{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:01:23Z","timestamp":1787702483707,"version":"build-2784847793"},"reference-count":99,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Women with polycystic ovary syndrome (PCOS) exhibit cardiovascular autonomic imbalance, an important predictor of mortality. Physical exercise is an intervention known to enhance cardiovascular autonomic modulation in various populations. However, it remains unclear whether these benefits extend to women with PCOS, given that specific pathophysiological characteristics may influence autonomic adaptations. Therefore, this review aimed to synthesize the available evidence to improve understanding of this topic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of CENTRAL, Embase, PubMed, Scopus, and Web of Science was conducted, followed by a snowball search to ensure comprehensive coverage of relevant randomized and non\u2010randomized clinical trials. Random\u2010effects meta\u2010analyses were performed to quantitatively summarize the effects of exercise interventions on autonomic cardiovascular regulation in this population. The certainty of evidence was assessed using the GRADEpro tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five studies were selected, including 316 women with PCOS (214 in the exercise group and 102 in the control group). The meta\u2010analysis indicated that aerobic exercise reduces the percentage of sequences with three consecutive cardiac cycles without significant variations (mean difference [MD\u2009=\u2009\u22126.13; 95% CI\u2009=\u2009\u22128.56 to \u22123.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%; moderate\u2010certainty evidence) and increase the percentage of sequences with three consecutive cardiac cycles with two different variations (MD\u2009=\u20097.16; 95% CI\u2009=\u20094.61 to 9.72;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20098%; moderate\u2010certainty evidence) and the root mean square of successive differences (MD\u2009=\u200912.84; 95% CI\u2009=\u20092.66 to 23.03;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200952%; low\u2010certainty evidence).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The benefits of aerobic exercise on cardiovascular autonomic modulation appear to extend to women with PCOS, increasing vagal modulation and reducing sympathetic modulation. However, further studies are needed to strengthen the evidence and clarify the effects of other exercise modalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.70042","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T10:45:43Z","timestamp":1758797143000},"page":"765-782","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Physical Exercise on Cardiovascular Autonomic Modulation in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6527-2304","authenticated-orcid":false,"given":"Jo\u00e3o Vitor Martins","family":"Bernal","sequence":"first","affiliation":[{"name":"Laboratory of Physiology and Cardiovascular Physiotherapy, Ribeir\u00e3o Preto Medical School University of S\u00e3o Paulo Ribeir\u00e3o Preto 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