effect of childhood trauma and family history of psychiatric illness on weight loss trajectories of obese, female adolescents with polycystic ovary syndrome (PCOS). DESIGN Prospective study. SETTING PCOS and adolescent medicine outpatient clinics. PARTICIPANTS Participants were, on average, 15.8 years of age, 80% Caucasian (39/49 participants), and had a body mass index of 36.8 ± 8.8. INTERVENTIONS Healthy Bodies, Healthy Minds is an evidence-based one-on-one intervention consisting of 4 weekly sessions, 4 biweekly sessions, and 3 monthly booster sessions. Each session was 45-60 minutes long with 15-30 minutes of physical activity with a lifestyle coach. MAIN OUTCOME MEASURES Paired sample t tests were used to assess group differences in pre- and post-treatment weight between participants reporting childhood trauma and body mass index-matched controls not endorsing trauma. One-way analysis of variance was performed to assess the influence of childhood trauma on weight loss between the 2 groups. RESULTS Adolescents without a family history of psychiatric illness lost more weight (mean, -1.28 kg; SD, 6.89) than those who had a family history of psychiatric illness (mean, -0.64 kg; SD, 4.7) from baseline to booster session completion (6 months). However, results of independent t tests did not reveal statistically significant group differences in weight loss from baseline to booster session completion (t21 = 0.51; P = .6). CONCLUSION Obese adolescents with PCOS who have experienced childhood trauma can lose weight and acquire its health benefits when enrolled in an intervention addressing weight, mood, and sleep. Family history of psychiatric illness emerged as a potential predictor of lesser weight loss.
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Affiliation(s)
- Dana L Rofey
- Weight Management and Wellness Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.
| | - Nermeen E El Nokali
- Weight Management and Wellness Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Lovie J Jackson Foster
- Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emily Seiler
- University of Pittsburgh School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heather L McCauley
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Benham JL, Yamamoto JM, Friedenreich CM, Rabi DM, Sigal RJ. Role of exercise training in polycystic ovary syndrome: a systematic review and meta-analysis. Clin Obes 2018; 8:275-284. [PMID: 29896935 DOI: 10.1111/cob.12258] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 01/20/2023]
Abstract
Preliminary evidence suggests exercise in polycystic ovary syndrome (PCOS) may improve reproductive and cardiometabolic parameters. Our primary aim was to determine the impact of exercise training on reproductive health in women with PCOS. Our secondary aim was to determine the effect of exercise training on cardiometabolic indices. A systematic review of published literature was conducted using MEDLINE and EMBASE based on a pre-published protocol (PROSPERO CRD42017065324). The search was not limited by year. Randomized controlled trials, non-randomized controlled trials and uncontrolled trials that evaluated an exercise intervention in women with PCOS and reported reproductive outcomes were included. Reproductive outcomes were analysed semi-quantitatively and a meta-analysis was conducted for reported cardiometabolic outcomes. Of 517 screened abstracts, 14 studies involving 617 women with PCOS were included: seven randomized controlled trials, one non-randomized controlled trial and six uncontrolled trials. There were insufficient published data to describe the effect of exercise interventions on ovulation quantitatively, but semi-quantitative analysis suggested that exercise interventions may improve menstrual regularity, pregnancy and ovulation rates. Our meta-analysis found that exercise improved lipid profiles and decreased waist circumference, systolic blood pressure and fasting insulin. The impact of exercise interventions on reproductive function remains unclear. However, our meta-analysis suggests that exercise interventions may improve cardiometabolic profiles in women with PCOS.
