Gislaine Satyko Kogure

Resistance Exercise Impacts Lean Muscle Mass in Women with Polycystic Ovary Syndrome

PURPOSE This study investigated the effects of progressive resistance training (PRT) on lean muscle mass (LMM) in women with or without polycystic ovary syndrome (PCOS) and its effects on metabolic factors and concentrations of related steroid hormones. DESIGN This was a nonrandomized, therapeutic, open, single-arm study. PARTICIPANTS All in all, 45 sedentary women with PCOS and 52 without (non-PCOS), 18-37 yr of age, with body mass indexes (BMI) of 18-39.9 kg·m(-2) of all races and social status, performed PRT three times a week for 4 months. Before and after PRT, the concentrations of hormones and metabolic factors and waist circumference were measured. LMM and total body fat percentage were determined using dual-energy x-ray absorptiometry. Clinical characteristics, LMM, and fasting glucose were adjusted for confounding covariables and compared using general linear mixed models. Each patients menstrual history was taken before study enrollment and after PRT. RESULTS PRT resulted in reduced plasma testosterone and fasting glucose levels. After PRT, the androstenedione concentration increased and the sex hormone-binding globulin concentration decreased in women with PCOS. The waist circumference was reduced (P < 0.01) and the muscle mass index, lean mass (LM)/height2, increased in women with PCOS (P = 0.04). Women with PCOS showed increased muscle mass indexes of appendicular LM/height2 (P = 0.03) and LM/height2 (P < 0.01) compared with the baseline. Total LM and trunk LM were elevated in women with PCOS (P = 0.01) at the baseline and after PRT. CONCLUSION To our knowledge, this is the first report to show that resistance exercise alone can improve hyperandrogenism, reproductive function, and body composition by decreasing visceral fat and increasing LMM, but it has no metabolic impact on women with PCOS.

A Nonrandomized Trial of Progressive Resistance Training Intervention in Women With Polycystic Ovary Syndrome and Its Implications in Telomere Content.

Background: Physical activity is known to relieve the metabolic complications of polycystic ovary syndrome (PCOS), and exercise is also associated with telomere biology. We investigated the changes induced by progressive resistance training (PRT) in telomere content and metabolic disorder in women with PCOS and controls. Participants and Methods: Forty-five women with PCOS and 52 healthy women aged 18 to 37 years were submitted to PRT. A linear periodization of PRT was prepared based on a trend of decreasing volume and intensity throughout the training period. The volunteers performed PRT 3 times a week for 4 months. The participants’ physical characteristics and hormonal concentrations were measured before and after PRT, as telomere content that was measured using quantitative real-time polymerase chain reaction. Results: Briefly, Progressive resistance training reduced waist circumference, body fat percentage, plasma testosterone and sex hormone-binding globulin concentrations, glycemia, and free androgen index. Fasting insulin and insulin resistance index were greater in women with PCOS. Androstenedione and homocysteine increased after PRT. There were no differences in telomere content between controls (0.96 ± 0.3 before vs 0.85 ± 0.21 after) and women with PCOS (0.94 ± 0.33 before vs 0.88 ± 0.39 after). Adjusted analysis showed telomere shortening after PRT in all women (0.95 ± 0.31 before vs 0.86 ± 0.31 after; P = .03). In women with PCOS, increased homocysteine levels were related to telomere reduction and increased androstenedione was positively correlated with telomere content after PRT. Conclusions: Progressive resistance training had positive effects on the hormonal and physical characteristics of women with PCOS and controls, but telomere content was reduced and homocysteine level increased in all participants.

Inflammatory biomarkers and telomere length in women with polycystic ovary syndrome.

