Comparison 1. Lifestyle intervention versus minimal treatment: secondary outcomes and subgroup analyses.

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Secondary reproductive: menstrual regularity and ovulation			Other data	No numeric data
2 Secondary reproductive: endocrine	10		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
2.1 Total testosterone (nmol/L)	10	392	Mean Difference (IV, Fixed, 95% CI)	‐0.12 [‐0.23, ‐0.02]
2.2 Sex hormone‐binding globulin (SHBG) (nmol/L)	9	364	Mean Difference (IV, Fixed, 95% CI)	2.52 [0.22, 4.82]
2.3 Free androgen index (FAI)	6	204	Mean Difference (IV, Fixed, 95% CI)	‐1.11 [‐1.96, ‐0.26]
2.4 Clinical hyperandrogenism (Ferriman‐Gallwey score)	4	166	Mean Difference (IV, Fixed, 95% CI)	‐1.12 [‐2.16, ‐0.08]
3 Anthropometric	13		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
3.1 Weight (kg)	9	353	Mean Difference (IV, Fixed, 95% CI)	‐1.68 [‐2.66, ‐0.70]
3.2 Body mass index (BMI) (kg/m2)	12	434	Mean Difference (IV, Fixed, 95% CI)	‐0.34 [‐0.68, ‐0.01]
3.3 Waist circumference (cm)	7	243	Mean Difference (IV, Fixed, 95% CI)	‐0.97 [‐1.80, ‐0.14]
3.4 Waist‐hip ratio	4	135	Mean Difference (IV, Fixed, 95% CI)	‐0.04 [‐0.07, ‐0.01]
4 Metabolic: oral glucose tolerance test (OGTT) glucose (mmol/L/minute)	3	121	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.38, 0.33]
5 Metabolic: fasting glucose (mmol/L)	11	354	Mean Difference (IV, Fixed, 95% CI)	‐0.07 [‐0.15, 0.01]
6 Metabolic: fasting lipids (mmol/L)	9		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
6.1 Total cholesterol (mmol/L)	9	331	Mean Difference (IV, Fixed, 95% CI)	‐0.14 [‐0.25, ‐0.02]
6.2 High‐density lipoprotein cholesterol (HDL‐C) (mmol/L)	9	327	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.03, 0.05]
6.3 Low‐density lipoprotein cholesterol (LDL‐C) (mmol/L)	9	326	Mean Difference (IV, Fixed, 95% CI)	‐0.16 [‐0.29, ‐0.03]
6.4 Triglycerides (mmol/L)	9	328	Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.06, 0.02]
7 Metabolic: fasting insulin (µU/mL)	10	321	Mean Difference (IV, Fixed, 95% CI)	‐1.42 [‐2.44, ‐0.39]
8 Metabolic: oral glucose tolerance test (OGTT) insulin (µU/mL/minute)	3	121	Std. Mean Difference (IV, Fixed, 95% CI)	‐1.32 [‐1.73, ‐0.92]
9 Quality of life	3	475	Mean Difference (IV, Fixed, 95% CI)	0.39 [0.16, 0.61]
9.1 PCOSQ (Weight)	3	95	Mean Difference (IV, Fixed, 95% CI)	‐0.11 [‐0.71, 0.49]
9.2 PCOSQ (Hirsutism)	3	95	Mean Difference (IV, Fixed, 95% CI)	‐0.01 [‐0.57, 0.56]
9.3 PCOSQ (Emotions)	3	95	Mean Difference (IV, Fixed, 95% CI)	0.77 [0.30, 1.23]
9.4 PCOSQ (Infertility)	3	95	Mean Difference (IV, Fixed, 95% CI)	0.68 [0.21, 1.14]
9.5 PCOSQ (Menstrual irregularity)	3	95	Mean Difference (IV, Fixed, 95% CI)	0.25 [‐0.24, 0.75]
10 Subgroup analyses for SHBG	9	1180	Mean Difference (IV, Fixed, 95% CI)	2.72 [1.45, 3.99]
10.1 Medium duration	7	253	Mean Difference (IV, Fixed, 95% CI)	2.28 [‐0.06, 4.63]
10.2 Long duration	2	111	Mean Difference (IV, Fixed, 95% CI)	4.82 [‐4.69, 14.33]