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Affiliation(s)
- J L Benham
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J M Yamamoto
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - C M Friedenreich
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Holy Cross Centre, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - D M Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R J Sigal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kiel IA, Lundgren KM, Mørkved S, Kjøtrød SB, Salvesen Ø, Romundstad LB, Moholdt T. Women undergoing assisted fertilisation and high-intensity interval training: a pilot randomised controlled trial. BMJ Open Sport Exerc Med 2018; 4:e000387. [PMID: 30057778 PMCID: PMC6059324 DOI: 10.1136/bmjsem-2018-000387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Overweight and obese women often seek assisted fertilisation. In the obese population, pregnancy rates are 30%-75% below that of normal weight women who undergo assisted fertilisation. We hypothesised that high-intensity interval training (HIT) would improve fertility by improving insulin sensitivity and thus affect the hypothalamic-pituitary-ovarian axis and ovarian androgen production. Our aim was to assess whether HIT prior to assisted fertilisation would increase pregnancy rate. METHODS Eighteen overweight and obese women (body mass index>25.0 kg/m2) were randomised to HIT (n=8) or usual care (control, n=10) before assisted fertilisation. HIT was undertaken three times weekly for 10 weeks; two sessions of 4×4 min HIT and one session of 10×1 min HIT. Primary outcome was ongoing pregnancy. Secondary outcomes included insulin sensitivity, reproductive hormones, oxygen uptake and body composition. RESULTS Four women got pregnant in both the HIT group (50%) and in the control group (44%), no between-group difference (p=0.6). Insulin sensitivity (glucose infusion rate) improved significantly after HIT, from 264.1 mg/m2/min (95% CI 193.9 to 334.4) at baseline to 324.7 mg/m2/min (95% CI 247.2 to 402.2) after 10 weeks (between-group difference, p=0.04). Fasting glucose, visceral fat, waist circumference and VO2peak were significantly improved in the group that undertook HIT. CONCLUSIONS HIT significantly improved insulin sensitivity, VO2peak and abdominal fat. Low statistical power makes it difficult to conclude on whether HIT prior to assisted fertilisation could increase pregnancy rate. Larger trials are needed to determine if improvements in insulin sensitivity are clinically relevant for assisted fertilisation success rates in this population.
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Affiliation(s)
- Ida Almenning Kiel
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Magrethe Lundgren
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siv Mørkved
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrun Beate Kjøtrød
- Department of Public Health and General Practice, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
- Research Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Fertility, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Liv Bente Romundstad
- Department of Public Health and General Practice, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women's Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Dokras A, Stener-Victorin E, Yildiz BO, Li R, Ottey S, Shah D, Epperson N, Teede H. Androgen Excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Steril 2018; 109:888-899. [PMID: 29778388 DOI: 10.1016/j.fertnstert.2018.01.038] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To formulate clinical consensus recommendations for screening depression, anxiety, health-related quality of life (HRQoL), and disordered eating symptoms in women with polycystic ovary syndrome (PCOS) and review prevalence based on phenotypes and ethnicity, changes over time, etiology, and impact of treatment. DESIGN Systematic reviews and preparation of position statement. SETTING Not applicable. PATIENT(S) Women with PCOS and controls screened using validated tools. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Depressive symptoms, anxiety symptoms, disordered eating, and HRQoL scores. RESULT(S) Several studies demonstrate that women with PCOS have an increased prevalence of higher depression and anxiety scores and higher odds of moderate and severe depressive and anxiety symptoms compared with controls. Obesity, hyperandrogenism, and fertility have a weak association with these symptoms. HRQoL scores are consistently reduced in PCOS, with infertility and weight concerns having the most significant impact. Some studies suggest an increased prevalence of disordered eating in women with PCOS compared with controls. The few studies that have evaluated the impact of PCOS-related treatments (lifestyle interventions and pharmacotherapy) show no detrimental effect or some improvement in depressive and anxiety symptoms and HRQoL scores. CONCLUSION(S) In women with PCOS, screening for depressive and anxiety symptoms should be offered at the time of diagnosis and screening for disordered eating should be considered. Further research is required across PCOS phenotypes, in longitudinal cohorts and on impact of therapy on depressive and anxiety syptoms, HRQOL, and disordered eating.
