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Despite the current guidelines, evidence on the benefits of physical exercise (PE) in PCOS remains limited and heterogeneous. While PE’s positive metabolic effects are established, its impact on menstrual symptoms is poorly understood. This review synthesises evidence on whether PE improves menstrual symptoms in reproductive-aged women with PCOS. Three databases (PubMed, Scopus, and Web of Science) were searched for peer-reviewed English articles up until March 25, 2025, without any restrictions on the publication date. The search results were conducted independently by two different reviewers, and the reference lists of the selected papers have been searched. A narrative synthesis of the included studies was conducted. The types of study selected were mainly randomised controlled trials, including High-Intensity Interval Training (HIIT) in three studies, Moderate-Intensity Continuous Training (MICT/aerobic) in seven, and combined aerobic-resistance training in two. PE lasted from 12 weeks to 6 months, primarily at 3 sessions/week. Menstrual Cyclicity/Frequency was measured in all studies via menstrual diaries. Ten studies involving 290 participants with PCOS (BMI ≥ 25 kg/m²; aged 18–40 years) were included. PE improved cycle regularity across interventions. HIIT showed the highest improvement rate (69%), while MICT was effective for the most participants (n = 132). Protocols typically lasted ≥ 3 months at 3 sessions/week. Adding resistance training provided further benefits, particularly for women with hyperandrogenism. The findings suggest that PE may lead to significant improvements in menstrual cyclicity. However, due to the high heterogeneity in patients’ enrolment and different intervention protocols applied with limited long-term follow-up, the reproducibility of our investigation remains to be confirmed. This systematic review was registered in PROSPERO (CRD420251009235).
Molinaro et al. (Mon,) studied this question.