Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review
Abstract
:1. Introduction
2. Pathogenesis and Aetiology
3. Obesity and Polycystic Ovary Syndrome
4. Management of Polycystic Ovary Syndrome
5. Lifestyle Management
6. Weight Management
7. Diet Intervention
8. Physical Activity
9. Behavioural Intervention
10. The Role of Healthcare Professionals in Lifestyle Management in Polycystic Ovary Syndrome
11. General Practitioners
12. Allied Health
13. Obstetricians-Gynaecologists
14. Endocrinologists
15. Barriers and Facilitators for Evidence Based Lifestyle Management
16. Knowledge and Practice Gaps
17. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Author | Intervention Type | Control | Number of Included Papers | Total Number of Participants (n) | Population and PCOS Diagnostic Criteria | Key Findings |
---|---|---|---|---|---|---|
Moran et al. [9] | Structured dietary, exercise or behavioural intervention or any combination | Minimal intervention | 6 | n = 164 | PCOS (Rotterdam or NIH) | Anthropometric: ↓ weight, waist, WHR; NC BMI |
Cardiovascular-Respiratory: NA | ||||||
Metabolic: ↓OGTT insulin, FI; NC glucose, cholesterol | ||||||
Reproductive: ↓ TT, hirsutism; NC FAI, SHBG | ||||||
Psychological: NA | ||||||
Domecq et al. [13] | Diet, physical exercise or combination diet and physical exercise | Metformin or minimal intervention | 10 | n = 610 | PCOS (criteria unspecified) | Lifestyle vs. Minimal intervention |
Anthropometric: NA | ||||||
Cardiovascular-Respiratory: NA | ||||||
Metabolic: ↓ FBG, FBI, direct correlation between BMI and FBG, no significant trend between BMI and FBG | ||||||
Reproductive: ↓ FGS | ||||||
Psychological: NA | ||||||
Lifestyle vs. Metformin | ||||||
Anthropometric: NA | ||||||
Cardiovascular-Respiratory: NA | ||||||
Metabolic: NSD FBG, FBI | ||||||
Reproductive: NSD hirsutism score pregnancy rate | ||||||
Psychological: NA | ||||||
Haqq et al. [14] | Physical exercise alone or combination diet and physical exercise | Usual care i.e., No active intervention, metformin, untreated controls, placebo, healthy diet only | 7 | n = 206 | PCOS (criteria unspecified) | Lifestyle Intervention (Combinatorial) |
Anthropometric: NA | ||||||
Cardiovascular-Respiratory: NA | ||||||
Metabolic: NA | ||||||
Reproductive:↑ FSH, SHBG; ↓ TT, androstenedione, FAI, FGS; NSD LH | ||||||
Psychological: NA | ||||||
Exercise Alone | ||||||
Anthropometric: NA | ||||||
Cardiovascular-Respiratory: NA | ||||||
Metabolic: NA | ||||||
Reproductive:↑ FSH, SHBG, free testosterone; ↓ TT, androstenedione, FGS; NSD LH, FAI, E2, LH:FSH | ||||||
Psychological: NA | ||||||
Haqq et al. [15] | Physical exercise alone or combination diet and physical exercise | Usual care Sedentary control, placebo, diet only, or metformin | 12 | n = 668 | PCOS (criteria unspecified) | Lifestyle intervention (Combinatorial) |
Anthropometric: ↓ BMI, BM, WC, WHR, BF% | ||||||
Cardiovascular-Respiratory: ↑ VO2 max | ||||||
Metabolic: ↓ CRP; NSD insulin, glucose, IR, TG, TC, LDL, HDL | ||||||
Reproductive: NA | ||||||
Psychological: NA | ||||||
Exercise alone | ||||||
Anthropometric: ↓ BMI, WC | ||||||
Cardiovascular-Respiratory: ↓ RHR; ↑ VO2 max | ||||||
Metabolic: NA | ||||||
Reproductive: NA | ||||||
Psychological: NA | ||||||
Naderpoor et al. [16] | Lifestyle and metformin or metformin alone | Lifestyle or lifestyle and placebo | 12 | n = 608 | PCOS (Rotterdam) | Lifestyle + Metformin vs. Lifestyle ± Placebo 6/12 |
Anthropometric: ↓ BMI, SAT; NSD WC, WHR, VAT | ||||||
Cardiovascular-Respiratory: NSD SBP, DBP | ||||||
Metabolic: NSD TC, HDL, LDL, TG, markers of IR, FBG | ||||||
Reproductive: ↑ menstrual frequency over 6/12 and 12/12; NC acne, FG score, FAI, SHBG, DHEAS, LH | ||||||
Psychological: NSD QOL | ||||||
Lifestyle±Placebo vs. Metformin | ||||||
Anthropometric: NSD BMI; ↓WC | ||||||
Cardiovascular-Respiratory: NA | ||||||
Metabolic: NSD FBG, insulin AUC, glucose AUC | ||||||
Reproductive: ↑ SHBG, TT; NSD FAI, menstrual cycles 6 to 12/12 | ||||||
Psychological: NA | ||||||
