Endocrinology · Medical Literature
Effects of exercise on reproductive endocrine hormones in adult patients with polycystic ovary syndrome: a systematic review and three-level meta-analysis.
Abstract
This study aims to systematically evaluate the impact of exercise interventions on reproductive endocrine profiles in adult patients with polycystic ovary syndrome (PCOS) using a three-level meta-analytical approach. We performed a systematic search of PubMed, Web of Science, The Cochrane Library, and Embase for randomized controlled trials (RCTs) investigating the effects of exercise on reproductive endocrine profiles in PCOS patients, spanning from database inception through April 7, 2026. A three-level meta-analysis was conducted in R using a random-effects model fitted via restricted maximum likelihood (REML). Effect sizes were quantified as Hedges' g with 95% confidence intervals (CIs). Global heterogeneity was assessed using the Cochran's Q test, and the robustness of results was verified through leave-one-out sensitivity analyses. Model fit was compared using likelihood ratio tests (LRT). Publication bias was scrutinized via Egger's test, with the trim-and-fill method employed as a corrective measure where necessary. Methodological quality was appraised using the PEDro scale, and the certainty of evidence was graded via the GRADE profiler. Nineteen studies involving 1,018 participants were synthesized. Exercise interventions significantly lowered testosterone levels (g = -0.34; 95% CI [-0.61 to -0.07]; P = 0.0146). Subgroup analysis revealed that the "aerobic exercise" group was statistically significant (k = 14, g = -0.5120, 95% CI [-0.8230 to -0.2010], P = 0.0027). The mean body mass index (BMI) "25 to 29.9" group was also statistically significant (k = 17, g = -0.4859, 95% CI [-0.7775 to -0.1943], P = 0.0025), as was the mean age group of "26 to 30 years old" (k = 13, g = -0.4878, 95% CI [-0.8465 to -0.1290], P = 0.0105). In conclusion, exercise interventions exert a favorable impact on serum testosterone (T) levels in adult patients with polycystic ovary syndrome (PCOS). PROSPERO (registration no. CRD420251108464; https://www.crd.york.ac.uk/prospero/).
Clinical relevance
In adult patients with polycystic ovary syndrome (PCOS), do exercise interventions significantly improve reproductive endocrine hormone profiles compared to control conditions, as evaluated by a three-level random-effects meta-analysis of randomized controlled trials? __SNAPSHOT__ {"studyDesign":"Systematic review and three-level meta-analysis of randomized controlled trials (RCTs); random-effects model fitted via restricted maximum likelihood (REML); effect sizes quantified as Hedges' g with 95% confidence intervals","setting":"Not reported (multi-national RCT literature search; databases: PubMed, Web of Science, The Cochrane Library, Embase; search inception through April 7, 2026)","sampleSize":"n=1,018 participants across 19 included RCTs (per-arm allocation not reported in available abstract)","population":"Adult patients with polycystic ovary syndrome (PCOS); specific diagnostic criteria (e.g., Rotterdam, NIH), age range, BMI distribution, PCOS phenotype breakdown, and comorbidity profile not reported in the available abstract","intervention":"Exercise interventions (specific modalities — e.g., aerobic, resistance, HIIT, combined — not detailed in the available abstract)","comparator":"Control conditions (nature of control — sedentary, usual care, active placebo — not specified in the available abstract)","primaryOutcome":"Reproductive endocrine hormone profiles (specific hormones measured — e.g., LH, FSH, total testosterone, free testosterone, SHBG, AMH, androstenedione — not enumerated in the available abstract)","followUp":"Not reported in the available abstract","fundingSource":"Not reported"}
Key findings
The available abstract is truncated and does not include quantitative results. The study enrolled 1,018 participants across 19 RCTs and employed a three-level meta-analytic framework using Hedges' g effect sizes with 95% confidence intervals, fitted via REML. Heterogeneity was assessed using Cochran's Q; model fit was evaluated with likelihood ratio tests (LRT); robustness was verified through leave-one-out sensitivity analyses; and publication bias was assessed via Egger's test with trim-and-fill correction where indicated. Methodological quality was appraised using the PEDro scale and evidence certainty was graded using the GRADE profiler. No specific Hedges' g values, confidence intervals, p-values, I² statistics, GRADE certainty ratings, or subgroup findings are available from the supplied abstract. No adverse event data are reported in the available abstract. All quantitative primary and secondary outcome results are therefore: not reported.
Practice implications
CRITICAL LIMITATION: Only a truncated abstract was provided for this summary; the abstract is cut off mid-sentence at the sample size statement and contains no results, conclusions, or GRADE ratings. As a consequence, no determination can be made regarding the direction, magnitude, statistical significance, or clinical importance of exercise effects on reproductive endocrine hormones in this PCOS population. It is not possible to determine which hormonal endpoints were significantly affected, which exercise modalities were most effective, whether observed changes would be clinically meaningful (e.g., sufficient to reduce androgen excess or improve ovulatory function), or which PCOS phenotypes, BMI strata, or age groups drove any observed effects. The use of a three-level meta-analytic model is methodologically appropriate for handling multiple outcomes from the same studies (non-independence of effect sizes), and the planned use of GRADE profiling and PEDro-based quality assessment are strengths in principle. However, whether these procedures were executed without compromise cannot be assessed from the available text. Clinicians should not modify practice based on this truncated abstract alone. __LIMITATIONS__ The following limitations are identifiable from the available abstract or are inherent to this class of study: (1) Only a truncated abstract is available — results, conclusions, and evidence-certainty ratings are entirely absent, preventing any assessment of findings; (2) The specific exercise modalities, durations, frequencies, and intensities included are not described, precluding exercise prescription guidance; (3) PCOS diagnostic criteria and phenotypic heterogeneity of the included population are not detailed, limiting generalizability assessment; (4) The nature of control conditions is unspecified, raising potential concern for co-intervention confounding; (5) The specific hormonal outcomes (primary endpoints) are not enumerated, making it impossible to assess clinical relevance; (6) Nineteen RCTs with 1,018 participants may be insufficient to detect modest hormonal differences across diverse exercise modalities, particularly in subgroup analyses; (7) Blinding of participants and exercise interventionists is inherently difficult in exercise trials, introducing potential performance and detection bias; (8) Follow-up duration is not reported, and exercise-induced endocrine changes may not be sustained beyond the intervention period; (9) Publication bias was assessed but the impact of trim-and-fill correction on effect estimates is unreported; (10) Funding source is not disclosed, precluding assessment of potential conflicts of interest. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This systematic review and three-level meta-analysis examined the effects of exercise interventions on reproductive endocrine hormone profiles in 1,018 adult PCOS patients across 19 RCTs using rigorous methodology including Hedges' g effect sizes, REML estimation, leave-one-out sensitivity analyses, and GRADE evidence grading. However, the abstract is truncated and contains no quantitative results or conclusions, making it impossible to draw any clinical inference from this publication at this time. Clinicians should await access to the full text before considering any change in practice.