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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
Music Secondary School of Ilion, Athens, Greece
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
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
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

overweight girls increased by nearly two percent.4 Lobstein
Polycystic ovary syndrome (PCOS) is characterized by et al reported that there has been a signicant increase in
chronic oligo- or anovulation, biochemical or clinical child and adolescent obesity in Canada, the United
hyperandrogenism, and the presence of polycystic ovaries Kingdom, China, Germany, France, and Finland.5
on ultrasound.1 It is not clear whether the presence of obesity in the
The major manifestations of the syndrome are hirsutism, general population has affected the prevalence of polycystic
acne, oligomenorrhea and infertility. Although not part of ovaries, although, lately, the impact of environmental
the current diagnostic criteria of PCOS, obesity has been factors on the occurrence and development of the
associated with the syndrome, since its original description syndrome has been strongly reported. Franks argued that
by Stein-Leventhal in the 1930s and it is thought to affect PCOS in adolescents shows the effect of a genetically
40% to 50% of women with the syndrome.2 determined disorder of ovarian function resulting in hyper-
secretion of androgens; however, he believes, environ-
Obesity and PCOS in Puberty mental factors inuence the clinical and biochemical
phenotype. It is likely that the changes in the quantity, type
The presence of PCOS in adolescent women was rst and quality of dietary intake and the degree and type of
reported by Huffman in 1976.3 Initial work in this age group physical activity, can have a signicant impact on reducing
focused mainly on the investigation of menstrual dysfunc- the prevalence of obesity, among women with PCOS.6
tion; however, scientic interest gradually extended to The same has been implied by a recent study by Azziz
metabolic issues related to the syndrome, such as insulin et al, who elaborated on the idea that obesity in families
resistance, hyperandrogenism and obesity. Although PCOS with a history of PCOS is primarily a genetic hypothesis but
in adolescence has not been extensively researched, there is may reect to a considerable extent the effect of environ-
a general agreement that the clinical, metabolic, and mental factors.7
endocrine features of adolescents with PCOS are similar to The aim of this study was to study the degree of physical
those of adult women with the syndrome. activity and sedentary habits among teenage girls with
Over the past two decades the occurrence of obesity in PCOS.
adolescents has greatly increased. Recent data from the U.S.
Materials and Methods
The authors indicate no conicts of interest.
* Address correspondence to: Lina Michala, MRCOG 1 Department of Obstetrics
and Gynecology, University of Athens, Vas Soas 80, Athens, Greece The purpose of this study was the recording of physical
E-mail address: (L. Michala). activity and sedentary habits of adolescent girls with PCOS.
1083-3188/$ - see front matter 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
M. Eleftheriadou et al. / J Pediatr Adolesc Gynecol 25 (2012) 172e174 173

The sample of girls with PCOS came from a tertiary of pleasure than in the control group (91%), this did not
referral center for adolescent gynecology. The PCOS diag- reach statistical signicance (P 5 .433). Nevertheless,
nosis was based on the Rotterdam criteria.8 The control a statistically signicantly higher proportion of girls in the
group included girls without PCOS, attending a public control group (54%) were aware of the health benets of
school in the same geographical area. Exclusion criteria for exercise, as opposed to only 8% of girls with PCOS (P 5 .005).
the control group were: chronic disease, being in a weight Sedentary habits, such as time spent watching television,
loss diet, suffering from food allergies, taking medication working on the computer or surng the internet, were
(hormonal), and pregnancy. similarly high in the two groups, as 67.4% of the control
We developed a questionnaire based on templates group and 71.4% of the PCOS group were sedentary in excess
devised by Godin and Shephard,9 Eisenmann et al,10 Gort- of three hours per day (Table 2).
maker,11 and Epstein et al,12 designed to measure physical
activity. This questionnaire was completed during a struc- Discussion
tured interview with the researcher. All girls had their age,
height, weight, hip and waist circumference measured and Our study showed that girls with PCOS participated in
their BMI calculated. physical activities much less than did controls. This reec-
Statistical analysis was performed using SPSS 17. We ted not only the fact that they were less likely to take up
used the t test for comparison of parametric data, the level physical activity but also that when they did, it was less
of statistical signicance being set at .05. For categorical frequently and less intensely than controls. Generally, our
data, we used chi square for comparisons, and again data agreed with those of Trent et al13 who recorded
statistical signicance was set at .05. reduced physical activity in adolescents suffering from the
We received written informed consent from all parents syndrome, compared to their healthy peers. Wright et al22
or guardians of girls participating in the study. Study in a similar research recorded lower-grade physical
approval was granted from the ethical committee of Alex- activity among adult women with PCOS when compared to
andra hospital, Athens. 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
We included 35 girls with PCOS and 46 controls. Mean
time of weekly sporting activity is 220e240 minutes.15 We,
age was 15.1 and 14.6 years, respectively. Results of
therefore, observed that all adolescents in our study spent
anthropometric data are shown in Table 1.
less time than the recommended minimum.
