Physical exercise for obesity and T2DM mitigation in polycystic ovary syndrome: the role of adipose tissue

Polycystic ovary syndrome (PCOS) is a complex disorder with a great heterogeneity of signs and symptoms. However, hyperandrogenism is considered a hallmark of PCOS, presented by most affected women. Women with PCOS are at high risk of developing type 2 diabetes mellitus (T2DM), which is associated with insulin resistance (IR) and hyperinsulinemia. In turn, hyperinsulinemia interferes with the androgen production by ovarian cells, and worsens the hyperandrogenism, initiating a feedback cycle. Women with PCOS are also at a greater risk of developing obesity. Indeed, a dysfunctional adipose tissue in obesity contributes to T2DM in PCOS by affecting insulin action and secretion through multiple mechanisms, such as lipotoxicity, inflammation, and adipokine signaling. Therefore, obesity-disrupted adipose tissue can be seen as an important target for T2DM development in women with PCOS. Because adipose tissue can be positively affected by non-pharmacological and easily accessible strategies such as physical exercise, this review provides a comprehensive summary of the benefits of physical exercise to improve adipose tissue health and decrease the risk of obesity and T2DM in women with PCOS.