Aerobic and Aerobic-Oriented Exercise for Anthropometric, Androgen-Related, and Reproductive Endocrine Outcomes in Polyendocrine Metabolic Ovarian Syndrome (Polycystic Ovary Syndrome): A Systematic Review and Meta-Analysis

Background: Aerobic exercise is recommended within lifestyle management for polycystic ovary syndrome (PCOS), but its effects on anthropometric and endocrine outcomes remain inconsistent. Methods: Five databases were searched from inception through July 2026. Controlled trials of structured aerobic or aerobic-oriented exercise lasting at least four weeks were eligible when the comparator did not receive an exercise program expected to improve aerobic fitness. Between-group changes were expressed as Hedges’ g and pooled using random-effects models with cluster-robust small-sample inference. Subgroup, univariable meta-regression, and dose–response analyses were exploratory. Results: Twenty-two reports representing 20 independent trials were included. The pooled standardized estimate marginally favored exercise for body weight (g = −0.09, 95% CI −0.13 to −0.05), although its magnitude was trivial and the 95% prediction interval crossed the null (−0.29 to 0.11). Exercise was associated with lower body mass index (g = −0.20, 95% CI −0.33 to −0.06), waist-to-hip ratio (g = −0.36, 95% CI −0.56 to −0.19), total testosterone (g = −0.43, 95% CI −0.67 to −0.20), and free testosterone (g = −0.60, 95% CI −0.99 to −0.21), and with higher sex hormone-binding globulin (SHBG; g = 0.24, 95% CI 0.04 to 0.44). No clear pooled effects were observed for waist circumference, body fat percentage, free androgen index, dehydroepiandrosterone sulfate, or anti-Müllerian hormone. Follicle-stimulating hormone and luteinizing hormone estimates lay at the statistical boundary and were heterogeneous; leave-one-study-out inference was also unstable for free testosterone and SHBG. Certainty was low or very low across outcomes. Conclusions: Aerobic or aerobic-oriented exercise showed favorable pooled differences in selected anthropometric and androgen-related markers, but low certainty and the sensitivity of some estimates preclude an endocrine-targeted dose or reproductive-benefit claim.