Bob Tygenhof MA CPT Director Center for Active Lifestyle Medicine Integrative Medical Group of Irvine Speaker Disclosure None Learning Objectives Current exercise recommendations for PCOS patients ID: 488446
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Slide1
PCOS & EXERCISE
Bob Tygenhof, MA, CPTDirector, Center for Active Lifestyle MedicineIntegrative Medical Group of IrvineSlide2
Speaker Disclosure
NoneSlide3
Learning Objectives
Current exercise recommendations for PCOS patientsLatest research impacting these recommendationsHow to incorporate exercise into a PCOS treatment planHow to write an exercise prescriptionSlide4
Benefits Of Exercise
Long-term benefitsShort-term benefits - you feel better NOW!
Premature Mortality
Metabolic Syndrome
CVD/CAD
Obesity
Hypertension
Colon Cancer
Stroke
Breast Cancer
Osteoporosis
Depression
Type 2 DM
Cognitive FunctionSlide5
PCOS Exercise Recommendations
“Hence, lifestyle management is useful for targeting weight loss and prevention of weight gain, and is first-line treatment for a large proportion of women with PCOS. Lifestyle management may also improve PCOS independent of weight loss, with exercise intervention improving metabolic risk factors associated with PCOS, including hypertension, IR and elevated blood glucose levels, even when no weight loss occurs.” Slide6
PCOS Exercise Recommendations
“However, it is difficult to be certain about the effectiveness of lifestyle interventions in women with PCOS, because available information is based on small uncontrolled trials that address different outcomes in different subgroups of women, and specific recommendations remain unclear.” Slide7
Section 5. Lifestyle Management In PCOS
5.1a Lifestyle management (single or combined approaches of diet, exercise and/or behavioral interventions) for weight loss, prevention of weight gain, or for general health benefits should be recommended in women with polycystic ovary syndrome. — level B5.2a Lifestyle management targeting weight loss (in women with a body mass index ≥25kg/m2 [overweight]) and prevention of weight gain (in women with a body mass index < 25 kg/m2 [lean]) should include both reduced dietary energy (caloric) intake and exercise and should be first-line therapy for all women with polycystic ovary syndrome. — level C
5.5a
Exercise
participation of at least 150 minutes per week should be recommended to all women with polycystic ovary syndrome, especially those with a body mass index
≥
25
kg/m2 (overweight), given the metabolic risks of polycystic ovary syndrome and the long-term metabolic benefits of exercise. Of this, 90 minutes per week should be aerobic activity at moderate to high intensity (60%–90% of maximum heart rate) to
optimize
clinical outcomes. — level D
Treatment Focus:
Reduce insulin resistance
Improve metabolic features
Improve reproductive function
Improve body image and moodSlide8
Research Findings Since 2011
Improved body compositionRestored insulin sensitivity
Enhanced
adipose tissue
lipolysis
Improved
depression
Slide9
Improved Body Composition
24 women with PCOS – 12 in aerobic exercise group, 12 in control groupIntervention: 12 weeks of moderate level (60 to 70% of maximum heart rate) aerobic exercise for 60 min., 3 times/weekResults: significant improvements in body composition measures - BMI, WHR, body fat percentage, body fat massSlide10
Restored Insulin Sensitivity
Control and PCOS rats were treated with vehicle or resveratrol, while another group of PCOS rats were allowed to exercise freely for 5 weeks“We have shown that 5-6 weeks of resveratrol treatment did not improve insulin sensitivity in DHT-induced PCOS rats
, but
exercise restored insulin sensitivity to a similar level as
in control
rats
.”
“Physical exercise also had beneficial effects on
fat mass, adipocyte
size
, and
estrus cyclicity
.”Slide11
Enhanced Adipose Tissue Lipolysis
8 women with PCOS and 8 normal-cycle women matched for BMI, age, and percent body fatIntervention: 16-week progressive moderate intensity
(55
%
VO2max)
aerobic exercise-training program
“Alterations
were seen in the gene expression in the adipose
tissue following exercise”
“Lipase
expression is increased following exercise training with no
decreases in
circulating concentrations of total testosterone or free androgen index, perhaps
indicating that
aerobic exercise can increase adipose tissue lipolysis despite altering
testosterone expression.”Slide12
Improved Depression
153 women with PCOS and 64 women without PCOS aged 18-50 yearsCompleted a questionnaire including
the Hospital Anxiety and Depression Scale and a survey regarding levels
of physical
activity, physical activity barriers, motivators and
supports
“Physical
activity is associated with lower depression in women with
PCOS”Slide13
Incorporating Exercise Into The PCOS Treatment Plan
3 Major Barriers Too many options
Adding a behavior, not replacing one
Exercise is punishment, right? Slide14
Too Many “Good” Options
A lifestyle program may include diet and nutrition, supplementation, exercise, stress management, sleep management, eating disorders, addictive behaviors, acupuncture, counselling, massage therapy, skincare aesthetics, meditation, on and on.All take time and moneyExercise must be prioritized near the top of the listSlide15
Adding, Not Replacing
Many of the elements in a lifestyle program – diet and nutrition, supplementation, stress management, sleep management, eating disorders, addictive behaviors, skincare aesthetics – involve activities that are already being done. Changing, not expanding, behaviors.
Exercise replaces something – this must be openly addressedSlide16
Exercise As Punishment
Long-term adherence is based on enjoymentPatient should never be sore or in pain
But she should be challenged
A challenge is engaging and rewarding; it increases enjoyment
Start low and go slowSlide17
Writing the Exercise Prescription
FITT-VPFrequencyIntensityTypeTimeVolumeProgressionSlide18
Writing The Exercise Prescription
FITT-VPFrequencyIntensityType: aerobic exerciseTimeVolumeProgressionSlide19
Writing The Exercise Prescription
FITT-VPFrequency: 5 days a weekIntensityType: aerobic exerciseTimeVolume
ProgressionSlide20
Writing The Exercise Prescription
FITT-VPFrequency: 5 days a weekIntensityType: aerobic exerciseTime: 30 minutes/day
Volume
ProgressionSlide21
Writing The Exercise Prescription
FITT-VPFrequency: 5 days a weekIntensity: moderateType: aerobic exerciseTime:
30 minutes/day
Volume
ProgressionSlide22
Writing The Exercise Prescription
FITT-VPFrequency: 5 days a weekIntensity: moderateType: aerobic exerciseTime:
30 minutes/day
Volume:
F x I x T = 150 minutes/week, moderate
intensity
ProgressionSlide23
Writing The Exercise Prescription
FITT-VPFrequency: 5 days a weekIntensity: moderateType: aerobic exerciseTime:
30 minutes/day
Volume:
F x I x T = 150 minutes/week, moderate
intensity
Progression:
start low, go slowSlide24
Thank You!
rtygenhof@integrativemgi.comwww.integrativemgi.comBob Tygenhof, MA, CPT
(949) 753-7475