A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. Effects of increased dietary protein-to-carbohydrate ratios in women with polycystic ovary syndrome. Beneficial Effects of a High-Protein, Low-Glycemic-Load Hypocaloric Diet in Overweight and Obese Women with Polycystic Ovary Syndrome: A Randomized Controlled Intervention Study Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. Effects of exercise and nutritional counseling in women with polycystic ovary syndrome. Metformin versus lifestyle changes in treating women with polycystic ovary syndrome Reduction in Obesity and Related Comorbid Conditions after Diet-Induced Weight Loss or Exercise-Induced Weight Loss in Men Six weeks of structured exercise training and hypocaloric diet increases the probability of ovulation after clomiphene citrate in overweight and obese patients with polycystic ovary syndrome: a randomized controlled trial. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Effects of acupuncture and exercise on insulin sensitivity, adipose tissue characteristics, and markers of coagulation and fibrinolysis in women with polycystic ovary syndrome: secondary analyses of a randomized controlled trial. Effect of exercise training on insulin sensitivity, mitochondria and computed tomography muscle attenuation in overweight women with and without polycystic ovary syndrome Effect of holistic yoga program on anxiety symptoms in adolescent girls with polycystic ovarian syndrome: A randomized control trial Metformin-Diet Ameliorates Coronary Heart Disease Risk Factors and Facilitates Resumption of Regular Menses in Adolescents with Polycystic Ovary Syndrome Effects of exercise on insulin resistance and body composition in overweight and obese women with and without polycystic ovary syndrome. Effects of resistance training and endurance training on insulin sensitivity in nonobese, young women: a controlled randomized trial. Exercise training improves autonomic function and inflammatory pattern in women with polycystic ovary syndrome (PCOS) Endocrine consequences of weight loss in obese, hyperandrogenic, anovulatory women. [Clinical, hormonal and biochemical changes after treatment with metformin and weight reduction in women with polycystic ovary syndrome]. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. A randomized, 48-week, placebo-controlled trial of intensive lifestyle modification and/or metformin therapy in overweight women with polycystic ovary syndrome: a pilot study. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Local recruitment experience in a study comparing the effectiveness of a low glycaemic index diet with a low calorie healthy eating approach at achieving weight loss and reducing the risk of endometrial cancer in women with polycystic ovary syndrome (PCOS). Effects of exercise on lipoprotein particles in women with polycystic ovary syndrome. Beneficial effects of a three-month structured exercise training program on cardiopulmonary functional capacity in young women with polycystic ovary syndrome. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. Effect of weight loss on menstrual function in adolescents with polycystic ovary syndrome. Structured exercise training programme versus hypocaloric hyperproteic diet in obese polycystic ovary syndrome patients with anovulatory infertility: a 24-week pilot study. Lifestyle management improves quality of life and depression in overweight and obese women with polycystic ovary syndrome.
We prospect ively estimated the prevalence of the polycystic ovary syndrome ( PCOS ) , as defined by the NIH/NICHHD 1990 endocrine criteria , in a population of 154 Caucasian women of reproductive age reporting spontaneously for blood donation .  Anthropometric data ; the presence of hirsutism , acne , and and rogenic alopecia ; and the menstrual history were recorded by a single investigator . In 145 women , blood sample s were also obtained for measurement of serum and rogen levels .  PCOS was defined by the presence of 1 ) oligomenorrhea , 2 ) clinical and /or biochemical hyper and rogenism , and 3 ) exclusion of hyperprolactinemia , thyroid disorders , and nonclassic 21-hydroxylase deficiency . Hirsutism was defined by a modified Ferriman-Gallwey score of 8 or more , acne was considered as a sign of hyper and rogenism when persistent after the second decade of life , and hyper and rogenemia was defined by an increase in circulating testosterone or dehydroepi and rosterone sulfate or an increase in the free and rogen index above the 95th percentile of the control values derived from the nonhirsute , nonacneic women having regular menses who were not receiving hormonal therapy . PCOS was present in 10(6.5 % ) , hirsutism was present in 11 ( 7.1 % ) , and acne was present in 19 ( 12.3 % ) of the 154 women . Our results demonstrate a 6.5 % prevalence of PCOS , as defined , in a minimally biased population of Caucasian women from Spain . The polycystic ovary syndrome , hirsutism , and acne are common endocrine disorders in women BACKGROUND Some evidence has suggested that a diet with a higher ratio of protein to carbohydrates has metabolic advantages in the treatment of polycystic ovary syndrome ( PCOS ) . OBJECTIVE The objective of this study was to compare the effect of a high-protein ( HP ) diet to a st and ard-protein ( SP ) diet in women with PCOS . DESIGN A controlled , 6-mo trial was conducted in 57 PCOS women . The women were assigned through rank minimization to one of the following 2 diets without caloric restriction : an HP diet ( > 40 % of energy from protein and 30 % of energy from fat ) or an SP diet ( < 15 % of energy from protein and 30 % of energy from fat ) . The women received monthly dietary counseling . At baseline and 3 and 6 mo , anthropometric measurements were performed , and blood sample s were collected . RESULTS Seven women dropped out because of pregnancy , 23 women dropped out because of other reasons , and 27 women completed the study . The HP diet produced a greater weight loss ( mean : 4.4 kg ; 95 % CI : 0.3 , 8.6 kg ) and body fat loss ( mean : 4.3 kg ; 95 % CI : 0.9 , 7.6 kg ) than the SP diet after 6 mo . Waist circumference was reduced more by the HP diet than by the SP diet . The HP diet produced greater decreases in glucose than did the SP diet , which persisted after adjustment for weight changes . There were no differences in testosterone , sex hormone-binding globulin , and blood lipids between the groups after 6 mo . However , adjustment for weight changes led to significantly lower testosterone concentrations in the SP-diet group than in the HP-diet group . CONCLUSION Replacement of carbohydrates with protein in ad libitum diets improves weight loss and improves glucose metabolism by an effect that seems to be independent of the weight loss and , thus , seems to offer an improved dietary treatment of PCOS women Objective : The recommended composition of a hypocaloric diet for obese women with polycystic ovary syndrome ( PCOS ) is unclear . The aim of this study was to investigate the effects of a high-protein , low-glycemic-load diet compared with a conventional hypocaloric diet on reproductive hormones , inflammatory markers , lipids , glucose , and insulin levels in obese women with PCOS . Methods : A total of 60 overweight and obese women with PCOS who did not use insulin-sensitizing agents were recruited and r and omly assigned to 1 of the 2 hypocaloric diet groups for a single-blind clinical trial . The groups included a conventional hypocaloric diet ( CHCD ) ( 15 % of daily energy from protein ) and a modified hypocaloric diet ( MHCD ) with a high-protein , low-glycemic load ( 30 % of daily energy from protein plus low-glycemic-load foods selected from a list ) that was prescribed via counseling visits weekly during 12 weeks of study . Anthropometric assessment s and biochemical measurements including reproductive hormones , inflammatory factors , lipids , glucose , and insulin were performed on fasting blood sample s at baseline and after 12 weeks of dietary intervention . Results : Weight loss was significant and similar in the 2 groups . Mean of testosterone in the MHCD and CHCD groups decreased from 1.78 ± 0.32 to 1.31 ± 0.26 ng/ml and from 1.51 ± 0.12 to 1.15 ± 0.11 ng/ml , respectively ( p < 0.001 ) . Follicle sensitizing hormone ( FSH ) , luteinizing hormone ( LH ) , and blood lipids concentrations were not changed except low-density lipoprotein cholesterol ( LDL-C ) was reduced by 24.5 % ± 12.3 % ( p < 0.001 for both ) after 12 weeks of intervention . MHCD result ed in a significant reduction in insulin level , homeostatic model assessment for insulin resistance ( HOMA ) , and high-sensitivity C- reactive protein ( hsCRP ) concentration ( p < 0.001 ) . Conclusions : In this study both hypocaloric diets significantly led to reduced body weight and and rogen levels in these two groups of women with PCOS . The combination of high-protein and low-glycemic-load foods in a modified diet caused a significant increase in insulin sensitivity and a decrease in hsCRP level when compared with a conventional diet Polycystic ovary syndrome ( PCOS ) , the most common endocrine disorder in women of reproductive age , is characterized by hyper and rogenism , oligo/amenorrhea , and polycystic ovaries . We aim ed to determine whether low-frequency electro-acupuncture ( EA ) would decrease hyper and rogenism and improve oligo/amenorrhea more effectively than physical exercise or no intervention . We r and omized 84 women with PCOS , aged 18 - 37 yr , to 16 wk of low-frequency EA , physical exercise , or no intervention . The primary outcome measure changes in the concentration of total testosterone ( T ) at week 16 determined by gas and liquid chromatography-mass spectrometry was analyzed by intention to treat . Secondary outcome measures were changes in menstrual frequency ; concentrations of and rogens , estrogens , and rogen precursors , and glucuroni date d and rogen metabolites ; and acne and hirsutism . Outcomes were assessed at baseline , after 16 wk of intervention , and after a 16-wk follow-up . After 16 wk of intervention , circulating T decreased by -25 % , and rosterone glucuronide by -30 % , and and rostane-3α,17β-diol-3-glucuronide by -28 % in the EA group ( P = 0.038 , 0.030 , and 0.047 , respectively vs. exercise ) ; menstrual frequency increased to 0.69/month from 0.28 at baseline in the EA group ( P = 0.018 vs. exercise ) . After the 16-wk follow-up , the acne score decreased by -32 % in the EA group ( P = 0.006 vs. exercise ) . Both EA and exercise improved menstrual frequency and decreased the levels of several sex steroids at week 16 and at the 16-wk follow-up compared with no intervention . Low-frequency EA and physical exercise improved hyper and rogenism and menstrual frequency more effectively than no intervention in women with PCOS . Low-frequency EA was superior to physical exercise and may be useful for treating hyper and rogenism and oligo/amenorrhea CONTEXT Polycystic ovary syndrome ( PCOS ) presents in adolescence , and obesity is a common finding . The benefits and risks of alternate approaches to the management of PCOS in obese adolescent women are not clear . OBJECTIVE We investigated the effects of metformin , oral contraceptives ( OCs ) , and /or lifestyle modification in obese adolescent women with PCOS . DESIGN Two small , r and omized , placebo-controlled clinical trials were performed . PATIENTS AND PARTICIPANTS A total of 79 obese adolescent women with PCOS participated . INTERVENTIONS In the single treatment trial , subjects were r and omized to metformin , placebo , a lifestyle modification program , or OC . In the combined treatment trial , all subjects received lifestyle modification and OC and were r and omized to metformin or placebo . MAIN OUTCOME MEASURES Serum concentrations of and rogens and lipids were measured . RESULTS Lifestyle modification alone result ed in a 59 % reduction in free and rogen index with a 122 % increase in SHBG . OC result ed in a significant decrease in total testosterone ( 44 % ) and free and rogen index ( 86 % ) but also result ed in an increase in C-reactive protein ( 39.7 % ) and cholesterol ( 14 % ) . The combination of lifestyle modification , OC , and metformin result ed in a 55 % decrease in total testosterone , as compared to 33 % with combined treatment and placebo , a 4 % reduction in waist circumference , and a significant increase in HDL ( 46 % ) . CONCLUSIONS In these preliminary trials , both lifestyle modification and OCs significantly reduce and rogens and increase SHBG in obese adolescents with PCOS . Metformin , in combination with lifestyle modification and OC , reduces central adiposity , reduces total testosterone , and increases HDL , but does not enhance overall weight reduction Estimates of the prevalence of the polycystic ovary syndrome ( PCOS )  in the general population have ranged from 2 - 20 % . The vast majority of these reports have studied White population s in Europe , used limited definitions of the disorder , and /or used bias population s , such as those seeking medical care . To estimate the prevalence of this disorder in the United States and address these limitations , we prospect ively determined the prevalence of PCOS in a reproductive-aged population of 369 consecutive women ( 174 White and 195 Black ; aged 18 - 45 yr ) , examined at the time of their preemployment physical .  Body measures  were obtained , and body hair was quantified by a modified Ferriman-Gallwey ( F-G ) method . All exams were initially performed by 2 trained nurses , and any subject with an F-G score above 3 was reexamined by a physician , the same for all patients . Of the 369 women , 277 ( 75.1 % ) also agreed to complete a question naire and have additional blood drawn . Subjects were studied regardless of current estrogen/progestin hormonal use ( 28.5 % ) . PCOS was defined as 1 ) oligoovulation , 2 ) clinical hyper and rogenism ( i.e. hirsutism ) and /or hyper and rogenemia , and 3 ) exclusion of other related disorders , such as hyperprolactinemia , thyroid abnormalities , and non-classic adrenal hyperplasia . Hirsutism was defined by a F-G score of 6 or more , and hyper and rogenemia was defined as a total or free testosterone , and rostenedione , and /or dehydroepi and rosterone sulfate level above the 95th percentile of control values [ i.e. all eumenorrheic women in the study , who had no hirsutism ( F-G < or = 5 ) or acne and were receiving no hormonal therapy ; n = 98 ] . Considering all 369 women studied , White and Black women had similar mean ages ( 29.4 + /- 7.1 and 31.1 + /- 7.8 yr , respectively ) , although White women had a lesser body mass than Black women ( 24.9 + /- 6.1 vs. 29.2 + /- 8.1 kg/m2 , respectively ; P < 0.001 ) . Of these 7.6 % , 4.6 % , and 1.9 % demonstrated a F-G score of 6 or more , 8 or 10 , respectively , and there was no significant racial difference , with hirsutism prevalences of 8.0 % , 2.8 % , and 1.6 % in Whites , and 7.1 % , 6.1 % , and 2.1 % in Blacks , respectively . Of the 277 women consenting to a history and hormonal evaluation , 4.0 % had PCOS as defined , 4.7 % ( 6 of 129 ) of Whites and 3.4 % ( 5 of 148 ) of Blacks . In conclusion , in our consecutive population of unselected women the prevalence of hirsutism varied from 2 - 8 % depending on the chosen cut-off F-G score , with no significant difference between White and Black women . Using an F-G score of 6 or more as indicative of hirsutism , 3.4 % of Blacks and 4.7 % of Whites had PCOS as defined . These data suggest that PCOS may be one of most common reproductive endocrinological disorders of women Abdominal obesity and hyperinsulinemia play a key role in the development of the polycystic ovary syndrome ( PCOS ) . Dietary-induced weight loss and the administration of insulin-lowering drugs , such as metformin , are usually followed by improved hyper and rogenism and related clinical abnormalities . This study was carried out to evaluate the effects of combined hypocaloric diet and metformin on body weight , fat distribution , the glucose-insulin system , and hormones in a group of 20 obese PCOS women [ body mass index ( BMI ) > 28 kg/m2 ] with the abdominal phenotype ( waist to hip ratio > 0.80 ) , and an appropriate control group of 20 obese women who were comparable for age and pattern of body fat distribution but without PCOS . At baseline , we measured sex hormone , sex hormone-binding globulin ( SHBG ) , and leptin blood concentrations and performed an oral glucose tolerance test and computerized tomography ( CT ) at the L4-L5 level , to measure sc adipose tissue area ( SAT ) and visceral adipose tissue area . All women were then given a low-calorie diet ( 1,200 - 1,400 kcal/day ) alone for one month , after which anthropometric parameters and CT scan were newly measured . While continuing dietary treatment , PCOS women and obese controls were subsequently placed , in a r and om order , on metformin ( 850 mg/os , twice daily ) ( 12 and 8 , respectively ) or placebo ( 8 and 12 , respectively ) , according to a double-blind design , for the following 6 months . Blood tests and the CT scan were performed in each woman at the end of the study while they were still on treatment . During the treatment period , 3 women of the control group ( all treated with placebo ) were excluded because of noncompliance ; and 2 PCOS women , both treated with metformin , were also excluded because they became pregnant . Therefore , the women cohort available for final statistical analysis included 18 PCOS ( 10 treated with metformin and 8 with placebo ) and 17 control women ( 8 treated with metformin and 9 with placebo )  . The treatment was well tolerated . In the PCOS group , metformin therapy improved hirsutism and menstrual cycles significantly more than placebo .  