Workouts for PCOS

By: Emily Karataeva and Igor Klibanov

Alright, so youve been diagnosed with PCOS (polycystic ovarian syndrome), and its very likely that youre here because everything your doctor or any other medical professional has told you is everything but helpful. 

Youve probably heard things like:

• Just lose weight.
• Eat less, move more.
• Just take birth control and come back when you want to get pregnant.
• We can put you on a diabetic drug – Metformin
• And my personal favourite, sorry, nothing we can do .

These are all incredibly frustrating things to hear from someone who is supposed to know what to do to help you. Maybe youve already gotten the eat less part of that mantra down, but what about moving more? Its an incredibly vague and impractical statement on its own, so you wont find any answers there. 

Whats worse is that your symptoms are nothing to be laughed about either, and can have severe impacts on your physical and mental health. You may be experiencing such symptoms as:

• Missed or irregular periods
• Excess body/facial hair
• Excessive weight gain or unexplained weight gain, particularly in the abdomen (even if you are a normal weight or even slightly underweight, you will still have more abdominal fat, no matter what)
• Difficulty losing weight
• High blood pressure
• Poor reproductive health
• Acne/oily skin
• Ovarian cysts
• Increased risk of diabetes
• Anxiety & depression 
• Poor sleep and therefore, also low energy levels

With all the unhelpful doctors and lack of research there is on PCOS, it may be incredibly difficult to find the best kind of exercise for you and your body, that takes everything into account. 

In this article, you can expect to learn:

• Why exercise is even beneficial for PCOS in the first place
• How to correctly and optimally exercise with PCOS
• What you can actually do for exercise 
• How much exercise you need as someone with PCOS
• All exercise is good exercise, but

Before we get to all that however, who am I, and what makes me qualified to help you? 

Hiya!

Im Igor Klibanov. I am the proud author of 7 different books on fitness and nutrition, and I am also a personal trainer with many clients with PCOS who were previously left completely in the dark about their condition that I have helped find the right exercise plan for, to lose weight, improve their insulin resistance, and more.

Its undoubtedly hard to shake even the smallest bit of advice out of your doctor about your PCOS, and even harder when it seems that all they care about is your ability to reproduce adequately. However, as a personal trainer, I am specifically here to care more about your physical wellbeing and how your physical exercise plan can play a role in that.

Before we get right down to the brass tacks, lets first establish,

The Relationship Between PCOS and Exercise

Starting to regularly exercise can be difficult, especially when youre constantly hit with fatigue, which can then be compounded by depression. In addition to that, one of the biggest barriers is simply just not knowing what to do. This can be solved by either hiring a personal trainer to help you out, or by doing a lot of research yourself. Either way, this article is here to help you.

So, here are some of the benefits of exercising when you have PCOS:

• Improve insulin resistance (applies if you have insulin resistance, which many women with PCOS do)
• Improved sleep (very important in fatigue management, and also insulin sensitivity)
• Better mental health 
• Decreased inflammation (inflammation may also be the cause of many symptoms, so when its decreased, symptoms may lessen)
• Potential fat loss/weight loss
• More energy

If youve truly been looking for a way to not feel exhausted all day, actually sleep throughout the whole night, manage some of your symptoms, and potentially see some fat loss occur, then keep reading!

By choosing to exercise, you are finally getting to the root of your problems. No more band aid solutions!

On that note, lets jump right into,

How to Exercise With PCOS

You may have already explored different avenues of exercise interventions for PCOS, and heard things like:

• HIIT is bad because it spikes your cortisol and makes you gain weight!
• Theres no reason to do yoga, its not even real exercise!
• Lifting weights will make you bulky!
• Anything that isnt done slowly will worsen your symptoms!

Well, if HIIT (High Intensity Interval Training) will make you gain weight, yoga isnt even real exercise, and lifting weights will make you bulky, then what are you even meant to do? Might as well just lay around on the couch all day, right?

Regardless of all that, the information that is seldom told to women with PCOS, is that they might benefit from taking exercise tips from diabetics.

Due to the lack of research on polycystic ovarian syndrome, there isnt enough information out there to truly find out the best way to exercise for it. However, since some of the symptoms/causes of PCOS mirror those of diabetes, such as insulin resistance, we can extrapolate information from there, and apply it here.

Luckily, I have an entire bestselling book on this topic called Type 2 Diabetes Reversal Secrets, which has a dedicated chapter on exercise. 

So as a general how to exercise with PCOS, youve got to train like a diabetic, essentially.

