Effectiveness of Aerobic Exercise on Metabolic Profiles in Women with Polycystic Ovary Syndrome: A Systematic Review, Meta-Analysis, and GRADE Assessment of RCTs

Abstract

Background Polycystic ovary syndrome (PCOS) is a metabolic and endocrine disorder that affects women of reproductive age. There is no absolute treatment for PCOS, but it is managed symptomatically. Adopting a healthy lifestyle comprising a balanced diet and physical exercise is the major recommendation for management of PCOS. Objective To evaluate the effectiveness of aerobic exercise as an intervention for improving metabolic profiles in women suffering from PCOS. Methods A systematic search was performed in 4 databases; Scopus, MEDLINE (via PubMed), Embase, and Web of Science, since inception till 28.2.2025. Risk of bias was performed using Cochrane RoB 2.0 tool and meta-analysis was done by using random-effects models. Results Twenty-five RCTs were included in the review for qualitative synthesis and 5 RCTs with a total of 192 participants were included for quantitative analysis. A low but statistically significant decrease was observed in waist-to-hip ratio). Lipid profile analysis revealed a significant reduction in low-density lipoprotein (LDL) cholesterol. Further, HIIT also improved insulin sensitivity, by decreasing fasting insulin levels and HOMA-IR. A non-significant reduction was observed in body mass index (BMI), waist circumference, total cholesterol, and fasting glucose. Changes in triglycerides, and HDL were also non-significant. Conclusion Aerobic exercise, especially HIIT, appears effective in improving regional fat distribution, LDL cholesterol, and insulin resistance in PCOS women, though evidence for BMI and hormonal changes remains inconclusive. Larger, longer-term RCTs are needed to confirm these findings and clarify hormonal outcomes. Prospero Registration: crd420251003425