Health-related physical fitness in women with polycystic ovary syndrome versus controls: a systematic review and meta-analysis

Introduction Polycystic ovary syndrome (PCOS) is a common endocrinopathy associated with cardiometabolic dysfunction. Purpose (1) To compare HRPF indices, including cardiorespiratory fitness (CRF), muscle strength, and muscle endurance, between women with and without PCOS (i.e., controls). (2) To explore the impact of moderating factors, i.e., insulin sensitivity, androgen levels, physical activity levels, and body mass index, on these indices. Methods Articles comparing HRPF between PCOS and control groups were identified until February 27th, 2022. Random-effects meta-analyses were conducted and moderating factors were explored with subgroup and meta-regression analyses. Results Twenty studies were included. Compared to controls, CRF was lower in women with PCOS (n = 15, − 0.70 [− 1.35, − 0.05], P = 0.03, I 2 = 95%). Meta-regression analyses demonstrated that fasting insulin (P = 0.004) and homeostatic model assessment of insulin resistance (P = 0.006) were negatively associated with CRF, while sex-hormone binding globulin levels (P = 0.003) were positively associated. Absolute muscle strength was not different between PCOS and controls (n = 7, 0.17 [− 0.10, 0.45], P = 0.22, I 2 = 37%). One study evaluated muscle endurance and reported lower core endurance in PCOS subjects compared to controls. Conclusion These data suggest that PCOS may be associated with impaired CRF. It remains unclear whether muscle strength and endurance differ between women with PCOS and controls. As this data set was limited by a small sample size, potential for bias, and inconsistent findings, additional studies accounting for the heterogeneous presentation of PCOS as well as improved matching between PCOS and controls for characteristics known to affect HRPF would help elucidate the impact of PCOS on indices of HRPF. PROSPERO registration number CRD42020196380.