Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis
The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic-pituitary-ovarian axis. Consequently, finding the most appropriate strategies to lose...
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| Veröffentlicht in: | Human reproduction update 2024-07, Vol.30 (4), p.472-487 |
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| creator | Ruiz-González, David Cavero-Redondo, Iván Hernández-Martínez, Alba Baena-Raya, Andrés Martínez-Forte, Sonia Altmäe, Signe Fernández-Alonso, Ana M Soriano-Maldonado, Alberto |
| description | The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic-pituitary-ovarian axis. Consequently, finding the most appropriate strategies to lose weight and improve ovulation in women with overweight or obesity is a clinically relevant matter that needs to be investigated. A comprehensive comparison of the independent and combined efficacy of lifestyle and/or pharmacological interventions on BMI, ovulation, and hormonal profile in women with overweight or obesity at risk of anovulatory infertility would facilitate improving fertility strategies in this population.
This study aimed to evaluate the comparative efficacy of exercise, diet, and pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity.
A systematic review was performed by searching PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library up to 14 December 2023, for randomized controlled trials assessing the effects of exercise, diet and/or pharmacological interventions (i.e. weight-lowering drugs or ovulation inducers) on BMI, ovulation, and/or hormonal profile in reproductive-aged women with overweight or obesity. We performed frequentist random-effect network meta-analyses and rated the certainty of the evidence. The primary outcomes were BMI and ovulation rate, and the secondary outcomes were serum reproductive hormone levels (gonadotrophins, androgens, or oestrogens). We performed sensitivity analyses, including the studies that only involved women with PCOS.
Among 1190 records screened, 148 full texts were assessed for eligibility resulting in 95 trials (9910 women), of which 53% presented a high or unclear risk of bias. The network meta-analyses revealed that, compared to control: diet combined with weight-lowering drugs (mean difference (MD) -2.61 kg/m2; 95% CI -3.04 to -2.19; τ2 = 0.22) and adding exercise (MD -2.35 kg/m2; 95% CI -2.81 to -1.89; τ2 = 0.22) led to the greatest decrease in BMI; exercise combined with diet and ovulation inducers (risk ratio (RR) 7.15; 95% CI 1.94-26.40; τ2 = 0.07) and exercise combined with diet and weight-lowering drugs (RR 4.80; 95% CI 1.67-13.84; τ2 = 0.07) produced the highest increase in ovulation rate; and exercise combined with diet and weight-lowering drugs was the most effective strategy in reducing testosterone levels (stand |
| doi_str_mv | 10.1093/humupd/dmae008 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_857693</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3040320961</sourcerecordid><originalsourceid>FETCH-LOGICAL-c409t-1fc16acbfc6157905f8272f9797732a5b410033839d63cdb840ce8767feb61ed3</originalsourceid><addsrcrecordid>eNp1ks1u1DAUhSMEoqWwZYm8ZDHp2HESJ2wQjPipVMQG1pbjXE9M4zjYzoS8KY-D05kWumBl-_p851jXN0leEnxJcE233WSmsd22RgDG1aPknOQlTjNa1o_jnhZFmrOqPEueef8DY1KSij1NzmhVZiyj9Dz5vbNmFE4EfQAESmkp5IKsQvALnNQeNqjVEJAY2q11aOyEM0La3u6jskd6COAOMARtB4_sgN5_udoge5h6sZY2K4c664wdonp0VukeIoUcxEM7yTU3FXto0WwNDGjWoYs8uBn0vgsoZtoGvA7LGySQX3wAE61lNDhomG_9BwizdTfIQBCpiEGL1_558kSJ3sOL03qRfP_44dvuc3r99dPV7t11KnNch5QoSUohGyVLUrAaF6qKnVE1qxmjmSianGBMaUXrtqSybaocS6hYyRQ0JYGWXiTp0dfPME4NH502wi3cCs1PpZu4A14VrKxp1Nf_1a8t-QvdgaQoCkIZWdm3RzYKDLQy9t2J_qHFg5tBd3xvD5yQjBTx86PD65ODsz8n8IEb7SX0vRjATp5TnGOa4fpWenmUSme9d6Ducwjm6-zx4-zx0-xF4NW_r7uX3w0b_QPHMOCp</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3040320961</pqid></control><display><type>article</type><title>Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis</title><source>MEDLINE</source><source>SWEPUB Freely available online</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Ruiz-González, David ; Cavero-Redondo, Iván ; Hernández-Martínez, Alba ; Baena-Raya, Andrés ; Martínez-Forte, Sonia ; Altmäe, Signe ; Fernández-Alonso, Ana M ; Soriano-Maldonado, Alberto</creator><creatorcontrib>Ruiz-González, David ; Cavero-Redondo, Iván ; Hernández-Martínez, Alba ; Baena-Raya, Andrés ; Martínez-Forte, Sonia ; Altmäe, Signe ; Fernández-Alonso, Ana M ; Soriano-Maldonado, Alberto</creatorcontrib><description>The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic-pituitary-ovarian axis. Consequently, finding the most appropriate strategies to lose weight and improve ovulation in women with overweight or obesity is a clinically relevant matter that needs to be investigated. A comprehensive comparison of the independent and combined efficacy of lifestyle and/or pharmacological interventions on BMI, ovulation, and hormonal profile in women with overweight or obesity at risk of anovulatory infertility would facilitate improving fertility strategies in this population.