10.3 Physical activity	4	173	Mean Difference (IV, Fixed, 95% CI)	1.11 [‐1.39, 3.61]
10.4 Combined intervention	5	191	Mean Difference (IV, Fixed, 95% CI)	8.73 [3.27, 14.19]
10.5 Weight loss	3	43	Mean Difference (IV, Fixed, 95% CI)	9.02 [3.03, 15.02]
10.6 Weight maintenance	1	45	Mean Difference (IV, Fixed, 95% CI)	2.27 [‐6.28, 10.82]
10.7 Overweight participants	6	281	Mean Difference (IV, Fixed, 95% CI)	2.46 [0.09, 4.83]
10.8 Not specified weight of participants	3	83	Mean Difference (IV, Fixed, 95% CI)	2.10 [‐5.86, 10.05]
11 Subgroup analyses for FAI	6	688	Mean Difference (IV, Fixed, 95% CI)	‐0.53 [‐1.09, 0.04]
11.1 Medium duration	5	191	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐1.06, 1.08]
11.2 Long duration	1	13	Mean Difference (IV, Fixed, 95% CI)	‐2.30 [‐6.23, 1.63]
11.3 Physical activity	4	173	Mean Difference (IV, Fixed, 95% CI)	0.15 [‐0.94, 1.23]
11.4 Combined intervention	2	31	Mean Difference (IV, Fixed, 95% CI)	‐3.30 [‐6.81, 0.21]
11.5 Weight loss	2	31	Mean Difference (IV, Fixed, 95% CI)	‐3.30 [‐6.81, 0.21]
11.6 Weight maintenance	1	45	Mean Difference (IV, Fixed, 95% CI)	3.97 [‐6.19, 14.13]
11.7 Overweight participants	3	121	Mean Difference (IV, Fixed, 95% CI)	‐0.30 [‐1.62, 1.03]
11.8 Not specified weight of participants	3	83	Mean Difference (IV, Fixed, 95% CI)	‐1.66 [‐2.97, ‐0.34]
12 Subgroup analyses for HDL‐C	9	1023	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.02, 0.03]
12.1 Medium duration	7	216	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.03, 0.06]
12.2 Long duration	2	111	Mean Difference (IV, Fixed, 95% CI)	‐0.01 [‐0.11, 0.09]
12.3 Physical activity	6	198	Mean Difference (IV, Fixed, 95% CI)	0.02 [‐0.03, 0.07]
12.4 Combined intervention	3	129	Mean Difference (IV, Fixed, 95% CI)	‐0.02 [‐0.11, 0.07]
12.5 Weight loss	2	31	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.15, 0.17]
12.6 Weight maintenance	1	11	Mean Difference (IV, Fixed, 95% CI)	‐0.10 [‐0.46, 0.26]
12.7 Overweight participants	4	219	Mean Difference (IV, Fixed, 95% CI)	‐0.04 [‐0.11, 0.04]
12.8 Not specified weight of participants	5	108	Mean Difference (IV, Fixed, 95% CI)	0.03 [‐0.02, 0.08]
13 Subgroup analyses for OGTT insulin	3	121	Std. Mean Difference (IV, Fixed, 95% CI)	‐1.32 [‐1.73, ‐0.92]
13.1 Physical activity	1	90	Std. Mean Difference (IV, Fixed, 95% CI)	‐1.71 [‐2.20, ‐1.22]
13.2 Combined intervention	2	31	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.48 [‐1.20, 0.24]
14 Subgroup analyses for PCOSQ Weight	3	95	Mean Difference (IV, Fixed, 95% CI)	‐0.11 [‐0.71, 0.49]
14.1 Behavioural	1	38	Mean Difference (IV, Fixed, 95% CI)	9.25 [3.69, 14.81]
14.2 Physical activity	2	57	Mean Difference (IV, Fixed, 95% CI)	‐0.22 [‐0.83, 0.38]
15 Sensitivity analyses for BMI	5	99	Mean Difference (IV, Fixed, 95% CI)	0.29 [‐1.91, 2.49]
16 Sensitivity analyses for FAI	4	69	Mean Difference (IV, Fixed, 95% CI)	‐0.64 [‐2.16, 0.87]