Pesonen E, Farrahi V, Brakenridge C J, Ollila M M, Morin-Papunen L C, Nurkkala M, Jämsä T, Korpelainen R, Moran L J, Piltonen T T, Niemelä M
Research Unit of Clinical Medicine, Department of Obstetrics and Gynecology, Oulu University Hospital, University of Oulu, Oulu, Finland.
Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland.
Hum Reprod. 2024 Dec 1;39(12):2830-2847. doi: 10.1093/humrep/deae232.
Are 24-h movement composition and time reallocations between the movement behaviours (moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), sedentary behaviour (SB), and sleep) differentially associated with cardiometabolic markers in women with polycystic ovary syndrome (PCOS) relative to women without PCOS?
There was no difference in 24-h movement composition between the groups, although among women without PCOS, reducing SB time while increasing either MVPA or LPA time was associated with beneficial differences in cardiometabolic markers, whereas in women with PCOS beneficial differences were observed only when SB time was replaced with MVPA.
Women with PCOS display lower levels of physical activity, higher sedentary time, and less total sleep than women without the syndrome. Exercise interventions among women with PCOS have shown improvements in body composition and insulin sensitivity, while the findings regarding blood pressure, insulin resistance, and lipid profiles are contradictory.
STUDY DESIGN, SIZE, DURATION: This study was part of a prospective, general population-based Northern Finland Birth Cohort 1966 (NFBC1966) (n = 5889 women). At the 31-year and 46-year follow-up, data collection was performed through postal and clinical examinations, including fasting blood samples and anthropometric measurements. Accelerometer data collection of 14 days (n = 2602 women) and a 2-h oral glucose tolerance test (n = 2780 women) were performed at the 46-year follow-up. Participants were identified as women with or without PCOS at age 31 (n = 1883), and the final study population included those who provided valid accelerometer data at age 46 (n = 857).
PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with PCOS (n = 192) were identified based on the 2023 International Evidence-based Guideline, while those who exhibited no PCOS features were considered women without PCOS (controls; n = 665). Accelerometer-measured MVPA, LPA, and SB were combined with self-reported sleep to obtain 24-h compositions. Multivariable regression analysis based on compositional data analysis and isotemporal reallocations were performed to investigate the associations between 24-h movement composition and cardiometabolic markers. Isotemporal reallocations were expressed as differences (%Δ) from the sample's mean.
There was no difference in overall 24-h movement composition between women with PCOS and controls in midlife. The 24-h movement composition was associated with waist circumference, triglycerides, fasting serum insulin, and Homeostatic Model Assessment-insulin resistance (HOMA-IR) in both controls and women with PCOS. Reallocating 15 min from SB to MVPA was associated with favourable differences in cardiometabolic markers in both controls (%Δ range from -1.7 to -4.9) and women with PCOS (%Δ range from -1.9 to -8.6). Reallocating 15 min from SB to LPA was also associated with favourable differences in cardiometabolic markers among controls (%Δ range from -0.5 to -1.6) but not among women with PCOS.
LIMITATIONS, REASONS FOR CAUTION: The substitution technique used in this study is theoretical, which can be considered as a limitation. Other limitations of this study are the use of self-reported sleeping time and the difference in the group sample sizes.
These findings suggest that women with PCOS should be targeted with interventions involving physical activity of at least moderate intensity to improve their cardiometabolic health and underline the importance of developing tailored activity guidelines for women with PCOS.
STUDY FUNDING/COMPETING INTEREST(S): This study was funded by the Jenny and Antti Wihuri Foundation, Sigrid Juselius Foundation, Novo Nordisk (NNF21OC0070372), Research Council of Finland (315921/2018, 321763/2019, 6GESS 336449), Ministry of Education and Culture of Finland (OKM/54/626/2019, OKM/85/626/2019, OKM/1096/626/2020, OKM/20/626/2022, OKM/76/626/2022, and OKM/68/626/2023), and Roche Diagnostics International Ltd. L.J.M. is supported by a Veski Fellowship. M.Nu. has received funding from Fibrobesity-project, a strategic profiling project at the University of Oulu, which is supported by Research Council of Finland (Profi6 336449). NFBC1966 follow-ups received financial support from University of Oulu (Grant no. 65354, 24000692), Oulu University Hospital (Grant no. 2/97, 8/97, 24301140), Ministry of Health and Social Affairs (Grant no. 23/251/97, 160/97, 190/97), National Institute for Health and Welfare, Helsinki (Grant no. 54121), Regional Institute of Occupational Health, Oulu, Finland (Grant no. 50621, 54231), and ERDF European Regional Development Fund (Grant no. 539/2010 A31592). T.T.P. declares consulting fees from Gedeon Richter, Organon, Astellas, Roche; speaker's fees from Gedeon Richter, Exeltis, Roche, Stragen, Merck, Organon; and travel support from Gedeon Richter. The remaining authors declare no conflicts of interest.