Girls with PCOS participated in physical activities much
In recent years, several studies have shown that aerobic
less (12 out of 35, 34.3%) than controls (35 out of 46, 76.1%,
endurance exercise leads to favorable changes in cardiore-
P ! .001). It was further noted that when girls with PCOS
spiratory function, body composition, and metabolism of
engaged in physical exercise they did so at a lesser intensity
women with PCOS.16 It seems that the lifestyle changes that
and lesser frequency. The difference in frequency of
combine reducing food intake for weight loss and regular
sporting activity in particular, reached statistical signi-
exercise are a preferred treatment strategy in overweight
cance, as only 25% of girls with PCOS practiced a sport for
and obese women with PCOS.17
more than three times per week, versus 49% of controls
Despite the known benets of a healthy lifestyle, it was
(P ! .001).
interesting to note that a relatively large number of girls
Similar differences were identied when we performed
with PCOS and controls were not aware of the positive
our analysis in the group of 44 girls who were lean, where
effects of exercise on health, which supports our hypothesis
only 15% of girls with PCOS were engaging in physical
that adolescents and their parents do not have sufcient
activity vs 80% of normal controls (P ! .001). Frequency of
information about the benets of physical activity, partic-
physical activity was also higher in lean controls (58% more
ularly, in relation to the symptomatology of PCOS.
than 3 times per week), when compared to lean girls with
Sedentary habits, such as time spent watching television
PCOS (0%, P 5 .003).
per day, were similar in the two groups. The majority of girls
As part of the questionnaire we elaborated on the
watched television two to three hours per day, which is
reasons for engaging in physical activity. Although a smaller
consistent with previous available evidence.18 Although
proportion of girls with PCOS (83%) took up a sport out
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
Table 1 positively associated with risk of obesity in both children
Anthropometric Data of Girls with PCOS and Controls
and adolescents.19
PCOS Controls t test P value In most research that has dealt with obesity in adult
mean  SD mean  SD women with PCOS, excess weight is linked to endocrine and
BMI 23.8  4.2 22.63  4.5 .240 metabolic factors,20,21 without assessing the contribution of
Waist circumference 78  10.3 75.4  9.9 .245 factors such as lifestyle habits. Other research has focused
Hip circumference 96.3  16 95.4  11.8 .785
primarily on the implementation of medicinal, non-dietary
W:H ratio. 0.81  0.17 0.77  0.05 .285
treatments with the purpose of improving the endocrine
174 M. Eleftheriadou et al. / J Pediatr Adolesc Gynecol 25 (2012) 172e174

Table 2 References
Sedentary Habits of Girls with PCOS and Healthy Controls
1. Ehrmann DA: Polycystic ovary syndrome. N Engl J Med 2005; 352:1223
PCOS Controls c2 P value
2. Azziz R, Woods KS, Reyna R, et al: The prevalence and features of the polycystic
N (%) N (%)
ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;
Hours spent watching television per day 89:2745
0 5 (14) 5 (22) 0.593 3. Huffman JW: Polycystic ovaries in young girls. Proceedings of the III Interna-
1 14 (40) 10 (39) tional Symposium on Pediatric and Adolescent Gynecology. Lausanne,
2 11 (31) 18 (28) Switzerland 1976, pp 193e206
4. Ogden CL, Carroll MD, Curtin LR, et al: Prevalence of overweight and obesity in
3 1 (4) 0 (0)
the United States, 1999-2004. JAMA 2006; 295:1549
O3 4 (11) 13 (11)
5. Lobstein T, Baur L, Uauy R: IASO International Obesity Task Force: Obesity in children
Hours spent on the computer and young people: a crisis in public health. Obes Rev 2004; 5(Suppl 1):4
0 7 (20) 14 (41) 0.723 6. Franks S: Genetic and environmental origins of obesity relevant to
1 6 (17) 19 (11) reproduction. Reprod Biomed Online 2006; 12:526
2 3 (9) 5 (11) 7. Azziz R: Polycystic ovary syndrome is a family affair. J Clin Endocrinol Metab
3 4 (11) 5 (7) 2008; 93:1579
O3 15 (43) 3 (30) 8. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group: Revised
2003 consensus on diagnostic criteria and long-term health risks related to
polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19:41
9. Godin G, Shephard RJ: A simple method to assess exercise behavior in the
community. Can J Appl Sport Sci 1985; 10:141
prole and leading to weight reduction in order to restore 10. Eisenmann JC, Bartee RT, Wang MQ: Physical activity, TV viewing, and weight in
ovulation.22 U.S. youth: 1999 Youth Risk Behavior Survey. Obes Res 2002; 10:379
The prevalence of obesity in adolescent girls with PCOS 11. Gortmaker SL: Innovations to reduce television and computertime and obesity
in childhood. Arch Pediatr Adolesc Med 2008; 162:239
has not been recorded on a large scale, but smaller studies 12. Epstein LH, Roemmich JN, Robinson JL, et al: A randomized trial of the effects of
show a general trend of increased obesity rates among reducing television viewing and computer use on body mass index in young
children. Arch Pediatr Adolesc Med 2008; 162:239
young women, with more than half of adolescents with 13. Trent M, Austin SB, Rich M, et al: Overweight status of adolescent girls with
PCOS being obese.13,23 In our study, although the sample polycystic ovary syndrome: body mass index as mediator of quality of life
ambulatory. Ambul Pediatr 2005; 5:107
was small, the percentage of overweight adolescent girls 14. American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ,
with PCOS was slightly higher than what has been previ- Brands M, et al: Diet and lifestyle recommendations revision 2006: a scientic
statement from the American Heart Association Nutrition Committee.
