PCOS and Exercise

Key Highlights:

• PCOS is more than a reproductive condition — it involves hormones, metabolism, genetics, and lifestyle, all of which shape symptoms and health over time.

• Insulin resistance is common, seen in 75% of lean women and up to 95% of women who are overweight or obese.

• Exercise improves insulin sensitivity, menstrual cycles, body composition, heart health, and mood, even without weight loss.

• Aerobic, HIIT, and resistance training each have unique benefits, and combining them gives the best results.

• General guidelines help, but the most effective plan is individualised — an exercise physiologist can guide safe and empowering programs.

Polycystic ovary syndrome (PCOS) is more than a reproductive condition. It involves hormones, metabolism, genetics, and lifestyle factors, all of which shape how symptoms appear and how they change over time.

If you live with PCOS, you’ve probably heard advice about exercising more. While PCOS cannot be “cured”, it can be managed effectively, and exercise plays one of the most powerful roles in that journey.

But exercise isn’t just about burning calories or losing weight. For women with PCOS, movement is a cornerstone of management, helping to support both physical and emotional health.

PCOS Diagnosis

Because PCOS can look so different from one woman to another, diagnosis relies on agreed criteria rather than a single test. The most widely used are the Rotterdam criteria, which requires ruling out other conditions such as thyroid disease, Cushing’s syndrome, or adrenal disorders first.

• A diagnosis is made when two of the following three features are present:

• Irregular or absent ovulation (cycles that are unpredictable or too far apart).

• Signs of higher androgens (such as acne, excess facial or body hair, scalp hair thinning, or high testosterone on blood tests).

• Polycystic ovarian appearance on ultrasound.

PCOS: Genetics, Lifestyle, or Both?

There’s no single cause of PCOS. Research shows it often runs in families, suggesting a strong genetic component. But environment and lifestyle also play a large role.

This is sometimes referred to as the “chicken or egg” dilemma: does PCOS cause weight gain and insulin resistance, or do those factors worsen PCOS? The truth is that both interact. Someone may inherit a predisposition, but lifestyle choices, environment, and body weight can turn the volume of symptoms up or down.

PCOS and Insulin Resistance

One of the most common factors of PCOS is insulin resistance. This means the body has to work harder to process glucose, increasing the risk of type 2 diabetes, gestational diabetes during pregnancy, and other metabolic issues.

Research consistently shows this is common, even in women who are not overweight. Studies report insulin resistance in about 75% of lean women with PCOS and up to 95% of women with overweight or obesity who have PCOS. This makes it one of the core metabolic challenges of the condition.

But insulin resistance is not the only factor. Other metabolic features linked to PCOS include:

• Increased systemic inflammation.

• Altered gut microbiome diversity.

• Changes in appetite-regulating hormones such as leptin and adiponectin.

• Reduced “metabolic flexibility”, meaning the body finds it harder to switch between using fat and carbohydrate for fuel depending on demand.

All of these changes combine to increase the risk of developing type 2 diabetes, gestational diabetes, and other metabolic concerns over time. This is one reason why exercise is considered such an essential part of PCOS management, as it directly improves insulin sensitivity, reduces inflammation, and supports overall metabolic health.

PCOS and Exercise: Why exercise makes such a difference

Exercise directly addresses many of the underlying issues in PCOS. Regular movement can:

• Improve insulin sensitivity.

• Support menstrual regularity and ovulation.

• Reduce abdominal fat and improve body composition.

• Improve cardiovascular health.

• Lift mood and reduce anxiety.

Importantly, these benefits occur even without weight loss. Exercise is not just about body size; it’s about how the body functions.

Exercise for PCOS

Not all exercise works in the same way, and research has explored different styles to see which are most effective in PCOS. The good news is that several forms of movement bring measurable benefits.

Aerobic exercise

Regular cycling, running, or brisk walking at a moderate to vigourous pace improves insulin sensitivity, cardiovascular health, and body composition.

• Vigourous activity (like running or cycling at higher intensity) appears to offer the most benefits for body weight, waist circumference, and insulin response.

• For lasting change, aim for at least 120 minutes of vigourous exercise per week, or 225 minutes of moderate-intensity activity spread across the week.

High-Intensity Interval Training (HIIT)

HIIT alternates short bursts of high effort with recovery periods. For women with PCOS, this style of exercise has been shown to improve:

• insulin resistance,

• reduce abdominal fat, and

• enhance cardiovascular health in a relatively short amount of time.

It can also be more engaging for those who prefer variety over longer, steady workouts.

Resistance Training

Strength-based exercise, whether through free weights, machines, or bodyweight workouts is particularly powerful in PCOS. Two to three sessions per week can make a meaningful difference.

• Increases lean muscle mass

• Reduces body fat percentage

• Lowers testosterone levels

• Increases SHBG (sex hormone-binding globulin).

These hormonal shifts can help reduce symptoms such as acne and excess hair growth.

Combination Approaches

Research suggests the best outcomes often come from combining aerobic and resistance training. Together, they support insulin health, improve body composition, and boost mood and energy levels.

How much exercise is enough?

Guidelines and studies suggest:

• At least 120 minutes per week of vigourous activity, or

• Around 225 minutes per week of moderate intensity, spread across most days.

• Add two resistance training sessions per week for strength and hormone balance.

This may sound like a lot, but it doesn’t need to happen all at once. Even 10–20 minutes a day is a valuable start, and benefits grow with consistency.

Tips for Getting Started

• Start where you are. Even small increases in movement make a difference.

• Do what you enjoy. Walking with a friend, dancing, or swimming all count.

• Mix it up. A balance of cardio, strength, and (if possible) HIIT sessions keeps exercise engaging and effective.

• Focus on consistency, not perfection. The benefits build over time, even if progress feels slow.

• Listen to your body. Rest, recovery, and self-care are as important as structured exercise.

Even though these guidelines are a useful reference, they are not one-size-fits-all. The most effective program is one that considers your individual health, preferences, and lifestyle.

Why an Exercise Physiologist should be part of your healthcare team

While research gives us clear guidelines, PCOS doesn’t present the same way for everyone. Symptoms,

fitness levels, and other health considerations can vary widely, which means there is no true “one-size-fits-all” prescription. The most effective exercise plan is one that is tailored to your body, your lifestyle, and your long-term health goals.

That’s where guided support makes a difference. An exercise physiologist can help translate the evidence into a program that feels achievable and safe, while also adapting it as your needs evolve.

For us, this isn’t just theory. Supporting women with PCOS is very close to our hearts. The right approach to movement doesn’t just improve health outcomes, it can empower women to feel more in control of their bodies, their confidence, and their future wellbeing.

Book A Consultation With Our Exercise Physiologist