Objective
The purpose of this study was to describe the prevalence and predictors of physical activity in women with polycystic ovary syndrome (PCOS) and to explore the potential health benefits that are associated with physical activity in this population.
Study Design
This was a cross-sectional assessment of 150 women with PCOS. Active women (those who met Department of Health and Human Services [DHHS] guidelines for exercise) were compared with inactive women with regards to demographic and psychosocial variables and health characteristics.
Results
Fifty-nine percent (88/150 women) met the DHHS guidelines for physical activity. Active women were more likely than inactive women to be nulliparous (64.1% vs 40.0%; P = .04) and white (71.6% vs 42.6%; P = .0004). Inactive women were more likely to have mild depression (adjusted odds ratio, 2.2; 95% confidence interval, 1.01–4.79; P = .048).
Conclusion
Women with PCOS who met the DHHS guidelines for physical activity were more likely to enjoy a variety of health benefits. Our findings identify several groups that are at risk for inadequate physical activity.
Polycystic ovary syndrome (PCOS) affects 5-10% of reproductive-aged women and is primarily characterized by ovulatory dysfunction and hyperandrogenism. The long-term health consequences that are associated with PCOS are receiving increasing attention; women with PCOS are at heightened risk for obesity, dyslipidemia, and type II diabetes mellitus and may have an increased incidence of cardiovascular disease later in life.
Lifestyle modifications have been proposed to improve both metabolic and reproductive manifestations of PCOS. Several large intervention studies that have targeted at-risk individuals have shown that diet and exercise programs can decrease the likelihood of the development of diabetes mellitus, but research that addresses the particular effects of lifestyle interventions in women with PCOS is just emerging and is limited to small populations. Currently, there is no specific guideline for the amount or type of exercise that is recommended for women with PCOS. In 2008, the US Department of Health and Human Services (DHHS) updated its guidelines for physical activity for all American adults. Based on evidence regarding the minimum amount of aerobic activity that is necessary to produce substantial health benefits, these guidelines recommend at least 150 minutes of moderate-intensity activity per week or 75 minutes of vigorous-intensity activity per week or an equivalent combination of moderate- and vigorous-intensity physical activity.
National survey data indicate that 60% of all American women meet DHHS guidelines for physical activity. However, the prevalence of this level of physical activity among women with PCOS is not known. In addition, it has not been shown that if, and to what degree, exercise is performed outside the confines of an exercise intervention study correlates with improved cardio-metabolic status in women with PCOS. Finally, women with PCOS may be at increased risk of clinical depression, and exercise is purported to mitigate depressive symptoms. However, relatively little is known of the specific effects of exercise on depression in the PCOS population. Accordingly, this study has 2 primary aims: to describe the prevalence and demographic and psychosocial variables of physical activity that meet the 2008 DHHS guidelines in women with PCOS and to explore cardiometabolic and mental health benefits of such physical activity in this population.
Materials and Methods
Study population
This is a cross-sectional study of patients who were seen in the multidisciplinary PCOS clinic at University California, San Francisco, between May 2006 and October 2009. Institutional Review Board approval was obtained. Women who were ≥16 years old with PCOS were included. Patients were referred by outside providers who were seeking assistance in diagnosis and treatment of patients who were suspected of having PCOS. During a series of 2 visits, patients were evaluated in sequence by a reproductive endocrinologist, dermatologist, genetic counselor, psychologist, and nutritionist. Subsequently, the multidisciplinary team made diagnostic and treatment recommendations that were reviewed with the patient at a second visit.
PCOS diagnosis
Diagnosis of PCOS was made by application of the Rotterdam ESHRE/ASRM criteria. According to these criteria, PCOS was diagnosed if at least 2 of the following indications were present: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasonography. Other causes that appear similar to PCOS were excluded. Clinical hyperandrogenism was defined as the presence of hirsutism (Ferriman-Gallwey score, ≥8) and/or clinically significant acne. Acne was assessed by a single dermatologist and considered clinically relevant when the type, pattern, and distribution were consistent with increased androgen activity in the skin.
Biochemical hyperandrogenism was determined by the measurement of serum androgen (free testosterone, total testosterone, dehydroepiandrosterone sulfate, and androstenedione). Because of constraints of insurance coverage, patients obtained serum androgen levels at 1 of several clinical laboratories; values above the reference range for that particular laboratory were considered diagnostic of biochemical hyperandrogenism. Polycystic ovary was defined as the presence of at least 1 ovary at >10 cm 3 in volume and/or at least 1 ovary with ≥12 follicles that measured 2-9 mm in diameter. Ovarian assessments were made by transvaginal ultrasonography.
Clinical assessments
Before the initial clinic visit, patients completed a series of self-administered questionnaires. Herein, patients provided clinical and demographic information. Depression symptoms were assessed with the 7-item Beck Depression Inventory-Fast Screen (BDI-FS). The BDI-FS is a validated self-report screening inventory that was developed to produce less overlap with symptoms that are caused by many medical disorders (ie, fatigue). Scores of >4 are indicative of mild-to-moderate depression; scores of >9 are indicative of moderate-to-severe depression, and scores of >13 are indicative of severe depression.
Anthropomorphic data were collected systematically at the initial clinic visit. Body mass index (BMI; kilograms per square meter) was calculated and defined according to World Health Organization guidelines: overweight, 25.0-29.9 kg/m 2 ; obese, >30.0 kg/m 2 . Sex hormone–binding globulin, fasting lipids, glucose and insulin, and a 2-hour glucose tolerance test were obtained before the patient visit. Abnormal values for metabolic parameters were based on the American Heart Association definition of metabolic syndrome and the American Diabetes Association definition of impaired glucose tolerance.
