The Effects of Different Exercises on Insulin Resistance and Testosterone Changes in Women with Polycystic Ovarian Syndrome: A Network Meta-Analysis Study

Objective: To compare the efficacy of exercise modalities for simultaneously improving homeostasis model assessment for insulin resistance (HOMA-IR) and total testosterone in women with polycystic ovary syndrome (PCOS). Methods: We conducted a Bayesian network meta-analysis of 19 randomized controlled trials (n = 808) to evaluate six exercise interventions: yoga, moderate-intensity continuous training (MICT), high-intensity interval training (HIIT), resistance training (RT), combined aerobic-resistance training (CT), and control (CG). Primary outcomes were changes in HOMA-IR and total testosterone, with interventions ranked via surface under the cumulative ranking curve (SUCRA). Results: For HOMA-IR reduction, yoga (SUCRA = 90.73%; SMD = −0.73, 95% CrI: −1.3 to −0.086) and HIIT (SUCRA = 74.12%; SMD = −0.47, 95% CrI: −0.75 to −0.15) demonstrated superior efficacy versus MICT (SUCRA = 50.56%) and CT (SUCRA = 42.29%), while RT was the least effective (SUCRA = 32.53%). For testosterone lowering, yoga was ranked the highest again (SUCRA = 92.46%; SMD = −0.85, 95% CrI: −1.7 to −0.12), followed by MICT (SUCRA = 75.72%; SMD = −0.56, 95% CrI: −0.97 to −0.25) and HIIT (SUCRA = 61.12%; SMD = −0.42, CrI: −0.88 to −0.12). CT and RT showed non-significant effects for both outcomes (p > 0.05). Conclusions: Yoga is the optimal intervention for dual-pathway improvement in PCOS. HIIT and MICT provide outcome-specific benefits (metabolic vs. endocrine), whereas CT and RT necessitate protocol refinement. Systematic review registration: This systematic review and network meta-analysis study was registered in PROSPERO (CRD420251011979).