COMBINED VERSUS SINGLE-MODALITY LIFESTYLE INTERVENTIONS ON INSULIN RESISTANCE AND HORMONAL PARAMETERS IN WOMEN WITH POLYCYSTIC OVARY SYNDROME: A STRUCTURED NARRATIVE REVIEW

Natalia Badowska; Izabela Matuszek; Bartosz Wiśniewski; Dominika Pachnowska; Natalia Pluta; Katarzyna Aleksandra Nowak; Alicja Rutkowska-Nowosielska; Oliwia Nikola Czekanow; Zofia Kania-Bonicka; Jerzy Demkow

doi:10.31435/ijitss.2(50).2026.5729

Authors

Natalia Badowska Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0003-9767-334X
Izabela Matuszek Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0008-4002-2868
Bartosz Wiśniewski Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0004-1025-5573
Dominika Pachnowska Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0000-6326-655X
Natalia Pluta Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0006-9108-8993
Katarzyna Aleksandra Nowak Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0002-2324-3219
Alicja Rutkowska-Nowosielska Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0008-4018-7179
Oliwia Nikola Czekanow Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0008-4813-7862
Zofia Kania-Bonicka Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0007-5511-133X
Jerzy Demkow Medical University of Warsaw, ul. Żwirki i Wigury 61, 02-091 Warszawa, Poland https://orcid.org/0009-0009-8637-9181

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5729

Keywords:

Polycystic Ovary Syndrome, PCOS, Insulin Resistance, Lifestyle Intervention, Combined Intervention, Exercise, Diet, Hormonal Parameters, HOMA-IR, Hyperandrogenism

Abstract

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with an estimated global prevalence of 8-13% depending on the population studied and diagnostic criteria applied. Its pathophysiology involves insulin resistance (IR) and hyperandrogenism, which mutually reinforce each other: elevated insulin drives ovarian androgen overproduction and suppresses sex hormone-binding globulin (SHBG), while excess androgens themselves worsen IR. Both IR and hyperandrogenism are modifiable through lifestyle interventions - specifically dietary modification and physical activity - making them the primary targets of non-pharmacological management in PCOS. Lifestyle interventions are recommended as first-line therapy, but the comparative effectiveness of combined versus single-modality approaches on IR and hormonal parameters remains unclear.

Aim: To synthesise and compare the effects of combined lifestyle interventions (diet plus exercise) versus single-modality approaches (diet alone or exercise alone) on markers of insulin resistance and key hormonal parameters in women with PCOS.

Material and methods: A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, and Cochrane Library databases. Search terms included polycystic ovary syndrome, PCOS, insulin resistance, HOMA-IR, lifestyle intervention, combined intervention, diet, exercise, testosterone, and SHBG. Studies evaluating lifestyle interventions in women with PCOS and reporting insulin resistance and/or hormonal outcomes were included, with no restriction on study design.

Results: Both single-modality and combined interventions improved insulin sensitivity and hormonal profiles. Available evidence suggests that combined diet-and-exercise programmes may produce broader improvements in metabolic (HOMA-IR, fasting insulin) and hormonal (free testosterone, SHBG) markers than either approach applied alone; however, direct comparative evidence remains limited and heterogeneous. Vigorous aerobic exercise and resistance training have been associated with the strongest independent effects on IR in the reviewed evidence, while low-glycaemic-index and Mediterranean diets improved hormonal balance through complementary mechanisms - principally reduction of postprandial hyperinsulinaemia and attenuation of chronic low-grade inflammation respectively.

Conclusions: The available evidence suggests that combined lifestyle interventions may produce greater improvements in insulin resistance and hormonal parameters in women with PCOS than single-modality approaches, though the current evidence base is limited by the quality and number of available trials. Consistent with this, international guidelines recommend multimodal programmes integrating structured exercise with evidence-based dietary strategies as first-line PCOS care. Further large-scale randomised controlled trials directly comparing combined versus single-modality protocols are needed.

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