I have always been athletic. In my teens, I played basketball, softball, and golf. I loved moving and competing. Somewhere along the line, though, the joy I felt in movement got lost in “getting exercise.” Frustrated with weight gain, I began running. Obsessively. I ran miles and miles every day, no matter what. The more I ate, the farther I ran. Any type of food indulgence was punished on the treadmill or trail. I thought I could run off the extra calories and not gain weight. I wish someone had told me it didn’t work that way. Of course, exercise was burning calories, but I was damaging my body and counteracting my hard work. I never ran because I loved the way it felt; I ran because I hated the way my body looked. There was no joy in exercise, and there was little positive result. In fact, I ultimately injured myself and had to stop.
This injury was a blessing. Unable to run, I began to take walks. Guess what? The pounds slowly came off. I was no longer overtaxing my adrenal glands, muscles, and bones, and my body began to heal the damage. Moreover, with my adrenals no longer working overtime, they could get back to keeping my hormones balanced. My body felt better, my moods lifted, and I felt more like myself again.
Now I am sure to get in some movement every day. Sometimes it is a group class; sometimes it is a walk. On great days, it is playing basketball with my kids in the driveway. In my experience and that of the women I have coached, the most effective and sustainable exercise is the one you enjoy.
Movement Instead of Exercise
A PCOS Diva moves it every day. There is a big difference between exercise and movement. Exercise is something you do because you “have to.” For example, “I have to go to this spin class (which I hate), or I will get fatter.” Movement is something you do because it makes you feel good. For example, “I went for a bike ride today. I love the way my body feels after a good ride.” See the difference?
Many of us fear that if we don’t do something grueling, our bodies will not benefit. Here’s a secret that will save you a lot of time, energy, and frustration. You should enjoy the movement in your day. You should feel good afterward. If you dread your daily exercise and feel exhausted and achy for days afterward, you are doing it wrong. Moreover, you are not doing yourself any good. Approach exercise as extreme self-care, and you’ll feel the change almost right away. PCOS Divas move every day, because we love to feel good and because we love our bodies and want to take care of them.
Beating yourself up with exercise won’t help you get healthy. Punishing yourself for how you look or what you ate is destructive—mentally and physically. For one thing, it is not sustainable. How many times have you started on an exercise routine to lose weight and then stopped after only a few weeks? That was probably because you didn’t like what you were doing. The exercise was moving your body, but not your spirit. The motivation to continue wasn’t complete. If you choose movement that you love, that feeds your spirit, you will continue to do it because it feels great. Second, you are likely overtaxing your adrenal glands and making your PCOS symptoms worse.
“I don’t work out because I hate my body. I work out because I love it.”
—AMY MEDLING
Studies indicate that 25 percent of women with PCOS have adrenal fatigue. If you are pushing extra hard, training for a marathon, or sweating it out at CrossFit and you feel as though you have been hit by a truck every morning, this may be you. The stress of your workouts might be exacerbating your PCOS symptoms and worsening your hormonal imbalances.
When you experience stress (mental or physical), your adrenal glands receive the signal to produce more cortisol (the “stress hormone”) and androgens. It is the body’s natural survival response to give you energy and strength to escape a predator.
Cortisol manages your body’s stress response by increasing blood sugar to give you energy to run from the predator and suppressing less immediately vital functions, such as your immune system. Since women with PCOS naturally produce more cortisol to begin with, when stress is added, the problem compounds. After a period of unrelenting or chronic stress, your adrenal glands “burn out” and produce less cortisol. As a result, you feel lethargic instead of energized after a workout.
A high cortisol level creates a couple of other problems for women with PCOS. First, it raises blood sugar levels. Since most of us are working hard to balance our insulin, a cortisol imbalance can complicate the issue. Second, cortisol stores energy in fat, so that abdominal weight so many of us have only gets worse.