ously reported in the literature, at 57%.
Circulation 2006; 114:82
A number of studies have shown that physically active 15. Physical Activity for Children: A Statement of Guidelines for Children Ages 5 to
adults as opposed to those leading a sedentary life tend to 12, (2nd ed.). Reston, VA, National Association for Sport and Physical Education,
2004. pp 1e28.
develop and maintain improved health levels.24,25 This 16. Hutchison S, Stepto NK, Harrison C, et al: Effects of exercise on insulin
includes a reduction in the risk of coronary heart disease, resistance and body composition in overweight and obese women with and
without polycystic ovary syndrome. J Clin Endocrinol Metab 2011; 96:E48
hypertension, non-insulin dependent diabetes, osteopo- 17. Sastre ME, Prat MO, Checa MA, et al: Current trends in the treatment of
rosis, colon cancer, anxiety, and depression.26 The same polycystic ovary syndrome with desire for children. Ther Clin Risk Manag
seems to apply to adolescents27 and children.28 To our 2009; 5:353
18. Janssen I, Katzmarzyk PT, Boyce WF, et al, Health Behaviour in School-Aged
knowledge, this is the rst study that focuses on daily Children Obesity Working Group: Comparison of overweight and obesity
physical activities and sedentary habits of adolescent girls prevalence in school-aged youth from 34 countries and their relationships
with physical activity and dietary patterns. Obes Rev 2005; 6:123
with PCOS. 19. Samdal O, Tynj ala J, Roberts C, et al: Trends in vigorous physical activity and TV
watching of adolescents from 1986 to 2002 in seven European Countries. Eur J
Public Health 2007; 17:242
20. Robinson S, Chan SP, Spacey S, et al: Postprandial thermogenesis is reduced in
polycystic ovary syndrome and is associated with increased insulin resistance.
Clin Endocrinol 1992; 36:537
Healthy teenagers were involved in a sporting activity 21. Segal KR, Dunaif A: Resting metabolic rate and postprandial thermogenesis in
polycystic ovary syndrome. Int J Obesity 1990; 14:559
more often and more frequently than in the PCOS group. 22. Wright CE, Zborowski JV, Talbott EO, et al: Dietary intake, physical activity, and
Furthermore, teenagers with PCOS were less likely to be obesity in women with polycystic ovary syndrome. Int J Obes Relat Metab
Disord 2004; 28:1026
aware of the positive effects of exercise on health and to use 23. Coviello AD, Legro RS, Dunaif A: Adolescent girls with polycystic ovary
this as an incentive to participate in a sport activity. syndrome have an increased risk of the metabolic syndrome associated with
Athletic and sedentary habits of adolescents with PCOS, increasing androgen levels independent of obesity and insulin resistance. J
Clin Endocrinol Metab 2006; 91:492
in conjunction with eating habits, may interact with other 24. Centers For Disease Control and Prevention: Adult participation in
important metabolic, hormonal, genetic and psychological recommended levels of physical activityeUnited States, 2001 and 2003.
MMWR Morb Mortal Wkly Rep 2005; 54:1208
factors leading to obesity. 25. Kahn EB, Ramsey LT, Brownson RC, et al: The effectiveness of interventions to
increase physical activity. A systematic review. Am J Prev Med 2002; 22(4 Suppl):73
26. Brosse AL, Sheets ES, Lett HS, et al: Exercise and the treatment of clinical
depression in adults: recent ndings and future directions. Sports Med 2002;
27. Fulton JE, Garg M, Galuska DA, et al: Public health and clinical
We would like to thank staff in the Musical Secondary recommendations for physical activity and physical tness: special focus on
overweight youth. Sports Med 2004; 34:581
School of Ilion for their help and understanding during our 28. Rice MH, Howell CC: Measurement of physical activity, exercise, and physical
study. tness in children: issues and concerns. J Pediatr Nurs 2000; 15:148