OBJECTIVE To analyze whether leukocyte telomere length (LTL) is impaired in women with polycystic ovary syndrome (PCOS). DESIGN Case-control study. SETTING Hospital. PATIENT(S) A total of 274 women, including 150 patients with PCOS and 124 controls. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Body mass index (BMI), waist circumference, systemic arterial pressure, lipid profile, E(2), LH, T, androstenedione, PRL, TSH, sex hormone-binding globulin, C-reactive protein (CRP), homocysteine, free androgen index, and the homeostatic model of insulin sensitivity (HOMA-IR) index were analyzed. The LTL evaluation was measured by quantitative polymerase chain reaction. RESULT(S) The PCOS group had higher values for weight, BMI, waist circumference, systolic arterial pressure, triglycerides, LH, T, insulin, CRP, free androgen index, and HOMA-IR compared with the control group. Sex hormone-binding globulin and E(2) levels were lower in the PCOS group than in the control group. The LTL did not differ between groups. Age, BMI, and HOMA-IR had no significant effect on LTL. The inflammatory biomarkers CRP and homocysteine were negatively correlated with LTL in patients with PCOS. CONCLUSION(S) Our results showed no differences in LTL between patients with PCOS and controls, but CRP and homocysteine biomarkers negatively correlated with LTL in the PCOS group.

Women with polycystic ovary syndrome have greater muscle strength irrespective of body composition.

Abstract The aim of this study was to compare metabolic parameters, body composition (BC) and muscle strength of women with and without polycystic ovary syndrome (PCOS). This was a case–control study that evaluated 40 women with PCOS and 40 controls. Androgens and insulin resistance were measured. BC was based on dual-energy X-ray absorptiometry. Isometric handgrip and maximal dynamic muscle strength (1-RM) strength tests were performed. Median total testosterone (p < 0.01), free androgen index (p < 0.01), insulin (p < 0.01) and homeostasis model assessment-insulin resistance (p = 0.02) were higher and sex hormone binding globulin (SBHG) (p = 0.04) was lower in the PCOS group. Normoweight women with PCOS had higher percentages of android body fat. However, the prevalence of android fat distribution was higher in the PCOS than in the control group (p = 0.04). The strength 1-RM in bench press (p < 0.01), muscle strength relative to lean muscle mass in the dominant lower limb (p = 0.04) and isometric handgrip strength tests (p = 0.03) was higher in the PCOS group. PCOS was a determinant of strength in the bench press exercise (p = 0.04). The hyperandrogenism was a predictor of increased strength in biceps curl exercises (p = 0.03) in the dominant lower limb (p = 0.02) and isometric handgrip strength (p = 0.03). In conclusion, women with PCOS have greater muscle strength and a higher prevalence of central obesity, but no difference in BC. Muscle strength may be related to high androgen levels in these women.

Análise de força muscular e composição corporal de mulheres com Síndrome dos Ovários Policísticos

