With Polycystic Ovary Syndrome affecting around half a million Australian women, and difficulty in losing weight being a common symptom, it wouldn’t be unusual for a personal trainer to be engaged by a client who is living with this condition. We asked our resident dietitian, Talia Sparks for her advice when it comes to supporting a PT client with PCOS.
What is PCOS?
Polycystic ovary syndrome (or ‘PCOS’) is the most common endocrine-metabolic disorder in reproductive-aged women. PCOS has many different symptoms that can manifest at different stages of a woman’s life starting at puberty and lasting until, sometimes beyond, menopause. Symptoms include menstrual irregularities, infertility, hirsutism (excess hair growth), obesity and an increased risk of diabetes mellitus, hypertension, blood lipid abnormalities and metabolic syndrome. According to the Medical Journal of Australia, PCOS affects 8-13% of reproductive age women, with approximately 21% of Indigenous women affected.
PCOS is a condition closely related to obesity. With weight-gain and obesity being major contributors toward an individual’s development of PCOS and conversely, PCOS itself contributes toward further weight-gain and hampering efforts to achieve effective weight loss. By managing weight, hormone production can be normalised and potentially lead to the improvement of PCOS symptoms. Adhering to a healthy lifestyle including eating a balanced diet, being physically active, stopping smoking and reducing alcohol intake can all help to manage weight in women with PCOS. As well as positively impacting weight management, by following a healthy lifestyle the chance of developing some long-term health risks of PCOS such as Type 2 Diabetes mellitus, cardiovascular disease and sleep apnoea can be reduced.
How can PCOS affect weight management?
Hormones are chemical messengers that serve a number of critical functions in our body that help regulate processes such as appetite, metabolism and body fat distribution. When hormone levels are controlled, our metabolism can function as normal, however if not symptoms may worsen.
Insulin is a hormone produced by the pancreas, and is crucial to the regulation of carbohydrates in the bloodstream and the metabolism of fat. Insulin resistance is present in approximately 85% of women with PCOS, resulting in the body not able to effectively respond to insulin and therefore producing excess of the hormone. This extra insulin can trigger the ovaries to produce more male hormones (‘androgens’) leading to further difficulty with weight management and fat distribution.
How does PCOS impact training?
As mentioned earlier, lifestyle changes such as implementing a regular exercise regime have been shown to be beneficial in managing PCOS. A variety of physical activity can be beneficial for managing PCOS through a combination of increasing cardiorespiratory fitness, improving body composition and controlling insulin resistance. Current exercise guidelines suggest a minimum of 150 minutes of physical activity per week, with this guideline forming the basis of any healthcare professionals prescription for clients.
A study published in 2023 recommended exercise such as high-intensity interval training, progressive resistance training, aerobic exercise and yoga may improve PCOS. The mechanism of such was attributed to treating associated risk factors such as body composition, insulin resistance, hyperandrogenism, lipid profile, sex hormones, menstrual cycle and overall quality of life. This is an important distinction to make, as we know that exercise is not only beneficial for physical health, but mental health also. Research has shown that patients with PCOS have significantly more depressive and anxiety disorders, with up to three times more depressive symptoms and five times more anxiety disorders compared to patients without PCOS.
In my experience, it’s been quite important to consider the psychological and emotional effects of PCOS on our clients. A combination of PCOS-related complications and depressive symptoms has been shown to contribute to lower quality of life scores among women diagnosed with PCOS. In saying this, management of such symptoms through lifestyle interventions was found to lead to improved quality of life scores. It is important to consider mental health when working with this population, as although lifestyle modifications are integral to the management of the condition, there may be barriers in place to achieving and sustaining them.
How to support a PT client with PCOS:
Leading on from the psychology of making change, it is equally important to assess your client’s level of intrinsic motivation and set realistic goals and expectations accordingly. PCOS adds an additional barrier to achieving body recomposition (weight loss and muscle gain) due to the hormonal influences the condition has on the body. Experts recommend that instead of setting unrealistic weight loss targets, encourage clients to set meaningful small goals that will not only help them feel accomplished, but have health benefits as well and I’ve seen the same in practice. Research shows that losing only 5-10% of body weight can significantly improve insulin levels, fertility, mental health and even reduce the risk of developing conditions such as Type 2 Diabetes and heart disease.
In my experience, I’ve seen the best results when a supportive environment is created for clients, and we’re able to develop a relationship in which they can trust my professional opinion and effectively adopt the lifestyle changes I suggest. Any approach centering around weight loss should consider that women with PCOS have a higher prevalence of disordered eating, eating disorders and poor body image. Mental health, as discussed earlier, plays a large role in the management of PCOS. Working in collaboration with other health professionals such as a dietitian and/or psychologist may help to support you and your client, particularly if you are aware of your own history with disordered eating or are actively mending your own relationship with food.
Do PT's need to collaborate with healthcare professionals when working with a client who has PCOS?
In healthcare, the gold standard approach to patient care is through a multidisciplinary approach. This involves professionals from various fields working together to provide comprehensive patient care, recognising that complex health issues often require expertise beyond a single discipline to address and manage such conditions effectively. Many clients I’ve seen have benefited from a multidisciplinary approach for the management of PCOS, as the condition encompasses numerous different aspects of one’s health. Collaboration between different health professionals can ensure that all aspects of PCOS are addressed, from hormonal imbalances and reproductive health to lifestyle factors and mental well-being. Suggested health professionals may include
- General practitioner (GP): provides overall management, initial diagnosis, and coordination of care. They often work with other specialists to create a comprehensive treatment plan.