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Affiliation(s)
- Anuja Dokras
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Bulent O Yildiz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Hacettepe, Ankara, Turkey
| | - Rong Li
- Department of Obstetrics and Gyneocology, Reproductive Medical Center, Peking University Third Hosptal, Bejing, People's Republic of China
| | | | | | - Neill Epperson
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University and Monash Health, Clayton, Victoria, Australia
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Anwar S, Shikalgar N. Prevention of type 2 diabetes mellitus in polycystic ovary syndrome: A review. Diabetes Metab Syndr 2017; 11 Suppl 2:S913-S917. [PMID: 28711517 DOI: 10.1016/j.dsx.2017.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 07/01/2017] [Indexed: 01/28/2023]
Abstract
Polycystic ovary syndrome (PCOS) is recognized as one of the most common endocrinopathies in women of reproductive age, associated with metabolic sequelae which includes increased risk factors for impaired glucose tolerance (IGT), type 2 diabetes mellitus (DM2) and cardiovascular disease (CVD). The adverse effects of DM2 affects a woman throughout her lifespan. Health care expenditure of DM2 highlights the need for prevention through appropriate screening, diagnosis and intervention. Lifestyle modification (LSM) programs that include diet and/or physical activity are suggested for patients characterized as prediabetic to delay the onset of adult DM2. Diet (i.e. low carbohydrate), combination of aerobic and resistance exercise with high intensity interval training (HIT) 150 to 175min/week with resistance exercise 2 to 3days/week and weight loss may be valuable supporters in the fight against IR, IGT and DM2 associated with PCOS.
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Affiliation(s)
- Safa Anwar
- Department of Physical Therapy, College of Applied Medical Sciences, Buraydah Private Colleges, Qassim, Saudi Arabia.
| | - Nigar Shikalgar
- Department of Physical Therapy, College of Applied Medical Sciences, Buraydah Private Colleges, Qassim, Saudi Arabia
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Aghaie F, Khazali H, Hedayati M, Akbarnejad A. The Effects of Exercise on Expression of CYP19 and StAR mRNA in Steroid-Induced Polycystic Ovaries of Female Rats. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:298-303. [PMID: 29043706 PMCID: PMC5641462 DOI: 10.22074/ijfs.2018.5035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 04/11/2017] [Indexed: 12/23/2022]
Abstract
Background: Polycystic ovarian syndrome (PCOS) is the most frequent female endocrine disorder that affects
5-10% of women. PCOS is characterized by hyperandrogenism, oligo-/anovulation, and polycystic ovaries. The
aim of the present research is to evaluate the expression of steroidogenic acute regulatory protein (StAR) and
aromatase (CYP19) mRNA in the ovaries of an estradiol valerate (EV)-induced PCOS rat model, and the effect of
treadmill and running wheel (voluntary) exercise on these parameters. Materials and Methods: In this experimental study, we divided adult female Wistar rats that weighed approximately
220 ± 20 g initially into control (n=10) and PCOS (n=30). Subsequently, PCOS group were divided to
PCOS, PCOS with treadmill exercise (P-ExT), and PCOS with running wheel exercise (P-ExR) groups (n=10
per group). The expressions of StAR and CYP19 mRNA in the ovaries were determined by quantitative real-time
reverse transcriptase polymerase chain reaction (qRT-PCR). Data were analyzed by one-way ANOVA using SPSS
software, version 16. The data were assessed at α=0.05. Results: There was significantly lower mRNA expression of CYP19 in the EV-induced PCOS, running wheel and
treadmill exercise rats compared to the control group (P<0.001). Treadmill exercise (P=0.972) and running wheel
exercise (P=0.839) had no significant effects on CYP19 mRNA expression compared to the PCOS group. mRNA
expression of StAR in the ovaries of the PCOS group indicated an increasing trend compared to the control group,
however this was not statistically significant (P=0.810). We observed that 8 weeks of running wheel and treadmill
exercises could not statistically decrease StAR mRNA expression compared to the PCOS group (P=0.632). Conclusion: EV-induced PCOS in rats decreased CYP19 mRNA expression, but had no effect on StAR mRNA expression.
We demonstrated that running wheel and moderate treadmill exercise could not modify CYP19 and StAR
mRNA expressions.