This study aimed to evaluate the comparative efficacy of exercise, diet, and pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity.
A systematic review was performed by searching PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library up to 14 December 2023, for randomized controlled trials assessing the effects of exercise, diet and/or pharmacological interventions (i.e. weight-lowering drugs or ovulation inducers) on BMI, ovulation, and/or hormonal profile in reproductive-aged women with overweight or obesity. We performed frequentist random-effect network meta-analyses and rated the certainty of the evidence. The primary outcomes were BMI and ovulation rate, and the secondary outcomes were serum reproductive hormone levels (gonadotrophins, androgens, or oestrogens). We performed sensitivity analyses, including the studies that only involved women with PCOS.
Among 1190 records screened, 148 full texts were assessed for eligibility resulting in 95 trials (9910 women), of which 53% presented a high or unclear risk of bias. The network meta-analyses revealed that, compared to control: diet combined with weight-lowering drugs (mean difference (MD) -2.61 kg/m2; 95% CI -3.04 to -2.19; τ2 = 0.22) and adding exercise (MD -2.35 kg/m2; 95% CI -2.81 to -1.89; τ2 = 0.22) led to the greatest decrease in BMI; exercise combined with diet and ovulation inducers (risk ratio (RR) 7.15; 95% CI 1.94-26.40; τ2 = 0.07) and exercise combined with diet and weight-lowering drugs (RR 4.80; 95% CI 1.67-13.84; τ2 = 0.07) produced the highest increase in ovulation rate; and exercise combined with diet and weight-lowering drugs was the most effective strategy in reducing testosterone levels (standardized mean difference (SMD) -2.91; 95% CI -4.07 to -1.74; τ2 = 2.25), the third most effective strategy in increasing sex hormone-binding globulin levels (SMD 2.37; 95% CI 0.99-3.76; τ2 = 2.48), and it was coupled with being ranked first in terms of free androgen index reduction (SMD -1.59; 95% CI -3.18 to 0.01; τ2 = 1.91). The surface under the cumulative ranking curve scores suggested that: diet combined with weight-lowering drugs is the strategy most likely (94%) to produce the highest BMI reduction; and exercise combined with diet and ovulation inducers is the strategy most likely (89%) to produce the highest ovulation rate improvement. The sensitivity analyses, which exclusively included studies involving women diagnosed with PCOS, were consistent with the results presented above.
Overall, the findings of this network meta-analysis indicate that the combination of exercise, diet, and pharmacological interventions is effective for weight loss, improving ovulation, and normalizing the androgen levels of women with overweight or obesity. Although higher quality studies are needed, these results support that the optimal treatment strategy for women with overweight or obesity wishing to conceive must consider exercise, diet, and pharmacological interventions during the shared decision-making process.</description><identifier>ISSN: 1355-4786</identifier><identifier>ISSN: 1460-2369</identifier><identifier>EISSN: 1460-2369</identifier><identifier>DOI: 10.1093/humupd/dmae008</identifier><identifier>PMID: 38627233</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Adult ; Body Mass Index ; Diet ; Exercise ; Female ; Humans ; Medicin och hälsovetenskap ; Network Meta-Analysis ; Obesity - blood ; Obesity - complications ; Obesity - diet therapy ; Obesity - therapy ; Overweight - blood ; Overweight - complications ; Overweight - diet therapy ; Overweight - therapy ; Ovulation - drug effects ; Review</subject><ispartof>Human reproduction update, 2024-07, Vol.30 (4), p.472-487</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c409t-1fc16acbfc6157905f8272f9797732a5b410033839d63cdb840ce8767feb61ed3</citedby><cites>FETCH-LOGICAL-c409t-1fc16acbfc6157905f8272f9797732a5b410033839d63cdb840ce8767feb61ed3</cites><orcidid>0000-0002-9297-1028 ; 0000-0002-0708-1865 ; 0000-0002-4626-420X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,552,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38627233$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:155513713$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Ruiz-González, David</creatorcontrib><creatorcontrib>Cavero-Redondo, Iván</creatorcontrib><creatorcontrib>Hernández-Martínez, Alba</creatorcontrib><creatorcontrib>Baena-Raya, Andrés</creatorcontrib><creatorcontrib>Martínez-Forte, Sonia</creatorcontrib><creatorcontrib>Altmäe, Signe</creatorcontrib><creatorcontrib>Fernández-Alonso, Ana M</creatorcontrib><creatorcontrib>Soriano-Maldonado, Alberto</creatorcontrib><title>Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis</title><title>Human reproduction update</title><addtitle>Hum Reprod Update</addtitle><description>The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic-pituitary-ovarian axis. Consequently, finding the most appropriate strategies to lose weight and improve ovulation in women with overweight or obesity is a clinically relevant matter that needs to be investigated. A comprehensive comparison of the independent and combined efficacy of lifestyle and/or pharmacological interventions on BMI, ovulation, and hormonal profile in women with overweight or obesity at risk of anovulatory infertility would facilitate improving fertility strategies in this population.
