Progressive Resistance Training as Complementary Therapy for Polycystic Ovarian Syndrome.

Polycystic ovarian syndrome (PCOS) significantly impacts women, since the broad spectrum of clinical manifestations associated with it are significant and include reproductive dysfunction, menstrual irregularities, and an increased risk of infertility. However, the consequences of PCOS go beyond the reproductive axis, with psychological and social impairments, including stress, depression, anxiety, and sexual dissatisfaction.1 There is also a high prevalence of dyslipidemia, hyperinsulinemia, obesity, hypertension, and glucose intolerance, which are risk factors that predispose women to cardiovascular disease (CVD) and diabetes mellitus type 2 (DM2).2 Therefore, PCOS assumes aspects of a chronic disease, as these factors extend throughout life. If not prevented and treated, they can lead to increased morbidity and mortality.3 The etiology of PCOS has not been fully elucidated, but it is known to be linked to excess androgens.4,5 Insulin resistance (IR) is a common feature of PCOS,6 and although it is not considered a diagnostic criterion, it is a key factor in the syndrome’s etiology and evolution.7 In 2008, the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) published a consensus suggesting lifestyle changes as the first line of treatment for women with PCOS.8This consensuswas reinforced in2009byTheAndrogen Excess and Polycystic Ovary Syndrome Society,9 which investigated evidence of lifestyle management (dietary, exercise, or behavioral interventions) for obesity in women with PCOS. Sincethen, thebenefitsof lifestylechanges resulting fromPCOS therapy havebeenwell documented.10,11 The rationale for this non-pharmacological therapy is based on regular exercise and a healthy diet, as well as combined interventions that aim to achieve and maintain a healthy weight to minimize hormonal and reproductive complications, reduce the long-term risks of chronic diseases such as CVD and DM2, and consequently improve quality of life. In this way, weight loss has been considered the main goal of PCOS therapy in obese women. Moderateto high-intensity aerobic physical exercise12 has been predominantly recommended as a treatment for PCOS.13 Preliminary data from our group with an interval aerobic training protocol (exercises alternating in intensity frommoderate to heavyeffort with low-effort recovery periods) showed a decreased central obesity index measured by anthropometric measures and improved testosterone levels. However, other training programs, such as aerobic exercises, alone or in combinationwith resistance training, with or without dietary restriction, have also effectively reduced total and abdominal body fat or body fat percentile,12,14–16 leading to improved menstrual frequency and/or ovulation,12,17 reduced serum testosterone concentrations and fasting plasma glucose levels,12 and improved insulin sensitivity.18,19 More recently, a review presented evidence that progressive resistance training (PRT), or strength training, may also be beneficial for women with PCOS, promoting changes in body composition and associated factors, especially IR.20 However, this type of physical exercise has not been well explored in terms of its therapeutic purposes. Facedwith the phenotypic characteristics of PCOS, we set out to perform a periodic protocol of resistance exercises in lean, overweight, and obesewomenwith the intention of evaluating the results of this therapy. The PRT improvedhyperandrogenismand the menstrual cycle, as well as the functional capacity with increased muscle strength, and resulted in changes in body