PCOS lifestyle meta-analysis finds cardiometabolic improvements, but evidence certainty remains low

Women with polycystic ovary syndrome (PCOS) face elevated long-term risks of type 2 diabetes and cardiovascular disease. A systematic review in Human Reproduction Update included 43 randomized trials involving 2,433 participants and evaluated 16 outcomes spanning body composition, glucose and insulin regulation, lipids, inflammation, and blood pressure. Researchers used Bayesian network meta-analysis, excluding pharmacological interventions and interventions lasting less than two weeks.

Within the dietary network, ketogenic diets reduced waist circumference by 5.74 cm (95% credible interval [CrI], −8.48 to −3.04) and BMI by 2.61 kg/m² (95% CrI, −4.53 to −0.77) versus controls; these estimates involved 86 participants across two study arms. Within the exercise network, mind–body exercise ranked highest for several metabolic markers, including HOMA-IR (mean difference, −0.63; 95% CrI, −1.06 to −0.24). Aerobic exercise ranked highest for systolic blood pressure reduction (−3.49 mmHg; 95% CrI, −6.87 to −0.09), while high-intensity interval training ranked highest for HDL cholesterol improvement (0.05 mmol/l; 95% CrI, 0.01 to 0.10).

Dose–response modelling associated approximately 480–1,012 MET-minutes/week of exercise with overlapping predicted benefits across multiple outcomes. However, evidence certainty was generally low or very low, and several estimates relied on small samples. These findings concern cardiometabolic risk markers rather than demonstrated reductions in diabetes or cardiovascular events; treatment rankings and modelled exercise doses should not be interpreted as established optimal prescriptions.