Investigation of the Effectiveness of Spinal Stabilization Exercises Added to Aerobic Exercise in Women With Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common multisystem endocrine and metabolic disorder among women of reproductive age, characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphology. In addition to reproductive disturbances, PCOS is associated with insulin resistance, chronic low-grade inflammation, hormonal imbalances, obesity, and an increased risk of long-term metabolic complications. These alterations may also negatively affect physical fitness, particularly cardiorespiratory fitness and muscular endurance. Furthermore, PCOS may be accompanied by psychosocial problems, including depression and anxiety, which may contribute to impaired quality of life.

Lifestyle interventions, particularly physical activity and exercise, are considered first-line strategies in the management of PCOS. Aerobic and resistance exercise have been shown to improve insulin resistance, cardiometabolic risk factors, hormonal profiles, inflammation, body composition, and reproductive outcomes. However, evidence regarding their effects on physical fitness components that may be impaired in PCOS, particularly cardiorespiratory fitness and muscular endurance, remains limited. Moreover, there is no clear consensus regarding the specific effectiveness of different exercise modalities, contents, and training volumes on physical fitness outcomes in women with PCOS.

Spinal stabilization exercises focus on activating the deep trunk muscles and improving lumbopelvic stability, neuromuscular control, core muscle strength and endurance, postural control, and movement quality. Considering the adverse effects of insulin resistance, chronic inflammation, and hormonal disturbances on muscle morphology and physical fitness in PCOS, spinal stabilization exercises may provide additional benefits in this population. Although Pilates-based interventions targeting the core region have demonstrated beneficial effects on quality of life, hormonal profiles, menstrual symptoms, and certain physical fitness parameters in women with PCOS, the effects of spinal stabilization exercises, either alone or in combination with aerobic exercise, have not yet been investigated in this population. Therefore, adding spinal stabilization exercises to aerobic exercise may provide additional benefits for metabolic and hormonal functions, body composition, cardiorespiratory fitness, and muscular endurance.

The aim of this study is to compare the effects of aerobic exercise combined with spinal stabilization exercises versus aerobic exercise alone on metabolic, hormonal, and inflammatory markers, anthropometric parameters, cardiorespiratory fitness, core muscle strength, core muscle endurance, and quality of life in individuals with PCOS.

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Other: Aerobic Exercise

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Other: Aerobic Exercise · Other: Spinal Stabilization Exercise

The aerobic training group will undergo aerobic exercise on a treadmill three days a week for eight weeks under the supervision of a specialist physiotherapist. For patients with no prior treadmill experience, the first session will serve as a trial session to facilitate adaptation to the treadmill. In subsequent sessions, the aerobic training will be conducted in phases comprising warm-up, exertion, and cool-down periods.

As a first step in spinal stabilization training, individuals will be instructed on proper postural alignment. To determine each individual's ideal posture, a neutral spine position-characterized by comfort and a lack of pain in the lumbopelvic region-will be identified in front of a mirror, and the contraction of deep muscles (abdominal bracing) will be taught. Individuals will be required to maintain proper posture and deep muscle group activation throughout the exercises. Stretching and mobility exercises targeting the lumbar region, trunk muscles, and lower extremities will be performed for approximately 5-10 minutes as part of the warm-up and cool-down periods surrounding the spinal stabilization exercises. The exercises will be conducted for approximately 30 minutes.

Plazo: At baseline and after 8 weeks of treatment

Fasting blood glucose concentration will be measured from venous blood samples after an overnight fast and reported in mg/dL.

Plazo: At baseline and after 8 weeks of treatment

Fasting serum insulin concentration will be measured from venous blood samples after an overnight fast and reported in µIU/mL.

Plazo: At baseline and after 8 weeks of treatment

Fasting serum triglyceride concentration will be measured from venous blood samples after an overnight fast and reported in mg/dL.

Plazo: At baseline and after 8 weeks of treatment

Serum high-density lipoprotein cholesterol (HDL-C) concentration will be measured from venous blood samples after an overnight fast and reported in mg/dL.

Plazo: At baseline and after 8 weeks of treatment

Serum low-density lipoprotein cholesterol concentration will be measured from venous blood samples after an overnight fast and reported in mg/dL.

Plazo: At baseline and after 8 weeks of treatment

Serum total cholesterol concentration will be measured from venous blood samples after an overnight fast and reported in mg/dL.

Plazo: At baseline and after 8 weeks of treatment

Serum prolactin concentration will be measured from venous blood samples after an overnight fast and reported in ng/mL.

Plazo: At baseline and after 8 weeks of treatment

Serum luteinizing hormone concentration will be measured from venous blood samples after an overnight fast and reported in mIU/mL.

Plazo: At baseline and after 8 weeks of treatment

Serum follicle-stimulating hormone concentration will be measured from venous blood samples after an overnight fast and reported in mIU/mL.

Plazo: At baseline and after 8 weeks of treatment

Serum thyroid-stimulating hormone concentration will be measured from venous blood samples after an overnight fast and reported in µIU/mL.

Plazo: At baseline and after 8 weeks of treatment

Serum high-sensitivity C-reactive protein concentration will be measured from venous blood samples after an overnight fast and reported in mg/L.

Plazo: At baseline and after 8 weeks of treatment

Free androgen index will be calculated using total testosterone and sex hormone-binding globulin concentrations and reported as a dimensionless value.

Plazo: At baseline and after 8 weeks of treatment

Serum estradiol concentration will be measured from venous blood samples after an overnight fast and reported in pg/mL.

Plazo: At baseline and after 8 weeks of treatment

Serum sex hormone-binding globulin concentration will be measured from venous blood samples after an overnight fast and reported in nmol/L.