Physical activity categorization
Exercise behavior was ascertained by the validated International Physical Activity Questionnaire, which was self-administered before the initial visit. In this questionnaire, moderate exercise is defined as moderate physical effort, such as carrying a light load or bicycling at a regular pace. Vigorous exercise is defined as strenuous physical activity that takes hard physical effort and makes you breathe harder than normal, such as fast bicycling, aerobics, or heavy lifting. Patients reported minutes per day and days per week for each category. Subjects were divided into 2 groups based on whether they met the DHHS guidelines for adequate physical activity. To make this determination, minutes of moderate exercise per week that were reported on the International Physical Activity Questionnaire were added to 2 times the number of minutes of vigorous exercise per week. If the total was ≥150, the patient was considered active (meeting the DHHS Guidelines); if <150 minutes, the patient was considered inactive (not meeting the DHHS Guidelines).
Statistical analysis
Statistical analysis was performed with STATA software (version 9.0; Stata Corporation, College Station, TX). Descriptive data are reported as mean ± SD. Demographic and health-related variables were compared between active and inactive patients with the Student t test or χ 2 test, as appropriate. The relationship between exercise and health outcomes was assessed initially with univariate logistic regression and followed by multiple logistic regression that was adjusted for BMI, age, and ethnicity. An α-level of significance was set at < .05.
Results
Demographic characteristics of the population
Two hundred three patients were examined at the clinic during the study period; of these, 161 women (79.3%) met the Rotterdam criteria for PCOS. One hundred fifty patients with PCOS (150/161; 93.2%) completed the International Physical Activity Questionnaire and comprise the study sample. Of those patients, 97.3% (146/150) completed the Beck Depression Inventory.
Characteristics of the study population are given in Table 1 . All patients had at least partial health insurance. More than 70% (n = 113) were overweight (BMI, >25 kg/m 2 ), and 48% (n = 77) were obese (BMI, >30 kg/m 2 ). Seventy-two percent of the patients (n = 95) reported weight fluctuations, with an average calculated life-time fluctuation (highest weight minus lowest weight) of 22.7 ± 18.6 kg (range, 0–103 kg).
| Variable | Polycystic ovary syndrome [Mean ± SD or n (%)] |
|---|---|
| Age, y, n = 150 a | 28.1 ± 5.9 |
| Marital status, n (%) n = 130 | |
| Single | 69 (55.7) |
| Married/living together | 61 (44.3) |
| Parity, n (%) n = 124 | |
| Nulliparous | 103 (83.7) |
| Parous | 21 (16.3) |
| Household income, n (%) n = 123 | |
| <$75,000/y | 73 (59.4) |
| ≥$75,000/y | 50 (40.6) |
| Education, n (%) n = 128 | |
| Not a college graduate | 37 (28.9) |
| College graduate | 91 (71.1) |
| Ethnicity, n (%) n = 149 | |
| White | 81 (54.4) |
| Asian | 31 (20.8) |
| Latino | 16 (10.7) |
| African American | 10 (6.7) |
| Middle Eastern | 4 (2.7) |
| Other | 7 (4.7) |
| Met Department of Health and Human Services guidelines, n (%) n = 150 | 88 (58.7) |
| Body mass index, kg/m 2 , n = 147 b | 31.5 ± 8.7 (16.6–60.3) |
| Metabolic syndrome, n (%) n = 113 c | 30 (26.6) |
a Data are given as mean ± SD;
b Data are given as mean ± SD (range);
c Defined as at least 3 of the following: systolic blood pressure, >130 mm Hg; diastolic blood pressure, >85 mm Hg; triglycerides, ≥150 mg/dL; high-density lipoprotein, <50 mg/dL; waist, > 88.9 cm; and fasting glucose, ≥100 mg/dL.
Prevalence of physical activity
Fifty-nine percent of the patients (n = 88) were active according the DHHS guidelines defined earlier; 29% of the patients (n = 44) reported no exercise. The mean amount of exercise was just >4 hours (248 minutes) of moderate or vigorous exercise per week, with a median of 140 minutes per week. Among those who meet the DHHS guidelines, the mean amount of exercise was >6 hours per week (403 minutes), with a median of 285 minutes per week. Fifty-four percent of the patients (n = 66) reported spending >7 hours per day sitting.
Association of physical activity and demographic characteristics
For subsequent analyses, we compared patients who were physically active, according to 2008 DHHS guidelines, with those who were not. Demographic comparisons are shown in Table 2 . Active patients were more likely to be white and nulliparous. There were no significant differences in age, household income, or educational level between the 2 groups.
| Variable | Not physically active (n = 62; 41.3%) | Physically active (n = 88; 58.7%) | P value |
|---|---|---|---|
| Age, y a | 29.2 ± 5.7 | 27.3 ± 5.9 | .054 |
| Marital status, n (%) | |||
| Single | 30 (43.5) | 39 (56.5) | .42 |
| Married/living together | 20 (36.4) | 35 (63.6) | |
| Parity, n (%) | |||
| Nulliparous | 37 (35.9) | 66 (64.1) | .04 |
| Parous | 12 (60.0) | 8 (40.0) | |
| Household income, n (%) | |||
| <$75,000/y | 29 (39.7) | 44 (60.3) | .85 |
| ≥$75,000/y | 19 (38.0) | 31 (62.0) | |
| Education, n (%) | |||
| Not a college graduate | 13 (35.1) | 24 (64.9) | .56 |
| College graduate | 37 (40.7) | 54 (59.3) | |
| Ethnicity, n (%) | |||
| White | 23 (28.4) | 58 (71.6) | .0004 |
| Nonwhite | 39 (57.4) | 29 (42.6) | |
| Tobacco use, n (%) | 11 (17.7) | 12 (13.6) | .49 |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
