PCOS & Exercise

When it comes to managing PCOS, lifestyle factors can play a strong role. One of these factors is exercise, which has been shown to improve PCOS symptoms such as insulin-resistance and mental health struggles.

But, it’s important to keep in mind that there is no one-size-fits-all approach to PCOS and exercise. While some sources say you must include high intensity workouts in your routine to manage insulin resistance, others maintain that light yoga and walking are the best forms of movement for PCOS.

This messaging is not only inconsistent, it can be overwhelming. When it comes to exercise, the most important thing is to find a form of movement that is as good for our minds as it is for our bodies. And just as it wouldn’t feel fair to tell a runner with PCOS that they must quit endurance sports forever to manage their chronic condition, it seems unrealistic to expect to force someone who does not particularly enjoy exercise to embark on daily HIIT workouts to better manage their symptoms.

At Pollie, we believe that the best form of symptom management is an agenda that feels authentic to you. Exercise is a prime example of this. In this article, we’ll be exploring:

• The research: How has movement been shown to improve PCOS symptom severity?
• The options: How do different forms of exercise uniquely impact PCOS?
• Getting there: How can you think about what forms of movement may be best for you today vs. in the future?

Exercise & PCOS: The research

Exercise has been shown to improve PCOS symptoms (1, 2, 3). For example, it has shown to help with:

• Insulin regulation: People with PCOS experience a much higher rate of insulin resistance than the general population; in fact, it’s estimated that roughly 70% of PCOSers are insulin-resistant! Insulin resistance drives severity of PCOS symptoms, and if you can get this under control, you are one step closer to better managing your PCOS. Exercise has been shown in countless studies to improve insulin resistance (4, 5), and in turn help people see better results in weight management, skin health, energy levels, and more.  
• Mental health: Did you know that people with PCOS are 3x more likely to experience anxiety and depression than people without PCOS? And consistent physical exercise is positively correlated with  fewer “bad” mental health days (6). Exercise helps produce feel-good endorphins, which over time can improve our mental wellbeing.
• Fertility: While evidence is mixed, some research suggests that exercise does improve reproductive function for people with PCOS through helping regulate ovulation (3, 7). More research is needed on this, but in general it is recommended to focus on gentle movement like walks, yoga, and Pilates if you are trying to conceive, particularly if you have non-insulin resistant PCOS.

It’s been shown that all forms of movement, from strength training to aerobic activity, are beneficial for managing PCOS (8). Given this, the TL;DR of exercise and PCOS is to find something that you will do regularly.

So, what types of exercise are out there, and how do they help manage PCOS symptoms?

High intensity exercise (e.g., HIIT)

If you have ever been to a Barry’s Bootcamp, Orange Theory, or similar class, you have experienced high intensity interval training (HIIT) exercise.

This type of exercise is particularly helpful if you have insulin-resistant PCOS or if weight loss is a primary goal in your PCOS journey. Consider the research:

• A meta-analysis of studies relating to PCOS and exercise found that high intensity exercise was the most likely to reduce body mass index (BMI) and insulin resistance in women with PCOS (9).
• In a study that compared vigorous exercisers to those who maintained low and moderate exercise routines, those in the vigorous group exhibited greater insulin sensitivity and lower BMI at the end of the trial (10).

Many PCOS specialists recommend shorter HIIT workouts in lieu of a 60 minute sweat session. If you love the heart-pumping adrenaline of this type of exercise, it is important not to overdo it: a few short HIIT sessions can be helpful, but if you are doing burpees for an hour per day, 7 days per week, your hormones may rebel from not enough recovery time.

To learn more, refer to the “tips for avid exercisers” section below.

Strength training

Believe it or not, strength training is more than Olympic-style weightlifting. It includes any form of resistance training including lighter weights, resistance bands, and body weight exercises.

Strength training is known to greatly improve our metabolic functioning through increasing muscle mass. It has been shown to improve body composition and cardiometabolic profile of people with PCOS (11). It has also been shown to lower androgens, which is a key element that drives PCOS symptoms like irregular ovulation and periods, acne, hair loss, hirsutism, and more (11).

If you are new to strength training and are curious to check it out, consider working with a personal trainer who can help you adjust your form as needed. Especially if you start adding heavier weights, doing an exercise incorrectly can lead to an injury.

Endurance sports

Our co-founder Jane has been what she describes a “sometimes competitive but mostly recreational runner” for over a decade. If you’re a hormonal health nerd that loves to run, swim, cycle, or row, chances are you’ve picked up that endurance sports like long distance running are generally not recommended for women with PCOS.

The reason?

Moderate intensity endurance activities have a real knack for putting your body under stress. Studies show that endurance athletes are at risk for significantly higher long-term cortisol exposure, as our bodies pump this stress hormone out more intensely once our muscles are out of their glycogen stores. This typically happens after roughly 60 minutes of moderate exercise - a duration which many runners, swimmers, and cyclists hit quite frequently.

Cortisol is a stress hormone produced by our adrenal glands that helps control our blood sugar, regulate our metabolism, reduce inflammation, and more. It plays an integral part in our hormonal health, but too much of it can suppress ovulation (the reasoning behind this: our bodies are smart, and don’t want to get pregnant if we are in a high-stress environment) while exasperating the hormonal imbalance symptoms that accompany this.

