Beyond a one-size-fits-all prescription: shared and differential anti-inflammatory responses to exercise modalities in polycystic ovary syndrome

Abstract

Polycystic ovary syndrome (PCOS) is a multisystem disorder in which chronic low-grade inflammation intersects with metabolic, reproductive, and psychological dysfunction, yet exercise guidance remains largely generic. This narrative review examines whether different exercise stimuli are associated with different patterns of anti-inflammatory adaptation in PCOS. Four intervention categories are considered: high-intensity interval training (HIIT), characterized by repeated high-intensity metabolic perturbations; resistance training (RT), characterized by progressive mechanical loading; endurance training (ET), characterized by sustained aerobic and vascular shear-stress exposure; and mind-body training (MBT), a heterogeneous complementary category that includes yoga, controlled breathing, meditation, and mindful movement. These categories are operational rather than biologically discrete. Mitochondrial remodeling, improved insulin signaling, redox adaptation, myokine and adipokine changes, vascular responses, and immune modulation occur across several modalities, although their relative magnitude, timing, and tissue emphasis may differ. Direct head-to-head mechanistic comparisons in women with PCOS remain scarce; therefore, assignments of AMPK-PGC-1α emphasis to HIIT, mTOR-centered mechanotransduction to RT, eNOS-related vascular adaptation to ET, and autonomic-HPA regulation to MBT should be interpreted as hypothesis-generating rather than modality-exclusive. Current evidence supports benefits of several exercise approaches for fitness, insulin sensitivity, body composition, vascular function, psychological health, and selected inflammatory markers, but does not establish phenotype-specific superiority. Future comparative trials should combine standardized exercise reporting, phenotype stratification, acute and resting biomarker sampling, and tissue-level or multi-omic endpoints to determine whether clinically useful response profiles can support more individualized exercise prescription in PCOS.