This means: 

• Trying for high intensity aerobic exercise/physical activity (over 85% of your maximal heart rate)
• Combining different forms of physical activity (weight training AND cardio, not weight training OR cardio)
• Training 4-6 days a week

All of this is elaborated upon in my book in much greater detail, but I will be referencing some key points here .

Now that all of that is out of the way, let’s discuss:

Strength Training

Strength training, or as its more colloquially known, lifting weights, is a great way to get moving and build some muscle mass in the process. Now, keep in mind that when I say strength training or resistance training, I will be referring to the act of lifting heavy weights, and a heavy focus on compound lifts like squats, bench presses, and deadlifts. These can, in theory, be done with bodyweight only, but the extra health benefits and improvements to physical fitness that external resistance adds is unrivaled.

Resistance training is the process of lifting heavy weights for a set amount of sets and reps, with the goal of either increasing those reps over time, or increasing the weight over time (or both). This is how the process of getting stronger occurs, as well as the process of building muscle (of course, you can build strength without muscle, if thats what youre going for). I elaborate more on what is strength training in my article on that topic.

Now, a great myth you may have heard is that building muscle is great for women with PCOS, because it boosts your metabolism! The claim isnt entirely wrong, but it’s also not entirely correct, either. 

Unfortunately, women are bound by the laws of physiology to be capped at being able to build approximately 20-25 pounds of muscle on their bodies. This may seem like a lot, but in the grand scheme of boosting your metabolism, it really means very little.

You may have also heard that the reason building resistance training boosts your metabolism is because muscle burns more calories than fat, which isnt entirely wrong. However, what you arent told is that one pound of muscle burns about 6 calories a day, as opposed to a pound of fat only burning 2. 

This means that youll burn at least 175 extra calories a day after building 25 pounds of muscle. Realistically, you might be able to reach about 10-12 in your first year of weight training, which then amounts to about 60-70 extra calories. That really isnt a lot when it’s compared to other sources of energy expenditure. The biggest one of which is simply maintaining your body temperature. About two thirds of your metabolism is devoted to just that. A body temperature of 36.5-36.8 degrees Celsius (97.7-98.2 Fahrenheit) is considered optimal. For every degree that youre below that, youll burn 10-13% calories fewer. 

That being said, you should still strength train because itll have massive benefits on your energy levels, strength levels, insulin resistance, sleep, and many more. Your progress and strength is very palpable with this form of exercise, and being able to finally increase your weight after a couple of weeks can potentially provide a good stimulus to your brains reward system, which is whatll make you want to keep doing it! 

In terms of how you should strength train, here is a method that is understandable and accessible for beginners to start:

• Step 1: find a weight, and lift it 12 times. Stop after 12, even if you feel you could have done more.
• Step 2: After you finish the set, ask yourself how many more could I have done? The answer should be somewhere around 2-4.
• Step 3: If you feel that you couldnt have done at least 2 more, its too heavy. If you feel like you could have done more than 4, its too light.
• Step 4: on the next set, adjust the weight, and try again.

Try to keep reps between 10-15, and try sticking to about 6-8 exercises per workout. Dont exhaust yourself the first day with a thousand different exercises, because I doubt youre gonna be associating good memories with the gym after that. 

Instead, focus on compound lifts like squats, bench presses, lat pulldowns (I like to call them the cornerstone or the foundation lifts), and others that I discuss in my article on exercise for weight loss. Make sure you are doing progressive resistance training, where you go up in weight or reps after some time.

Now, thats not to say you should only be doing these, you can try incorporating some less intensive and focused exercises. These are called accessory and isolation movements. When structuring your workout, you should make sure your lifts are going from recruiting the most amount of your muscles/body, to the least. For example, an upper body routine might start off with bench presses, and then finish with lateral raises. 

That does it for strength training! If youre interested in building some more muscle mass (wont make you bulky!), and getting stronger or if you just like the idea of lifting weights, then this is the right exercise for you! After all, you do have to like your workout, or youre going to dread doing it every time until youre finally fed up with it. 

Although strength training can sometimes be a good way to get your heart rate up (lifting heavy isn’t an easy task!), its still a good idea to incorporate some form of:

Cardio

Cardio, or aerobic training, essentially refers to any form of exercise training that keeps your heart rate above a certain threshold for a prolonged period of time. It’s aerobic exercises that you can do for half an hour or so without needing to take a break in between. 

Now, I will say, for women with PCOS it is very likely that more vigorous intensity exercise might show more significant improvements than lower/moderate intensity exercise, as one study claimed to find. But this doesnt mean you should instantly get up and start sprinting around your neighbourhood, if youve never done it before.

