The Effects of Different Exercises on Insulin Resistance and Testosterone Changes in Women with Polycystic Ovarian...

To compare the efficacy of exercise modalities for simultaneously improving homeostasis model assessment for insulin resistance (HOMA-IR) and total testosterone in women with polycystic ovary syndrome (PCOS).

We conducted a Bayesian network meta-analysis of 19 randomized controlled trials (n = 808) to evaluate six exercise interventions: yoga, moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), resistance training (RT), combined aerobic-resistance training (CT), and control (CG). Primary outcomes were changes in HOMA-IR and total testosterone, with interventions ranked via surface under the cumulative ranking curve (SUCRA).

For HOMA-IR reduction, yoga (SUCRA = 90.73%; SMD = -0.73, 95% CrI: -1.3 to -0.086) and HIIT (SUCRA = 74.12%; SMD = -0.47, 95% CrI: -0.75 to -0.15) demonstrated superior efficacy versus MICT (SUCRA = 50.56%) and CT (SUCRA = 42.29%), while RT was the least effective (SUCRA = 32.53%). For testosterone lowering, yoga was ranked the highest again (SUCRA = 92.46%; SMD = -0.85, 95% CrI: -1.7 to -0.12), followed by MICT (SUCRA = 75.72%; SMD = -0.56, 95% CrI: -0.97 to -0.25) and HIIT (SUCRA = 61.12%; SMD = -0.42, CrI: -0.88 to -0.12). CT and RT showed non-significant effects for both outcomes (p > 0.05).

Yoga is the optimal intervention for dual-pathway improvement in PCOS. HIIT and MICT provide outcome-specific benefits (metabolic vs. endocrine), whereas CT and RT necessitate protocol refinement.

This systematic review and network meta-analysis study was registered in PROSPERO (CRD420251011979).