Benham et al. [17] | Aerobic exercise, resistance training, combination of aerobic and resistance training both with and without behavioural and diet interventions | Diet intervention alone or standard care | 14 | n = 617 | PCOS (Rotterdam NIH, NIH Phenotypes, physician diagnosed and unreported) | Meta-analysis |
Anthropometric: ↓WC; NC BMI, BF% | ||||||
Cardiovascular-Respiratory: ↓ SBP; NC VO2 max, DBP | ||||||
Metabolic: ↓ FI, TC, LDL, TGs; ↑ HDL; NC FBG | ||||||
Semi-quantitative Analysis | ||||||
Reproductive: NC/↑ pregnancy ↑ovulation rate/cycles, menstrual frequency/regularity menstrual cycle length | ||||||
Psychological: NA | ||||||
Kite et al. [18] | Exercise or | Control or diet alone | 18 | n = 758 | PCOS (Rotterdam NIH, physician diagnosed) | Exercise vs. Control—Change from Baseline |
Anthropometric: NSD BMI, WHR, ↓WC, FM, FFM, BF% | ||||||
Cardiovascular-Respiratory: NSD SBP, DBP, VO2 max, RHR | ||||||
Exercise and diet | Control or diet alone | Metabolic: NSD FBG; ↓ FI, HOMA-IR, TC, LDL, TG; NC HDL | ||||
Reproductive: NSD TT, SHBG, FT, FAI, FGS, E2, DHEA-S, LH, FSH, LH:FSH ratio, PG, Prolactin, AMH, Adiponectin. | ||||||
Psychological: NA |
Barriers to Lifestyle and Obesity Interventions | Studies with Identified Barrier(s) | Potential Facilitators and Solutions |
---|---|---|
Health System Level | ||
Lack of time | Kushner et al. [88] Campbell et al. [89] Nicholas et al. [87] Jansink et al. [93] Lambe et al. [92] Passey et al. [94] Salinas et al. [91] Epling et al. [90] | |
Lack of reimbursement | Kushner et al. [88] Passey et al. [94] Lambe et al. [92] Salinas et al. [91] Epling et al. [90] Ko et al. [97] |
|
Limited access to and availability of allied health providers and other members of the multidisciplinary care team | Nicholas et al. [87] Passey et al. [94] Epling et al. [90] Teixeira et al. [98] Glauser et al. [99] Kim et al. [95] |
|
Provider location | Kushner et al. [88] Kim et al. [95] |
|
Lack of coordination between healthcare providers | Jansink et al. [93] Kim et al. [95] |
|
Lack of high quality and affordable material for patient education | Jansink et al. [93] Kushner et al. [88] |
|
Health Professional Level | ||
Self-perceived lack of expertise and training | Kushner et al. [88] Nicholas et al. [87] Ampt et al. [96] Jansink et al. [93] Lambe et al. [92] Salinas et al. [91] Glauser et al. [99] |
|
Perception of low patient motivation, responsibility, and/or compliance | Kushner et al. [88] Campbell et al. [90] Nicholas et al. [87] Ampt et al. [96] Lambe et al. [92] Jansink et al. [93] Salinas et al. [91] Epling et al. [90] Glauser et al. [99] Kim et al. [95] Teixeira et al. [98] Ko et al. [97] |
|
Poor patient-provider partnership | Jansink et al. [93] |
|
Reluctance to or fear of offending patient | Jansink et al. [93] Lambe et al. [92] Glauser et al. [99] |
|
Motivation to implement based on provider’s own interests, expectations and experiences | Jansink et al. [93] Kim et al. [95] Teixeira et al. [98] |
|
Limited patient time and priority to regularly attend consultations | Teixeira et al. [98] Ko et al. [97] |
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Blackshaw, L.C.D.; Chhour, I.; Stepto, N.K.; Lim, S.S. Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review. Med. Sci. 2019, 7, 76. https://doi.org/10.3390/medsci7070076
Blackshaw LCD, Chhour I, Stepto NK, Lim SS. Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review. Medical Sciences. 2019; 7(7):76. https://doi.org/10.3390/medsci7070076
Chicago/Turabian StyleBlackshaw, Lucinda C. D., Irene Chhour, Nigel K. Stepto, and Siew S. Lim. 2019. "Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review" Medical Sciences 7, no. 7: 76. https://doi.org/10.3390/medsci7070076
APA StyleBlackshaw, L. C. D., Chhour, I., Stepto, N. K., & Lim, S. S. (2019). Barriers and Facilitators to the Implementation of Evidence-Based Lifestyle Management in Polycystic Ovary Syndrome: A Narrative Review. Medical Sciences, 7(7), 76. https://doi.org/10.3390/medsci7070076