Context: In overweight women with polycystic ovary syndrome (PCOS) the benefits of the addition of exercise to an energy-restricted diet in further improving cardiometabolic risk factors and reproductive function has not been extensively studied.

Objective: To evaluate the effects of aerobic and aerobic-resistance exercise when combined with an energy-restricted high protein diet (5000–6000 kJ/d) on metabolic risk factors and reproductive function in women with PCOS.

Design and Setting: 20-week outpatient, randomised, parallel study in a metropolitan research clinic.

Patients and Intervention: Ninety-four overweight and obese women with PCOS (age 29.3±0.7 yr; BMI 36.1±0.5 kg/m²) were randomised to: diet only (DO; n=30), diet and aerobic exercise (DA; n=31) or diet and combined aerobic-resistance exercise (DC; n=33).

Main Outcome Measures: Weight, body composition, cardiometabolic risk factors, hormonal status, menstrual cyclicity and ovulatory function were assessed.

Results: All interventions reduced weight (DO 8.9±1.6%, DA 10.6±1.7%, DC 8.7±1.7%; P<0.001) with no difference between treatments (P=0.7, time x treatment). Fat mass decreased more (3 kg) and fat-free mass decreased less (2 kg) in DA and DC compared with DO (P0.03). Reductions in blood pressure (5.6/2.7 mmHg), triglycerides (0.4 mmol/L), total cholesterol (0.5 mmol/L), LDL cholesterol (0.1 mmol/L), glucose (0.2 mmol/L), fasting insulin (4.3 mIU/L), testosterone (0.4 nmol/L), SHBG (7.0 nmol/L) and FAI (2.8) (P<0.001) and improvements in reproductive function occurred in all groups, with no difference between treatments.

Conclusion: In overweight and obese women with PCOS, the addition of aerobic or combined aerobic-resistance exercise to an energy-restricted diet improved body composition but had no additional effect on improvements in cardiometabolic, hormonal and reproductive outcomes relative to diet alone.