EFFECT OF HIIT AND MICT ON CARDIOVASCULAR INDICES IN WOMEN WITH PCOS
DOI:
https://doi.org/10.55766/sujst9146Keywords:
Cardiovascular health, Heart Rate Variability, High-Intensity Interval Training, Moderate-Intensity Continuous Training, Polycystic ovary syndrome, VO₂ maxAbstract
Polycystic ovary syndrome is one of the most prevalent endocrine dysfunction affecting women in their reproductive age. Women with PCOS are at a higher risk of cardiovascular complications due to central adiposity, dyslipidemia, insulin resistance and alterations in cardiovascular autonomic function. Exercise Interventions such as High and Moderate intensity training can help in enhancing cardiovascular health and effectively mitigating the metabolic and vascular dysfunction seen in PCOS. An extensive Literature search was performed through five databases namely PubMed, Scopus, Cochrane Library, Science direct and PeDro (from 2010 to 2024) using the appropriate keywords. Study selection followed the PRISMA flow diagram, and data extraction and quality assessment were performed independently by two authors. The Cochrane Risk of Bias tool was used for evaluating risk of bias for RCTs , PeDro and Newcastle-Ottawa Scale were used for quality assessment of RCTs and Non-RCTs respectively. This review included nine studies.Cohen’s d and Hedges’ g were used in order to calculate effect size of all the outcome measures. Results indicated that VO₂ max was considerably increased by both interventions, with HIIT being more effective in improving the maximal aerobic capacity. In contrast, MICT was more effective in enhancing endothelial function which was measured by Flow-mediated dilation. The study concluded that MICT efficiently improves vascular function whereas HIIT seems to offer more advantages in improving maximal aerobic capacity. More research in this field is needed to determine the best exercise strategy for enhancing cardiovascular health in PCOS women.
References
Almenning, I., Rieber-Mohn, A., Lundgren, K. M., Løvvik, T. S., Garnæs, K. K., & Moholdt, T. (2015). Effects of high-intensity interval training and strength training on metabolic, cardiovascular, and hormonal outcomes in women with polycystic ovary syndrome: A pilot study. PLoS ONE, 10(9), e0138793. https://doi.org/10.1371/journal.pone.0138793
Binder, R. K., Wonisch, M., Corra, U., Cohen-Solal, A., Vanhees, L., Saner, H., & Schmid, J. P. (2008). Methodological approach to the first and second lactate threshold in incremental cardiopulmonary exercise testing. European Journal of Cardiovascular Prevention & Rehabilitation, 15(6), 726-734. https://doi.org/10.1097/HJR.0b013e328304fed4
Bozdag, G., Mumusoglu, S., Zengin, D., Karabulut, E., & Yildiz, B. O. (2016). The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction, 31(12), 2841-2855. https://doi.org/10.1093/humrep/dew218
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., Dempsey, P. C., DiPietro, L., Ekelund, U., Firth, J., Friedenreich, C. M., Garcia, L., Gichu, M., Jago, R., Katzmarzyk, P. T., … Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451-1462. https://doi.org/10.1136/bjsports-2020-102955
Calderon-Margalit, R., Siscovick, D., Merkin, S. S., Wang, E., Daviglus, M. L., Schreiner, P. J., Sternfeld, B., Williams, O. D., Lewis, C. E., & Jacobs, D. R. (2014). Prospective association of polycystic ovary syndrome with coronary artery calcification and carotid intima-media thickness. Arteriosclerosis, Thrombosis, and Vascular Biology, 34(12), 2688-2694. https://doi.org/10.1161/ATVBAHA.114.304136
Doshi, S. N., Naka, K. K., Payne, N., Jones, C. J. H., Ashton, M., Lewis, M. J., & Goodfellow, J. (2001). Flow-mediated dilatation following wrist and upper arm occlusion in humans: The contribution of nitric oxide. Clinical Science, 101(6), 629-635. https://doi.org/10.1042/cs1010629
Fauser, B. C. J. M., Tarlatzis, B. C., Rebar, R. W., Legro, R. S., Balen, A. H., Lobo, R., Carmina, E., Chang, J., Yildiz, B. O., Laven, J. S. E., Boivin, J., Petraglia, F., Wijeyaratne, C. N., Norman, R. J., & Dunaif, A. (2011). Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertility and Sterility, 97(1), 28-38.e25. https://doi.org/10.1016/j.fertnstert.2011.09.024