This study aimed to evaluate the comparative efficacy of exercise, diet, and pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity.
A systematic review was performed by searching PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library up to 14 December 2023, for randomized controlled trials assessing the effects of exercise, diet and/or pharmacological interventions (i.e. weight-lowering drugs or ovulation inducers) on BMI, ovulation, and/or hormonal profile in reproductive-aged women with overweight or obesity. We performed frequentist random-effect network meta-analyses and rated the certainty of the evidence. The primary outcomes were BMI and ovulation rate, and the secondary outcomes were serum reproductive hormone levels (gonadotrophins, androgens, or oestrogens). We performed sensitivity analyses, including the studies that only involved women with PCOS.
Among 1190 records screened, 148 full texts were assessed for eligibility resulting in 95 trials (9910 women), of which 53% presented a high or unclear risk of bias. The network meta-analyses revealed that, compared to control: diet combined with weight-lowering drugs (mean difference (MD) -2.61 kg/m2; 95% CI -3.04 to -2.19; τ2 = 0.22) and adding exercise (MD -2.35 kg/m2; 95% CI -2.81 to -1.89; τ2 = 0.22) led to the greatest decrease in BMI; exercise combined with diet and ovulation inducers (risk ratio (RR) 7.15; 95% CI 1.94-26.40; τ2 = 0.07) and exercise combined with diet and weight-lowering drugs (RR 4.80; 95% CI 1.67-13.84; τ2 = 0.07) produced the highest increase in ovulation rate; and exercise combined with diet and weight-lowering drugs was the most effective strategy in reducing testosterone levels (standardized mean difference (SMD) -2.91; 95% CI -4.07 to -1.74; τ2 = 2.25), the third most effective strategy in increasing sex hormone-binding globulin levels (SMD 2.37; 95% CI 0.99-3.76; τ2 = 2.48), and it was coupled with being ranked first in terms of free androgen index reduction (SMD -1.59; 95% CI -3.18 to 0.01; τ2 = 1.91). The surface under the cumulative ranking curve scores suggested that: diet combined with weight-lowering drugs is the strategy most likely (94%) to produce the highest BMI reduction; and exercise combined with diet and ovulation inducers is the strategy most likely (89%) to produce the highest ovulation rate improvement. The sensitivity analyses, which exclusively included studies involving women diagnosed with PCOS, were consistent with the results presented above.