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Affiliation(s)
- Fatemeh Aghaie
- Department of Physiology, Faculty of Life Science and Biotechnology, Shahid Beheshti University, Tehran, Iran. Electronic address :
| | - Homayoun Khazali
- Department of Physiology, Faculty of Life Science and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbarnejad
- College of Physical Education and Sports Sciences, University of Tehran, Tehran, Iran
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Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-age women. PCOS causes hyperandrogenism and anovulation and increases the risk of multiple health conditions including infertility, diabetes mellitus, and cardiovascular disease. This article outlines current recommendations for diagnostic testing, treatment options, and holistic care of the woman with PCOS.
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Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2016; 25 Suppl 3:1-72. [PMID: 26606383 DOI: 10.1111/sms.12581] [Citation(s) in RCA: 1694] [Impact Index Per Article: 211.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/12/2022]
Abstract
This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.
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Affiliation(s)
- B K Pedersen
- The Centre of Inflammation and Metabolism and The Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Saltin
- The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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21
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Cao SF, Hu WL, Wu MM, Jiang LY. Effects of Exercise Intervention on Preventing Letrozole-Exposed Rats From Polycystic Ovary Syndrome. Reprod Sci 2016; 24:456-462. [DOI: 10.1177/1933719116657892] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Si-Fan Cao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People’s Republic of China
- Luohu Population & Family Planning Service Center, Shenzhen, Guangdong, People’s Republic of China
| | - Wen-Long Hu
- Department of Pathogen Biology, School of Basic Medicine, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People’s Republic of China
| | - Min-Min Wu
- Department of Obstetrics and Gynecology, Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, People’s Republic of China
| | - Li-Yan Jiang
- Department of Obstetrics and Gynecology, School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People’s Republic of China
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Vizza L, Smith CA, Swaraj S, Agho K, Cheema BS. The feasibility of progressive resistance training in women with polycystic ovary syndrome: a pilot randomized controlled trial. BMC Sports Sci Med Rehabil 2016; 8:14. [PMID: 27175282 PMCID: PMC4865007 DOI: 10.1186/s13102-016-0039-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 05/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND To evaluate the feasibility of executing a randomized controlled trial of progressive resistance training (PRT) in women with polycystic ovary syndrome (PCOS). METHODS Women with PCOS were randomized to an experimental (PRT) group or a no-exercise (usual care) control group. The PRT group was prescribed two supervised and two unsupervised (home-based) training sessions per week for 12 weeks. Feasibility outcomes included recruitment and attrition, adherence, adverse events, and completion of assessments. Secondary outcomes, collected pre and post intervention, included a range of pertinent physiological, functional and psychological measures. RESULTS Fifteen participants were randomised into the PRT group (n = 8) or control group (n = 7); five women (n = 2 in PRT group and n = 3 in control group) withdrew from the study. The most successful recruitment sources were Facebook (40 %) and online advertisement (27 %), while least successful methods were referrals by clinicians, colleagues and flyers. In the PRT group, attendance to supervised sessions was higher (95 %; standard deviation ±6 %) compared to unsupervised sessions (51 %; standard deviation ±28 %). No adverse events were attributed to PRT. Change in menstrual cycle status was not significantly different between groups over time (p = 0.503). However, the PRT group significantly increased body weight (p = 0.01), BMI (p = 0.04), lean mass (p = 0.01), fat-free mass (p = 0.005) and lower body strength (p = 0.03), while reducing waist circumference (p = 0.03) and HbA1c (p = 0.033) versus the control group. The PRT group also significantly improved across several domains of disease-specific and general health-related quality of life, depression, anxiety and exercise self-efficacy. CONCLUSION A randomized controlled trial of PRT in PCOS would be feasible, and this mode of exercise may elicit a therapeutic effect on clinically important outcomes in this cohort. The success of a large-scale trial required to confirm these findings would be contingent on addressing the feasibility hurdles identified in this study with respect to recruitment, attrition, compliance, and collection of standardized clinical data. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry; ACTRN12614000517673 Registered 15 May 2014.