Baseline anthropometric and CT parameters were similar in all groups . Hypocaloric dieting for 1 month similarly reduced BMI values and the waist circumference in both PCOS and control groups , without any significant effect on CT scan parameters . In both PCOS and control women , however , metformin treatment reduced body weight and BMI significantly more than placebo . Changes in the waist-to-hip ratio values were similar in PCOS women and controls , regardless of pharmacological treatment . Metformin treatment significantly decreased SAT values in both PCOS and control groups , although only in the latter group were SAT changes significantly greater than those observed during the placebo treatment . On the contrary , visceral adipose tissue area values significantly decreased during metformin treatment in both PCOS and control groups , but only in the former was the effect of metformin treatment significantly higher than that of placebo .  Fasting insulin significantly decreased in both PCOS women and controls , regardless of treatment , whereas glucose-stimulated insulin significantly decreased only in PCOS women and controls treated with metformin . Neither metformin or placebo significantly modified the levels of LH , FSH , dehydroepi and rosterone sulphate , and progesterone in any group , whereas testosterone concentrations decreased only in PCOS women treated with metformin .  SHBG concentrations remained unchanged in all PCOS women ; whereas in the control group , they significantly increased after both metformin and placebo .  Leptin levels decreased only during metformin treatment in both PCOS and control groups . ( ABSTRACT TRUNCATED This pilot study assessed the effects of exercise and nutritional counseling on hormonal , menstrual , and reproductive function in women with polycystic ovary syndrome ( PCOS ) . Twelve females with a clinical , biochemical , and ultrasonographic diagnosis of PCOS were r and omly assigned to endurance and resistance exercise plus nutritional counseling ( EN ) or nutritional counseling only ( N ) for a period of 12 weeks . Anthropometry , resting metabolic rate ( RMR ) , selected hormones , and ovarian follicle population were measured pre and post-intervention . Following the 12 week intervention , greater decreases in sum of 2 skinfolds ( p = 0.002 ) and a greater increase in estimated VO2 max ( p = 0.017 ) occurred in the exercise group . Significant decreases in waist girth ( p = 0.001 ) and insulin levels ( p = 0.03 ) occurred in both groups . Hormonal changes were not statistically significant ; however , a trend towards an improved hormonal profile , specifically sex-hormone binding globulin ( EN , 39 % increase ; N , 8 % increase ) and lutenizing hormone : follicle-stimulating hormone ( LH : FSH ) ( EN , 9 % decrease ; N , 27 % decrease ) occurred in the absence of weight loss . These findings suggest exercise and nutritional counseling may benefit the metabolic and reproductive abnormalities associated with PCOS Objective : To compare the efficacy of metformin with that of lifestyle changes in patients with polycystic ovary syndrome ( PCOS ) . Design : Prospect i ve , r and omized clinical trial of 40 women with PCOS to analyze the effects of metformin and lifestyle intervention treatments on menstrual pattern and hormone and metabolic profile . The duration of treatment was 6 months . Statistical analysis was done using Student ’s t-test . Results : Fifteen women in the metformin group and 12 in the lifestyle changes group completed the study . The menstrual pattern improved by ~67 % in both groups . There was a significant decrease in waist circumference in the lifestyle changes group ( 101.8 ± 3.9 and 95.1 ± 3.6 , at baseline and at 6 months of treatment , respectively ; p < 0.001 ) and in body mass index ( BMI ) in both groups . The predictor of menstrual pattern improvement was BMI . Conclusions : Both metformin and lifestyle changes may increase the number of menstrual cycles in PCOS . This effect was related to a decrease in BMI In 1997 , the World Health Organization published a l and mark document recognizing obesity as a worldwide disease that poses a serious threat to public health ( 1 ) . Persons who are overweight or obese have substantially increased risk for morbidity from numerous chronic disorders , such as diabetes ( 2 , 3 ) , hypertension ( 4 , 5 ) , and cardiovascular disease ( 6 , 7 ) . Obesity-related health risk is greater when excess fat is deposited in the abdomen region because this phenotype is a stronger predictor of cardiovascular disease and type 2 diabetes mellitus than general obesity is ( 8 - 11 ) . This may be partially explained by excess accumulation of visceral fat , an independent correlate of insulin resistance ( 9 - 11 ) and dyslipidemia ( 8 , 9 ) . These observations highlight the need to identify appropriate treatment strategies to prevent and reduce obesity and suggest that the effectiveness of these treatments would be enhanced if abdominal obesity , particularly visceral fat , was substantially reduced . Diet restriction remains the most common method of obesity reduction ( 12 ) . Despite the observation that low levels of physical activity are a major cause of obesity ( 13 ) , increased physical activity alone is not thought to be a useful strategy for obesity reduction . Some reports have suggested that physical activity in obese adults results in only modest weight loss ( approximately 1 to 2 kg ) independent of the effects of diet restriction ( 14 ) . However , these conclusions are drawn from studies in which individual energy intake and expenditure were not rigorously controlled or accurately measured ( 15 - 17 ) . Moreover , in most studies , the negative energy balance induced by exercise was modest enough that substantial weight loss was not expected ( 15 - 17 ) . Currently , no compelling evidence supports the observation that exercise alone is not a useful method for reducing total or abdominal obesity . It is well known that a single exercise session is associated with a significant improvement in insulin-stimulated glucose uptake ( 18 , 19 ) . It is also clear that weight loss is associated with an improvement in insulin action ( 20 - 24 ) . It is unclear , however , whether regular exercise improves glucose metabolism after the short-term effects of exercise and changes in body fat distribution are considered . Segal and colleagues ( 25 ) controlled for the confounding effect of the last exercise session and body composition changes and found that exercise had no independent effect on insulin sensitivity ( 25 ) . Given the established importance of insulin resistance as an antecedent to both cardiovascular disease and type 2 diabetes mellitus ( 26 ) , it is important to clarify whether exercise improves insulin action independent of fat loss . We performed a r and omized , controlled trial to determine the independent effect of diet-induced or exercise-induced weight loss on obesity and insulin resistance in moderately obese men . We also evaluated whether exercise without weight loss was associated with reductions in abdominal obesity and insulin resistance . Methods Participants Participants were recruited from Kingston , Ontario , Canada , a typical suburban region , through the general media . We selected men with a body mass index greater than 27 kg/m2 and a waist circumference greater than 100 cm whose weight had been stable ( 2 kg ) for 6 months before study entry . Participants were nonsmokers who consumed an average of fewer than two alcoholic beverages per day , had a sedentary lifestyle , and took no medications known to affect the principal outcome measures . All participants had a preparticipation medical examination that included screening for normal glucose tolerance and plasma lipid profile . A computer program was used to r and omly assign eligible men to one of the following four groups : control , diet-induced weight loss , exercise-induced weight loss , and exercise without weight loss ( Figure 1 ) . Of the 101 participants who were r and omly assigned to groups , 34 chose not