Overall, the findings of this network meta-analysis indicate that the combination of exercise, diet, and pharmacological interventions is effective for weight loss, improving ovulation, and normalizing the androgen levels of women with overweight or obesity. Although higher quality studies are needed, these results support that the optimal treatment strategy for women with overweight or obesity wishing to conceive must consider exercise, diet, and pharmacological interventions during the shared decision-making process.</description><subject>Adult</subject><subject>Body Mass Index</subject><subject>Diet</subject><subject>Exercise</subject><subject>Female</subject><subject>Humans</subject><subject>Medicin och hälsovetenskap</subject><subject>Network Meta-Analysis</subject><subject>Obesity - blood</subject><subject>Obesity - complications</subject><subject>Obesity - diet therapy</subject><subject>Obesity - therapy</subject><subject>Overweight - blood</subject><subject>Overweight - complications</subject><subject>Overweight - diet therapy</subject><subject>Overweight - therapy</subject><subject>Ovulation - drug effects</subject><subject>Review</subject><issn>1355-4786</issn><issn>1460-2369</issn><issn>1460-2369</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNp1ks1u1DAUhSMEoqWwZYm8ZDHp2HESJ2wQjPipVMQG1pbjXE9M4zjYzoS8KY-D05kWumBl-_p851jXN0leEnxJcE233WSmsd22RgDG1aPknOQlTjNa1o_jnhZFmrOqPEueef8DY1KSij1NzmhVZiyj9Dz5vbNmFE4EfQAESmkp5IKsQvALnNQeNqjVEJAY2q11aOyEM0La3u6jskd6COAOMARtB4_sgN5_udoge5h6sZY2K4c664wdonp0VukeIoUcxEM7yTU3FXto0WwNDGjWoYs8uBn0vgsoZtoGvA7LGySQX3wAE61lNDhomG_9BwizdTfIQBCpiEGL1_558kSJ3sOL03qRfP_44dvuc3r99dPV7t11KnNch5QoSUohGyVLUrAaF6qKnVE1qxmjmSianGBMaUXrtqSybaocS6hYyRQ0JYGWXiTp0dfPME4NH502wi3cCs1PpZu4A14VrKxp1Nf_1a8t-QvdgaQoCkIZWdm3RzYKDLQy9t2J_qHFg5tBd3xvD5yQjBTx86PD65ODsz8n8IEb7SX0vRjATp5TnGOa4fpWenmUSme9d6Ducwjm6-zx4-zx0-xF4NW_r7uX3w0b_QPHMOCp</recordid><startdate>20240701</startdate><enddate>20240701</enddate><creator>Ruiz-González, David</creator><creator>Cavero-Redondo, Iván</creator><creator>Hernández-Martínez, Alba</creator><creator>Baena-Raya, Andrés</creator><creator>Martínez-Forte, Sonia</creator><creator>Altmäe, Signe</creator><creator>Fernández-Alonso, Ana M</creator><creator>Soriano-Maldonado, Alberto</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-9297-1028</orcidid><orcidid>https://orcid.org/0000-0002-0708-1865</orcidid><orcidid>https://orcid.org/0000-0002-4626-420X</orcidid></search><sort><creationdate>20240701</creationdate><title>Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis</title><author>Ruiz-González, David ; Cavero-Redondo, Iván ; Hernández-Martínez, Alba ; Baena-Raya, Andrés ; Martínez-Forte, Sonia ; Altmäe, Signe ; Fernández-Alonso, Ana M ; Soriano-Maldonado, Alberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-1fc16acbfc6157905f8272f9797732a5b410033839d63cdb840ce8767feb61ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Body Mass Index</topic><topic>Diet</topic><topic>Exercise</topic><topic>Female</topic><topic>Humans</topic><topic>Medicin och hälsovetenskap</topic><topic>Network Meta-Analysis</topic><topic>Obesity - blood</topic><topic>Obesity - complications</topic><topic>Obesity - diet therapy</topic><topic>Obesity - therapy</topic><topic>Overweight - blood</topic><topic>Overweight - complications</topic><topic>Overweight - diet therapy</topic><topic>Overweight - therapy</topic><topic>Ovulation - drug effects</topic><topic>Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ruiz-González, David</creatorcontrib><creatorcontrib>Cavero-Redondo, Iván</creatorcontrib><creatorcontrib>Hernández-Martínez, Alba</creatorcontrib><creatorcontrib>Baena-Raya, Andrés</creatorcontrib><creatorcontrib>Martínez-Forte, Sonia</creatorcontrib><creatorcontrib>Altmäe, Signe</creatorcontrib><creatorcontrib>Fernández-Alonso, Ana M</creatorcontrib><creatorcontrib>Soriano-Maldonado, Alberto</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Human reproduction update</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ruiz-González, David</au><au>Cavero-Redondo, Iván</au><au>Hernández-Martínez, Alba</au><au>Baena-Raya, Andrés</au><au>Martínez-Forte, Sonia</au><au>Altmäe, Signe</au><au>Fernández-Alonso, Ana M</au><au>Soriano-Maldonado, Alberto</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis</atitle><jtitle>Human reproduction update</jtitle><addtitle>Hum Reprod Update</addtitle><date>2024-07-01</date><risdate>2024</risdate><volume>30</volume><issue>4</issue><spage>472</spage><epage>487</epage><pages>472-487</pages><issn>1355-4786</issn><issn>1460-2369</issn><eissn>1460-2369</eissn><abstract>The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic-pituitary-ovarian axis. Consequently, finding the most appropriate strategies to lose weight and improve ovulation in women with overweight or obesity is a clinically relevant matter that needs to be investigated. A comprehensive comparison of the independent and combined efficacy of lifestyle and/or pharmacological interventions on BMI, ovulation, and hormonal profile in women with overweight or obesity at risk of anovulatory infertility would facilitate improving fertility strategies in this population.
