Strength Training for PCOS: Why Muscle Matters for Insulin Resistance

Skeletal muscle is one of the main places your body clears glucose after a meal, so strength training is often described as a way to improve insulin resistance in PCOS. The biology supports that idea. The PCOS-specific trials are smaller and less conclusive.

Here is how muscle handles glucose, what we know about strength training in PCOS, what is still uncertain, and how to start.

What we know

Muscle is a major destination for glucose

Skeletal muscle is a major site where your body clears glucose after a meal. Glucose enters muscle cells through a transporter called GLUT4, and insulin helps move it to the cell surface, the “door opening” step from our insulin resistance article.

Here’s the important part. Muscle contraction can move GLUT4 to the surface through a separate pathway that does not depend on insulin. [3,4]

People with more muscle tend to have better insulin sensitivity

In a U.S. survey of more than 13,000 adults, each 10% increase in skeletal muscle relative to body size was linked to an 11% lower HOMA-IR. It was cross-sectional and not in women with PCOS, so it shows an association, not that building muscle improves insulin sensitivity. [5]

Muscle appears to be involved in PCOS insulin resistance

Insulin resistance in PCOS is partly intrinsic, meaning it shows up even in lean women and is not explained by body weight alone. Skeletal muscle appears to be part of the picture, since its energy production (mitochondrial function) is impaired in people with insulin resistance and PCOS. [6,7]

Strength training generally builds strength and lean mass in PCOS

Strength gains are the most dependable result. Muscular strength can improve relatively quickly in people with PCOS who are new to exercise, and a meta-analysis found that resistance exercise improved lean body mass and lowered body fat percentage. [7,8]

One case-control study also observed larger strength gains after four months of resistance training in women with higher androgen levels. That is an observation about how muscle responds to training, not a sign that high androgens are beneficial. Androgen excess has its own symptoms and health considerations, which we cover in our article on PCOS and high testosterone. [9]

What is still uncertain

This is where the evidence gets less clear. Resistance training has been studied far less than aerobic exercise in PCOS, and a 2022 scoping review found only six studies, mostly with before-and-after designs. [10]

Whether strength training improves insulin resistance in PCOS

The biology suggests it should, but the PCOS trials point in different directions. A 2020 meta-analysis found promising improvements in HOMA-IR and the free androgen index with resistance training, pending confirmation. A 2025 network meta-analysis ranked it lowest of the interventions it compared, behind yoga and HIIT. [11,12]

Why results may differ from person to person

Exercise has a plausible mechanism for improving insulin sensitivity, but results in PCOS vary from study to study. Most meta-analyses show fasting insulin improving while fasting glucose usually does not change, and some studies suggest PCOS can blunt the metabolic response to exercise. [7]

Whether it changes testosterone or cycles

Effects on androgens are inconsistent. The guideline’s analyses found that exercise alone or with diet left the free androgen index and testosterone unchanged, while a more recent meta-analysis reported lower total and free testosterone with exercise overall. [7,13]

For resistance exercise specifically, one meta-analysis found minimal effects on hormonal measures. Menstrual regularity may respond more to body composition than to hormones: in one randomized trial, a program combining aerobic and resistance exercise improved regularity while hormone profiles stayed the same. [7,8]

Whether it is better than other types of exercise

So far, no type of exercise comes out ahead. The guideline notes a lack of evidence that any one type or intensity beats another for metabolic, hormonal, reproductive, or psychological outcomes. [2,7]

Reviews rank the options differently. One network meta-analysis favored yoga and HIIT for HOMA-IR, while another found that moderate-intensity continuous training reduced HOMA-IR and HIIT improved fitness and fasting insulin. [12,14]

What the guideline recommends

Two strength days, alongside aerobic activity

The guideline recommends 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity aerobic activity per week, or an equivalent combination, plus muscle-strengthening activities on two non-consecutive days. For greater benefit, including modest weight loss, the targets rise to at least 250 minutes of moderate or 150 minutes of vigorous activity, with the same two strength days. [2,7]

Any physical activity counts, replacing sitting time with light activity has health benefits, and the guideline advises choosing activity based on your preferences and goals. [2,7]

Regular movement matters more than any single session

Exercise-related gains in muscle insulin sensitivity fade about 72 hours after the last session, so the position statement suggests exercising daily or at least every two days. So what does that mean in practice? Two strength days paired with regular walking or other movement, not lifting every day. [7]

Strength training has a distinct role when weight loss comes from eating less

When weight loss comes mainly from eating less, the position statement suggests prioritizing resistance training to help preserve lean muscle. That finding comes mostly from people with overweight or obesity in general, with similar results in PCOS when it was combined with aerobic exercise. We cover the eating side in our PCOS diet article. [7]

Getting started

Start gradually and tailor it to you

This is general information, not a training program. The position statement recommends individually tailored, progressive programs that build gradually, and points to American College of Sports Medicine guidelines for specific prescriptions. [7]