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Affiliation(s)
- Lisa Vizza
- />School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Caroline A. Smith
- />The National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751 Australia
| | - Soji Swaraj
- />Department of Endocrinology, Concord Repatriation General Hospital, Concord West, NSW 2138 Australia
| | - Kingsley Agho
- />School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Birinder S. Cheema
- />School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
- />The National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751 Australia
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Conte F, Banting L, Teede HJ, Stepto NK. Mental health and physical activity in women with polycystic ovary syndrome: a brief review. Sports Med 2015; 45:497-504. [PMID: 25430602 PMCID: PMC4382527 DOI: 10.1007/s40279-014-0291-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This review was designed to consider the available literature concerning mental health and physical activity in women with polycystic ovary syndrome (PCOS). A systematic approach was taken and two electronic databases (PubMed and EBSCO Research articles published between 1970 and 2013) were searched in 2013 to inform a narrative review. Inclusion criteria encompassed requirements for the research to involve a physical activity intervention and assessment of mental health outcomes in women with PCOS. Seven articles considered mental health outcomes and physical activity interventions for women with PCOS. The results demonstrated positive outcomes following physical activity intervention for health-related quality of life, depression, and anxiety. Only one paper reported the independent effects of physical activity on mental health. All other interventions included multi-factor lifestyle interventions or did not establish a control group. Physical activity is likely to be beneficial to the mental health of women with PCOS; however, more research is required to establish the nature of the relationship between physical activity and mental health outcomes.
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Affiliation(s)
- Francesca Conte
- Institute of Sport, Exercise and Active Living, Victoria University, Footscray Park Campus, PO Box 14428, Melbourne, VIC, 8001, Australia
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Bann D, Wu FCW, Keevil B, Lashen H, Adams J, Hardy R, Muniz G, Kuh D, Ben‐Shlomo Y, Ong KK. Changes in testosterone related to body composition in late midlife: Findings from the 1946 British birth cohort study. Obesity (Silver Spring) 2015; 23:1486-92. [PMID: 26053924 PMCID: PMC4744737 DOI: 10.1002/oby.21092] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/25/2015] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Randomized trials in men with testosterone deficiency have provided evidence of short-term effects of testosterone therapy on muscle and fat mass but it is unclear whether this persists over a longer period or how testosterone affects women. We examined whether the midlife decline in testosterone relates to fat and lean mass in both sexes. METHODS Data were collected from 440 men and 560 women participating in the 1946 British birth cohort study with testosterone measured at 53 and/or 60-64 years. Fat and appendicular lean mass were measured at 60-64 years using dual-energy X-ray absorptiometry. RESULTS Mean free testosterone concentrations were lower at 60-64 than 53 years, by 26% in both sexes. At both ages testosterone was negatively associated with fat mass in men and positively associated in women. A larger decline in free testosterone was associated with higher fat mass in men but with lower fat mass among women. In contrast, declines in testosterone were not associated with lean mass in either sex. CONCLUSIONS Our findings suggest sex-divergent relationships between testosterone and fat mass and their distribution but do not support the hypothesis that midlife declines in testosterone lead to lower lean mass.
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Affiliation(s)
- David Bann
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Frederick C. W. Wu
- Andrology Research Unit, School of BiomedicineUniversity of ManchesterManchesterUK
| | - Brian Keevil
- Andrology Research Unit, School of BiomedicineUniversity of ManchesterManchesterUK
| | - Hany Lashen
- Department of Human MetabolismThe University of SheffieldSheffieldUK
| | - Judith Adams
- Department of RadiologyCentral Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science CenterManchesterUK
| | - Rebecca Hardy
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | | | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Yoav Ben‐Shlomo
- School of Social and Community MedicineBristol UniversityBristolUK
| | - Ken K. Ong
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK.
