Effectiveness of exercise interventions on androgen and sex hormone-binding globulin levels in women with polycystic ovary syndrome: a systematic review and meta-analysis

Introduction Polycystic ovarian syndrome (PCOS) is a common disorder typified by hyperandrogenism, ovarian dysfunction, and metabolic disorders. Elevated androgen and decreased Sex Hormone Binding Globulin (SHBG) levels are some of the main features contributing to its clinical manifestations. Lifestyle interventions, especially exercise, are considered first-line management methods due to their positive effects on hormonal regulation. Due to a lack of comprehensively synthesized data on the effects of exercise on androgen and SHBG levels, in this systematic review and meta-analysis, we aimed to evaluate the effects of structured exercise on Total Testosterone and Dehydroepiandrosterone (DHEA-S) as primary parameters, and SHBG levels as secondary parameters. Methods Relevant databases (EMBASE, Scopus PubMed, Web of Science, Cochrane Trials) were searched for Randomized Clinical Trials (RCTs) and Controlled Clinical Trials (CCTs) on exercise in Rotterdam-diagnosed PCOS women. Study selection and data extraction were carried out by two separate reviewers. Risk of bias was assessed using Cochrane RoB 2. Meta-analyses, employing a random-effects model, calculated Mean Differences (MDs) for hormonal outcomes, with subgroup analyses for different exercise types [e.g., aerobic, high-intensity interval training (HIIT)]. Results A total of 23 studies involving women with PCOS were included. For the overall effect of exercise vs. control, meta-analysis of 12 studies ( n = 563 participants) showed no significant effect on Total Testosterone, DHEA-S (5 studies, n = 231 participants), or SHBG (10 studies, n = 422 participants). However, subgroup analysis revealed that aerobic exercise led to a statistically significant reduction in Total Testosterone levels (4 studies, n = 212 participants). HIIT did not show a significant effect on Total Testosterone or SHBG. Conclusion Aerobic exercise significantly reduces total testosterone levels in women with PCOS, according to this meta-analysis, indicating that it may be used as a non-pharmacological method of managing hyperandrogenism. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024502657 , PROSPERO CRD42024502657.