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Exercise as it relates to Disease/Polycystic Ovary Syndrome Patients fertility improved by lifestyle changes

This Wikibook page is a fact sheet and analysis of the journal article “Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study” by Palomba et al. (2008).[1] It has been created as an assignment as a part of Health, Disease & Exercise at the University of Canberra by u3096752

What Is The Background To This Research?Edit

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in 10% of pre-menopausal women.[2][3][4] As a disorder of the female reproductive system and hormones, many diagnosed experience the following primary symptoms:

• Menstrual abnormalities • Absence of ovulation due to non-release of an ova • Abnormal growth of facial and body hair in women [1]

Between 35-45% of women living with PCOS also experience the following symptoms:

• BMI exceeding 25+ (overweight /obese) • Insulin resistance • Higher risk of Type 2 Diabetes • Increased Risk of Cardiovascular Disease • Central distribution of body fat [4]

Lifestyle interventions such as diet and exercise are used with success to treat overweight and obese women with PCOS. The aim of this pilot study was to compare the effectiveness of structured exercise training versus a high-protein diet programme on reproductive function as well as studying the clinical, hormonal and metabolic effects of the lifestyle interventions.

Where Is The Research From?Edit

The research was conducted using two sample groups by various universities in Italy.

• University of Magna Gracia, Catanzaro, Italy • University of Federico II, Naples, Italy • University of Parthenhope, Naples, Italy

What Kind Of Research Was This?Edit

This study was a 24-week pilot study, utilising two groups with different interventions in place to determine a cause-effect response.

What Did The Research Involve?Edit

Forty obese women suffering from PCOS with infertility due to not releasing ova were divided into two groups, with group one prescribed a structured exercise programme intervention and group two prescribed a hypocaloric hyperproetic diet intervention. Baseline, 12-week and 24-week clinical, hormonal and metabolic data measures were taken to track results.

The methodology of this study was complicated in that they had many methods and analysis going on all at the same time. The diet group utilised a self-report questionnaire to report daily food-frequency, which is not a reliable measure as many individuals report better results than what is actually true. It is of interest that this study also considered the adherence to the diet programme in their methodology and results.

Limitations such as diet adherence, the response to hormones and the ultimate goal of pregnancy existed within this study. Subjects who fell pregnant during the research stopped the experimental intervention, and data obtained from their last follow-up visit was analysed. Initially 52 patients were asked to participate in this study, twelve of those refused to participate. A larger sample size would have been good to show a greater significance and effect.

What Were The Basic Results?Edit

• All PCOS cases used in the study satisfied the Rotterdam diagnosis • Both groups seen an improvement in menstrual cyclicity • Menses frequency was higher in the exercise group • After 24 weeks ovulation rate was higher in the exercise group • 40% difference between the two groups

How did the researchers interpret the results?

• The results were interpreted and shared via statistical tables and through explanation. • Graphs also could have been used to highlight the changes from baseline to 24 weeks better.

What Conclusions Should Be Taken Away From This Research?Edit

From this we can see that lifestyle changes are successful in bettering the health of those suffering from PCOS. Over a short period of time, with little to no cost associated, especially when compared with pharmaceutical fixes, significant changes have been made in bettering the fertility of women with PCOS and should continue to be the first-line treatment for the management of infertility in overweight / obese ladies with PCOS.[1][5]

Other studies have shown that the loss of weight, particularly in those with a central distribution of body fat, have resumed ovulation. A reduction in calories and an increase in aerobic exercise has shown a significant reduction in intra-abdominal fat. This consistent loss of intra-abdominal fat is then linked to ovulation beginning again.[6]

What Are The Implications Of This Research?Edit

Lifestyle changes such as diet and exercise are inexpensive, especially when compared to pharmacological treatments for infertility and are generally the first-line of treatment for overweight / obese, infertile women suffering from PCOS.[5] Research like this shows us that almost anyone is able to implement these changes in day-to-day life and with adherence can see significant fertility results within 12 weeks, however as this was a pilot study, more research is needed in this subject area. The real-world implication for this is that lifestyle interventions are successful and should be used more, before the use of drugs such as Clomifene and before invasive hormone and surgerical therapies are used.[5]

Always seek the advice of your GP or medical practitioners before undertaking any lifestyle intervention.

Further readingEdit

Reproductive Health: Polycystic Ovary Syndrome http://www.racgp.org.au/afp/2012/october/polycystic-ovary-syndrome/

Polycystic Ovary Syndrome https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/polycystic-ovarian-syndrome-pcos

Women's Health, Polycystic Ovary Syndrome Fact Sheet http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html

ReferencesEdit

  1. a b c Palomba, S., Giallauria, F., Falbo, A., Russo, T., Oppedisano, R., & Tolino, A. et al. (2008). Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Human Reproduction, 23(3), 642-650.
  2. Harrison, C., Lombard, C., Moran, L., & Teede, H. (2010). Exercise therapy in polycystic ovary syndrome: a systematic review. Human Reproduction Update, 17(2), 171-183.
  3. Practitioners, T. (2016). RACGP - Polycystic ovary syndrome - An update. Racgp.org.au. Retrieved 19 September 2016, from http://www.racgp.org.au/afp/2012/october/polycystic-ovary-syndrome/
  4. a b Álvarez-Blasco, F., Botella-Carretero, J., San Millán, J., & Escobar-Morreale, H. (2006). Prevalence and Characteristics of the Polycystic Ovary Syndrome in Overweight and Obese Women. Arch Intern Med, 166(19), 2081
  5. a b c Costello, M. & Ledger, W. (2012). Evidence-based lifestyle and pharmacological management of infertility in women with polycystic ovary syndrome. Women's Health, 8(3), 277-290.
  6. Kuchenbecker, W., Groen, H., van Asselt, S., Bolster, J., Zwerver, J., & Slart, R. et al. (2011). In women with polycystic ovary syndrome and obesity, loss of intra-abdominal fat is associated with resumption of ovulation. Human Reproduction, 26(9), 2505-2512. http://dx.doi.org/10.1093/humrep/der229