Acupuncture and physical exercise can help blood pressure/hypertension, insulin resistance and stress for PCOS

Effects of acupuncture and exercise
on insulin sensitivity, adipose tissue
characteristics, and markers of
coagulation and fibrinolysis in
women with polycystic ovary
syndrome: secondary analyses of
a randomized controlled trial
Elisabet Stener-Victorin, Ph.D.,a,b Fariba Baghaei, Ph.D., M.D.,c Goran Holm, Ph.D., M.D., € d Per Olof Janson, Ph.D., M.D.,e
Gunilla Olivecrona, Ph.D.,f Malin Lonn, Ph.D., € g and Louise Manneras-Holm, Ph.D.aIN THE ARTICLE "REPRODUCTIVE ENDOCRINOLOGY"

Conclusion:
Hyperinsulinemia due to insulin resistance impairs fibrinolysis
by increasing PAI-1 secretion (38). The women with
PCOS in the present study were insulin resistant and had aberrant
adipose tissue morphology, in addition to alteration in
their coagulation and hemostatic factors (3). Of note, EA decreased
high PAI-1 activity and sagittal diameter without affecting
metabolic variables, including insulin sensitivity
measured by euglycemic hyperinsulinemic clamp test and adipose
tissue abnormalities (e.g., adipocyte size). Clearly, the
intensity, frequency, and duration of low-frequency EA and
physical exercise in the present study were too low to affect
anthropometric and metabolic variables. The only metabolic
variable affected by physical exercise was the SC adipose tissue
LPL activity which increased after 16 weeks of exercise.
We have previously demonstrated that women with PCOS
have decreased SC adipose tissue LPL activity compared
with controls matched by age and BMI (3). Thus, an increased
LPL activity may be regarded as a normalization, which might
be beneficial for these women. These data contrast previous
reports demonstrating a decreased adipose tissue LPL activity
after exercise (39), although it is in agreement with other
studies (40). It remains to be determined whether the stronger
effects of more frequent low-frequency EA treatments observed
in experimental studies can be achieved in women
with PCOS.
Polycystic ovary syndrome is associated with an adverse
cardiovascular risk profile, including hypertension (41). In the
present study, low-frequency EA and physical exercise
decreased diastolic BP, and exercise also reduced systolic
BP at the 16-week follow-up, although no between-group
differences were detected. These results are in line with previous
reports, although the effect is less pronounced. Physical
exercise improves cardiovascular risk factors in subjects
with type 2 diabetes (42) and in women with PCOS (43). The
effect of acupuncture on hypertension is less clear, although
standardized acupuncture lowers high BP in randomized
clinical trials (44, 45). Interestingly, our finding that
low-frequency EA and physical exercise decrease high sympathetic
nerve activity in women with PCOS (24) at least in
part supports our findings of decrease in diastolic BP.
Although the role of the sympathetic nervous system in controlling
BP has been discussed (25), we have demonstrated
that women with PCOS have high sympathetic nervous system
activity (8). In addition, high circulating levels of T are
associated with high BP in women with PCOS (46), and we
have shown that low-frequency EA and physical exercise
decrease circulating androgens and improve menstrual function
in women with PCOS (19). However, in the recently
published RCT, 12 treatments of true acupuncture was compared
with sham acupuncture (so-called placebo needles)
during 8 weeks and the investigators found similar ovulation
frequency and improvement in LH-to-FSH ratio in
both groups of women with PCOS (21). Thus, they were
unable to demonstrate differences between true and sham
acupuncture and they did not include a no intervention
group.