This study aimed to evaluate the comparative efficacy of exercise, diet, and pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity.
A systematic review was performed by searching PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library up to 14 December 2023, for randomized controlled trials assessing the effects of exercise, diet and/or pharmacological interventions (i.e. weight-lowering drugs or ovulation inducers) on BMI, ovulation, and/or hormonal profile in reproductive-aged women with overweight or obesity. We performed frequentist random-effect network meta-analyses and rated the certainty of the evidence. The primary outcomes were BMI and ovulation rate, and the secondary outcomes were serum reproductive hormone levels (gonadotrophins, androgens, or oestrogens). We performed sensitivity analyses, including the studies that only involved women with PCOS.
Among 1190 records screened, 148 full texts were assessed for eligibility resulting in 95 trials (9910 women), of which 53% presented a high or unclear risk of bias. The network meta-analyses revealed that, compared to control: diet combined with weight-lowering drugs (mean difference (MD) -2.61 kg/m2; 95% CI -3.04 to -2.19; τ2 = 0.22) and adding exercise (MD -2.35 kg/m2; 95% CI -2.81 to -1.89; τ2 = 0.22) led to the greatest decrease in BMI; exercise combined with diet and ovulation inducers (risk ratio (RR) 7.15; 95% CI 1.94-26.40; τ2 = 0.07) and exercise combined with diet and weight-lowering drugs (RR 4.80; 95% CI 1.67-13.84; τ2 = 0.07) produced the highest increase in ovulation rate; and exercise combined with diet and weight-lowering drugs was the most effective strategy in reducing testosterone levels (standardized mean difference (SMD) -2.91; 95% CI -4.07 to -1.74; τ2 = 2.25), the third most effective strategy in increasing sex hormone-binding globulin levels (SMD 2.37; 95% CI 0.99-3.76; τ2 = 2.48), and it was coupled with being ranked first in terms of free androgen index reduction (SMD -1.59; 95% CI -3.18 to 0.01; τ2 = 1.91). The surface under the cumulative ranking curve scores suggested that: diet combined with weight-lowering drugs is the strategy most likely (94%) to produce the highest BMI reduction; and exercise combined with diet and ovulation inducers is the strategy most likely (89%) to produce the highest ovulation rate improvement. The sensitivity analyses, which exclusively included studies involving women diagnosed with PCOS, were consistent with the results presented above.
Overall, the findings of this network meta-analysis indicate that the combination of exercise, diet, and pharmacological interventions is effective for weight loss, improving ovulation, and normalizing the androgen levels of women with overweight or obesity. Although higher quality studies are needed, these results support that the optimal treatment strategy for women with overweight or obesity wishing to conceive must consider exercise, diet, and pharmacological interventions during the shared decision-making process.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>38627233</pmid><doi>10.1093/humupd/dmae008</doi><tpages>16</tpages><orcidid>https://orcid.org/0000-0002-9297-1028</orcidid><orcidid>https://orcid.org/0000-0002-0708-1865</orcidid><orcidid>https://orcid.org/0000-0002-4626-420X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1355-4786 |
| ispartof | Human reproduction update, 2024-07, Vol.30 (4), p.472-487 |
| issn | 1355-4786 1460-2369 1460-2369 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_857693 |
| source | MEDLINE; SWEPUB Freely available online; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Adult Body Mass Index Diet Exercise Female Humans Medicin och hälsovetenskap Network Meta-Analysis Obesity - blood Obesity - complications Obesity - diet therapy Obesity - therapy Overweight - blood Overweight - complications Overweight - diet therapy Overweight - therapy Ovulation - drug effects Review |
| title | Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-05T21%3A43%3A44IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Comparative%20efficacy%20of%20exercise,%20diet%20and/or%20pharmacological%20interventions%20on%20BMI,%20ovulation,%20and%20hormonal%20profile%20in%20reproductive-aged%20women%20with%20overweight%20or%20obesity:%20a%20systematic%20review%20and%20network%20meta-analysis&rft.jtitle=Human%20reproduction%20update&rft.au=Ruiz-Gonz%C3%A1lez,%20David&rft.date=2024-07-01&rft.volume=30&rft.issue=4&rft.spage=472&rft.epage=487&rft.pages=472-487&rft.issn=1355-4786&rft.eissn=1460-2369&rft_id=info:doi/10.1093/humupd/dmae008&rft_dat=%3Cproquest_swepu%3E3040320961%3C/proquest_swepu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3040320961&rft_id=info:pmid/38627233&rfr_iscdi=true |