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多囊卵巢综合征（PCOS）女性与非PCOS女性相比，24小时运动构成以及运动行为（中等到剧烈身体活动（MVPA）、轻度身体活动（LPA）、久坐行为（SB）和睡眠）之间的时间重新分配与心血管代谢指标的关联是否存在差异？
两组之间的24小时运动构成没有差异，不过在非PCOS女性中，减少久坐时间同时增加MVPA或LPA时间与心血管代谢指标的有益差异相关，而在PCOS女性中，只有当久坐时间被MVPA取代时才观察到有益差异。
与无该综合征的女性相比，PCOS女性的身体活动水平较低，久坐时间较长，总睡眠时间较少。PCOS女性的运动干预已显示出身体成分和胰岛素敏感性有所改善，而关于血压、胰岛素抵抗和血脂谱的研究结果相互矛盾。
研究设计、规模、持续时间：本研究是基于芬兰北部1966年出生队列（NFBC1966）的前瞻性、基于一般人群的研究的一部分（n = 5889名女性）。在31岁和46岁随访时，通过邮政和临床检查进行数据收集，包括空腹血样和人体测量。在46岁随访时进行了14天的加速度计数据收集（n = 2602名女性）和2小时口服葡萄糖耐量试验（n = 2780名女性）。在31岁时确定参与者为患有或未患有PCOS的女性（n = 1883），最终研究人群包括那些在46岁时提供有效加速度计数据的人（n = 857）。
参与者/材料、设置、方法：根据2023年国际循证指南确定患有PCOS的女性（n = 192），而那些没有PCOS特征的女性被视为非PCOS女性（对照组；n = 665）。将加速度计测量的MVPA、LPA和SB与自我报告的睡眠相结合，以获得24小时构成。基于成分数据分析和等时重新分配进行多变量回归分析，以研究24小时运动构成与心血管代谢指标之间的关联。等时重新分配表示为与样本均值的差异（%Δ）。
中年PCOS女性和对照组之间的总体24小时运动构成没有差异。24小时运动构成与对照组和PCOS女性的腰围、甘油三酯、空腹血清胰岛素和稳态模型评估胰岛素抵抗（HOMA-IR）相关。将15分钟从SB重新分配到MVPA与对照组（%Δ范围为-1.7至-4.9）和PCOS女性（%Δ范围为-1.9至-8.6）的心血管代谢指标的有利差异相关。将15分钟从SB重新分配到LPA也与对照组中心血管代谢指标的有利差异相关（%Δ范围为-0.5至-1.6），但在PCOS女性中不相关。
局限性、谨慎的原因：本研究中使用的替代技术是理论性的，这可被视为一个局限性。本研究的其他局限性包括使用自我报告的睡眠时间和组样本量的差异。
这些发现表明，应该针对PCOS女性进行至少中等强度的身体活动干预，以改善她们的心血管代谢健康，并强调为PCOS女性制定量身定制的活动指南的重要性。
研究资金/利益冲突：本研究由珍妮和安蒂·维胡里基金会、西格丽德·尤塞利乌斯基金会、诺和诺德（NNF21OC0070372）、芬兰研究理事会（315921/2日18、321763/2019、6GESS 336449）、芬兰教育和文化部（OKM/54/626/2019、OKM/85/626/2019、OKM/1096/626/2020、OKM/20/626/2022、OKM/76/626/2022和OKM/68/626/2023）以及罗氏诊断国际有限公司资助。L.J.M.得到了韦斯基奖学金的支持。M.Nu.获得了奥卢大学战略剖析项目Fibrobesity项目的资金，该项目由芬兰研究理事会（Profi6 336449）支持。NFBC1966随访获得了奥卢大学（资助号65354、24000692）、奥卢大学医院（资助号2/97、8/97、24301140）、卫生和社会事务部（资助号23/251/97、160/97、190/97）、赫尔辛基国家卫生和福利研究所（资助号54121）、芬兰奥卢地区职业健康研究所（资助号50621、54231）以及欧洲区域发展基金ERDF（资助号539/2010 A31592）的财政支持。T.T.P.声明从吉迪恩·里奇特、欧加农、安斯泰来、罗氏获得咨询费；从吉迪恩·里奇特、Exeltis、罗氏、Stragen、默克、欧加农获得演讲费；从吉迪恩·里奇特获得差旅支持。其余作者声明无利益冲突。
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