Stress takes an extra toll on women with PCOS, so we must find ways to manage it. One way is with movement that is pleasurable and stress relieving. If your workout leaves you feeling stressed and fatigued, it’s time to switch it up. It may seem counterintuitive, but reducing the intensity of your workout will help you lose weight and feel more energized, because you calm your stress-response system. The results are lower androgens, less belly fat, and more energy!
This doesn’t mean you shouldn’t sweat a little! Find a way to move every day that recharges you. Try yoga or Pilates, go for a walk, do some high-intensity interval training, find a group class you enjoy, or ride your bike. If you prefer a particularly strenuous workout, go for it. As long as you feel good afterward, any movement that you enjoy is right for you. Use your self-care movement time to reduce your physical and mental stress instead of adding to it.
The Best Movement for PCOS Divas
There is no “best” movement for women with PCOS. There is only the best movement for you. The only requirements are that you move every day and that you enjoy the time. Otherwise, how you move is entirely up to you. Here are some suggestions for finding movement you enjoy:
Think of activities you did in your youth. Did you bike, play soccer, climb? Why not start again?
Skip the gym. There are tons of group-movement alternatives that happen outside the gym walls. Look especially for outdoor activity groups. Your community may have kayaking or hiking clubs, walking groups, or tai chi in the park.
Join a gym. A large commercial gym or YMCA offers a variety of activities for you to sample. The trick is to choose a facility where the staff is friendly and you feel comfortable. Take your time before making a decision. Take a tour and ask about trial memberships. If you have a friend who belongs to a gym, ask her about a guest pass.
Choose a studio. Big gym not your thing? Look for smaller studios for special activities such as kickboxing, barre, yoga, or interval training. There are also studios for women only.
As you explore the kind of movement that’s best for you, consider the three types of movement that are particularly beneficial. Used in conjunction and in a way that you enjoy, they will foster weight loss, blood-sugar regulation, and mood stabilization.
High-intensity interval training (HIIT). Does “high-intensity” sound like the kind of exercise I just cautioned against as causing adrenal fatigue? It shouldn’t. HIIT is a short, intense workout lasting about 15 to 30 minutes during which you alternate between levels of intensity (for example, run, jog, walk, repeat). Regular HIIT has been shown to significantly increase both aerobic and anaerobic fitness. HIIT also significantly lowers insulin resistance and results in enhanced skeletal muscle fat oxidation and improved glucose tolerance. Many gyms have HIIT classes, or you can try it on your own. It’s quick, inexpensive, and the variation makes it fun. There are free apps that can guide you, including one in which you escape a zombie attack! As an added bonus, you continue to burn fat at an accelerated rate for two to twenty-four hours afterward.
Strength training. Strength training is necessary for women with PCOS for several reasons. First, muscle is metabolically active, which means it burns calories in order to sustain itself. The more muscle you have, the more calories you burn on a day-to-day basis. Second, muscle enhances your body’s ability to manage glucose. Finally, feeling strong is empowering. Knowing you can open a jar by yourself or complete a hike is gratifying. Yes, as you add muscle, you will weigh more, since muscle weighs more than fat, but it takes up less space too. If you are worried about bulking up, skip the weights and use your own body weight with movements like squats and planks. Strong is the new skinny!
Mind—body movement. Many women with PCOS feel very disconnected from their bodies. We have spent so many years fighting ourselves that we are out of touch with how our body feels and what it can do. Time spent with movement like yoga, Pilates, or tai chi has the triple benefit of providing strength training, stress relief, and an appreciation of exactly what our bodies are capable of achieving, given a little time, care, and patience. I specifically recommend yoga. Studies galore demonstrate its benefits, but a 2012 study specifically found that for young women with PCOS, it improved glucose, lipid, and insulin-resistance values. Yoga also triggers a dose of calm, probably because of its impact on the vagus nerve.
The vagus nerve is a major player in the parasympathetic nervous system, which is responsible for the body’s “rest and digest” function. This is of particular interest to women with PCOS, because we typically have significantly higher sympathetic nerve activity, or “fight or flight” response activity.
