The Effect of Exercise on Reproductive and Metabolic Outcomes in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder, and the independent effect of exercise as a fundamental intervention for it remains to be clarified. Therefore, this study aimed to examine the effect of exercise intervention alone on improving reproductive endocrine and metabolic profiles in individuals with PCOS. A systematic search of multiple databases was conducted for randomized controlled trials (RCTs) published until July 2025. Data from eligible RCTs were collected, and quality evaluation with meta-analysis was performed. This investigation encompassed 22 RCTs involving 1044 women with PCOS. The meta-analysis indicated that exercise significantly reduced total testosterone (TT), free testosterone, fasting insulin, and homeostatic model assessment of insulin resistance (HOMA-IR), while increasing high-density lipoprotein levels. Subgroup analyses showed that moderate-to-low intensity exercise specifically increased sex hormone-binding globulin. Exercise duration ≥ 150 min per week yielded more pronounced reductions in TT. Concerning population characteristics, Asian cohorts exhibited particularly prominent improvements in reducing body mass index, TT, low-density lipoprotein, fasting insulin, and HOMA-IR. South American and European populations showed significant benefits in lowering TT and fasting insulin, respectively. Moreover, non-obese women with PCOS experienced greater reductions in TT compared to their obese counterparts. Exercise intervention alone significantly ameliorates body composition, hyperandrogenism, and certain glucose and lipid metabolic disturbances in individuals with PCOS. The benefits are modulated by exercise parameters (intensity, weekly duration) and baseline patient characteristics (geographical distribution, obesity status), highlighting the importance of individualized interventions in clinical practice.