Ghardashi-Afousi, A., Davoodi, M., Hesamabadi, B. K., Asvadi-Fard, M., Bigi, M. A. B., Izadi, M. R., & Gaeini, A. A. (2020). Improved carotid intima-media thickness induced by high-intensity interval training associated with decreased serum levels of Dkk-1 and sclerostin in type 2 diabetes. Journal of Diabetes and Its Complications, 34(1), 107469. https://doi.org/10.1016/j.jdiacomp.2019.107469
Giallauria, F., Palomba, S., Sio, I. D., Maresca, L., Vuolo, L., Savastano, S., Lombardi, G., Colao, A., Vigorito, C., & Orio, F. (2009). Inflammatory markers and visceral fat are inversely associated with maximal oxygen consumption in women with polycystic ovary syndrome (PCOS). Clinical Endocrinology, 70(3), 394-400. https://doi.org/10.1111/j.1365-2265.2008.03336.x
Hambrecht, R., Adams, V., Erbs, S., Linke, A., Kränkel, N., Shu, Y., Baither, Y., Gielen, S., Thiele, H., Gummert, J. F., Mohr, F. W., & Schuler, G. (2003). Regular physical activity improves endothelial function in patients with coronary artery disease by increasing phosphorylation of endothelial nitric oxide synthase. Circulation, 107(25), 3152-3158. https://doi.org/10.1161/01.CIR.0000074229.93804.5C
Hofmann, P., & Tschakert, G. (2017). Intensity- and duration-based options to regulate endurance training. Frontiers in Physiology, 8, 337. https://doi.org/10.3389/fphys.2017.00337
Holloszy, J. O., & Coyle, E. F. (1984). Adaptations of skeletal muscle to endurance exercise and their metabolic consequences. Journal of Applied Physiology, 56(4), 831-838. https://doi.org/10.1152/jappl.1984.56.4.831
Iannetta, D., Inglis, E. C., Mattu, A. T., Fontana, F. Y., Pogliaghi, S., Keir, D. A., Murias, J. M., & Koga, S. (2019). A critical evaluation of current methods for exercise prescription in women and men. Medicine and Science in Sports and Exercise, 52(2), 466-473. https://doi.org/10.1249/MSS.0000000000002147
Kiel, I. A., Jones, H., Lionett, S., Røsbjørgen, R., Lydersen, S., Vanky, E., & Parr, E. B. (2022a). Cardiovascular health does not change following high-intensity interval training in women with polycystic ovary syndrome. Journal of Clinical Medicine, 11(6), 1626. https://doi.org/10.3390/jcm11061626
Kiel, I. A., Lionett, S., Parr, E. B., Jones, H., Røset, M. A. H., Salvesen, Ø., Vanky, E., & Moholdt, T. (2022b). High-intensity interval training in polycystic ovary syndrome: A two-center, three-armed randomized controlled trial. Medicine and Science in Sports and Exercise, 54(5), 717-727. https://doi.org/10.1249/MSS.0000000000002849
Kodama, S., Saito, K., Tanaka, S., Maki, M., Yachi, Y., Asumi, M., Sugawara, A., Totsuka, K., Shimano, H., Ohashi, Y., Yamada, N., & Sone, H. (2009). Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: A meta-analysis. JAMA, 301(19), 2024-2035. https://doi.org/10.1001/jama.2009.681
Lee, M. J., Hwang, D. S., Lee, J. M., Lee, C. H., Cho, J. H., Jang, J. B., & Lee, K. S. (2010). A study on oriental medicine diagnostic application through analysis of heart rate variability in females with polycystic ovary syndrome. Journal of Korean Obstetrics and Gynecology, 23(4), 155-163.
MacInnis, M. J., & Gibala, M. J. (2016). Physiological adaptations to interval training and the role of exercise intensity. The Journal of Physiology, 595(9), 2915-2930. https://doi.org/10.1113/JP273196
McGuinness, L. A., & Higgins, J. P. T. (2020). Risk-of-bias visualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Research Synthesis Methods, 12(1), 55-61. https://doi.org/10.1002/jrsm.1411
Meyer, M. L., Malek, A. M., Wild, R. A., Korytkowski, M. T., & Talbott, E. O. (2012). Carotid artery intima-media thickness in polycystic ovary syndrome: A systematic review and meta-analysis. Human Reproduction Update, 18(2), 112-126. https://doi.org/10.1093/humupd/dmr046
Mirzohreh, S. T., Panahi, P., & Heidari, F. (2024). Exploring heart rate variability in polycystic ovary syndrome: Implications for cardiovascular health: A systematic review and meta-analysis. Systematic Reviews, 13(1), 2617. https://doi.org/10.1186/s13643-024-02617-x
Mohammadi, S., Monazzami, A., & Alavimilani, S. (2023). Effects of eight-week high-intensity interval training on some metabolic, hormonal, and cardiovascular indices in women with PCOS: A randomized controlled trial. BMC Sports Science, Medicine and Rehabilitation, 15(1), 653. https://doi.org/10.1186/s13102-023-00653-z