The vagus nerve winds from your brain stem to the bottom of your abdomen, touching upon most major organs, including the heart, lungs, liver, spleen, pancreas, and digestive system, along the way. Positive stimulation of this nerve has been found to reduce inflammation. High vagal tone is associated with better blood-sugar regulation, reduced risk of stroke and cardiovascular disease, lower blood pressure, improved digestion, reduced migraines, better mood, less anxiety, and more stress resilience. Low vagal tone is associated with cardiovascular conditions and stroke, depression, diabetes, chronic fatigue syndrome, cognitive impairment, and significantly higher rates of inflammatory conditions (autoimmune disease, endometriosis, inflammatory bowel disease, etc.).
Increased parasympathetic activity via the vagus nerve improves vagal tone and improves many PCOS symptoms. Consider the following to improve your vagal tone (many of these are already part of the Healing PCOS 21-Day Plan):
- Slow, rhythmic, diaphragmatic breathing
- Humming, singing, or chanting
- Practicing yoga
- Washing your face with cold water
- Meditation
- Gargling
- Acupuncture
- Balancing your gut microbiome
Try to engage in all three types of movement several times per week. It is easy to combine strength training with either interval training or mind—body movement. Group classes and tons of online resources are available to inspire you and help you mix it up. If you don’t enjoy it, experiment and find another way.
Bonus Tip
Dress the part. Don’t wait to get to your ideal shape to buy workout clothes. Well-fitting clothes that are comfortable and make you feel good make movement more enjoyable and help motivate you. You don’t have to spend a fortune. My favorite yoga pants are from Old Navy!
Make a Date
Movement, just like meal planning and other self-care, must be scheduled so that it actually happens. Sit down with your calendar each week and plan when you will enjoy some self-care movement. Do not “squeeze it in.” Plan around it. Make it the priority. Like breakfast, it is nonnegotiable. This mindset shift will make all the difference in how you approach movement. This is an opportunity for you to flex your PCOS Diva muscles: “No, I cannot cover for you at lunch today. I have important plans.”
Once you have made the date, keep it! Treat movement like any other appointment. As the day progresses, there are always a thousand good excuses not to keep your date to move. If this sounds like you, get up early and go before the pressures of the day take hold. If you choose to move after work, don’t go home! Change your clothes and get moving before the sofa calls your name. Once you get home, the mental strain of the day can make you feel more tired than your body really is. If you can get moving before that mental letdown happens, you will have more energy throughout the evening. We will work more on this in Week Two of the 21-Day Plan.
Most every woman I work with has some sort of what I call “gym anxiety.” Concerns range from not knowing how to choose a good gym, to not knowing how to use the equipment, to the most common fear, being made fun of or looked down upon. The first two are easy to fix. A quality gym will have staff willing to help get you started safely. The third is tougher and reaches beyond gym walls to most any public exercise; you might have “track,” “pool,” or “court” anxiety.
We all seem to have this feeling that we can’t exercise where people might see us, because we aren’t perfect yet and we don’t belong there. No one likes the feeling of being judged and found lacking. The dread of feeling this way keeps many women from enjoying (or even making it to) the gym.
First, understand that, yes, you do belong there. The gym is for people who want to take care of their bodies and improve their lives. Everyone there is working on something (probably 99 percent of them are trying to lose weight or keep it off). A good gym will have employees and members who are encouraging and supportive. If they aren’t, find a place where they are.
Second (and most important), be among the 1 percent of people who aren’t breaking their necks trying to lose weight. Be the PCOS Diva who is there to practice extreme self-care. Engage in movement, whether it is at the gym, in a pool, on a trail, wherever you are, because you want to move your body so it feels good. That feeling will keep you coming back to whatever activity you have chosen and help you feel at home.