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Messinis IE, Messini CI, Anifandis G, Dafopoulos K. Polycystic ovaries and obesity. Best Pract Res Clin Obstet Gynaecol 2015; 29:479-88. [DOI: 10.1016/j.bpobgyn.2014.11.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/01/2014] [Indexed: 01/29/2023]
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26
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Progressive Resistance Training in Polycystic Ovary Syndrome: Can Pumping Iron Improve Clinical Outcomes? Sports Med 2014; 44:1197-207. [DOI: 10.1007/s40279-014-0206-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Li X, Guo YR, Lin JF, Feng Y, Billig H, Shao R. Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance. J Cancer 2014; 5:173-81. [PMID: 24563672 PMCID: PMC3931265 DOI: 10.7150/jca.8009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/14/2014] [Indexed: 01/02/2023] Open
Abstract
Background: Young women with polycystic ovary syndrome (PCOS) have a high risk of developing endometrial carcinoma. There is a need for the development of new medical therapies that can reduce the need for surgical intervention so as to preserve the fertility of these patients. The aim of the study was to describe and discuss cases of PCOS and insulin resistance (IR) women with early endometrial carcinoma while being co-treated with Diane-35 and metformin. Methods: Five PCOS-IR women who were scheduled for diagnosis and therapy for early endometrial carcinoma were recruited. The hospital records and endometrial pathology reports were reviewed. All patients were co-treated with Diane-35 and metformin for 6 months to reverse the endometrial carcinoma and preserve their fertility. Before, during, and after treatment, endometrial biopsies and blood samples were obtained and oral glucose tolerance tests were performed. Endometrial pathology was evaluated. Body weight (BW), body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), insulin area under curve (IAUC), and homeostasis model assessment of insulin resistance (HOMA-IR) were determined. Results: Clinical stage 1a, low grade endometrial carcinoma was confirmed before treatment. After 6 months of co-treatment, all patients showed normal epithelia. No evidence of atypical hyperplasia or endometrial carcinoma was found. Co-treatment resulted in significant decreases in BW, BMI, TT, FAI, IAUC, and HOMA-IR in parallel with a significant increase in SHBG. There were no differences in the FSH and LH levels after co-treatment. Conclusions: Combined treatment with Diane-35 and metformin has the potential to revert the endometrial carcinoma into normal endometrial cells in PCOS-IR women. The cellular and molecular mechanisms behind this effect merit further investigation.
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Affiliation(s)
- Xin Li
- 1. Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China ; 2. Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Yan-Rong Guo
- 1. Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Jin-Fang Lin
- 1. Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
| | - Yi Feng
- 2. Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden ; 3. Department of Integrative Medicine and Neurobiology, State Key Lab of Medical Neurobiology, Shanghai Medical College and Institute of Acupuncture Research (WHO Collaborating Center for Traditional Medicine), Institute of Brain Science, Fudan University, Shanghai 200032, China
| | - Håkan Billig
- 2. Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
| | - Ruijin Shao
- 2. Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg 40530, Sweden
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Panidis D, Tziomalos K, Papadakis E, Vosnakis C, Chatzis P, Katsikis I. Lifestyle intervention and anti-obesity therapies in the polycystic ovary syndrome: impact on metabolism and fertility. Endocrine 2013; 44:583-90. [PMID: 23625194 DOI: 10.1007/s12020-013-9971-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/23/2013] [Indexed: 12/17/2022]
Abstract
Obesity is frequently present in patients with polycystic ovary syndrome (PCOS) and plays an important role in the pathogenesis of the metabolic, endocrine, and reproductive abnormalities associated with this syndrome. We aimed to summarize the effects of lifestyle changes and anti-obesity pharmacotherapy in patients with PCOS. We reviewed the literature regarding the effects of lifestyle changes and anti-obesity agents on the metabolic and endocrine abnormalities of PCOS. Lifestyle changes, including diet, exercise, and behavioral modification, appear to improve the metabolic and reproductive abnormalities of overweight and obese patients with PCOS. Therefore, lifestyle changes appear to represent the first-line management for all overweight and obese patients with PCOS. However, the optimal composition of diet and the optimal type of exercise in these patients are unknown. Anti-obesity agents that have been studied in PCOS include orlistat, sibutramine, and rimonabant. However, the latter two agents have been withdrawn from the market because of side effects. Long-term studies with orlistat in overweight and obese diabetic patients showed greater weight loss and metabolic and cardiovascular benefits than those achieved with lifestyle changes alone. However, there are limited data on the efficacy of orlistat in women with PCOS. In conclusion, lifestyle changes (diet, exercise and behavioral modification), particularly when combined with anti-obesity agents, exert beneficial effects on the endocrine abnormalities of obese patients with PCOS and improve metabolic parameters.
