Original Study

Exercise and Sedentary Habits Among Adolescents with PCOS

M. Eleftheriadou MD, MSc 1, L. Michala MRCOG 1,*, K. Stefanidis MD, PhD 1, I. Iliadis PhD 2,
A. Lykeridou PhD 3, A. Antsaklis MD, PhD 1
1 st
1 Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece
2
Music Secondary School of Ilion, Athens, Greece
3
Technical Institute of Athens, School of Midwifery, Athens, Greece

a b s t r a c t
Study Objective: The purpose of this study was the recording of physical activity and sedentary habits of adolescents with polycystic ovarian
syndrome (PCOS).
Methods: We performed a structured interview to assess the level of physical activity and sedentary habits of girls with PCOS. We used
a group of healthy adolescents as controls. All girls had their age, height, weight, hip and waist circumference measured and their BMI
calculated.
Results: 81 girls (35 with PCOS and 46 controls) participated in the study. Girls with PCOS engaged in physical activities less than controls.
Even when they did, the frequency and intensity of exercise was less. Also, girls with PCOS were less likely to be aware of the positive
effects of exercise on their health. Girls in both groups were sedentary in excess of the 4 hours per day limit, which has been linked with
obesity.
Conclusion: Healthy teenagers were involved in a sporting activity more often and more frequently than the PCOS group. Athletic and
sedentary habits of adolescents with PCOS may interact with other factors leading to obesity.
Key Words: Adolescence, PCOS, Sedentary habits, Sporting activity

