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The PCOS Newsletter is a weekly publication answering one PCOS question at the time so we can be empowered by knowledge.

An issue will land in your inbox each Sunday

PCOS and High Intensity Exercise

Hi, this is Francesca from The PCOS Newsletter where we provide answers to complex PCOS questions in a concise and easy-to-understand format.

Have a question? Ask it here.


This week’s question:

Should I avoid high intensity exercise if I have PCOS


The answer:

There seem to be two main concerns regarding high-intensity exercise:

  1. Cortisol levels and its impact on hormones

  2. Stories about women losing their period when overexercising

High-intensity exercise is defined as exercise that reaches 70% to 85% of your maximum heart rate. Examples include HIIT, Spin, and popular gyms such as F45, Barry's Bootcamp, and SoulCycle.


But let’s unpick it, is there a reason to be worried?

️ ⚡️ Do cortisol levels impact my PCOS?

Cortisol is our stress hormone. However, if not chronic stress, it’s a positive mechanism in our lives. Our flight-or-fight response is what keeps us alive from crossing in front of a busy road, as well as stimulating our immune system, enhancing alertness and encouraging action.

Whilst we exercise, our adrenal glands secrete cortisol to stimulate the release of glucose into the bloodstream to provide energy for our muscles.

The moment cortisol becomes problematic is when is chronic. Our stress response is designed to be acute so it get us out of trouble fast. A state of continuous stress can cause inflammation, disrupt sleep, and keep blood sugar elevated, which increases insulin resistance. Some studies suggest that women with PCOS may have elevated cortisol levels and hence, they may worry about exercising.


From my research, there is nothing to worry about.

There are multiple studies proving that exercise has a positive impact on PCOS symptoms. Evidence confirms that this should form the basis of any prescription from a clinician or healthcare professional.


Ok, so what type of exercise is best for PCOS?

The best option is to find a type of exercise that you enjoy.

There are studies suggesting that HIIT (high intensity interval training) might be better than moderate exercise in improving insulin resistance and lowering BMI. Another study has found that after a HIIT workout, cortisol and testosterone levels return to normal within 2 to 3 hours. This study also found that despite the initial increase, HIIT workouts can actually help lower your cortisol and stress levels over a period of 24 hours.

On the other hand, there are studies that show the ability of strength training to reduce insulin resistance and lower testosterone by improving muscle mass.

As a result, it seems that we just need to get moving to see the positive impacts of exercise and find a routine that best suits us.


Can overexercising make me lose my period?


Yes, but it’s not the exercise itself. The reason some women lose their periods when they overtrain is the lack of sufficient energy. Reducing calories and under-eating, alongside exercising intensively, can lead to losing your period. This is because our body prioritises our vital bodily processes, and does its best to avoid the costly functions of pregnancy so it takes energy away from our reproductive system.

This is the reason why women should not be in an extreme caloric deficit for a long time, as our bodies are smart enough to know they can’t function properly with little food. It certainly doesn’t help when the main advice for women with PCOS is to lose weight, as it can drive women to resort to extreme dieting and further worsen the problem.


Ok, so what is the right dose?


Guidelines for PCOS suggest at least 150 min of physical activity per week.

I hope this helped get a perspective on intense exercising. I truly believe movement in any shape is beneficial.

If you have more specific goals such as building strength or running a certain distance, it’s important to work with someone that has knowledge that covers both the nutrition you need for those goals, and exercise plans. My friend Rosie (who you can find here) is a Registered Dietitian and Personal Trainer and can help with any specific questions you might have.


See you next Sunday,

Francesca



Sources

Dos Santos, I. K., Ashe, M. C., Cobucci, R. N., Soares, G. M., de Oliveira Maranhão, T. M., & Dantas, P. M. S. (2020). The effect of exercise as an intervention for women with polycystic ovary syndrome: A systematic review and meta-analysis. Medicine, 99(16), e19644. https://doi.org/10.1097/MD.0000000000019644


Gu, Y., Zhou, G., Zhou, F., Wu, Q., Ma, C., Zhang, Y., Ding, J., & Hua, K. (2022). Life modifications and PCOS: Old story but new tales. Frontiers in Endocrinology, 13, 808898. https://doi.org/10.3389/fendo.2022.808898


Hakimi, O., & Cameron, L.-C. (2017). Effect of exercise on ovulation: A systematic review. Sports Medicine (Auckland, N.Z.), 47(8), 1555–1567. https://doi.org/10.1007/s40279-016-0669-8


Ramos, F. K. P., Lara, L. A. da S., Kogure, G. S., Silva, R. C., Ferriani, R. A., Silva de Sá, M. F., & Reis, R. M. D. (2016). Quality of life in women with polycystic ovary syndrome after a program of resistance exercise training. Revista Brasileira de Ginecologia e Obstetricia: Revista Da Federacao Brasileira Das Sociedades de Ginecologia e Obstetricia, 38(7), 340–347. https://doi.org/10.1055/s-0036-1585457


Srikanthan, P., & Karlamangla, A. S. (2011). Relative muscle mass is inversely associated with insulin resistance and prediabetes. Findings from the third National Health and Nutrition Examination Survey. The Journal of Clinical Endocrinology and Metabolism, 96(9), 2898–2903. https://doi.org/10.1210/jc.2011-0435


Woodward, A., Klonizakis, M., & Broom, D. (2020). Exercise and polycystic ovary syndrome. Advances in Experimental Medicine and Biology, 1228, 123–136. https://doi.org/10.1007/978-981-15-1792-1_8


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