Guest Post by Despina Pavlou.
We all know exercise is important for our PCOS and overall health. However, you probably didn’t know that the type of exercise you are undertaking may be doing you more harm than good. Along with good nutrition, exercise is also a key component when trying to manage your PCOS.
If you have ever asked yourself, why am I not losing weight or why isn’t my PCOS improving, I am eating well and exercising, what is going on? A possible reason is that the type of exercise you are doing is not helping your hormones and in turn your PCOS.
Not One Type of PCOS
There is not one type of PCOS and therefore there is no best or standardised exercise program that can be given. Furthermore, we are all different, our bodies are not the same. So what works for one person, may not work for you.
As a result of the different types of PCOS, you have to undertake the exercise that takes into consideration your type of PCOS.
Insulin Resistant PCOS
Insulin Resistant PCOS is the most common type of PCOS. It is estimated that 70% of women with PCOS also suffer from insulin resistance (1).
Insulin is a hormone made in the pancreas, one of insulin’s many roles is to keep blood sugar levels under control. Cells in the body will burn glucose for fuel, but will also be sent to the liver.
Insulin is a like a key, it unlocks the door to allow glucose to enter the cells to be used as energy. However, if you are insulin resistant, insulin (the key), is faulty. Which means the cells have become resistant to the effects of insulin and instead of the glucose being used as energy, it builds up in the blood and gets stored as fat. Insulin resistance is when the cells in the body have trouble absorbing glucose in the blood and as a result, there is a build-up of sugar.
A high level of insulin causes the ovary to produce excess amounts of testosterone. This, in turn, causes PCOS symptoms, such as infertility, irregular periods, hair loss and acne.
Best Exercise for Insulin Resistant PCOS?
Countless studies have found both Resistance Training and High-Intensity Interval Training (HIIT) to be the best forms of exercise for this type of PCOS.
What is Resistance Training?
Resistance training is any exercise that causes the muscles to contract, in turn resulting in increased muscle mass, strength and endurance. You probably read that and thought, well this isn’t for me. A lot of women believe that weight training causes you to look ‘bulky’, however, this isn’t true. While women with PCOS do have an elevated level of testosterone, it is still not enough to build muscle like men.
The Benefits of Resistance Training for PCOS
If I still have not put your mind at rest and got you pumped and excited to lift some heavy weights, these benefits will.
Reduces insulin resistance
While any type of training is great for insulin resistance, studies have found that having more muscle increases your overall demand for energy. A study found that each 10% increase in muscle was associated with an 11% relative reduction in insulin resistance (2).
Research suggests that muscle mass can effectively increase glucose storage, facilitate glucose clearance from the circulation, and reduce the amount of insulin required to maintain a normal glucose tolerance (3).
Research has found that resistance training can help lower levels of testosterone in women with PCOS (4). As a result of the reduction of insulin this, in turn, helps to lower testosterone levels.
High-Intensity Interval Training
High-Intensity Interval Training (HIIT) is the second form of exercise that research has identified as being beneficial for insulin resistance. HIIT is a vigorous form of exercise, which involves full bursts of energy along with a short or active recovery period.
An Example of HIIT Workout
HIIT sessions often last for 25 minutes or less:
- 3 minutes of warm-up
- 10 sprints of 60 seconds, with 60 seconds of recovery
- 2 minutes of cool down
Researchers found that HIIT completed over the course of 10 weeks improved insulin resistance. A further study examining the effects of HIIT on women with insulin resistance and PCOS found that after 12 weeks of HIIT cardio, undertaken three times a week resulted in a reduction in waist and hip circumference (5).
High-intensity interval training increases insulin sensitivity as a result of the body expending glucose and then allowing blood glucose to enter the muscle cells. This, in turn, helps to lower the risk of developing diabetes.
Your HIIT Workout
There is no best HIIT workout, simply ensure you choose a workout that uses a range of muscles, such as sprints, rowing, boxing. Furthermore, most importantly, when it comes to creating your HIIT workout your initial fitness and experience is important. Therefore, if you are a beginner it is important to start off slow and gradually increase the intensity, duration and sets.
Androgens are not only produced by the ovary, it is estimated that 20-30% of women with PCOS have adrenal androgen excess (6).
In todays busy and fast-paced society, stress is experienced every day, whether it be from work, relationships or simply sitting in traffic. Stress levels are often not elevated the same way they would have been triggered during the time of our ancestors.
Cortisol, one of the primary stress hormones, is released by the adrenal glands. The stress hormone is triggered as a result of the fight-or-flight response. Stress or fear causes the body to automatically respond to ensure survival from any threat.