to participate because they were dissatisfied with their assigned group , 5 were diabetic or dyslipidemic , and 3 were relocated because of job transfers . Those who chose not to participate and those who completed the trial were similar with regard to anthropometric variables . In addition , those who completed the trial were similar to those who did not in each group ( P > 0.10 ) . Baseline characteristics among groups were similar for all participants ( Table 1 ) . All participants gave fully informed written consent . The study was conducted in accordance with the ethical guidelines of Queen 's University . The participants did not receive monetary compensation . Figure 1 . Flow of participants through the study . Table 1 . Selected Anthropometric , Magnetic Resonance Imaging , and Metabolic Variables before Treatment and 3 Months after Treatment Diet and Exercise Regimen During the baseline period , daily energy requirements for all participants were determined by estimating resting energy expenditure and multiplying the obtained value by a factor of 1.5 ( 27 ) . All participants followed a weight maintenance diet ( 55 % to 60 % carbohydrate , 15 % to 20 % protein , and 20 % to 25 % fat ) for a 4- to 5-week baseline period . During this period , body weight was monitored to determine the accuracy of the prescribed energy requirement , which was adjusted accordingly to maintain body weight . Controls were asked to maintain body weight throughout the 12-week treatment period . Participants in the diet-induced weight loss group were asked to reduce the isocaloric diet by 700 kcal/d during the treatment period to achieve a weekly weight loss of approximately 0.6 kg . To lose the same amount of weight , participants in the exercise-induced weight loss group were asked to maintain the isocaloric diet for the duration of the treatment period and to perform exercise that expended 700 kcal/d . Participants assigned to exercise without weight loss were asked to maintain body weight . Therefore , they consumed enough calories to compensate for the energy expended during the daily exercise sessions ( approximately 700 kcal ) . At the end of the treatment period , isocaloric requirements were determined and prescribed for a 2-week weight stabilization period . All participants were free-living and consumed self-selected foods .  No vitamins or other nutritional supplements were prescribed . Each person participated in a series of weekly 1-hour seminars in which a dietitian taught proper food selection and preparation . Participants were told that the composition of the maintenance and energy-reduced diets should be approximately 55 % to 60 % carbohydrate , 15 % to 20 % protein , and 20 % to 25 % fat . Participants kept and analyzed daily , detailed food records for the duration of the study period ( approximately 20 weeks ) ; the study dietitian also review ed these records . For the 2-week period during which doubly labeled water measurements were acquired ( weeks 6 and 7 ) , the diet records were analyzed by using a computerized program ( Food Processor , Esha Research , Salem , Oregon ) . Participants in both exercise groups performed daily exercise ( brisk walking or light jogging ) on a motorized treadmill for the duration of the 12-week trial . The length of each exercise session was determined by the time required to expend 700 kcal . Participants were asked to exercise at an intensity not greater than 70 % of their peak oxygen uptake ( Vo 2 ) ( approximately 80 % of maximal heart rate ) . Energy expenditure was determined by using the heart rate and oxygen consumption data that were obtained from the pretreatment grade d exercise test and were adjusted according to the results of two subsequent tests performed at weeks 4 and 8 . During each session , heart rate was monitored every 5 minutes by using an automated heart rate monitor ( Polar Oy , Kempele , Finl and ) . All exercise sessions were by appointment and were supervised . Peak Vo 2 was determined by using a grade d treadmill test and st and ard open-circuit spirometry techniques ( SensorMedics , Yorba Linda , California ) . Energy Expenditure Total energy expenditure for 14 days was measured by using a two-point doubly labeled water method ( 28 ) . Deuterium enrichment was analyzed by using a 903 deuterium dual-inlet isotope ratio mass spectrometer ( VG Isogas , Cheshire , United Kingdom ) . Oxygen-18 was determined by using a SIRA 12 isotope ratio mass spectrometer ( VG Isogas ) . Total energy expenditure was calculated by using the DeWeir formula ( 29 ) . After an overnight stay in the hospital , resting metabolic rate was measured at 7:00 a.m. by using indirect calorimetry with a modified mask system ( Teem 100 , Aerosport , Inc. , Ann Arbor , Michigan ) . Values were obtained for 30 minutes , and the last 25 minutes were used to determine resting metabolic rate . Resting systolic and diastolic blood pressure were measured when the participant was supine . Magnetic Resonance Imaging and Anthropometric Measurements Whole-body data from magnetic resonance imaging ( approximately 45 equidistant images ) were obtained with a General Electric 1.5-Tesla magnet ( Milwaukee , Wisconsin ) by using an established protocol described in detail elsewhere ( 30 ) . Once acquired , the data were transferred to a st and -alone work station ( Silicon Graphics , Mountain View , California ) for analysis with specially design ed computer software ( Tomovision , Inc. , Montreal , Canada ) , the procedures for which are described elsewhere ( 31 ) . For adipose tissue ( fat ) and skeletal muscle , volume units ( L ) were converted to mass units ( kg ) by multiplying the volumes by the assumed constant density for fat ( 0.92 kg/L ) and fat-free skeletal muscle ( 1.04 kg/L ) ( 32 ) . All anthropometric circumference measurements were obtained by using st and ard procedures described elsewhere ( 30 ) . Insulin Sensitivity and Glucose Tolerance Participants consumed a weight-maintenance diet consisting of at least 200 g of carbohydrate for a minimum of 4 days and were asked to avoid strenuous physical activity for 3 days before insulin BACKGROUND Clomiphene citrate ( CC ) is the first-line therapy for the induction of ovulation in infertile women with polycystic ovary syndrome ( PCOS ) , but ∼20 % of patients are unresponsive . The aim of the current study was to test the hypothesis that a 6-week intervention that consisted of structured exercise training ( SET ) and hypocaloric diet increases the probability of ovulation after CC in overweight and obese CC-resistant PCOS patients . METHODS A cohort of 96 overweight and obese CC-resistant PCOS patients was enrolled consecutively in a three-arm r and omized , parallel , controlled , assessor-blinded clinical trial . The three interventions were : SET plus hypocaloric diet for 6 weeks ( Group A ) ; 2 weeks of observation followed by one cycle of CC therapy ( Group B ) ; and SET plus hypocaloric diet for 6 weeks , with one cycle of CC after the first 2 weeks ( Group C ) . The primary end-point was the ovulation rate . Other reproductive data , as well as anthropometric , hormonal and metabolic data , were also collected and considered as secondary end points . RESULTS After 6 weeks of SET plus hypocaloric diet , the ovulation rate was significantly ( P = 0.008 ) higher in Group C [ 12/32 ( 37.5 % ) ] than in Groups A [ 4/32 ( 12.5 % ) ] and B [ 3/32 ( 9.4 % ) ] with relative risks of 3.9 [ 95 % confidence interval ( CI ) 1.1 - 8.3 ; P = 0.035 ] and 4.0 ( 95 % CI 1.2 - 12.8 ; P = 0.020 ) compared with Groups A and B , respectively . Compared with baseline , in Groups A and C , a significant improvement in clinical and biochemical and rogen and insulin sensitivity indexes was observed . In the same two groups , the insulin sensitivity index was significantly ( P < 0.05 ) better than that in Group B. CONCLUSIONS In overweight and obese CC-resistant PCOS patients , a 6-week intervention of SET and a hypocaloric diet was effective in increasing the probability of ovulation under CC treatment . The study was registered at Clinical trials.gov : NCT0100468 We have recently shown that polycystic ovary syndrome ( PCOS ) is associated with high muscle sympathetic nerve activity ( MSNA ) . Animal studies support the concept that low-frequency electroacupuncture ( EA ) and physical exercise , via stimulation of ergoreceptors and somatic afferents in the muscles , may modulate the activity of the sympathetic nervous system . The aim of the present study was to investigate the effect of these interventions on sympathetic nerve activity in women with PCOS . In a r and