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Affiliation(s)
- Dimitrios Panidis
- Division of Endocrinology and Human Reproduction, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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29
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Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol 2013; 2:1143-211. [PMID: 23798298 DOI: 10.1002/cphy.c110025] [Citation(s) in RCA: 1248] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic diseases are major killers in the modern era. Physical inactivity is a primary cause of most chronic diseases. The initial third of the article considers: activity and prevention definitions; historical evidence showing physical inactivity is detrimental to health and normal organ functional capacities; cause versus treatment; physical activity and inactivity mechanisms differ; gene-environment interaction (including aerobic training adaptations, personalized medicine, and co-twin physical activity); and specificity of adaptations to type of training. Next, physical activity/exercise is examined as primary prevention against 35 chronic conditions [accelerated biological aging/premature death, low cardiorespiratory fitness (VO2max), sarcopenia, metabolic syndrome, obesity, insulin resistance, prediabetes, type 2 diabetes, nonalcoholic fatty liver disease, coronary heart disease, peripheral artery disease, hypertension, stroke, congestive heart failure, endothelial dysfunction, arterial dyslipidemia, hemostasis, deep vein thrombosis, cognitive dysfunction, depression and anxiety, osteoporosis, osteoarthritis, balance, bone fracture/falls, rheumatoid arthritis, colon cancer, breast cancer, endometrial cancer, gestational diabetes, pre-eclampsia, polycystic ovary syndrome, erectile dysfunction, pain, diverticulitis, constipation, and gallbladder diseases]. The article ends with consideration of deterioration of risk factors in longer-term sedentary groups; clinical consequences of inactive childhood/adolescence; and public policy. In summary, the body rapidly maladapts to insufficient physical activity, and if continued, results in substantial decreases in both total and quality years of life. Taken together, conclusive evidence exists that physical inactivity is one important cause of most chronic diseases. In addition, physical activity primarily prevents, or delays, chronic diseases, implying that chronic disease need not be an inevitable outcome during life.
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Affiliation(s)
- Frank W Booth
- Departments of Biomedical Sciences, Medical Pharmacology and Physiology, and Nutrition and Exercise Physiology, Dalton Cardiovascular Institute, University of Missouri, Columbia, Missouri, USA.
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30
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Mani H, Khunti K, Levy M, Davies MJ. Diabetes advice for women with polycystic ovary syndrome: prevention, prevention, prevention. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/dmt.13.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Roessler KK, Birkebaek C, Ravn P, Andersen MS, Glintborg D. Effects of exercise and group counselling on body composition and VO2maxin overweight women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2013; 92:272-7. [DOI: 10.1111/aogs.12064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 11/22/2012] [Indexed: 01/07/2023]
Affiliation(s)
- Kirsten K. Roessler
- Department of Psychology; Faculty of Health Science; University of Southern Denmark; Odense
| | - Camilla Birkebaek
- Institute of Sports Science and Clinical Biomechanics; University of Southern Denmark; Odense
| | - Pernille Ravn
- Department of Gynecology and Obstetrics; Odense University Hospital; Odense; Denmark
| | | | - Dorte Glintborg
- Department of Endocrinology; Odense University Hospital; Odense; Denmark
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Dietary intake, glucose metabolism and sex hormones in women with polycystic ovary syndrome (PCOS) compared with women with non-PCOS-related infertility. Br J Nutr 2012; 109:2190-8. [PMID: 23046530 DOI: 10.1017/s0007114512004369] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The present study investigated dietary intake, glucose metabolism and sex hormones in women with polycystic ovary syndrome (PCOS). A total of forty-five women (aged 25–40 years) with PCOS and 161 control women (aged 25–43 years) with non-PCOS-related infertility were recruited. Anthropometry, glucose tolerance and sex hormones were determined and dietary intake was assessed. Women with PCOS had lower serum sex hormone-binding globulin and increased BMI, waist:hip ratio, luteinising hormone, ratio of luteinising hormone: follicle-stimulating hormone, testosterone and free androgen index (FAI). Postprandial glucose, fasting insulin and insulin resistance were elevated in women with PCOS. Women with PCOS had reduced energy and carbohydrate intake but higher fat intake. Serum sex hormone-binding globulin level was negatively associated with BMI in both groups and negatively correlated with macronutrient intake in the PCOS group with hyperandrogenism. However, FAI was positively correlated with BMI, waist circumference and glucose metabolic parameters in both groups. Therefore, women with PCOS consume lower energy and carbohydrate compared with those with non-PCOS-related infertility and macronutrient intake is only negatively associated with serum sex hormone-binding globulin level in the PCOS group with hyperandrogenism.