During the fight-or-flight response, cortisol increases blood sugar (the source of energy needed to survive) and shuts down anything within the body that is unnecessary, such as reproductive functions. The surge in blood sugar caused by the increase in cortisol also leads to an increase in insulin.
Stress causes the adrenal glands to produce cortisol, adrenaline and norepinephrine, along with 3 androgen hormones; DHEA, testosterone and androstenedione. Research has also found that DHEA can be converted into Dihydrotestosterone (DHT), which is what causes hair loss and hair thinning in women with PCOS (7).
The Effects of Chronic Stress
Long-term stress can cause an increase in the release of androgens, but also cortisol resistance, leading to adrenal fatigue or “burnout”. This is where the cells become resistant to the effects of the hormone. Therefore, if the body becomes resistant to cortisol you will not have the energy you are meant to have, for example in the morning cortisol is high, which is what makes us wake up.
Exercise for Adrenal PCOS
If you are struggling with fatigue or you feel tired after training, you may have to adjust or cut down on your workouts and their intensity. Endurance and intense exercise cause the body to produce increased amounts of cortisol. Exercise intensities between 80% and 90% of VO2 max, cause elevated cortisol levels to be secreted (8).
If you are someone who is looking to lose weight, this may sound counterproductive. However, what happens when you reduce your intensity and exercise is that the weight actually starts coming off, due a decrease in your cortisol levels. Therefore, do not panic, I am not telling you to completely put an end to all exercise.
Low-intensity exercise (40%) does not result in significant increases in cortisol levels. Instead, it reduces circulating cortisol levels (8). Therefore, aim to include more low-intensity exercise into your workout routine, such as walking, yoga, swimming.
There is not one type of PCOS and therefore it is important to know which type you have before you delve into a workout program as it may be doing you more harm than good. Resistance training and HIIT are two great exercises for women who suffer from insulin resistant PCOS, as a result of glucose expenditure. Whereas low-intensity exercise is more beneficial for women who suffer from adrenal PCOS, as cortisol levels do not increase significantly, compared to HIIT.
(1) Ovalle, F and Azziz, R. (2002). Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertility and Sterility. 77(6),1095-1105. Available from: https://www.sciencedirect.com/science/article/pii/S0015028202031114
(2) Srikanthan P, Karlamangla AS. (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):2898-903. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21778224
(3) Cuff, DJ., Meneilly, GS., Martin, A., Ignaszewski, A., Tildesley. HD., Frohlich, JJ. (2003). Effective Exercise Modality to Reduce Insulin Resistance in Women With Type 2 Diabetes. Diabetes Care Association Journal. Available from: http://care.diabetesjournals.org/content/26/11/2977 . 26(11): 2977-2982. [Accessed 11 February 2017].
(4) Miranda-Furtado, CL., Picchi Ramos, FK., GS Kogure, Santana-Lemos BA., Ferriani RA., Calado RT., dos Reis RM.(2016). A Nonrandomized Trial of Progressive Resistance Training Intervention in Women With Polycystic Ovary Syndrome and Its Implications in Telomere Content. Reproductive Sciences. Available from: http://journals.sagepub.com/doi/pdf/10.1177/1933719115611753 . 23(5) 644-654. [Accessed 10 February 2017].
(5) Liza Haqq, Josh Denham, Gudrun Dieberg, Jim McFarlane, Neil Smart . (2016). Effects of high intensity interval training on insulin resistance in women with polycystic ovarian syndrome. University of New England. Available from: https://www.researchgate.net/publication/319154178_Effects_of_high_intensity_interval_training_on_insulin_resistance_in_women_with_polycystic_ovarian_syndrome
(6) Kumar, A., Woods, SK., Bartolucci, AA., Azziz, R. (2005). Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS). Clinical Endocrinology.62(6), 644–649. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2005.02256.x/full
(7) Androgen therapy in women. European Journal of Endocrinology. 1541-11. Available from: http://www.eje-online.org/content/154/1/1.full
(8) Hill EE, Zack E, Battaglini C, Viru M, Viru A, Hackney AC. (2008). Exercise and circulating cortisol levels: the intensity threshold effect. Journal of Endocrinological Investigation. 31(7):587-91. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18787373
Despina Pavlou is the founder of PCOS and Nutrition and a certified personal trainer. She takes a holistic and evidence-based approach to both nutrition and training. She believes both diet and lifestyle modifications are an effective approach to managing PCOS and its symptoms.
On her website, you will find tips on how to treat PCOS with lifestyle, diet, and supplement changes, as well as recipes. You will also find a host of general health and wellness information.