Motlagh Asghari, K., Nejadghaderi, S. A., Alizadeh, M., Sanaie, S., Sullman, M. J., Kolahi, A. A., Avery, J., & Safiri, S. (2022). Burden of polycystic ovary syndrome in the Middle East and North Africa region, 1990-2019. Scientific Reports, 12(1), 7039. https://doi.org/10.1038/s41598-022-11006-0
Nasiri, M., Monazzami, A., Alavimilani, S., & Asemi, Z. (2022). The effect of high intensity intermittent and combined (resistant and endurance) trainings on some anthropometric indices and aerobic performance in women with polycystic ovary syndrome: A randomized controlled clinical trial study. International Journal of Fertility & Sterility, 16(4), 268-274. https://doi.org/10.22074/ijfs.2022.551096.1279
Norman, R. J., Dewailly, D., Legro, R. S., & Hickey, T. E. (2007). Polycystic ovary syndrome. The Lancet, 370(9588), 685-697. https://doi.org/10.1016/S0140-6736(07)61345-2
Patten, R. K., McIlvenna, L. C., Levinger, I., Garnham, A. P., Shorakae, S., Parker, A. G., Teede, H. J., & Hutchison, S. K. (2022). High-intensity training elicits greater improvements in cardio-metabolic and reproductive outcomes than moderate-intensity training in women with polycystic ovary syndrome: A randomized clinical trial. Human Reproduction, 37(5), 1018-1029. https://doi.org/10.1093/humrep/deac047
Philbois, S. V., Ribeiro, V. B., Tank, J., Reis, R. M. D., Gerlach, D. A., & Souza, H. C. D. (2022). Cardiovascular autonomic modulation differences between moderate-intensity continuous and high-intensity interval aerobic training in women with PCOS: A randomized trial. Frontiers in Endocrinology, 13, 1024844. https://doi.org/10.3389/fendo.2022.1024844
Richards, C. T., Meah, V. L., James, P. E., Rees, D. A., & Lord, R. N. (2021). HIIT’ing or MISS’ing the optimal management of polycystic ovary syndrome: A systematic review and meta-analysis of high- versus moderate-intensity exercise prescription. Frontiers in Physiology, 12, 715881. https://doi.org/10.3389/fphys.2021.715881
Rissanen, A. P. E., Koskela-Koivisto, T., Hägglund, H., Koponen, A. S., Aho, J. M., Pöyhönen-Alho, M., & Tapanainen, J. S. (2016). Altered cardiorespiratory response to exercise in overweight and obese women with polycystic ovary syndrome. Physiological Reports, 4(4), e12719. https://doi.org/10.14814/phy2.12719
Roessler, K. K., Birkebaek, C., Ravn, P., Andersen, M. S., & Glintborg, D. (2013). Effects of exercise and group counselling on body composition and VO2max in overweight women with polycystic ovary syndrome. Acta Obstetricia et Gynecologica Scandinavica, 92(3), 272-277. https://doi.org/10.1111/aogs.12064
Sprung, V. S., Cuthbertson, D. J., Pugh, C. J. A., Aziz, N., Kemp, G. J., Daousi, C., & Jones, H. (2013). Exercise training in polycystic ovarian syndrome enhances flow-mediated dilation in the absence of changes in fatness. Medicine and Science in Sports and Exercise, 45(12), 2234-2242. https://doi.org/10.1249/MSS.0b013e31829ba9a1
Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H.-Y., Corbett, M. S., Eldridge, S. M., Emberson, J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., McAleenan, A., Reeves, B. C., Shepperd, S., Shrier, I., Stewart, L. A., Tilling, K., White, I. R., Whiting, P. F., & Higgins, J. P. T. (2019). RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ, 366, l4898. https://doi.org/10.1136/bmj.l4898
Teede, H. J., Misso, M. L., Costello, M. F., Dokras, A., Laven, J., Moran, L., Piltonen, T., Norman, R. J., & International PCOS Network. (2018). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clinical Endocrinology, 89(3), 251-268. https://doi.org/10.1111/cen.13795
Van Der Zwaard, S., De Ruiter, C. J., Noordhof, D. A., Sterrenburg, R., Bloemers, F. W., De Koning, J. J., & Jaspers, R. T. (2016). Maximal oxygen uptake is proportional to muscle fiber oxidative capacity, from chronic heart failure patients to professional cyclists. Journal of Applied Physiology, 121(3), 636-645. https://doi.org/10.1152/japplphysiol.00355.2016
Wang, Y., Wu, H., Sun, J., Wei, M., Wang, J., Li, H., Wu, X., & Wu, J. (2022). Effect of exercise on carotid artery intima-media thickness in adults: A systematic review and meta-analysis. Journal of Physical Activity and Health, 19(12), 855-867. https://doi.org/10.1123/jpah.2022-0372
Yildirir, A., Aybar, F., Kabakci, G., Yarali, H., & Oto, A. (2006). Heart rate variability in young women with polycystic ovary syndrome. Annals of Noninvasive Electrocardiology, 11(4), 306-312. https://doi.org/10.1111/j.1542-474X.2006.00122.x