PURPOSE To compare the metabolic parameters, body composition and muscle strength of women with Polycystic Ovary Syndrome (PCOS) to those of women with ovulatory menstrual cycles. METHODS A case-control study was conducted on 27 women with PCOS and 28 control women with ovulatory cycles, aged 18 to 27 years with a body mass index of 18 to 39.9 kg/m², who did not practice regular physical activity. Serum testosterone, androstenedione, prolactin, sex hormone-binding globulin (SHBG), insulin and glycemia levels were determined. Free androgen index (FAI) and resistance to insulin (by HOMA) were calculated. The volunteers were submitted to evaluation of body composition based on skin folds and DEXA and to 1-RM maximum muscle strength tests in three exercises after familiarization procedures and handgrip isometric force was determined. RESULTS Testosterone levels were higher in the PCOS group than in the Control Group (68.07 ± 20.18 versus 58.20 ± 12.82 ng/dL; p=0.02), as also were the FAI (282.51 ± 223.86 versus 127.08 ± 77.19; p=0.01), insulin (8.41 ± 7.06 versus 4.05 ± 2.73 µIU/mL; p=0.01), and HOMA (2.3 ± 2.32 versus 1.06 ± 0.79; p=0.01), and SBHG levels were lower (52.51 ± 43.27 versus 65.45 ± 27.43 nmol/L; p=0.04). No significant differences in body composition were observed between groups using the proposed methods. The PCOS group showed greater muscle strength in the 1-RM test in the bench press (31.2 ± 4.75 versus 27.79 ± 3.63 kg; p=0.02), and leg extension exercises (27.9 ± 6.23 versus 23.47 ± 4.21 kg; p=0.02) as well as handgrip isometric force (5079.61 ± 1035.77 versus 4477.38 ± 69.66 kgf/m², p=0.04). PCOS was an independent predictor of increase muscle strength in bench press exercises (estimate (E)=2.7) (p=0.04) and leg extension (E=3.5) (p=0.04), and BMI in the exercise of isometric handgrip (E=72.2) (p<0.01), bench press (E=0.2) (p=0.02) and arm curl (E=0.3) (p<0.01). No association was found between HOMA-IR and muscle strength. CONCLUSIONS Women with POS showed greater muscle strength, with no difference in body composition, and IR was not associated with muscle strength performance. Muscle strength may be possibly related to high levels of androgens in these women.PURPOSE: To compare the metabolic parameters, body composition and muscle strength of women with Polycystic Ovary Syndrome (PCOS) to those of women with ovulatory menstrual cycles. METHODS: A case-control study was conducted on 27 women with PCOS and 28 control women with ovulatory cycles, aged 18 to 27 years with a body mass index of 18 to 39.9 kg/m2, who did not practice regular physical activity. Serum testosterone, androstenedione, prolactin, sex hormone-binding globulin (SHBG), insulin and glycemia levels were determined. Free androgen index (FAI) and resistance to insulin (by HOMA) were calculated. The volunteers were submitted to evaluation of body composition based on skin folds and DEXA and to 1-RM maximum muscle strength tests in three exercises after familiarization procedures and handgrip isometric force was determined. RESULTS: Testosterone levels were higher in the PCOS group than in the Control Group (68.07±20.18 versus 58.20±12.82 ng/dL; p=0.02), as also were the FAI (282.51±223.86 versus 127.08±77.19; p=0.01), insulin (8.41±7.06 versus 4.05±2.73 µIU/mL; p=0.01), and HOMA (2.3±2.32 versus 1.06±0.79; p=0.01), and SBHG levels were lower (52.51±43.27 versus 65.45±27.43 nmol/L; p=0.04). No significant differences in body composition were observed between groups using the proposed methods. The PCOS group showed greater muscle strength in the 1-RM test in the bench press (31.2±4.75 versus 27.79±3.63 kg; p=0.02), and leg extension exercises (27.9±6.23 versus 23.47±4.21 kg; p=0.02) as well as handgrip isometric force (5079.61±1035.77 versus 4477.38±69.66 kgf/m2, p=0.04). PCOS was an independent predictor of increase muscle strength in bench press exercises (estimate (E)=2.7) (p=0.04) and leg extension (E=3.5) (p=0.04), and BMI in the exercise of isometric handgrip (E=72.2) (p<0.01), bench press (E=0.2) (p=0.02) and arm curl (E=0.3) (p<0.01). No association was found between HOMA-IR and muscle strength. CONCLUSIONS: Women with POS showed greater muscle strength, with no difference in body composition, and IR was not associated with muscle strength performance. Muscle strength may be possibly related to high levels of androgens in these women.

Quality of Life in Women with Polycystic Ovary Syndrome after a Program of Resistance Exercise Training.

Purpose Aerobic exercises may improve quality of life (QoL) in women with polycystic ovary syndrome (PCOS). However, there is no data on the effect of resistance exercise training (RET) programs on the QoL of women with PCOS. Thus, this study aimed to assess the effect of a 16-week RET program on QoL in PCOS women. Methods This 16-week case-control study enrolled 43 women with PCOS (PCOS group, PCOSG) and 51 healthy pre-menopausal controls aged 18 to 37 years (control group, CG). All women underwent a supervised RET program for 16 weeks, and were evaluated in two different occasions: week-0 (baseline), and week-16 (after RET). Quality of life was assessed using the 36-Item Short Form Health Survey (SF-36). Results Testosterone reduced significantly in both groups after RET (p < 0.01). The PCOSG had improvements in functional capacity at week-16 relative to week-0 (p = 0.02). The CG had significant improvements in vitality, social aspects, and mental health at week-16 relative to week-0 (p ≤ 0.01). There was a weak correlation between social aspects of the SF-36 domain and testosterone levels in PCOS women. Conclusion A 16-week RET program modestly improved QoL in women with PCOS.

