Effectiveness of Physical Activity and Diet Interventions to Improve Insulin Resistance, Hyperandrogenism, and Body Composition in Polyendocrine Metabolic Ovarian Syndrome: A Systematic Review

Polyendocrine metabolic ovarian syndrome (PMOS) is a prevalent and complex endocrine disorder, often underdiagnosed due to its heterogeneous clinical presentation and diagnostic criteria. Lifestyle interventions, including dietary modifications and physical activity, are widely recommended as first-line strategies to manage cardiometabolic risk; however, their effects on hormonal regulation remain less clearly defined. The aim of this systematic review is to synthesize current evidence on the effectiveness of dietary and physical activity interventions in adult women diagnosed with PMOS and to critically examine the consistency of their effects across metabolic and hormonal outcomes, addressing an important gap in the scientific literature. This review was prospectively registered in PROSPERO (ID: CRD420251246379) and follows PRISMA guidelines, and was conducted in December 2025 using PubMed, Web of Science, and ScienceDirect databases. Methodological quality of each study was assessed using the NIH Quality Assessment Tool for Controlled Intervention Studies. As results, 1054 records were identified, and 22 studies met the inclusion criteria. Lifestyle modifications, particularly energy-restricted diets, structured exercise programs, and their combination, were associated with improvements in body composition and metabolic parameters. However, a more heterogeneous and less predictable response was observed in hormonal outcomes, suggesting a partial dissociation between metabolic improvements and endocrine regulation in women diagnosed with PMOS. This variability reflects the complexity of PMOS and the influence of factors such as phenotype and baseline metabolic status. Overall, while diet and physical activity strategies effectively improve metabolic health, their impact on hormonal balance is less consistent, highlighting the need for more personalized approaches and well-designed trials with standardized criteria and longer follow-up.