Physical activity, sedentary behavior, and metabolic-reproductive health in women with PMOS (PCOS): a narrative review of mechanisms, clinical evidence, and individualized intervention strategies

Polyendocrine Metabolic Ovarian Syndrome (PMOS) is a common endocrine-metabolic disorder in reproductive-aged women, characterized by clinical heterogeneity and an increased susceptibility to insulin resistance, type 2 diabetes mellitus, dyslipidemia, non-alcoholic fatty liver disease, and cardiometabolic risk. Although PMOS is often recognized through reproductive manifestations such as menstrual irregularity, ovulatory dysfunction, hyperandrogenism, and infertility, metabolic dysfunction is closely linked to reproductive outcomes through effects on androgen excess, ovulatory function, oocyte competence, and the intrauterine metabolic environment. Physical activity, structured exercise, and sedentary behavior are modifiable lifestyle factors that may influence both metabolic and reproductive health in PMOS. This narrative review synthesizes current evidence on the associations among physical activity, sedentary behavior, and metabolic complications in women with PMOS. We summarize interconnected mechanisms involving insulin signaling, adipose tissue dysfunction, chronic low-grade inflammation, oxidative stress, mitochondrial function, and gut microbiota in women with PMOS, while distinguishing evidence from observational studies, clinical intervention trials, and mechanistic or preclinical research. We also review clinical evidence on exercise modalities, including aerobic exercise, resistance training, combined training, and high-intensity interval training, as well as emerging strategies to reduce or interrupt prolonged sedentary time. Available evidence supports physical activity and structured exercise as important components of PMOS management, particularly for improving insulin sensitivity, body composition, cardiometabolic risk markers, and, in some studies, menstrual cyclicity and ovulatory function. However, findings vary according to baseline BMI, hyperandrogenic phenotype, intervention type, intensity, duration, adherence, and co-interventions such as diet or pharmacotherapy. Evidence regarding sedentary behavior remains more limited and is largely observational. Therefore, causal interpretations should be made cautiously. Finally, this review discusses individualized, patient-centered intervention strategies and identifies research gaps, including long-term randomized controlled trials, reproductive and cardiometabolic hard outcomes, combined lifestyle-pharmacological approaches, and precision medicine frameworks for women with PMOS.