omized controlled trial , 20 women with PCOS were r and omly allocated to one of three groups : low-frequency EA ( n = 9 ) , physical exercise ( n = 5 ) , or untreated control ( n = 6 ) during 16 wk . Direct recordings of multiunit efferent postganglionic MSNA in a muscle fascicle of the peroneal nerve before and following 16 wk of treatment . Biometric , hemodynamic , endocrine , and metabolic parameters were measured . Low-frequency EA ( P = 0.036 ) and physical exercise ( P = 0.030 ) decreased MSNA burst frequency compared with the untreated control group . The low-frequency EA group reduced sagittal diameter ( P = 0.001 ) , while the physical exercise group reduced body weight ( P = 0.004 ) and body mass index ( P = 0.004 ) compared with the untreated control group . Sagittal diameter was related to MSNA burst frequency ( Rs = 0.58 , P < 0.005 ) in the EA group . No correlation was found for body mass index and MSNA in the exercise group . There were no differences between the groups in hemodynamic , endocrine , and metabolic variables . For the first time we demonstrate that low-frequency EA and physical exercise lowers high sympathetic nerve activity in women with PCOS . Thus , treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS OBJECTIVE To investigate the possible effects of low-frequency electroacupuncture ( EA ) and physical exercise on markers of coagulation and fibrinolysis , insulin sensitivity , and adipose tissue characteristics in women with polycystic ovary syndrome ( PCOS ) . DESIGN Secondary analyses of a prospect i ve , r and omized controlled clinical trial . SETTING Department of Physiology and Department of Obstetrics and Gynecology , University of Gothenburg . PATIENT(S ) Eighty-four women with PCOS were r and omized . INTERVENTION(S ) Women with PCOS were r and omized to 16 weeks of low-frequency EA ( 14 treatments ) , physical exercise ( at least 3 times/wk ) , or no intervention . MAIN OUTCOME MEASURE(S ) Anthropometrics , circulating coagulation and fibrinolytic markers , insulin sensitivity ( euglycemic hyperinsulinemic clamp ) , hemodynamics , and adipose tissue morphology/function recorded at baseline , after 16 weeks of intervention , and after a 16-week follow-up . RESULT ( S ) In the low-frequency EA group , circulating plasminogen activator inhibitor 1 activity decreased by 21.8 % after 16 weeks of intervention and by 31.1 % at the 16-week follow-up and differed from the physical exercise and the no intervention groups . The EA group had decreases in circulating fibrinogen and tissue plasminogen activator ( t-PA ) , sagittal diameter , and diastolic blood pressure after treatment , and fibrinogen remained lower at the 16-week follow-up . In the physical exercise group , lipoprotein lipase activity increased and diastolic blood pressure decreased after treatment , and both diastolic and systolic blood pressure were lower at follow-up . No other variables were affected . CONCLUSION ( S ) Low-frequency EA counteracted a possible prothrombotic state in women with PCOS , as reflected by a decrease in plasminogen activator inhibitor 1 activity . Despite within-group improvements , there were no between-group differences in anthropometric , metabolic , or hemodynamic variables after 16 weeks of EA or physical exercise at the dose/intensity studied Aims /hypothesisPolycystic ovary syndrome ( PCOS ) is an insulin resistant ( IR ) state . Increased skeletal muscle lipid content and impaired mitochondrial biogenesis have been implicated in the pathogenesis of IR . We investigated whether differences in these variables explain the IR of women affected by PCOS and whether improvements in IR with exercise are reflected by changes in these variables . Methods Sixteen PCOS and 13 non-PCOS overweight women were assessed , and eight PCOS and seven non-PCOS women were reassessed after 12 weeks of moderate and vigorous exercise training . Outcomes included insulin sensitivity ( glucose infusion rate [ GIR ] ) , skeletal muscle gene expression and protein abundance , enzyme activity of selected mitochondrial components , and computed tomography ( CT ) attenuation-estimated muscle lipid . Results GIR was lower in women with PCOS versus those without ( p = 0.01 ) and increased with exercise in both groups . Baseline CT muscle attenuation suggested a trend to less muscle lipid in PCOS , which increased with exercise training , with a difference in the change in muscle lipid ( p = 0.01 , age-corrected ) , compared with non-PCOS women . GIR correlated with PGC1A gene expression across the whole group ; skeletal muscle expression of mitochondrial biogenesis markers was not different between groups at baseline , or after training . Neither lipid changes nor mitochondrial changes correlated with changes in GIR . Conclusions /interpretationDifferences in IR in women with and without PCOS were not explained by differences in skeletal muscle lipid or mitochondrial parameters . Improvements in IR with exercise were dissociated from mitochondrial parameters . CT muscle attenuation suggested a differential capacity of PCOS muscle to store lipid compared with non-PCOS.Trial registration : Clinical trials.gov IS RCT N84763265 Funding : National Health & Medical Research Council ( Grant number 606553 ) , Monash University and The Jean Hailes Foundation Context : Yoga techniques practice d for varying duration s have been shown to reduce state anxiety . This was never assessed in adolescents with polycystic ovarian syndrome ( PCOS ) . Aims : To compare the effect of a holistic yoga program with the conventional exercise program on anxiety level in adolescents with PCOS . Setting s and Design : Ninety adolescent ( 15 - 18 years ) girls from a residential college in And hra Pradesh , who satisfied the Rotterdam criteria , were r and omized into two groups . Material s and Methods : Anxiety levels were assessed at inclusion and after 12 weeks of intervention wherein yoga group practice d a holistic yoga module while the control group practice d a matching set of physical exercises ( 1 h/day , for 12 weeks ) . Statistical Analysis Used : Mann-Whitney U test was used to compare difference scores ( delta change ) between the two groups Results : Changes in state anxiety after the intervention were nonsignificantly different between the two groups ( P=0.243 ) , while changes after the intervention were significantly different between the two groups ( P=0.002 ) for trait anxiety . Conclusions : Twelve weeks of a holistic yoga program in adolescents with PCOS is significantly better than physical exercise program in reducing anxiety symptoms BACKGROUND In 35 adolescent females ( 17 + /- 2 years ) with polycystic ovary syndrome ( PCOS ) , median body mass index ( BMI ) 30.8 kg/m2 , we assessed effeicacy of metformin-diet for 1 year for reduction of weight , insulin , HOMA insulin resistance ( IR ) , cholesterol , triglycerides , and resumption of regular menses . METHODS Calories ( 26 % protein , 44 % carbohydrate ) were targeted to 1,500 - 1,800/day if BMI was < 25 or to 1,200 - 1,500/day if BMI was > or = 25 , along with 2,550 mg metformin . RESULTS Median weight fell from 82.7 to 79.1 kg ( p = 0.009 ) , insulin 16.7 to 13.3 microU/ml ( p < 0.0001 ) , HOMA IR 3.41 to 2.74 ( p = 0.0004 ) , total cholesterol 164 to 151 mg/dl ( p = 0.002 ) , and triglyceride 103 to 85 mg/dl ( p = 0.006 ) . The percentage of cycles with normal menses rose from a pre-treatment mean of 22 % to 74 % , p < 0.0001 . CONCLUSIONS In adolescents with PCOS , metformin-diet reduces weight , insulin , IR , cholesterol , and triglycerides , and facilitates resumption of regular menses CONTEXT Polycystic ovary syndrome ( PCOS ) is an insulin-resistant ( IR ) state . Visceral fat ( VF ) is independently associated with IR . OBJECTIVES The objectives of the study were to explore mechanisms underpinning IR by assessing the effect of exercise training on IR and body composition in overweight PCOS and non-PCOS women . DESIGN This was a prospect i ve exercise intervention study . SETTING AND PARTICIPANTS The study was conducted at an academic medical center . Participants included 20 overweight PCOS and 14 overweight non-PCOS women . INTERVENTION The intervention included 12 wk of intensified aerobic exercise ( 3 h/wk ) . MAIN OUTCOME MEASURES IR on euglycemic hyperinsulinemic clamp , body composition including abdominal visceral and sc fat distribution by computer tomography and lipids was measured . RESULTS PCOS subjects were more IR ( P = 0.02 ) and had more VF ( P = 0.04 age adjusted ) than non-PCOS women . In PCOS women , IR correlated with VF ( r = -0.78 , P < 0.01 ) . With exercise