Early Cardiovascular Risk and Polycystic Ovary Syndrome: The Emerging Role of Cardiopulmonary Rehabilitation: A Narrative Review

Abstract

Background: Polycystic ovary syndrome (PCOS) is increasingly recognized as a significant risk factor for early cardiovascular disease (CVD) in women of reproductive age. Beyond reproductive manifestations, women with PCOS exhibit reduced cardiorespiratory fitness, insulin resistance (IR), dyslipidaemia, hypertension, endothelial dysfunction, autonomic imbalance, and chronic low-grade inflammation. Objectives: This narrative review aimed to synthesize current evidence on early cardiovascular risk in PCOS and to evaluate the growing potential of cardiopulmonary rehabilitation (CPR) as a preventative and therapeutic strategy. Methods: A structured search of major electronic databases (PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar) was conducted. Studies published between January 2010 and June 2024 were qualitatively analysed for cardiovascular, metabolic, inflammatory, and cardiopulmonary outcomes in women with PCOS. Results: Structured exercise interventions, particularly those incorporating CPR principles, significantly improved VO₂ max, blood pressure regulation, lipid profiles, insulin sensitivity, inflammatory biomarkers (C-reactive protein [CRP] and interleukin-6 [IL-6]), and autonomic function. Supervised, individualized rehabilitation programs demonstrated superior outcomes compared to unsupervised lifestyle advice alone. Conclusion: Despite mounting evidence supporting exercise-based management, CPR remains underutilized in routine PCOS care. Integrating rehabilitation-focused physiotherapy into multidisciplinary PCOS management may substantially reduce long-term cardiovascular risk, enhance functional capacity, and improve quality of life (QoL).