Skewed X-chromosome inactivation and shorter telomeres associate with idiopathic premature ovarian insufficiency

OBJECTIVE To analyze whether telomere length, X-chromosome inactivation (XCI), and androgen receptor (AR) GAG polymorphism are related to idiopathic premature ovarian insufficiency (POI). DESIGN Case-control study. SETTING University hospital. PATIENT(S) A total of 121 women, including 46 nonsyndromic POI and 75 controls. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Age, weight, height, body mass index (BMI), systolic and diastolic arterial pressure, E2, androstenedione, T, and C-reactive protein were assessed. Telomere length was estimated by quantitative real-time polymerase chain reaction, XCI was measured using the Human Androgen Receptor and X-linked retinitis pigmentosa 2 (RP2) methylation assays. AR and FMR1 polymorphism was assessed by quantitative fluorescent polymerase chain reaction and sequencing. RESULT(S) Premature ovarian insufficiency women had a higher mean age, weighed less, and exhibited lower C-reactive protein, E2, and androstenedione levels. The AR polymorphism did not differ between the groups. Four patients had premutation (55-200 CGG repeats), and none displayed a full mutation in the FMR1 gene. However, patients with POI showed shorter telomere length and higher frequency of skewed XCI. Extreme skewing (≥90%) was observed in 15% of women with POI, and shorter telomeres correlated with XCI skewing in both groups. CONCLUSION(S) Skewed XCI and shortened telomere length were associated with idiopathic POI, despite no alterations in the AR and FMR1 genes. Additionally, there is a tendency for women with short telomeres to exhibit skewed XCI.

Progressive Resistance Training as Complementary Therapy for Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) significantly impacts women, since the broad spectrum of clinical manifestations associated with it are significant and include reproductive dysfunction, menstrual irregularities, and an increased risk of infertility. However, the consequences of PCOS go beyond the reproductive axis, with psychological and social impairments, including stress, depression, anxiety, and sexual dissatisfaction.1 There is also a high prevalence of dyslipidemia, hyperinsulinemia, obesity, hypertension, and glucose intolerance, which are risk factors that predispose women to cardiovascular disease (CVD) and diabetes mellitus type 2 (DM2).2 Therefore, PCOS assumes aspects of a chronic disease, as these factors extend throughout life. If not prevented and treated, they can lead to increased morbidity and mortality.3 The etiology of PCOS has not been fully elucidated, but it is known to be linked to excess androgens.4,5 Insulin resistance (IR) is a common feature of PCOS,6 and although it is not considered a diagnostic criterion, it is a key factor in the syndrome’s etiology and evolution.7 In 2008, the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) published a consensus suggesting lifestyle changes as the first line of treatment for women with PCOS.8This consensuswas reinforced in2009byTheAndrogen Excess and Polycystic Ovary Syndrome Society,9 which investigated evidence of lifestyle management (dietary, exercise, or behavioral interventions) for obesity in women with PCOS. Sincethen, thebenefitsof lifestylechanges resulting fromPCOS therapy havebeenwell documented.10,11 The rationale for this non-pharmacological therapy is based on regular exercise and a healthy diet, as well as combined interventions that aim to achieve and maintain a healthy weight to minimize hormonal and reproductive complications, reduce the long-term risks of chronic diseases such as CVD and DM2, and consequently improve quality of life. In this way, weight loss has been considered the main goal of PCOS therapy in obese women. Moderateto high-intensity aerobic physical exercise12 has been predominantly recommended as a treatment for PCOS.13 Preliminary data from our group with an interval aerobic training protocol (exercises alternating in intensity frommoderate to heavyeffort with low-effort recovery periods) showed a decreased central obesity index measured by anthropometric measures and improved testosterone levels. However, other training programs, such as aerobic exercises, alone or in combinationwith resistance training, with or without dietary restriction, have also effectively reduced total and abdominal body fat or body fat percentile,12,14–16 leading to improved menstrual frequency and/or ovulation,12,17 reduced serum testosterone concentrations and fasting plasma glucose levels,12 and improved insulin sensitivity.18,19 More recently, a review presented evidence that progressive resistance training (PRT), or strength training, may also be beneficial for women with PCOS, promoting changes in body composition and associated factors, especially IR.20 However, this type of physical exercise has not been well explored in terms of its therapeutic purposes. Facedwith the phenotypic characteristics of PCOS, we set out to perform a periodic protocol of resistance exercises in lean, overweight, and obesewomenwith the intention of evaluating the results of this therapy. The PRT improvedhyperandrogenismand the menstrual cycle, as well as the functional capacity with increased muscle strength, and resulted in changes in body