training , both groups maintained weight but within PCOS , VF ( -12.0 cm(2 ) , P = 0.03 ) and within non-PCOS abdominal sc fat ( -40.2 cm(2 ) , P = 0.02 ) decreased . Despite exercise-induced improvement in IR within PCOS ( + 27.9 mg · m(-2 ) · min(-1 ) , P = 0.03 ) , no relationship with decreased VF ( r = -0.08 , P = 0.84 ) and no differential changes in IR and VF between groups were noted . Triglycerides decreased within PCOS ( -0.27 mmol/liter , P = 0.02 ) and decreased differentially between groups ( P < 0.01 ) . CONCLUSIONS Higher IR was related to increased VF in PCOS , suggesting an etiological role for VF in intrinsic IR in PCOS ; however , changes with exercise intervention did not support a causal relationship . Triglycerides were modulated more by exercise training in PCOS than non-PCOS women . Within-group exercise-induced reductions in cardiometabolic risk factors including IR , triglycerides , and VF in PCOS were observed without significant weight loss and if confirmed in future controlled trials , suggest weight loss should not be the sole focus of exercise programs We examined the effects of a 6-month r and omized program of endurance training ( n = 14 ) , resistance training ( n = 17 ) , or control conditions ( n = 20 ) on insulin sensitivity in nonobese , younger women ( 18 - 35 yr ) . To examine the possible mechanism(s ) related to alterations in insulin sensitivity , we measured body composition , regional adiposity , and skeletal muscle characteristics with computed tomography . We observed no changes in total body fat , sc abdominal adipose tissue , or visceral adipose tissue with endurance or resistance training .  Insulin sensitivity , however , increased with endurance training ( pre , 421 + /- 107 ; post , 490 + /- 133 mg/min ; P < 0.05 ) and resistance training ( pre , 382 + /- 87 ; post , 417 + /- 89 mg/min ; P = 0.06 ) . When the glucose disposal rate was expressed per kg fat-free mass ( FFM ) , the improved insulin sensitivity persisted in endurance-trained ( pre , 10.5 + /- 2.7 ; post , 12.1 + /- 3.3 mg/min x kg FFM ; P < 0.05 ) , but not in resistance-trained ( pre , 9.7 + /- 1.9 ; post , 10.2 + /- 1.8 mg/min x kg FFM ; P = NS ) women . Muscle attenuation ratios increased ( P < 0.05 ) in both endurance- and resistance-trained individuals , but this was not related to changes in insulin sensitivity . Moreover , the change in insulin sensitivity was not related to the increased maximum aerobic capacity in endurance-trained women ( r = 0.24 ; P = NS ) . We suggest that both endurance and resistance training improve glucose disposal , although by different mechanisms , in young women . An increase in the amount of FFM from resistance training contributes to increased glucose disposal probably from a mass effect , without altering the intrinsic capacity of the muscle to respond to insulin . On the other h and , endurance training enhances glucose disposal independent of changes in FFM or maximum aerobic capacity , suggestive of an intrinsic change in the muscle to metabolize glucose . We conclude that enhanced glucose uptake after physical training in young women occurs with and without changes in FFM and body composition Background Polycystic ovary syndrome ( PCOS ) is a common female reproductive‐age endocrine disease predominantly characterized by chronic anovulation , hyper and rogenism , insulin‐resistance and low‐ grade inflammatory status . Exercise training ( ET ) favourably modulates cardiopulmonary function and insulin‐sensitivity markers in PCOS women . The present study investigated the effects of ET  on autonomic function and inflammatory pattern in PCOS women OBJECTIVE To determine whether weight loss in obese , hyper and rogenic , anovulatory women is associated with resumption of ovulation and /or with changes in insulin , and rogen , and gonadotropin concentrations . DESIGN Prospect i ve , r and omized , controlled study . SETTING University research center . PATIENTS Twelve obese , hyper and rogenic , anovulatory women . INTERVENTIONS Twelve-week weight loss program in treatment ( n = 6 ) ; 12-week " waiting list " in control group ( n = 6 ) . MAIN OUTCOME MEASURES [ 1 ] Ovulation ; [ 2 ] fasting insulin and glucose measurements ; [ 3 ] sex hormone-binding globulin ( SHBG ) , total and non-SHBG T concentrations ; [ 4 ] LH pulse frequency , amplitude , and concentration ; and [ 5 ] FSH concentration . RESULTS In contrast with the control group who showed no change in weight , ovulation status , or hormone levels , women in the treatment group lost an average of 16.2 kg and showed a significant increase in SHBG , a significant decline in non-SHBG T , and a decline ( though nonsignificant ) in fasting insulin . Four of six subjects resumed ovulation . However , no changes were evident in LH pulse frequency or amplitude or in mean LH and FSH concentrations . CONCLUSIONS Weight loss in obese , hyper and rogenic , anovulatory women appears to reduce insulin and non-SHBG T concentrations despite the absence of a change in gonadotropin secretion and may lead to resumption of ovulation AIM OF THE STUDY to compare the clinical , hormonal and biochemical changes after the application of the two ways of influence upon insulin resistance in women with PCOS - reduction of weight and application of metformin . MATERIAL S AND METHODS It is an open , 6 months , prospect i ve study , including 60 women with PCOS , divided in two groups . The first group ( n=35 ) received 1700 mg metformin ( M ) per day . The second group ( n = 25 ) was put on a low caloric diet ( 1200 - 1400 kcal ) for reduction of weight . The following anthropological and clinical parameters have been checked in the beginning and at the end of the study - weight , BMI , frequency of menstruation , waist to hip ratio , hirsutismus , defined by the Ferriman-Gallwey index . The following hormonal parameters have been studied as well - testosterone , SHBG , insulin , DHEAS , LH and FSH . FAI and HOMAIR have also been determined . RESULTS A considerable improvement in the frequency of menstruation has been noticed in both groups , while hirsutism has been influenced positively mostly in the group , where M is applied . In group 2 the clinical improvement is directly connected with the percent of weight reduction . In group 1 the clinical changes depend on the degree of influence over insulin resistance . CONCLUSION The higher BMI is , the more likely to expect is an effect over the menstruation cycle , due to weight reduction , than to M application or to the increase dosage of the drug . In cases of women with expressed hirsutism , it is more appropriate to apply M as a monotherapy or in combination with programs for body-weight reduction OBJECTIVE To determine the prevalence of insulin resistance ( IR ) in a large population of patients with the polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve , case-control . SETTING University medical center . PATIENT(S ) Two hundred seventy-one PCOS patients and 260 eumenorrheic , non-hirsute , control women . INTERVENTION(S ) History and physical examination and blood sampling . MAIN OUTCOME MEASURE(S ) Total T , free T , DHEAS , sex hormone-binding globulin , and fasting glucose and insulin levels ; homeostatic model assessment values for IR ( HOMA-IR ) and percent beta-cell function ( HOMA-%beta-cell ) . RESULT ( S ) Patients with PCOS and controls differed significantly in all parameters studied , except fasting glucose . Because the HOMA-IR and HOMA-%beta-cell values were variably associated with race , age , and body mass index , the HOMA-IR and HOMA-%beta-cell values were then adjusted for these cofounders . After adjustment , 64.4 % of PCOS patients were noted to be insulin resistant , and 2.6 % had beta-cell dysfunction . Compared with PCOS patients without IR ( n = 96 ) , patients with IR ( n = 174 ) were more obese and had higher beta-cell function . CONCLUSION ( S ) In patients with PCOS , the prevalence of IR was 64 % according to the HOMA-IR measurement , after adjustment . Patients with IR were more clinical ly affected . Although IR is a common abnormality in PCOS , it does not seem to be a universal feature OBJECTIVE To obtain data from a pilot r and omized trial on the effect of metformin therapy and lifestyle modification on ovulation and and rogen concentrations in women with polycystic ovary syndrome ( PCOS ) . DESIGN Prospect i ve , r and omized , placebo-controlled pilot trial . SETTING Academic medical center . PATIENT(S ) Thirty-eight overweight or obese women with PCOS . INTERVENTION(S ) All subjects were r and omized to one of four 48-week interventions : metformin 850 mg two times per day , lifestyle modification plus metformin 850 mg two times per day , lifestyle modification plus placebo , or placebo alone . MAIN OUTCOME MEASURE(S ) Recruitment , dropout , and compliance with a long-term lifestyle intervention in PCOS ; preliminary estimates of treatment effect on ovulation , as measured by weekly urinary pregnanediol glucuronide , and on total T and free and rogen index . RESULT ( S ) It was necessary to screen seven women to have one subject r and omized . The dropout rate was 39 % , with the majority of dropouts occurring within the first 24 weeks . Mean body mass index was > 39 mg/kg(2 ) . Modest weight reduction was found in all treatment groups , with the most significant reduction occurring with the combination of metformin and lifestyle intervention .  