Plazo: At baseline and after 8 weeks of treatment

Serum anti-Müllerian hormone concentration will be measured from venous blood samples after an overnight fast and reported in ng/mL.

Plazo: At baseline and after 8 weeks of treatment

Insulin resistance will be calculated using fasting glucose and fasting insulin concentrations according to the Homeostatic Model Assessment of Insulin Resistance formula and reported as an index value.

Plazo: At baseline and after 8 weeks of treatment

Serum interleukin-6 concentration will be measured from venous blood samples using an enzyme-linked immunosorbent assay and reported in pg/mL.

Plazo: At baseline and 8 weeks after treatment.

Serum interleukin-10 concentration will be measured from venous blood samples using an enzyme-linked immunosorbent assay and reported in pg/mL.

Plazo: At baseline and 8 weeks after treatment.

Serum tumor necrosis factor-alpha concentration will be measured from venous blood samples using an enzyme-linked immunosorbent assay and reported in pg/mL.

Plazo: At baseline and 8 weeks after treatment.

Serum adiponectin concentration will be measured from venous blood samples using an enzyme-linked immunosorbent assay and reported in ng/mL.

Plazo: At baseline and 8 weeks after treatment.

Serum irisin concentration will be measured from venous blood samples using an enzyme-linked immunosorbent assay and reported in ng/mL.

Plazo: At baseline and 8 weeks after treatment

Waist circumference and hip circumference will be measured in meters (m). The waist-to-hip ratio will be calculated by dividing waist circumference by hip circumference.

Plazo: At baseline and 8 weeks after treatment

Waist circumference and height will be measured in meters (m). The waist-to-height ratio will be calculated by dividing waist circumference by height.

Plazo: At baseline and 8 weeks after treatment

Body mass index will be calculated as body weight in kilograms divided by height in meters squared and reported in kg/m².

Plazo: At baseline and 8 weeks after treatment

Body weight will be measured using a Tanita bioelectrical impedance analysis device and reported in kilograms (kg).

Plazo: At baseline and 8 weeks after treatment

Body fat mass will be assessed using a Tanita bioelectrical impedance analysis device and reported in kilograms (kg).

Plazo: At baseline and 8 weeks after treatment

Body fat percentage will be assessed using a Tanita bioelectrical impedance analysis device and reported as a percentage (%).

Plazo: At baseline and 8 weeks after treatment

Fat-free mass will be assessed using a Tanita bioelectrical impedance analysis device and reported in kilograms (kg).

Plazo: At baseline and 8 weeks after treatment

Body muscle percentage will be assessed using a Tanita bioelectrical impedance analysis device and reported as a percentage (%).

Plazo: At baseline and 8 weeks after treatment

Total body water will be assessed using a Tanita bioelectrical impedance analysis device and reported in kilograms (kg).

Plazo: At baseline and 8 weeks after treatment

Total body water percentage will be assessed using a Tanita bioelectrical impedance analysis device and reported as a percentage (%).

Plazo: At baseline and 8 weeks after treatment

Visceral fat will be assessed using a Tanita bioelectrical impedance analysis device and reported as the visceral fat rating provided by the device.

Plazo: At baseline and 8 weeks after treatment

Cardiovascular fitness will be assessed using the 6-Minute Walk Test. Participants will be instructed to walk along a 30-meter corridor for 6 minutes at their usual walking pace. The total distance walked during 6 minutes will be recorded in meters (m).

Plazo: At baseline and 8 weeks after treatment

Trunk flexor endurance will be assessed using the McGill Trunk Flexor Test. Participants will maintain the standardized trunk flexion position for as long as possible. The duration for which the position is maintained will be recorded in seconds (s).

Plazo: At baseline and 8 weeks after treatment

Trunk extensor endurance will be assessed using the McGill Trunk Extensor Test. Participants will maintain the standardized horizontal trunk position for as long as possible. The duration for which the position is maintained will be recorded in seconds (s).

Plazo: At baseline and after 8 weeks of treatment

Lateral trunk muscle endurance will be assessed using the Side Bridge Test. Participants will maintain the standardized side bridge position for as long as possible. The duration for which the position is maintained will be recorded in seconds (s).

Plazo: At baseline and after 8 weeks of treatment

Core muscle strength will be assessed using the 30-second Sit-Up Test. Participants will perform as many sit-ups as possible within 30 seconds. The total number of correctly completed repetitions will be recorded.

Plazo: At baseline and after 8 weeks of treatment

Core muscle strength will be assessed using the 30-second Modified Push-Up Test. Participants will perform as many modified push-ups as possible within 30 seconds. The total number of correctly completed repetitions will be recorded.

Plazo: At baseline and after 8 weeks of treatment

Quality of life will be assessed using the Polycystic Ovary Syndrome Quality of Life-50 Scale. The scale consists of 50 items across six domains: psychosocial and emotional status, fertility, sexual function, obesity and menstrual disorders, hirsutism, and coping with the disease. Each item is scored from 1 to 5, with a total score ranging from 50 to 250. Higher total scores indicate better quality of life.

Plazo: After 8 weeks of treatment

Participants' perceived change in polycystic ovary syndrome-related symptoms compared with baseline will be assessed using the Global Perceived Improvement Scale. The scale ranges from 1 to 7: 1 = very much better, 2 = much better, 3 = slightly better, 4 = no change, 5 = slightly worse, 6 = much worse, and 7 = very much worse. Lower scores indicate greater perceived improvement, whereas higher scores indicate greater perceived worsening.

Investigation of the Effectiveness of Spinal Stabilization Exercises Added to Aerobic Exercise in Women With Polycystic Ovary Syndrome