- Endocrinologist: specialises in hormone-related issues. They can help manage the hormonal imbalances associated with PCOS and treat conditions like insulin resistance.
- Gynecologist: focuses on reproductive health and can manage symptoms related to the menstrual cycle, fertility issues, and ovarian cysts.
- Dietitian: helps with dietary advice and weight management. Since PCOS is often associated with insulin resistance, a dietitian can provide guidance on managing blood sugar levels and creating a balanced diet.
- Mental Health Professional: psychologist or psychiatrist can assists with mental health aspects, such as anxiety, depression, or stress, which are common among women with PCOS.
- Dermatologist: addresses skin issues related to PCOS, such as acne and excessive hair growth (hirsutism). They can recommend treatments for these symptoms.
- Exercise Specialist: exercise specialists such as personal trainers, exercise physiologists or physiotherapists can help design an exercise program to manage weight and improve insulin sensitivity, which is beneficial for women with PCOS.
- Pharmacist: assists with medication management, ensuring that prescriptions are correctly filled and advising on potential interactions and side effects.
As a part of the multidisciplinary team (MDT), it is important to identify when your client is engaging with other professionals and encouraging the same. One important aspect in the management of PCOS is regular blood tests to monitor hormone levels, evaluation of blood glucose levels, metabolic health through lipid profiles and liver function tests and reproductive health. It is the primary role of the GP and other medical specialists to ensure these tests are regularly performed, but as part of the MDT you should provide encouragement to your clients to regularly engage with other professionals and stay on top of these measures.
Nutritional considerations for PCOS clients
So we know that lifestyle changes are the primary treatment approach for women with PCOS, and diet is a key part of lifestyle. So what is the best way to eat? Well, no optimal diet has been determined yet, but it is likely to be very individual based on the presentation of the person, and this is where a dietitian can help!
Overall, regardless of the type of dietary change made to help improve hormone levels and insulin sensitivity, it should not restrict whole food groups. A diet that includes healthy low-glycaemic index (GI) foods naturally high in fibre combined with spreading regular meals out over the day can help with the management of insulin resistance. Some examples of low-GI foods include
- Oats
- Beans, lentils, chickpeas
- Bananas, oranges, nectarines and many other fruits
- Wholegrain bread and pasta
- Basmati or doongara rice
Ensuring adequate inclusion of healthy (unsaturated) fats such as avocado, nuts & seeds, olive oil and fish is beneficial for hormone health and improving the ratio of good to bad cholesterol in our blood. Ultimately, the dietary pattern that is most sustainable will be the most beneficial for your client, as it can be maintained over time.
In conjunction with a good dietary pattern, some supplements have been shown to potentially support symptoms of PCOS and support overall health. As always, it’s important to consult with a healthcare provider before starting any new supplement, as specific needs and health conditions vary between individuals. Below are some commonly recommended supplements and their potential benefits:
- Inositol: Myo-inositol is one of the most studied supplements for PCOS. Numerous studies have shown that it can improve insulin sensitivity, restore menstrual regularity, and support ovarian function. The combination of myo-inositol and D-chiro-inositol has been particularly noted for its benefits in managing symptoms of PCOS.
- Vitamin D: Low vitamin D levels and PCOS have been repeatedly linked in research. Supplementation with vitamin D has been shown to improve insulin sensitivity, menstrual regularity, and overall symptoms in some women with PCOS. However, the degree of benefit can vary, and more research is needed to determine optimal dosing and long-term effects.
- Omega-3 Fatty Acids: Omega-3 fatty acids, especially from fish oil, have been shown to reduce inflammation, improve insulin sensitivity, and help with symptoms like acne and mood swings in women with PCOS. Studies suggest that omega-3s can have a positive impact on metabolic parameters and overall health.
- N-Acetylcysteine (NAC): NAC has been studied for its potential to improve insulin sensitivity, reduce androgen levels, and support ovarian function. Research has indicated that NAC can be effective in improving metabolic and reproductive outcomes in women with PCOS.
It is important to note that the above research findings are deemed preliminary; meaning larger – and more robust – studies are needed to draw conclusions that can be made in regard to the treatments’ effectiveness in women with PCOS.
In conclusion, when working with individuals diagnosed with PCOS, it’s important to work in a multidisciplinary manner to help them manage symptoms and improve long-term health outcomes. Although this population can be challenging due to the complexity of the condition, seeing improvements in an individual’s health is rewarding for not only these women but for ourselves as the providers.
References
https://pubmed.ncbi.nlm.nih.gov/32701517/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734597/
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/polycystic-ovarian-syndrome-pcos
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/polycystic-ovarian-syndrome-pcos
https://www.betterhealth.vic.gov.au/health/healthyliving/obesity-and-hormones
https://pubmed.ncbi.nlm.nih.gov/32342454/
https://dietitiansaustralia.org.au/health-advice/polycystic-ovary-syndrome-pcos
Thanks to Talia Sparks for this article.
About the author:
Talia Sparks is an Accredited Practicing Dietitian, holding a Masters of Nutrition and Dietetics (with Distinction) as well as a Bachelor of Nutrition Science (with Distinction). She is passionate about preventative health and helping people improve their lifestyles through diet and exercise and works hard to challenge traditional weight-centric and restrictive ideas around food.
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