Losing weight is a byproduct of bringing yourself back into physical and emotional balance. There are lots of unhealthy skinny people. If the perfect bikini body is your ultimate goal, you will struggle to lose a pound. Feel sorry for all those miserable-looking people as you move and enjoy it. You deserve to feel good!
One of the best ways to beat gym anxiety? Take a buddy. It can be a lot more fun to move with a friend. You can motivate each other, share in your successes, commiserate in setbacks, and laugh when things just go wrong. Studies show that people who engage in movement with a partner have more success and move more regularly.
Sleep Is an Important Exercise
Sleep is critical to a PCOS Diva’s movement plan. Obviously, you will not be able to move in an enjoyable way if you are dragging due to a lack of sleep, but there’s more to it. If you are chronically sleep deprived, you are at greater risk for injury; hormones are imbalanced; your body is less able to repair organs, muscles, bones, and tissues; you make bad food choices; and you become increasingly forgetful. Several recent studies show the clear relationship between sleep, food consumption, weight regulation, and metabolism.
Did you know that people who habitually sleep less than six hours per night are more likely to have a higher-than-average body mass index (BMI)? Researchers believe that this is because our bodies secrete hormones while we sleep that control appetite, metabolism, and glucose processing. Lack of sleep can wreak serious havoc on your insulin levels, put you at higher risk for diabetes, anxiety, and depression, and worsen your PCOS symptoms, especially if you sleep less than five hours per night.
Leptin and Ghrelin
Chronically sleep-deprived people have low levels of leptin, a hormone that signals your brain when you have eaten enough food. They also have high levels of ghrelin, which stimulates appetite. Put these two together, and you have a body craving food it doesn’t need, taking in sugar to boost lagging energy, and being too tired to exercise.
Millions of us are chronically sleep deprived for many reasons.
Lifestyle choices: Sleep is often the first thing to be sacrificed when we are overcommitted. Work, family, and social obligations compete for time in our day with self-care, including movement and sleep.
Disease and/or medical conditions: Many diseases and conditions make it difficult to sleep, either because you cannot get comfortable and relax or because they literally wake you, as in the case of sleep apnea. Often these diseases are caused, in part, by sleep deprivation. Diseases such as coronary disease are worsened by sleep deprivation, creating an unhealthy cycle.
Sleep apnea: Women with PCOS are at least thirty times more likely to struggle with sleep apnea than those without. It is closely linked to insulin resistance and creates a vicious cycle in which insulin resistance causes sleep apnea and vice versa. If you snore loudly and wake with a dry mouth, headaches, or shortness of breath, and if your partner observes that you stop breathing during sleep, you should be tested for sleep apnea right away. Sleep apnea will worsen your insulin resistance and glucose processing, making your PCOS symptoms worse and possibly leading to other serious health problems.
Medication: Sleep disruption is a common side effect of many popular medications. Read the label, and ask your pharmacist and doctor about the side effects of all medications, whether over-the-counter or prescription.
Melatonin imbalance: Melatonin is a powerful hormone that regulates your circadian rhythm, the cycle of waking and sleep. Disruption in its levels often results in sleep deprivation or unhealthy sleep patterns.
Cortisol imbalance: Your cortisol levels should naturally rise and fall. Ideally, they peak around 8 a.m. and drop off between midnight and 4 a.m. If you wake between 1 and 3 a.m., it may be because of low adrenal function and cortisol or inadequate glycogen reserves in the liver.
Strive to sleep seven to eight hours per night. Six hours seems to be the minimum amount of sleep the average person needs per night to function and be healthy. More than eight and a half to nine hours can also create metabolic issues. Here are some tips for getting a good night’s sleep:
Eat the right foods. During the day, choose foods that promote sleep (potassium-rich fruit, dark leafy greens, turkey, whole grains), and avoid sleep-interfering foods (anything high in fat or sugar—even natural sugars like berries). If blood sugar drops below 50 mg/dL at night, it can increase levels of adrenaline, glucagon, cortisol, and growth hormone, all of which can stimulate the brain. But eating a big meal before sleep is not a good idea either. Your body will be too busy digesting to focus on the restorative aspects of sleep, like detoxifying, regenerating cells, and reviving. If you must eat before bed, the best snacks contain both a carbohydrate and the amino acid tryptophan. Legumes, nuts, and seeds are all good choices. Apples and nut butter or a little gluten-free, oat-based granola with nuts and coconut milk are my go-to choices for a before-bed snack.
