Effectiveness of Aerobic Exercise on Metabolic Profiles in Women with Polycystic Ovary Syndrome: A Systematic Review, Meta-Analysis, and GRADE Assessment of RCTs

BACKGROUND: Polycystic ovary syndrome (PCOS) is a metabolic and endocrine disorder that affects women of reproductive age. There is no absolute treatment for PCOS, but it is managed symptomatically. Adopting a healthy lifestyle comprising a balanced diet and physical exercise is the major recommendation for management of PCOS. OBJECTIVE: To evaluate the effectiveness of aerobic exercise as an intervention for improving metabolic profiles in women suffering from PCOS. METHODS: A systematic search was performed in 4 databases; Scopus, MEDLINE (via PubMed), Embase, and Web of Science, since inception till 28.2.2025. Risk of bias was performed using Cochrane RoB 2.0 tool and meta-analysis was done by using random-effects models. RESULTS: Twenty-five RCTs were included in the review for qualitative synthesis and 5 RCTs with a total of 192 participants were included for quantitative analysis. A low but statistically significant decrease was observed in waist-to-hip ratio). Lipid profile analysis revealed a significant reduction in low-density lipoprotein (LDL) cholesterol. Further, HIIT also improved insulin sensitivity, by decreasing fasting insulin levels and HOMA-IR. A non-significant reduction was observed in body mass index (BMI), waist circumference, total cholesterol, and fasting glucose. Changes in triglycerides, and HDL were also non-significant. CONCLUSION: Aerobic exercise, especially HIIT, appears effective in improving regional fat distribution, LDL cholesterol, and insulin resistance in PCOS women, though evidence for BMI and hormonal changes remains inconclusive. Larger, longer-term RCTs are needed to confirm these findings and clarify hormonal outcomes.