# Evaluating the efficacy of aerobic exercise as therapy for depression and anxiety in women with PCOS: a systematic review

## TL;DR

This review finds that aerobic exercise can help reduce depression and anxiety in women with PCOS, but more research is needed due to limited studies.

## Contribution

The study is the first systematic review to evaluate aerobic exercise's impact on depression and anxiety specifically in women with PCOS.

## Key findings

- Aerobic exercise reduced depression symptoms by 4.8%–32.4% in women with PCOS.
- Anxiety symptoms decreased by 3.6%–42.2% following aerobic exercise interventions.
- Only three trials met the inclusion criteria, limiting the strength of the conclusions.

## Abstract

This systematic review aims to evaluate the effectiveness of exercise interventions in alleviating depression and anxiety symptoms in women with polycystic ovary syndrome (PCOS).

PubMed, CINAHL, Cochrane Library, SportDiscus, EMBASE and Web of Science databases were searched from their inception to July 2025.

Randomised controlled trials were eligible if they examined the effects of exercise lasting ≥4 weeks on validated measures of depression and/or anxiety in women aged 18–45 with PCOS diagnosed using the Rotterdam criteria. Publications not written in English were excluded.

Two reviewers independently extracted data and assessed study quality using the Cochrane Risk of Bias tool. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science guidelines. A narrative/qualitative synthesis was used to provide an overview of the current literature on the topic. Given the limited number of eligible trials, outcomes and measurement tools, a meta-analysis was not undertaken.

From 363 full-text records, three trials (n=221) met the inclusion criteria. Interventions lasted 12–16 weeks, and aerobic exercise (continuous, intermittent or high-intensity interval training) was prescribed at least three times per week. Across all studies, depression symptoms improved by 4.8%–32.4%, with one study indicating a minimal clinically important difference, while anxiety symptoms decreased by 3.6%–42.2%, measured using validated scales, including Hospital Anxiety and Depression Measurement Scale, Depression, Anxiety, and Stress Scale-21, Montgomery Åsberg Depression Rating Scale and Brief Scale for Anxiety.

Findings should be interpreted cautiously due to limited report numbers, methodological concerns and heterogeneity in interventions and outcome measures. While this review aimed to assess all exercise modalities, only aerobic exercise interventions were identified. These interventions appear effective in reducing depression and anxiety symptoms in women with PCOS. Future research should include psychological outcomes and explore resistance or combined diet-exercise interventions.

CRD42023408190.