Debunking the myth of the "worst exercise for PCOS"

Everyone says exercise plays an important role in managing polycystic ovarian syndrome (PCOS). But specific guidelines on the ideal exercise programme is lacking. During my own search for answers, I pored over blog posts, YouTube videos, and research papers on the topic. 

Honestly, there’s just a ton of contradictory advice on the internet. If you're scratching your head after a quick internet search, you're not alone. I ended up with more questions than answers. 

But there’s good news. There are simple ways you can incorporate exercise into your life. Of course, I'm only a humble blogger, not a personal trainer or medical professional. So, although I'm sharing the resources I've found, I'd encourage you to see an expert if you're ready to embark on a fitness regime.

Now, here’s what you need to know about exercise and PCOS, along with workout ideas. 

The connection between PCOS and exercise 

Exercise’s positive impact on PCOS is well-documented. Several studies show exercise improves cycle regularity, ovulation, insulin resistance, and self-esteem. That’s not all. Research published in BMS Women’s Health found when women with PCOS engaged in regular exercise, they were less depressed. In short, exercise can ease your PCOS symptoms. 

Even though exercise produces these benefits, most of us with PCOS don’t really know how to build the right exercise plan. You’re definitely not alone if you feel lost. Even a team of international PCOS experts notes “women with PCOS report receiving limited lifestyle advice and specific efficacy of different types and intensity of exercise is unclear…”.

So, why exactly do we battle to find a neat data-backed list of the best or worst exercises for PCOS? One group of researchers believe there are three core reasons for the “insufficient evidence for strong recommendations for exercise” for people with PCOS. And they share these arguments in a 2019 opinion piece published in the Sports Med journal:

• Exercise isn’t prioritised as a PCOS treatment where there’s “an apparent pharmacological solution”
• The field of clinical exercise practice is new, and therefore, practitioners are still “catching up on” acting on research
• Securing funding for lifestyle interventions, like exercise, is challenging 

All of this sounds super discouraging, I know. But there's a wealth of resources about exercise and PCOS online, and below I'll share a couple of the best I've found.

Can some exercise make PCOS worse?

First up: the truth is there doesn’t seem to be a universal best or worst workout for every person with PCOS. After all, there are multiple types of PCOS and the disorder affects us in different ways. According to a chapter in Physical Exercise for Human Health, the most effective PCOS exercise plan depends on you and your unique factors:

“An optimal dose–response relationship to exercise in PCOS may not be feasible because of the highly individualised characteristics of the disorder. Indeed, the AE-PCOS Society (The Androgen Excess and Polycystic Ovary Syndrome Society) suggests that individualised exercise programmes may improve compliance, and suggest group or home exercise.”

It makes sense, right? Each of us requires a customized approach to an exercise routine. That’s exactly why researchers encourage practitioners to perform fitness testing before making precise PCOS exercise recommendations.

Still, even if you can’t prescribe the perfect exercise plan for PCOS, there are claims that some exercises are straight-out bad for PCOS. Let’s look at these more closely below.

Is HIIT workout bad for PCOS

Some research shows high-intensity interval training (HIIT) is good for PCOS, while some experts caution against it.

According to the Nature journal, a pilot trial found HIIT workouts for PCOS improved some “anthropometric and cardiometabolic health outcomes in women with PCOS”.

But the message from HIIT detractors is this: HIIT workouts spike your cortisol levels if you don’t recover properly between sessions.  That’s also why you might be wondering if too much exercise is bad for PCOS. Laurence Fountaine, the founder of Salus London, tells The Metro overdoing HIIT triggers a negative cycle:

“For many of us, we enjoy exercise but we don’t consider that it creates the release of our stress hormone (cortisol). As a result, it simply adds to increasing the total volume of stress we are exposed to.

“The fitness industry sells its value in blood, sweat and tears. The “go hard or go home” attitude is not only suboptimal for getting into shape but when done with increased frequency, will have a detrimental effect on both your physical and mental wellbeing.”

Fountaine advocates for activities like yoga and pilates, adding that these practices accomplish two things. They reduce the release of cortisol and actively release oxytocin, also known as the love hormone.  

Tedi Nikova, a Registered Dietitian, explains research found any cortisol release was acute so it shouldn’t have long-term effects. Besides, Nikova adds that studies show even low-intensity exercise stimulates cortisol release.

“For some people, intense exercise can dramatically improve insulin sensitivity and raise your metabolic rate. But for others it may cause more stress and worsen symptoms.”