First of all, what does high intensity even mean? Well, it means that your heart rate should be at or above 85% of its max. The theoretical maximum heart rate is about 220, and a general rule of thumb for finding out what yours is, is to subtract your age from that number. For example, if youre 35, your maximal heart rate would be 185 beats per minute (BPM). 85% of 185 is around 157 BPM. 

This isnt the most accurate way of getting your maximal heart rate, but it’s a good range, and the alternative is quite frankly a higher risk test than whats necessary at this point. However, if you really are a stickler for accuracy and numbers, then you might benefit from working with a personal trainer to find out what your maximal heart rate is more accurately. 

Now, this doesnt mean that low intensity exercise is completely out of the question, you shouldnt just throw yourself into insane cardio circuits or just not bother at all. You can see improvements in your health at even just 50% of your maximal heart rate (exercising at this intensity can still work towards improving insulin sensitivity by 35%!). Using the figure from above, that would be about 92 BPM if you are 35, for example. Thats usually a moderate to fast walk.

However, there are definitely much greater benefits seen in your cardiorespiratory fitness and physical health when you go for at least 65% of your maximal heart rate. So in short, if you want to incorporate cardio into your workout routine, then make sure youre doing it intentionally and in a way that actually gets your heart rate up enough.

Now that we know how to do cardio, let’s discuss what we can do for cardio!

There are many different ways of consistently getting your heart rate up and keeping it there, which means there’s a whole world out there for you to try and find what you like in. 

You can try:

• Swimming
• Biking
• Hiking
• Brisk walking
• Walking uphill
• Rowing
• Jogging/running
• Jumping rope
• Dancing

Now, before you ask me but Igor, whats the best one? I want to know what the best one is!, let me tell you this: the best exercise from that list is the one you enjoy doing, and one that is accessible to you. 

This is because your body does not care/notice how youre getting your heart rate up, just that your heart rate is up. The heart does not beat any differently whether youre swimming, or dancing. So the activity itself matters a whole lot less than the heart rate during the activity, the duration, and the frequency. 

My best advice for you is to explore many different forms of cardio to find which one you actually enjoy doing, and then just do it! Or, you might hate them all, and decide to spread out the misery equally 🙂

So you might do 10 minutes on the treadmill, 10 minutes on the elliptical, and 10 minutes on the bike, for example.

In addition to that, you might want to be wary of very vigorous exercise if you are overweight, which many women with PCOS are. Before partaking in intense exercise, it may be a good idea to pay your doctor a visit for a stress test, and maybe some advice on how to be safe when exercising.

It is also very possible that theyll simply just tell you to lose weight without any other very helpful advice. In that case, you may want to try your hand at some more moderate physical activity like swimming and walking first, as those can be a little easier on the joints. 

And thats it on cardio! If this sounds appealing to you, then it might be time to start incorporating a bit of it into your workout routine. That being said, it’s also a good idea to not put all your eggs in one fitness basket, and try to do cardio alongside a strength training routine.

Just remember, regardless of what’s optimal, you should always do what jives best with your body. If you find that higher intensity exercise causes your symptoms to worsen, then stick to lower intensity exercise like walking. Do not force yourself to perform at a higher intensity simply because its supposed to work and be better. I can assure you, anything that actively feels like it’s hurting you is not better, and you should stick to what ultimately works for you.

Now, if youre looking for a bit of a challenge and to work up a bit of a sweat without doing the same thing for half an hour, look no further than:

HIIT

HIIT, or, High Intensity Interval Training is another form of cardio, but it works a little differently which is why it has its own section.

With general cardio, you want to be doing one activity at a high enough intensity for a prolonged period of time. With HIIT, you have a chance to be able to catch your breath in between exercises.

If youre not a fan of doing something for a long period of time, then this might be the exercise for you! Now, before you get worried because youve heard that high intensity interval training just doesnt work for people with PCOS because it spikes their cortisol and worsens PCOS symptoms, let me establish a couple things.

This may be true for some women with PCOS, but not all, as shown in this one study, where HIIT was actually very effective in decreasing BMI (body mass index). PCOS is a very complicated metabolic syndrome which will look different in everyone who has it. Just because one person with PCOS had a bad reaction to it, doesnt necessarily mean you will too.

That being said, doing HIIT is a great way to ensure youre improving your cardio fitness by staying at or above 85% of your maximal heart rate for most of the workout without needing to put much thought into it. As long as you’re giving it your all for that interval, you should be fine. 

However, HIIT is very hard to get right on your own, especially if you have no experience. On the flip side, it can be very accessible and not much different than regular cardio. For your workout to be classified as HIIT, it just needs to have intervals of 85% effort or more, and then rest. Ideally, youd measure your heart rate, to gauge your 85%, but even without a measurement, if you subjectively evaluate what feels like 85% of your max effort, that will be better than nothing.

