The effect of diet and exercise on markers of endothelial function in overweight and obese women with polycystic ovary syndrome

Background Women with polycystic ovary syndrome (PCOS) present with vascular abnormalities, including elevated markers of endothelial dysfunction. There is limited evidence for the effect of lifestyle modification and weight loss on these markers. The aim of this study was to determine if 20 weeks of a high-protein energy-restricted diet with or without exercise in women with PCOS could improve endothelial function. Methods This is a secondary analysis of a subset of 50 overweight/obese women with PCOS (age: 30.3 ± 6.3 years; BMI: 36.5 ± 5.7 kg/m²) from a previous study. Participants were randomly assigned by computer generation to one of three 20-week interventions: diet only (DO; n 14, ∼6000 kJ/day), diet and aerobic exercise (DA; n 16, ∼6000 kJ/day and five walking sessions/week) and diet and combined aerobic-resistance exercise (DC; n 20, ∼6000 kJ/day, three walking and two strength sessions/week). At Weeks 0 and 20, weight, markers of endothelial function [vascular cell adhesion molecule-1 (sVCAM-1), inter-cellular adhesion molecule-1 (sICAM-1), plasminogen activator inhibitor-1 (PAI-1) and asymmetric dimethylarginine (ADMA)], insulin resistance and hormonal profile were assessed. Results All three treatments resulted in significant weight loss (DO 7.9 ± 1.2, DA 11.0 ± 1.6, DC 8.8 ± 1.1; P < 0.001 for time; P 0.6 time × treatment). sVCAM-1, sICAM-1 and PAI-1 levels decreased with weight loss (P≤ 0.01), with no differences between treatments (P< 0.4). ADMA levels did not change significantly (P 0.06). Testosterone, sex hormone-binding globulin and the free androgen index (FAI) and insulin resistance also improved (P < 0.001) with no differences between treatments (P< 0.2). Reductions in sVCAM-1 were correlated to reductions in testosterone (r 0.32, P 0.03) and FAI (r 0.33, P 0.02) as well as weight loss (r 0.44, P 0.002). Weight loss was also associated with reductions in sICAM-1 (r 0.37, P 0.008). Conclusions Exercise training provided no additional benefit to following a high-protein, hypocaloric diet on markers of endothelial function in overweight/obese women with PCOS.Clinical Trials Registration Number: ACTRN12606000198527.