Support your adrenal glands. Although cortisol helps your body to adjust to perceived emergencies, chronic stress can lead to adrenal fatigue, a cortisol imbalance, and sleeplessness. Consider supporting your adrenals with a high dose of rhodiola, licorice root, ashwagandha, ginseng, and maca root. My PCOS Diva DeStress supplement is a terrific herbal combination, and it can help. Also, take steps to manage your stress during the day. Experiment with relaxation techniques, yoga, and daily movement.
Supplement with magnesium. Magnesium is the “relaxation mineral.” Unfortunately, women with PCOS are nineteen times more likely to be deficient than the average person. Leafy green veggies, oatmeal, pumpkin seeds, black beans, and almonds are all good sources of magnesium. You can also choose a high-quality supplement or take an Epsom-salt bath. Adequate magnesium doesn’t guarantee a good night’s sleep, but lack of magnesium will literally keep you up at night.
Boost your melatonin. Melatonin must have darkness to trigger activation (even if it is supplemented). Turn off lights and pull light-blocking shades (I swear by my sleep mask). Turn off electronics at least an hour before bedtime.
Practice a sleep ritual. A sleep ritual is a crucial element for ensuring a good night’s sleep. Relax your body and mind for 30 to 60 minutes before bedtime to signal your body that it is time to sleep. It gives your mind time to settle so it isn’t racing and making “to-do lists” and helps your muscles to let go of the stress of the day. Try to go to bed at the same time each night. Turn off electronics at least an hour before bed, and practice letting the stresses of the day melt away. Repeat the same steps every night before bed, and your body will begin to anticipate going to sleep. This will be part of your 21-Day Plan.
Cut back (or cut out) caffeine, stimulants, and sugar, especially after lunch. Don’t consume caffeine four to six hours before bed. This includes dark chocolate!
Avoid alcohol. Don’t drink alcohol for several hours before sleep. If you have a glass of wine to help you sleep, it will initially act as a sedative, but it disrupts REM (rapid eye movement) sleep, and you’ll wake up in the middle of the night when the alcohol is being metabolized. Stick with a drink at dinner if you must, three hours or so before bedtime.
Try sleep-inducing herbs. Valerian root is one of the most studied herbs connected with sleep. It increases receptors for gamma-aminobutyric acid (GABA), a neurotransmitter that is involved in regulating normal sleep. Chaste tree, or Vitex, may increase body’s production of melatonin during the night too. Lemon-balm tea can calm a restless mind and is effective for easing anxiety.
Breathe. Focused breathing helps reduce your heart rate and blood pressure, releases endorphins, and relaxes your body, getting you ready for sleep. Try the Box Breath: Inhale for 4 counts, hold for 4 counts, exhale for 4 counts, rest for 4 counts, and repeat 4 times. We will experiment more with more breathing techniques during the 21-Day Plan.
Seek treatment if you have an underlying medical condition. A health-care professional can help you resolve sleep apnea, depression, or anxiety.
During the next 21 days, you will find a way to joyfully move every day. You will experiment with types of movement and find the right ones for you. You will seek out joy in movement and find activities that make you feel good. You will discover ways to stay motivated and on track and make movement a sustainable part of your everyday life from now on. You will sleep well. While nourishing your body with the food it craves, you will treat your body as it deserves to be treated—with love, care, and respect. Movement is as critical to thriving with PCOS as changing how you think and eat. Done the PCOS Diva way, it balances your body, mind, and spirit.