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Chen MJ, Han DS, Yang JH, Yang YS, Ho HN, Yang WS. Myostatin and its association with abdominal obesity, androgen and follistatin levels in women with polycystic ovary syndrome. Hum Reprod 2012; 27:2476-83. [PMID: 22693174 DOI: 10.1093/humrep/des209] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the role of myostatin and its relationship with obesity, androgens and follistatin levels in women with polycystic ovary syndrome (PCOS)? SUMMARY ANSWERS: The myostatin level was positively correlated to the risk of abdominal obesity, but negatively associated with circulating levels of dehydroepiandrosterone sulfate (DHEAS) and follistatin in women with PCOS. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Myostatin is a well-known negative regulator of skeletal muscle and is involved in metabolism; however, little is known about the role of myostatin in women with PCOS. In this study, we found that the myostatin level was positively related to the risk of abdominal obesity, but negatively related to the circulating levels of DHEAS and follistatin in women with PCOS. Such a relationship might imply a potential regulatory role of androgens and follistatin in the metabolism of skeletal muscle in women with PCOS. DESIGN A cross-sectional case-control study. PARTICIPANTS AND SETTING A total of 239 untreated, consecutive women with PCOS and 38 healthy volunteer women without PCOS were enrolled and studied in a tertiary medical center. MAIN RESULTS AND THE ROLE OF CHANCE Myostatin level was higher in women with PCOS than those without PCOS (16.6±15.6 and 14.2±9.7, P=0.025), but were not significantly different between non-obese women with and without PCOS after considering the effect of obesity (P=0.09). Stepwise multivariate regression analysis in women revealed that only the presence of PCOS (β=0.256, P=0.0001), total testosterone (β=0.159, P=0.031), DHEAS (β=-0.188, P=0.0003) and follistatin (β=-0.171, P=0.0001) levels were left in the final model and were significantly related to the myostatin level after considering all the explanatory variables. By using stepwise multivariate regression analysis, the total testosterone levels (β=0.196, P=0.003) were positively, but the DHEAS (β=-0.196, P<0.0001) and follistatin (β=-0.151, P=0.0001) levels were negatively, related to myostatin levels in women with PCOS after adjustment for age, anthropometric measurements, insulin sensitivity index and hormonal profiles. The high myostatin level was associated with the increased risk of abdominal obesity after further adjusting the androgens and follistatin levels in women with PCOS. LIMITATION, REASONS FOR CAUTION This study is a cross-sectional case-control design, and therefore, cannot answer the cause-effect relationship among the androgens, follistatin and myostatin levels. The small sample size and non-obese control group may also limit the application of the conclusion of the present study to general population other than women with PCOS. In addition, lack of data regarding muscle mass is another limitation in this study that prevents clarification of the relationship between myostatin, lean mass and obesity and therefore restricts the clinical application of the results. WIDER IMPLICATIONS OF THE FINDINGS Future studies to investigate the efficacy of exercise and lifestyle modification in treating women with PCOS should consider the myostatin, follistatin and androgen levels as well as the effect of muscle mass and BMI. STUDY FUNDING/COMPETING INTEREST This study was supported by grants NSC97-2314-B002-079-MY3, NSC98-2314-B002-105-MY3 and NSC 100-2314-B002-027-MY3 from the National Science Council of Taiwan. There is no competing interest declared in this study.
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Affiliation(s)
- Mei-Jou Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, and Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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