Armed with this knowledge, we have a decision: forgo endurance exercise in lieu of something that’s more hormonal balance-friendly, or continue in a way that works for us.

While you may need to make short or mid-term tweaks to your endurance exercise if you are trying to get your PCOS under control (e.g., take a temporary break from running or cut your cycling mileage back for several months), let your coach know if your ultimate goal is to re-incorporate these exercises into your lifestyle. While all of our bodies are different and some of our thresholds may be higher or lower for maintaining hormone balance with avid exercise, with patience and experimentation you can find a middle ground. Check out the “tips for avid exercisers” section below for more information on this.

Low & moderate intensity exercise (e.g., yoga, Pilates, walking, easy hiking)

Low and moderate intensity exercise is the least debated of all the exercise types, both for people with PCOS and people without PCOS. While a 20 minute HIIT session may burn more calories than a 20 minute walk, lower intensity movement is more sustainable, you can fit it in to more parts of your day like doing housework, and it poses a lower risk of increasing your stress hormones and leading to physical and emotional burnout.

Examples of low and moderate intensity exercise include:

• Walking
• Low to moderate intense hiking
• Yoga
• Pilates
• Cleaning your house
• Gardening, and more!

Particularly for those with adrenal type PCOS, which is largely aggravated by stress, focusing on lower intensity movement can be helpful. While we can always test out higher intensity exercise once stress and inflammation has been reigned in, it can take some time to get there.

Helpful tips for developing your PCOS exercise routine

Starting a new habit can be daunting, and making changes to an existing routine is challenging. Below are some of our tips for incorporating exercise into your PCOS management plan.

Tips for those new to exercise

• Find movement you love. Key word here: movement. “Exercise” can be a daunting word and for many of us, it is associated with unhealthy fixations on weight, body image, and calorie burn. If traditional forms of exercise feel at all triggering to you or just downright boring, it’s up to you to find other types of movement that both your mind and body enjoy. Do you enjoy long walks and solo dance parties but your skin crawls at the thought of lifting weights or hitting the treadmill? That’s okay. Perhaps with time you will begin to appreciate forms of movement that do not resonate with you today, but do not force yourself to do anything you actively dislike. When it comes to changing our habits, especially with routines that we want to last in order to manage a lifelong chronic condition like PCOS, doing what feels true to you is key. Take an inventory of types of movement that you enjoy or are just convenient to your schedule: walking with friends, doing yard work, hikes with your dog, deep cleaning your home, learning a TikTok dance. When done routinely and mindfully, all forms of movement can ultimately build a healthy foundation and subsequently healthy body.
• Learn, learn, learn! It’s hard to commit to a new routine if you do not understand the “why,” particularly when that new routine includes some not-so-fun aspects like transitioning from a more sedentary to active lifestyle. Getting in shape is not easy, and most people push through several weeks or even months of discomfort before getting into the groove of a new workout regimen. But, understanding how consistent movement can improve your PCOS symptoms and overall health can serve as motivation for your why. Hopefully this article is a starting point, and we advocate you learn more from your coach and Pollie care coordinator if the science behind exercise and PCOS symptoms interests you.

Tips for avid exercisers

• Eat enough. While the saying you can’t out-exercise a bad diet is certainly true - and as a society we tend to overestimate how much energy we expend while working out - research shows that endurance, high impact, and intense sports like running and weightlifting can cause hypothalamic amenorrhea (period loss) if we are not replenishing our body properly. For this reason, sheer energy input (i.e., calories) is really, really, important. Weight plays into this as well, particularly for those with lean PCOS. If you are in a period of active training, you may find that you actually need to weigh more to keep your cycles regular and PCOS symptoms at bay. This may be counterintuitive for endurance junkies who are compulsive about maintaining their goal race weight (or, you know, every one of us who has absorbed a “thinner is better” mentality from the $200B weight loss industry). But for those of us that are avid exercisers, a few additional vanity pounds are well-worth being able to train hard without worrying about period loss and subsequent bone density issues. A good indicator if you are eating enough is having a regular cycle.
• Carbs are not the enemy. This food group gets a really bad rep in the world of PCOS and hormonal health. There’s some truth to that: if you’re making refined grains and processed sugar a major part of your diet, you probably won’t feel so hot. Particularly if you have insulin-resistant PCOS. But! Did you know that you need carbs to ovulate? Moreover, did you know that your body isn’t able to recover as quickly without carbs post-workout? For us endurance athletes, carbs are a must, especially immediately before and after workouts as well as during the follicular phase of our cycle.
• Fats are also not the enemy. Fats are integral to proper hormone functioning. For those who are more active, their importance intensifies. Beyond being an energy-dense source of fuel that can keep you training your best and have enough energy left over to ovulate, incorporating ample health fats can help with skin dryness, acne, brain fog, and poor sleep.
• Keep tabs on other stressors in your life. While exercise is hopefully a good stressor, it can certainly be a bad stressor when you are not giving your body enough time to recover. And, non-exercise stressors can impede your athletic recovery ability. It’s all connected! “Other stressors” translates to lack of sleep, working long hours at work, over-committing socially, the existential crises thrust upon us in 2020, and more.

Questions on this article? Make sure to reach out to your care coordinator or coach!

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