For example, you can do HIIT on a treadmill, or even an elliptical. Rather than just using them at one continuous speed or resistance, you can augment your workout so that you are running as fast as you can for 30-120 seconds, then slowly walking and resting for 1-4 minutes. Then, you repeat that cycle from 3-12 times. Ill talk about how much women with PCOS should exercise a little later. 

Just remember, during your rest intervals, youre not resting completely, but still moving. If you choose running as your activity, then your rest will be a light to moderate walk. Not completely sitting down or lying down.

And that wraps it up for exercises! Now that you know about strength training, cardio, and HIIT, we can begin to discuss:

How Much Should Those With PCOS Exercise?

Whether you want to exercise for your health, weight management/weight loss, there are certain differences between how much you should exercise, especially depending on the kind of exercise intervention.

For strength training, the greatest benefits are seen when it is done 3 times a week. Now, if you wanna shoot for 4 days a week or even 5, then go for it – just understand that from a blood sugar and insulin levels management perspective, theres not much benefit to going beyond 3, as seen in this study. From a strength/muscle mass perspective, there is. 

Just make sure you dont burn yourself out, especially if youre just starting out. 

You can experiment with 2 days a week, then move up to 3, and perhaps even up to 4 if youre feeling daring. Just make sure you have at least 1-2 rest days a week, where you properly rest and give your muscles, and yourself a break.

As a general rule of thumb, you dont want to actively do a strength training routine more than 2-3 days in a row. This way, you can actually let your muscles recover so that you can exercise at a high enough intensity next time youre back in the gym. 

This also helps with stress management in PCOS, as high levels of cortisol can sometimes exacerbate your symptoms. If youre diligent with your rest days, then you will see great improvements in that field. Plus, youre less likely to burn out and stop doing your workout. 

In terms of reps, try to stick within the 10-15 rep range. If you find yourself not being able to do 10, then try lowering the weight. If you find yourself being able to do more than 15, then it’s time to lift heavier! 

In terms of cardio, the rules are a little more complicated. The frequency directly relates to how intense your workout is. With moderate cardio (think 65-70% of your maximal heart rate), you should be aiming for about 4-5 times per week. With high intensity cardio, you can stick to 3 times per week (if doing 20 minutes/workout), or twice per week (if doing 30 minutes/workout) and see good results. 

But in terms of how long each session should be, that really depends on you and how much you enjoy your activity. With moderate intensity, you can get away with doing 30-60 minutes of it. With high intensity, you should aim for 20-40 minutes. Of course more is better, but it’s not better if youre doing an hour of very low effort jogging on the treadmill. If you can keep your heart rate consistently up for half an hour, then that is better than having it teeter between just above the threshold, and slightly below it for a whole hour. The key here is the intensity. 

For HIIT, you can try structuring your intervals in blocks of 8-14, with exercise intervals ranging from 30 seconds to 2 minutes, and rest intervals from 1 minute to 4 minutes. Whatever works with you is fine by me! You can get benefits from as little as 12 minutes of pure HIIT so as long as youre reaching that minimum with the correct intensity, then youre good! 

Now that weve covered how long we should do these exercises for, is it then safe to say that:

Is All Exercise is Good Exercise?

To this, I would say it depends.

If youve never exercised in your entire life, and you live a sedentary lifestyle then yes, at this point any exercise you can get is good for you. However, in the practical sense, I would lean more towards not really.

The most important factor in an exercise program is actually intensity – not the exercises themselves. 

With that in mind, of course any exercise that you do at the right intensity is good exercise. However, if youre just lazily lifting some weights without proper form for half an hour, thats not going to be a good workout. The exercises themselves are actually one of the least important variables. This is because, like I said previously, your heart cant distinguish whether its beating so fast because youre swimming, or because youre dancing. 

Plus, anything below 65% of your HRmax wont improve your cardiovascular fitness, if that’s what youre looking to do. 

If youre just looking to get up for an hour everyday and move around, regardless of whether you get any improvements in your fitness, then yes, all exercise is good exercise. However, if you want to actually see improvements in your symptoms, glucose metabolism, and your fitness, then you need to focus on the intensity at which you do your workouts, as well as a couple other factors. 

So in conclusion, all exercise is good exercise, but the devil is in the details. 

And with that, weve covered all our bases for exercising with PCOS!

As long as you remember to:

• Do what you enjoy
• Combine cardio and strength training
• Be consistent
• And keep at it

You will have no problem getting your PCOS symptoms, as well as your health under control!