Nikova said you might be pushing yourself too hard if you: 

• Get frequent colds
• Have trouble sleeping 
• Need longer times rest 
• Experience constant food cravings 

If you’re concerned about elevated cortisol levels, chat to your health provider and get tested, said Nikova.

Does resistance training increase androgens 

Like HIIT workouts for PCOS, there’s more than one narrative about resistance training. Resistance training appears to support insulin sensitivity. However, there’s a concern that resistance training might increase androgens. 

So, what’s the verdict?

According to the International Journal of Exercise Science, resistance training is beneficial for people with PCOS but more research is needed:

“Research that examines the hormonal response to RT does exist; however, most of the studies involve men or trained athletes…Several positive hormonal outcomes unique to RT have been documented, all of which create a cascade of events that support energy production, improved insulin sensitivity, and increased strength...A hypothesis still under investigation and of relevance to women with PCOS is the possible upregulation of androgen receptors due to RT…”

Over on her PCOS Personal Trainer blog, Volk expands on this case for resistance training for PCOS:

“Physicians who specialize in PCOS recommend strength training because it is a proven method of managing insulin resistance, belly fat, and obesity. Strength training is more likely to improve your hormonal balance than make it worse.”

The best exercise for PCOS 

After all of that information, you might be wondering what is the best exercise for PCOS?

Don’t worry: there do appear to be general best practices, based on general guidelines for exercise.

The International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS) provides these exercise recommendations:

• To prevent weight gain and maintain health: a minimum of 150 minutes of moderate intensity physical activity each week or 75 min/week of vigorous intensities or an equivalent combination 
• To lose weight and prevent weight regain: a minimum of 250 min/week of moderate intensity activities or 150 min/week of vigorous intensity or an equivalent combination of both, and muscle strengthening activities involving major muscle groups on 2 non-consecutive days/week 
  

But don’t panic if you’re worried about falling short of these recommendations.

Take a walk

Even a brisk walk can deliver health benefits. 

Researchers from the Centre for Sport and Exercise Science at Sheffield Hallam University recommend walking for PCOS:

“...many of the benefits associated with exercise can be obtained by brisk walking, defined as faster than normal walking but at a pace that could be sustained for at least 20 min…”

Find exercise your enjoy

What’s more, is people with PCOS often have very specific barriers to starting – and maintaining – an exercise regime. 

Here’s what these barriers to PCOS exercise look like:

1. We often aren’t confident we’ll be able to stick to an exercise routine
2. We’re worried about getting hurt
3. We have physical limitations that might interfere with exercise 

The solution? Find an exercise you enjoy. For me, I do this low-impact HIIT workout once a week. It doesn't feel overwhelming because it's only 10 minutes. Plus, the trainer has PCOS and offers a lot of motivation along the way.

Opt for short PCOS workouts

Erica Volk, a fitness blogger, nutritious coach, and personal trainer, said the best exercises for PCOS were short, intense workouts. 

“Keep your cardio sessions short. Long, drawn-out cardio sessions have a tendency to stress out our bodies. A better choice is shorter, more intense workouts like this 20-minute interval workout. Several research studies have shown that PCOS responds particularly well to interval training.”

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Volk shares brief workouts like the one below on her YouTube channel.

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The best and worst exercise for PCOS depends on you

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Any type of exercise can produce benefits, notes Healthline. 

The online publication reviewed multiple studies on exercise and PCOS. It concludes that any amount and type of exercise can improve PCOS symptoms.

“The message from these and other studies is that exercise can usually help you when you have PCOS, and the best exercise is what you will do regularly.” 

One Reddit user sums it well on this thread about the best and worst exercise for PCOS:

“Don't get too hung up on what you should or shouldn't do according to others. If you love to run, then run. If you love weights, then lift. If you're a yogi, then do yoga. 

“All movement is good and beneficial and it is much better to do some form of movement than nothing. We are all unique so what you and I respond to may be different. You can find people with PCOS who have had amazing results with all forms of exercise.”

The research backs up this Redditor’s sentiment. A review of multiple studies found these benefits. For example, yoga showed a reduction in total testosterone while one study linked cycling with a decrease in fasting insulin.

If you have polycystic ovarian syndrome (PCOS), you must exercise. What’s less clear is the best (or worst) exercise for PCOS.  But labelling any form of physical activity as the worst exercise for PCOS seems a bit too simplistic.

Pick an exercise that you enjoy and do it consistently. Over to you. Start small with exercise regime you can practice regularly. Always put your safety first. This means discussing options with a trained professional.

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Featured image credit: Photo by Sarah Pflug from Burst