Check in with your clinician when your situation calls for it

Whether to see an exercise professional first depends on your health, any injuries, and your medications, so it is worth checking with your clinician before starting a new program. A clinical exercise physiologist can help some people, and one systematic review found that supervised programs worked best. If you take medication for insulin resistance or weight, ask whether it affects how you should exercise. [7]

Track strength and habits, not only lab numbers

Strength is one of the fastest-responding measures, which makes it a useful marker of progress when other numbers move slowly. Behavior goals, such as strength sessions per week, can be easier to track than clinical outcomes. [7]

When exercise advice backfires

Exercise can become compulsive

PCOS is associated with higher rates of disordered eating, and some people with disordered eating develop a harmful relationship with exercise. If exercise feels compulsive or distressing, raise it with a clinician or psychologist. [7]

Where you exercise matters

Weight stigma can keep people away from gyms. The position statement notes that some people may do better exercising somewhere they feel safe, such as at home. [7]

The bottom line

Strength training generally builds strength and lean mass in women with PCOS, fits within the guideline’s recommendations, and has a strong biological rationale for insulin sensitivity. Its effects on insulin resistance and testosterone in PCOS are still being worked out, and nothing so far suggests it beats other types of exercise.

A balanced approach pairs the two strength days with regular aerobic activity and everyday movement, built around what you will keep doing.

Good questions to bring to an appointment:

• Is there anything about my health, medications, or injuries that should shape how I start?
• Can you refer me to a clinical exercise physiologist or someone experienced with PCOS?
• What progress should we track, such as strength, activity minutes, cycles, or labs, and over what time frame?
• How does exercise fit with my diet and any medication?

This article is for general education and does not replace advice from a qualified healthcare provider or exercise professional.

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References

1. Endocrine Society. Polyendocrine Metabolic Ovarian Syndrome: new name to improve diagnosis and care of condition affecting 170 million women worldwide (press release, 12 May 2026). https://www.endocrine.org/news-and-advocacy/news-room/2026/pcos-name-change
2. Teede H, Tay CT, Laven JJE, et al. International evidence-based guideline for the assessment and management of polyendocrine metabolic ovarian syndrome (formerly PCOS) 2023, with terminology update June 2026. Monash University. https://www.monash.edu/medicine/mchri/pcos/guideline. Journal version: J Clin Endocrinol Metab. 2023;108(10):2447-2469. doi:10.1210/clinem/dgad463
3. Richter EA, Hargreaves M. Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev. 2013;93(3):993-1017. https://pubmed.ncbi.nlm.nih.gov/23899560/
4. Richter EA, Nielsen JN, Jørgensen SB, et al. Exercise signalling to glucose transport in skeletal muscle. Proc Nutr Soc. 63(2):211-216. https://pubmed.ncbi.nlm.nih.gov/15294032/
5. Srikanthan P, Karlamangla AS. Relative muscle mass is inversely associated with insulin resistance and prediabetes: findings from the Third National Health and Nutrition Examination Survey. J Clin Endocrinol Metab. 2011;96(9):2898-2903. doi:10.1210/jc.2011-0435
6. Stepto NK, Cassar S, Joham AE, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Hum Reprod. 2013;28(3):777-784. doi:10.1093/humrep/des463
7. Sabag A, Patten RK, Moreno-Asso A, et al. Exercise in the management of polycystic ovary syndrome: a position statement from Exercise and Sports Science Australia. J Sci Med Sport. 2024;27(10):668-677. doi:10.1016/j.jsams.2024.05.015. Open full text: https://vuir.vu.edu.au/48965/
8. Effects of physical activity in women with polycystic ovary syndrome: a systematic review and meta-analysis. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12520725/
9. Kogure GS, Silva RC, Miranda-Furtado CL, et al. Hyperandrogenism enhances muscle strength after progressive resistance training, independent of body composition, in women with polycystic ovary syndrome. J Strength Cond Res. 2018. PDF copy
10. Kite C, Parkes E, Taylor SR, et al. Time to load up: resistance training can improve the health of women with polycystic ovary syndrome (PCOS): a scoping review. Med Sci (Basel). 2022;10(4):53. doi:10.3390/medsci10040053
11. Exercise interventions in polycystic ovary syndrome: a systematic review and meta-analysis. Front Physiol. 2020;11:606. doi:10.3389/fphys.2020.00606
12. The effects of different exercises on insulin resistance and testosterone changes in women with polycystic ovarian syndrome: a network meta-analysis study. Healthcare. 2025;13(17):2132. doi:10.3390/healthcare13172132
13. The effect of exercise on reproductive and metabolic outcomes in women with polycystic ovary syndrome: a systematic review and meta-analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC13533584/
14. Comparative cardiometabolic effects of high, moderate, and low intensity exercise in polycystic ovary syndrome: a systematic review and network meta-analysis of randomized controlled trials. BMC Womens Health. 2025. doi:10.1186/s12905-025-04201-4