Table 1.

Outcomes of studies assessing the influence of exercise on mental health for women with PCOS

Study	Design	N	Population (values are mean ± SD)	Measures	Intervention duration	Intervention(s)	Psychological outcomes
Lifestyle interventions: diet and exercise
Galletly et al. [40]	RCT	28	Overweight females with PCOS HPLC: age 33.0 ± 1.2 years BMI 37.6 ± 6.4 kg/m2 LPHC: age 32.0 ± 1.2 years BMI 37.2 ± 6.9 kg/m2	HADS Rosenberg Self Esteem Rating Scale	12 weeks	Two energy-restricted diets (6,000 kJ/day) + one exercise training per week (brisk walking and aerobic and stretching exercises) 4 weeks maintenance diet HPLC diet: n = 14, DO: 2 LPHC diet: n = 14, DO: 1	Depressive symptoms decreased (p < 0.01) and self-esteem increased (p < 0.05) in HPLC group. No significant change in anxiety in either group
Thomson et al. [37]	RCT	94	Obese females with PCOS (relatively high depressive symptoms and impaired HRQoL) Age 29.3 ± 0.7 years BMI 36.1 ± 0.5 kg/m2	CES-D PCOSQ	20 weeks	Diet and aerobic exercise (n = 31, DO: 16), 5/week walking/jogging Diet and combined aerobic–resistance exercise (n = 33, DO: 13): 3/week walking/jogging + 2/week strength training Diet (n = 30, DO: 16): 6,000 kJ/day energy-restricted high-protein meal plan	All groups improved in all PCOS-specific HRQoL scores, except for body hair domain score. Clinically significant improvements in emotion, body weight and menstrual problems (d > 0.5)
Exercise and medicine
Harris-Glocker et al. [43]	RCT	36	Obese, adolescent females with PCOS Age range: 12–18 years BMI 34.8 kg/m2	PCOSQ	6 months	MET group: Oral contraceptive with metformin + motivation + diet + exercise (weekly, 60-min group exercise) PBO group: Placebo + motivation + diet + exercise (weekly, 60-min group exercise)	PCOSQ total scores significantly improved in both groups, across all domains, between baseline and conclusion. No significant difference between the groups
Ladson et al. [41]	RCT	22	Obese, adolescent females with PCOS MET group: age 16.1 ± 1.5 years BMI 37.1 ± 5.8 kg/m2 PBO group: age 15.4 ± 1.2 years BMI 35.9 ± 6.6 kg/m2	PCOSQ	6 months	MET group (n = 11, DO: 1): metformin + 150 min/week of exercise + low-calorie diet PBO group (n = 11, DO: 3): placebo + 150 min/week of exercise + low-calorie diet	Improvements in overall quality of life in both groups (data not reported)
Ladson et al. [42]	RCT	114	Obese females with PCOS MET group: age 29.0 ± 4.5 years BMI 38.0 ± 7.8 kg/m2 PBO group: age 28.8 ± 4.6 years BMI 38.3 ± 8.0 kg/m2	PCOSQ	6 months	MET group (n = 55, DO: 33): metformin + low-calorie diet + 150 min/week of exercise PBO group (n = 59, DO: 43): placebo + low-calorie diet + 150 min/week of exercise	Non-significant improvements in domains of quality of life (weight and emotion only) for both groups
Other interventions
Nidhi et al. [39]	RCT	90	Healthy adolescent females with PCOS Exercise: age 16.2 ± 0.9 years BMI 21.2 ± 3.0 kg/m2 Yoga: age 16.2 ± 1.1 years BMI 20.3 ± 1.9 kg/m2	STAI	12 weeks	Typical exercise (n = 45, DO: 10): 1 h/day Traditional yoga (n = 45, DO: 8): 1 h/day	Both groups significantly decreased state and trait anxiety over the intervention. Yoga group decreased trait anxiety more than exercise group
Stener-Victorin et al. [38]	RCT	72	Females with PCOS Age 29.9 ± 4.4 years BMI = 28.1 ± 7.4 kg/m2	BSA-S MADRS PCOSQ SF-36	16 weeks	Exercise (n = 29): 3/week for 16 weeks, self-selected, more than 30 min Acupuncture (n = 28): 2/week for 2 weeks + 1/week for 14 weeks Controls (n = 15): oral information about exercise, no intervention	Exercise: Role physical significantly decreased, Emotions and infertility (PCOSQ) significantly increased Acupuncture: Role physical, social function, energy/vitality, general health perception, mental component, emotions (PCOSQ) significantly increased Controls: Emotions, weight, menstruation (PCOSQ) significantly increased Between-group change: Acupuncture significantly increased role physical

BMI body mass index, BSA-S Brief Scale for Anxiety, CES-D depression scores from the Center of Epidemiologic Studies Depression scale, DO drop out, HADS Hospital Anxiety and Depression Rating Scale, HPLC high protein, low carbohydrate diet condition, HRQoL health-related quality of life, LPHC low protein, high carbohydrate diet condition, MADRS Montgomery Asberg Depressing Rating Scale, MET metformin, PBO placebo group, PCOS polycystic ovary syndrome, PCOSQ Polycystic Ovary Syndrome Questionnaire, RCT randomized controlled trial, SF-36 Short Form 36, STAI State-trait Anxiety Inventory