Abstract
Disclosure: E. Calderon Martinez: None. M. Samano Sanchez: None. L.M. Floridia Rietmann: None. C. Sierra Cogollos: None. M.A. Arredondo González: None. A. Magallanes Bajana: None. T.A. Moreno Díaz: None. C.F. Caro Rodriguez: None. S. Sultana: None. M. De la Luz Franco: None. D. Castillo Vera: None. A. Ayala Aguilar: None. C. Sanchez Cruz: None. J. Almeida Hidalgo: None. Introduction: Polycystic ovarian syndrome (PCOS) is a prevalent endocrine disorder affecting up to 13% of reproductive-aged women, frequently associated with insulin resistance, dyslipidemia, and obesity. While exercise is central to lifestyle management, the optimal intensity to improve metabolic outcomes remains undefined. This network meta-analysis compared the effects of high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), and low-intensity training (LIT) in women with PCOS. Methods: A systematic review and network meta-analysis (NMA) were conducted following PRISMA guidelines. Randomized controlled trials comparing HIIT, MICT, LIT, or no exercise in women with PCOS were included. Primary outcomes were body mass index (BMI), insulin levels, and maximal oxygen consumption (VO₂max). Secondary outcomes included HOMA-IR, lipid profile, glucose, HbA1c, and blood pressure. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects models, and intervention rankings were derived from surface under the cumulative ranking curve (SUCRA) probabilities. Results: Twenty-two RCTs (n = 1005) were included. HIIT significantly improved insulin levels (MD = −1.88, 95% CI: −2.70 to −1.07, p < 0.001), VO₂max (MD = 3.16, 95% CI: 1.07 to 5.25, p = 0.003), LDL cholesterol (MD = −6.81, 95% CI: −10.71 to −2.91, p < 0.01), and HDL (MD = 2.89, 95% CI: 0.10 to 5.68, p = 0.04), and was superior to MICT for insulin reduction (MD = −1.02, 95% CI: −1.96 to −0.07, p = 0.03). MICT significantly reduced HOMA-IR (MD = −0.19, 95% CI: −0.33 to −0.05, p < 0.01) and LDL (MD = −4.89, 95% CI: −7.57 to −2.22, p = 0.03), but had non-significant effects on VO₂max (MD = 2.39, 95% CI: −0.41 to 5.19) and BMI (MD = −0.54, 95% CI: −1.31 to 0.23). LIT was ineffective and associated with worsened insulin resistance (MD = 0.65, 95% CI: 0.41 to 0.90, p < 0.01). SUCRA rankings favored HIIT for insulin (SUCRA = 0.99), VO₂max (SUCRA = 0.85), LDL (SUCRA = 0.90), and HDL (SUCRA = 0.99), while MICT ranked highest for BMI (SUCRA = 0.75) and HOMA-IR (SUCRA = 0.86). Conclusion: HIIT and MICT are effective non-pharmacological strategies for metabolic management in PCOS, with HIIT offering superior benefits for insulin sensitivity and cardiorespiratory fitness. MICT provides clinically meaningful improvements in insulin resistance and lipid profile. LIT is not recommended. Exercise prescriptions should be personalized to individual goals, tolerance, and adherence potential. Presentation: Monday, July 14, 2025