Combined effects of aerobic exercise with ketogenic mediterranean and hypocaloric balanced diets on adolescents with polycystic ovarian syndrome

Background and purpose Polycystic ovarian syndrome (PCOS), the most common endocrine disorder in women of reproductive age, is characterized by hyperandrogenism, chronic anovulation, and insulin resistance (IR), with obesity and low-grade inflammation exacerbating its metabolic sequelae. While dietary interventions such as the hypocaloric balanced diet (HBD) are widely recommended, the anti-inflammatory ketogenic Mediterranean diet (KMD) rich in monounsaturated fats, fiber, and phytonutrients has emerged as a potential therapeutic tool. Despite evidence supporting aerobic exercise for improving IR and body composition in PCOS, no studies have directly compared the synergistic effects of KMD versus HBD combined with structured aerobic training in adolescents, a critical population for early metabolic intervention. This study aimed to evaluate whether a 12-week aerobic exercise program paired with KMD outperforms exercise with HBD in ameliorating PCOS phenotypes in obese adolescents. Materials and Methods Forty adolescents with PCOS were randomized into two groups: Group 1 (n=20) underwent aerobic exercise (3 sessions/week; 60%–75% HRmax) with KMD (70% fat, <10% carbohydrates), while Group 2 (n=20) followed identical aerobic training paired with HBD (55% carbohydrates, 30% fat). Body composition (weight, BMI, waist/hip circumference), hormonal markers (FSH/LH ratio, free androgen index), and metabolic parameters (blood pressure, lipid profiles) were assessed at baseline, 6 weeks, and post-intervention. Mixed-model MANOVA evaluated time, treatment, and interaction effects. Results While no significant interaction between treatment and time was observed (p=0.980, η²=0.04), both groups showed significant within-group improvements over time (p=0.001, η²=0.253). A treatment effect favored KMD + exercise for overall outcomes (p=0.030, η²=0.253). Although weight, BMI, waist/hip circumference, androgen levels, and blood pressure did not differ between groups at any time point (p>0.05), Group 1 demonstrated a significantly greater reduction in the follicle-stimulating hormone/luteinizing hormone ratio post-intervention compared to Group 2 (p=0.017), suggesting enhanced hypothalamic-pituitary-ovarian axis regulation. Conclusion Aerobic exercise combined with ketogenic Mediterranean Diet may offer unique benefits for hormonal regulation in adolescents with polycystic ovarian syndrome, as evidenced by the superior normalization of the follicle-stimulating hormone/luteinizing hormone ratio compared to HBD. While both diets paired with exercise improved metabolic and anthropometric parameters over time, ketogenic Mediterranean Diet’s anti-inflammatory properties and metabolic flexibility likely synergize with aerobic training to target polycystic ovarian syndrome specific endocrine dysfunction. These findings advocate for personalized dietary strategies alongside structured exercise in adolescent polycystic ovarian syndrome management.