The Effects of High-intensity and Moderate-intensity Exercise on Polycystic Ovary Syndrome

Study Overview
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Brief Summary
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This study will investigate the impact of high- and moderate-intensity exercise on the cardiometabolic and brain health of women with Polycystic Ovary syndrome (PCOS). The aim is to measure and compare normal, healthy women without PCOS, to those with the condition. All participants will undergo a blood test. The investigators will then assess the participants cardiovascular fitness by means of a maximal exercise test and measure body composition through height, weight, and hip-to-waist ratio. Participants will undergo an MRI, where the investigators will assess the participants brain structure and how the brain responds to a number of tests. The investigators will also conduct some tests that will assess the participants cognition, such as IQ, memory etc. The investigators will measure the blood vessels leading to the brain and the blood flow through them to measure how much blood the brain receives when rested, using ultrasound. The investigators will use a number of tests to look at brain function, measure the responses to these tests, and compare them between the normal, healthy women and those with PCOS. This will show if women with PCOS have a similar brain function when rested and when their brains are tested to those without the condition. The investigators will use exercise as an intervention, where the aim will be to investigate whether women with PCOS respond similarly to those without the condition to both high-intensity and moderate-intensity exercise. The tests of brain function will be repeated following the exercise, and see if both normal, healthy women and those with PCOS have a similar response to the brain function tests. All tests and measures will be compared between the PCOS group, and the healthy control group to establish any potential differences or similarities as a result of the condition.

Official Title
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The Effects of High- and Moderate-Intensity Exercise on the Cerebrovascular and Cardiometabolic Health of Women With Polycystic Ovary Syndrome

Conditions
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Polycystic Ovary Syndrome, Exercise, Cerebrovascular Circulation

Intervention / Treatment
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* Other: High-Intensity Exercise
* Other: Moderate-Intensity Exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Polycystic Ovary Syndrome as diagnosed by any recognised criteria. Inactive (less than 40 mins of structured exercise per week). Exclusion Criteria: Pregnant or breastfeeding. Congenital adrenal hyperplasia, Cushing's syndrome, thyroid disease, hyperprolactinaemia and androgen secreting tumours. Known history of cardiovascular disease. Contraindications to MRI (fitted with ferromagnetic devices).

Ages Eligible for Study
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Minimum Age: 16 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Participants will complete multiple baseline assessments. Within the crossover model, participants will complete a baseline cerebrovascular assessment, followed by a random bout of acute exercise and then a post-exercise repeat of the baseline tests. Following a pre-designated washout, the participants will complete the same visit with the remaining exercise bout.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Polycystic Ovary Syndrome<br>Women with PCOS | Other: High-Intensity Exercise<br>* Acute, low-volume HIIT 12x (1min:1min) Working intensity: >85% heart rate reserve Resting intensity: Active rest<br>Other: Moderate-Intensity Exercise<br>* Continuous, MISS 50mins Working intensity: 50-60% heart rate reserve<br>|
| Active Comparator: Controls<br>Healthy, age and BMI matched controls | Other: High-Intensity Exercise<br>* Acute, low-volume HIIT 12x (1min:1min) Working intensity: >85% heart rate reserve Resting intensity: Active rest<br>Other: Moderate-Intensity Exercise<br>* Continuous, MISS 50mins Working intensity: 50-60% heart rate reserve<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cerebrovascular Reactivity to Carbon Dioxide (CO2) | 6% CO2 administered to measure reactivity of the cerebrovasculature as measured by extra-cranial ultrasonography. | Baseline | 
| Cerebrovascular Reactivity to Carbon Dioxide (CO2) | 6% CO2 administered to measure reactivity of the cerebrovasculature as measured by extra-cranial ultrasonography. | Less than 1 hour post-exercise | 
| Neurovascular coupling (NVC) | NVC will be assessed using a visual task (flashing checkerboard) measured via transcranial Doppler. | Baseline | 
| Neurovascular coupling (NVC) | NVC will be assessed using a visual task (flashing checkerboard) measured via transcranial Doppler. | Less than 1 hour post-exercise | 
| Dynamic cerebral autoregulation (dCA) | dCA will be assessed using a squat-stand method to induce forced oscillations in blood pressure and measured using finger plethysmography and transcranial Doppler. | Baseline | 
| Dynamic cerebral autoregulation (dCA) | dCA will be assessed using a squat-stand method to induce forced oscillations in blood pressure and measured using finger plethysmography and transcranial Doppler. | Less than 1 hour post-exercise | 
| Cerebral blood velocity in the middle (MCAv) and posterior cerebral arteries (PCAv) during exercise | MCAv and PCAv will be assessed using transcranial Doppler and employed throughout both bouts of acute exercise. | During high-intensity exercise (24 minutes) | 
| Cerebral blood velocity in the middle (MCAv) and posterior cerebral arteries (PCAv) during exercise | MCAv and PCAv will be assessed using transcranial Doppler and employed throughout both bouts of acute exercise. | During moderate-intensity exercise (50 minutes) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cardiorespiratory fitness (CRF) | CRF will be assessed via peak oxygen uptake using a step protocol on a cycle ergometer. to achieve VO2peak. | Baseline | 
| Cerebral structure | MRI will be employed to assess grey and white matter structure. | Baseline | 
| Cerebral blood flow | Functional MRI will be employed to assess global and regional cerebral blood flow. | Baseline | 
| Cerebral metabolic rate of oxygen consumption | Functional MRI will be employed to assess cerebral metabolic rate of oxygen consumption. | Baseline | 
| Cerebrovascular reactivity | Functional MRI will be employed to assess cerebrovascular reactivity during a breath hold challenge. | Baseline | 
| Cognitive testing | A comprehensive cognitive battery will be employed to test across multiple cognitive sub-domains (IQ, working memory, episodic memory, attention and executive function). | Baseline | 
| Blood pressure during exercise | Finger plethysmography will be used to non-invasively monitor systolic and diastolic blood pressure throughout both acute bouts of exercise. | During High-intensity interval exercise (HIIT) (24 minutes) and Moderate-intensity steady state (MISS) (50 minutes) exercise | 
| Hormone profile | Hormonal profile will be measured through blood sampling, including androstenedione, sex hormone binding globulin and testosterone. From these values, free androgen index (FAI) will be calculated. | Baseline | 
| Metabolic profile | Metabolic profile will be measured through blood sampling, including fasting glucose and fasting insulin. From these values, the homeostatic model assessment of insulin resistance (HOMA-IR) will be calculated. | Baseline | 
| Lipid profile | Lipid profile will be measured through blood sampling, including total cholesterol, high-density lipoproteins, low-density lipoproteins and triglycerides. | Baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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PCOS, Polycystic Ovary Syndrome, Exercise, High-Intensity Interval Training, Moderate-Intensity Steady State, Cerebrovascular