Introduction indicate that from 1999 to 2004 the overall percentage of

Polycystic ovary syndrome (PCOS) is characterized by
chronic oligo- or anovulation, biochemical or clinical
hyperandrogenism, and the presence of polycystic ovaries
on ultrasound.1
The major manifestations of the syndrome are hirsutism,
acne, oligomenorrhea and infertility. Although not part of
the current diagnostic criteria of PCOS, obesity has been
associated with the syndrome, since its original description
by Stein-Leventhal in the 1930s and it is thought to affect
40% to 50% of women with the syndrome.2
Obesity and PCOS in Puberty
The presence of PCOS in adolescent women was rst
reported by Huffman in 1976.3 Initial work in this age group
focused mainly on the investigation of menstrual dysfunc-
tion; however, scientic interest gradually extended to
metabolic issues related to the syndrome, such as insulin
resistance, hyperandrogenism and obesity. Although PCOS
in adolescence has not been extensively researched, there is
a general agreement that the clinical, metabolic, and
endocrine features of adolescents with PCOS are similar to
those of adult women with the syndrome.
Over the past two decades the occurrence of obesity in
adolescents has greatly increased. Recent data from the U.S.
The authors indicate no conicts of interest.
st
* Address correspondence to: Lina Michala, MRCOG 1 Department of Obstetrics
and Gynecology, University of Athens, Vas Soas 80, Athens, Greece
E-mail address: linamichalas@hotmail.com (L. Michala).
1083-3188/$ - see front matter 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
doi:10.1016/j.jpag.2011.11.009
overweight girls increased by nearly two percent.4 Lobstein
et al reported that there has been a signicant increase in
child and adolescent obesity in Canada, the United
Kingdom, China, Germany, France, and Finland.5
It is not clear whether the presence of obesity in the
general population has affected the prevalence of polycystic
ovaries, although, lately, the impact of environmental
factors on the occurrence and development of the
syndrome has been strongly reported. Franks argued that
PCOS in adolescents shows the effect of a genetically
determined disorder of ovarian function resulting in hyper-
secretion of androgens; however, he believes, environ-
mental factors inuence the clinical and biochemical
phenotype. It is likely that the changes in the quantity, type
and quality of dietary intake and the degree and type of
physical activity, can have a signicant impact on reducing
the prevalence of obesity, among women with PCOS.6
The same has been implied by a recent study by Azziz
et al, who elaborated on the idea that obesity in families
with a history of PCOS is primarily a genetic hypothesis but
may reect to a considerable extent the effect of environ-
mental factors.7
The aim of this study was to study the degree of physical
activity and sedentary habits among teenage girls with
PCOS.
Materials and Methods
The purpose of this study was the recording of physical
activity and sedentary habits of adolescent girls with PCOS.
 M. Eleftheriadou et al. / J Pediatr Adolesc Gynecol 25 (2012) 172e174
The sample of girls with PCOS came from a tertiary
referral center for adolescent gynecology. The PCOS diag-
nosis was based on the Rotterdam criteria.8 The control
group included girls without PCOS, attending a public
school in the same geographical area. Exclusion criteria for
the control group were: chronic disease, being in a weight
loss diet, suffering from food allergies, taking medication
(hormonal), and pregnancy.
We developed a questionnaire based on templates
devised by Godin and Shephard,9 Eisenmann et al,10 Gort-
maker,11 and Epstein et al,12 designed to measure physical
activity. This questionnaire was completed during a struc-
tured interview with the researcher. All girls had their age,
height, weight, hip and waist circumference measured and
their BMI calculated.
Statistical analysis was performed using SPSS 17. We
used the t test for comparison of parametric data, the level
of statistical signicance being set at .05. For categorical
data, we used chi square for comparisons, and again
statistical signicance was set at .05.
We received written informed consent from all parents
or guardians of girls participating in the study. Study
approval was granted from the ethical committee of Alex-
andra hospital, Athens.
Results
We included 35 girls with PCOS and 46 controls. Mean
age was 15.1 and 14.6 years, respectively. Results of
anthropometric data are shown in Table 1.
Girls with PCOS participated in physical activities much
less (12 out of 35, 34.3%) than controls (35 out of 46, 76.1%,
P ! .001). It was further noted that when girls with PCOS
engaged in physical exercise they did so at a lesser intensity
and lesser frequency. The difference in frequency of
sporting activity in particular, reached statistical signi-
cance, as only 25% of girls with PCOS practiced a sport for
more than three times per week, versus 49% of controls
(P ! .001).
Similar differences were identied when we performed
our analysis in the group of 44 girls who were lean, where
only 15% of girls with PCOS were engaging in physical
activity vs 80% of normal controls (P ! .001). Frequency of
physical activity was also higher in lean controls (58% more
than 3 times per week), when compared to lean girls with
PCOS (0%, P 5 .003).
As part of the questionnaire we elaborated on the
reasons for engaging in physical activity. Although a smaller
proportion of girls with PCOS (83%) took up a sport out
Table 1
Anthropometric Data of Girls with PCOS and Controls
PCOS Controls
mean  SD mean  SD
BMI 23.8  4.2 22.63  4.5
Waist circumference 78  10.3 75.4  9.9
Hip circumference 96.3  16 95.4  11.8
W:H ratio. 0.81  0.17 0.77  0.05
173
of pleasure than in the control group (91%), this did not
reach statistical signicance (P 5 .433). Nevertheless,
a statistically signicantly higher proportion of girls in the
control group (54%) were aware of the health benets of
exercise, as opposed to only 8% of girls with PCOS (P 5 .005).
Sedentary habits, such as time spent watching television,
working on the computer or surng the internet, were
similarly high in the two groups, as 67.4% of the control
group and 71.4% of the PCOS group were sedentary in excess
of three hours per day (Table 2).
Discussion
Our study showed that girls with PCOS participated in
physical activities much less than did controls. This reec-
ted not only the fact that they were less likely to take up
physical activity but also that when they did, it was less
frequently and less intensely than controls. Generally, our
data agreed with those of Trent et al13 who recorded
reduced physical activity in adolescents suffering from the
syndrome, compared to their healthy peers. Wright et al22
in a similar research recorded lower-grade physical
activity among adult women with PCOS when compared to
a healthy control group.
It has been suggested that the minimum time spent in
aerobic exercise per week in order to achieve cardiovascular
benets for adults is 150e180 minutes, depending on age
and sex.14 In children and adolescents, the recommended
time of weekly sporting activity is 220e240 minutes.15 We,
therefore, observed that all adolescents in our study spent
less time than the recommended minimum.
In recent years, several studies have shown that aerobic
endurance exercise leads to favorable changes in cardiore-
spiratory function, body composition, and metabolism of
women with PCOS.16 It seems that the lifestyle changes that
combine reducing food intake for weight loss and regular
exercise are a preferred treatment strategy in overweight
and obese women with PCOS.17
Despite the known benets of a healthy lifestyle, it was
interesting to note that a relatively large number of girls
with PCOS and controls were not aware of the positive
effects of exercise on health, which supports our hypothesis
that adolescents and their parents do not have sufcient
information about the benets of physical activity, partic-
ularly, in relation to the symptomatology of PCOS.
Sedentary habits, such as time spent watching television
per day, were similar in the two groups. The majority of girls
watched television two to three hours per day, which is
consistent with previous available evidence.18 Although
daily time spent watching TV was relatively low, when time
spent using the internet was combined, this exceeded the
four hour per day limit of sedentary activity, which is
positively associated with risk of obesity in both children
and adolescents.19
t test P value In most research that has dealt with obesity in adult
women with PCOS, excess weight is linked to endocrine and
.240 metabolic factors,20,21 without assessing the contribution of
.245 factors such as lifestyle habits. Other research has focused
.785
primarily on the implementation of medicinal, non-dietary
.285
treatments with the purpose of improving the endocrine
174 M. Eleftheriadou et al. / J Pediatr Adolesc Gynecol 25 (2012) 172e174

Table 2 References
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Acknowledgments
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