Significant and rogen reduction occurred in the combination group only . Ovulation rates did not differ significantly between groups . However , when data were analyzed by presence or absence of weight reduction in subjects , independent of treatment group , the estimated odds ratio for weight loss was 9.0 ( 95 % confidence interval 1.2 - 64.7 ) with respect to regular ovulation . If weight loss occurred during metformin therapy , the odds ratio for regular ovulation was 16.2 ( 95 % confidence interval 4.4 - 60.2 ) . CONCLUSION ( S ) Key method ologic issues for a large-scale , r and omized trial of lifestyle intervention in PCOS include minimizing early dropout from the lifestyle intervention and including a range of body mass index that is not skewed toward severe obesity . Weight reduction might play the most significant role in restoration of ovulation in obese women with PCOS BACKGROUND Type 2 diabetes affects approximately 8 percent of adults in the United States . Some risk factors -- elevated plasma glucose concentrations in the fasting state and after an oral glucose load , overweight , and a sedentary lifestyle -- are potentially reversible . We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes . METHODS We r and omly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo , metformin ( 850 mg twice daily ) , or a lifestyle-modification program  with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week . The mean age of the participants was 51 years , and the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) was 34.0 ; 68 percent were women , and 45 percent were members of minority groups . RESULTS The average follow-up was 2.8 years . The incidence of diabetes was 11.0 , 7.8 , and 4.8 cases per 100 person-years in the placebo , metformin , and lifestyle groups , respectively . The lifestyle intervention reduced the incidence by 58 percent ( 95 percent confidence interval , 48 to 66 percent ) and metformin by 31 percent ( 95 percent confidence interval , 17 to 43 percent ) , as compared with placebo ; the lifestyle intervention was significantly more effective than metformin . To prevent one case of diabetes during a period of three years , 6.9 persons would have to participate in the lifestyle-intervention program , and 13.9 would have to receive metformin . CONCLUSIONS Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk . The lifestyle intervention was more effective than metformin Obesity affects ovulation , response to fertility treatment , pregnancy rates and outcome . In this prospect i ve study , a weight loss programme was assessed to determine whether it could help obese infertile women , irrespective of their infertility diagnosis , to achieve a viable pregnancy , ideally without further medical intervention . The subjects underwent a weekly programme aim ed at lifestyle changes in relation to exercise and diet for 6 months ; those that did not complete the 6 months were treated as a comparison group . Women in the study lost an average of 10.2 kg/m2 , with 60 of the 67 anovulatory subjects resuming spontaneous ovulation , 52 achieving a pregnancy ( 18 spontaneously ) and 45 a live birth . The miscarriage rate was 18 % , compared to 75 % for the same women prior to the programme . Psychometric measurements also improved . None of these changes occurred in the comparison group . The cost savings of the programme were considerable . Prior to the programme , the 67 women had had treatment costing a total of A$ 550,000 for two live births , a cost of A$ 275,000 per baby . After the programme , the same women had treatment costing a total of A$ 210,000 for 45 babies , a cost of A$ 4600 per baby . Thus weight loss should be considered as a first option for women who are infertile and overweight OBJECTIVE Feasibility of a clinical -trial comparing a low-glycaemic diet with a low-calorie healthy eating approach at achieving weight loss and reducing the risk of endometrial cancer in women with PCOS . DESIGN A pilot R and omised-Controlled-Trial using different recruitment strategies . SETTING A University Hospital in the United Kingdom . PATIENTS Women seen at specialist gynaecology clinics over a 12 month period in one University Hospital , and women self identified through a website and posters . INTERVENTIONS Potential recruits were assessed for eligibility , gave informed consent , r and omised , treated and assessed as in the definitive trial . MAIN OUTCOME MEASURES Eligibility and recruitment rates , compliance with the allocated diet for 6 months and with clinical assessment s , blood tests , pelvic ultrasound scans and endometrial biopsies . RESULTS 1433 new and 2598 follow up patients were seen in 153 gynaecology clinics for over 12 months . 441 ( 11 % ) potentially eligible women were identified , 19 ( 0.4 % ) of whom met the trial entry criteria . Eleven consented to take part , of which 8 ( 73 % ) completed the study . CONCLUSIONS Planned future trials on over-weight women with PCOS should be multicentre and should incorporate primary care . This data will help other research ers plan and calculate the sample size and potential recruitment rates in future clinical trials in PCOS . The results will also be useful for inclusion in future meta-analyses PURPOSE Women with polycystic ovary syndrome ( PCOS ) commonly have insulin resistance . Insulin resistance is associated with marked abnormalities of lipoprotein size and subclass particle concentration . The purpose of this study was to examine the effects of a moderate-intensity exercise program without weight loss on lipoprotein profiles in women with PCOS . METHODS Thirty-seven sedentary PCOS women were r and omized to either an 8- to 12-wk ramp-up followed by a 12-wk moderate-intensity exercise program ( 16 - 24 wk total , approximately 228 min x wk at 40 - 60 % peak V x O2 , n = 21 ) or control ( no change in lifestyle , n = 16 ) . PCOS was defined as < or=8 menses per year and hyper and rogenism ( biochemical or clinical with Ferriman-Gallwey score > or=8 ) . Fasting lipoprotein profiles were obtained before and after the intervention . Nuclear magnetic resonance spectroscopy was used to quantify the following : average particle size , total and subclass concentrations of HDL , LDL , and VLDL particles , and calculated HDL cholesterol , triglycerides , and VLDL triglycerides . Wilcoxon exact rank sums tests were used to compare changes in these parameters in the exercise group relative to controls . RESULTS Twenty women ( 8 exercisers , 12 controls ) completed the study . Comparing exercisers to controls , significant changes were seen in concentrations of the following lipoprotein parameters that are associated with decreased insulin resistance : decreased large VLDL ( P = 0.007 ) , calculated triglycerides ( P = 0.003 ) , VLDL triglycerides ( P = 0.003 ) , and medium/small HDL ( P = 0.031 ) and increased large HDL ( P = 0.002 ) and average HDL size ( P = 0.001 ) . CONCLUSIONS In this trial , moderate-intensity exercise without significant weight loss improved several components of the lipoprotein profiles of women with PCOS . These findings support the beneficial role of moderate exercise in this high-risk population CONTEXT Polycystic ovary syndrome ( PCOS ) is an endocrine disease closely related to several risk factors for cardiovascular disease . An impaired cardiopulmonary functional capacity was previously demonstrated in PCOS women . No data regarding the effects of a structured exercise training ( ET ) program on cardiopulmonary functional capacity in PCOS women are available . OBJECTIVE Our objective was to evaluate the effects of a 3-month ET program on cardiopulmonary functional capacity in young PCOS women . DESIGN AND SETTING A prospect i ve baseline-r and omized clinical study was conducted at the University " Federico II " of Naples , School of Medicine ( Italy ) . PATIENTS Ninety young overweight PCOS women were enrolled . MEAN OUTCOME MEASURES Ninety young PCOS women were r and omly subdivided into two groups , each composed of 45 subjects . The PCOS-T ( trained ) group underwent a 3-month structured ET program , whereas the PCOS-UnT ( untrained ) group did not . Hormonal and metabolic profiles and cardiopulmonary and exercise parameters were evaluated . RESULTS After 3-month ET , PCOS-T showed a significant improvement in peak oxygen consumption ( + 35.4 % ; P<0.001 ) and in maximal workload ( + 37.2 % ; P<0.001 ) . In PCOS-T we also observed a significant reduction in body mass index ( -4.5 % ; P<0.001 ) and in C-reactive protein ( -10 % ; P<0.001 ) , and a significant ( P<0.001 ) improvement in insulin sensitivity indexes . After 3 months , no changes were observed in PCOS-UnT. CONCLUSIONS A 3-month structured ET program improves cardiopulmonary functional capacity in young PCOS women Women with polycystic ovary syndrome ( PCOS ) are insulin resistant , have insulin secretory defects , and are at high risk for glucose intolerance . We performed this study to determine the prevalence of glucose intolerance and parameters associated with risk for this in PCOS women . Two-hundred and fifty-four PCOS women , aged 14 - 44 yr , were prospect ively evaluated at 2 centers , 1 urban and ethnically diverse ( n = 110 ) and 1 rural and ethnically homogeneous ( n = 144 ) . The rural PCOS women were compared to 80 control women of similar weight , ethnicity , and age . A 75-g oral glucose challenge was administered after a 3-day 300-g carbohydrate diet and an overnight fast with 0 and 2 h blood sample s for glucose levels .  Diabetes was categorized according to WHO criteria . The prevalence of glucose intolerance was 31.1 % impaired glucose intolerance ( IGT ) and 7.5 % diabetes . In nonobese PCOS women ( body mass index , < 27 kg/m2 ) , 10.3 % IGT and 1.5 % diabetes were found . The prevalence of glucose intolerance was significantly higher in PCOS vs. control women ( chi2 = 7.0 ; P = 0.01 ; odds ratio = 2.76 ; 95 % confidence interval = 1.23 - 6.57 ) . Variables most associated with postchallenge glucose levels were fasting glucose levels ( P < 0.0001 ) , PCOS status ( P = 0.002 ) , waist/hip ratio ( P = 0.01 ) , and body mass index ( P = 0.021 ) . The American Diabetes Association criteria applied to fasting glucose significantly underdiagnosed diabetes compared to the WHO criteria ( 3.2 % vs. 7.5 % ; chi2 = 4.7 ; P = 0.046 ; odds ratio = 2.48 ; 95 % confidence interval = 1.01 - 6.69 ) . We conclude that 1 ) PCOS women are at significantly increased risk for IGT and type 2 diabetes mellitus at all weights and at a young age ; 2 ) these prevalence rates are similar in 2 different population s of PCOS women , suggesting that PCOS may be a more important risk factor than ethnicity or race for glucose intolerance in young women ; and 3 ) the American Diabetes Association diabetes diagnostic criteria failed to detect a significant number of PCOS women with diabetes by postchallenge glucose values STUDY OBJECTIVE To compare the effects of a hypocaloric low-fat diet with those of a very low carbohydrate diet on body mass index ( BMI ) , waist circumference ( WC ) , and menstrual function in overweight adolescent females with polycystic ovary syndrome ( PCOS ) . DESIGN R and omized pilot trial of two diets in a prospect i ve , 12-week study . SETTING A hospital-based , academic adolescent medicine division . PARTICIPANTS 24 females , age 12 - 22 years ( mean 15.8 ± 2.2 ) , with PCOS and a BMI above the 85(th ) percentile for age ( mean 35.7 ± 6.0 kg/m(2 ) ) . INTERVENTIONS Nutrition counseling was given biweekly , and dietary compliance , menstrual history , and weight were recorded . WC was measured at the beginning and end of the study . MAIN OUTCOME MEASURES Changes in weight , BMI , WC , and improvement in menstrual function over the course of the study period . RESULTS 16 participants completed the study . 12 completers menstruated during the study period , 8 with regularity . The number of periods over 3 months increased from 0.6 ± 0.6 pre-treatment to 1.6 ± 1.3 post-treatment ( P = 0.003 ) . Overall , weight loss averaged 6.5 % ( P < 0.0001 ) and the WC decreased by an average of 5.7 ± 7.7 cm ( P = 0.01 ) . Those who lost weight were 3.4 times more likely to have improved menstrual function ( P = 0.001 ) . There were no statistically significant differences between the two groups . CONCLUSIONS Weight loss is feasible in adolescents with PCOS and results in significant improvements in BMI , WC , and menstrual function . Weight management may be preferable as first-line treatment in adolescents , because it targets both the menstrual dysfunction and risk factors for long-term morbidity associated with PCOS BACKGROUND Lifestyle modifications are successfully employed to treat obese and overweight women with polycystic ovary syndrome ( PCOS ) . The aims of the current pilot study were ( i ) to compare the efficacy on reproductive functions of a structured exercise training ( SET ) programme with a diet programme in obese PCOS patients and ( ii ) to study their clinical , hormonal and metabolic effects to eluci date potentially different mechanisms of action . METHODS Forty obese PCOS patients with anovulatory infertility underwent a  SET programme ( SET group , n = 20 ) and a hypocaloric hyperproteic diet ( diet group , n = 20 ) . Clinical , hormonal and metabolic data were assessed at baseline , and at 12- and 24-week follow-ups . Primary endpoint was cumulative pregnancy rate . RESULTS The two groups had similar demographic , anthropometric and biochemical parameters . After intervention , a significant improvement in menstrual cycles and fertility was noted in both groups , with no differences between groups . The frequency of menses and the ovulation rate were significantly ( P < 0.05 ) higher in the SET group than in diet group but the increased cumulative pregnancy rate was not significant . Body weight , body mass index , waist circumference , insulin resistance indexes and serum levels of sex hormone-binding globulin , and rostenedione and dehydroepi and rosterone sulphate changed significantly ( P < 0.05 ) from baseline and were significantly different ( P < 0.05 ) between the two groups . CONCLUSIONS Both SET and diet interventions  improve fertility in obese PCOS patients with anovulatory infertility . We hypothesize that in both interventions an improvement in insulin sensitivity is the pivotal factor involved in the restoration of ovarian function but potentially acting through different mechanisms OBJECTIVE To assess the impact of adding exercise to dietary restriction on depressive symptoms and health-related quality of life ( HRQOL ) in women with polycystic ovary syndrome ( PCOS ) . DESIGN Analysis of depression and quality of life outcomes from a r and omized , controlled prospect i ve clinical intervention that evaluated the effects on a range of health outcomes in women with PCOS . SETTING Clinical research unit . PATIENT(S ) One hundred four overweight/obese PCOS women ( aged 29.3 ± 0.7 years ; body mass index [ BMI ] 36.1 ± 0.5 kg/m(2 ) ) . INTERVENTION(S ) R and omized to one of three 20-week lifestyle programs : diet only , diet and aerobic exercise , or diet and combined aerobic-resistance exercise . MAIN OUTCOME MEASURE(S ) Depression and PCOS-specific HRQOL . RESULT ( S ) Forty-nine women completed the intervention ( diet only = 14 , diet and aerobic exercise = 15 , diet and combined aerobic-resistance exercise = 20 ) . By week 20 all groups achieved weight loss and had improvements in depression and PCOS-specific HRQOL scores , except for body hair domain score . There was no difference between treatments for all outcomes . CONCLUSION ( S ) This study demonstrated that dietary restriction alone and combined with exercise had similar benefits for improving depression and HRQOL scores in overweight and obese women with PCOS
BACKGROUND Polycystic ovary syndrome ( PCOS ) affects 4 % to 18 % of reproductive-aged women and is associated with reproductive , metabolic and psychological dysfunction .
Obesity worsens the presentation of PCOS and weight management ( weight loss , maintenance or prevention of excess weight gain ) is proposed as an initial treatment strategy , best achieved through lifestyle changes incorporating diet , exercise and behavioural interventions .
OBJECTIVES To assess the effectiveness of lifestyle treatment in improving reproductive , anthropometric ( weight and body composition ) , metabolic and quality of life factors in PCOS .