I started gaining weight rapidly when I was in high school (pre-diagnosis). I was scared, and decided to commit to being on the treadmill for 1 hour and eating less than 1,000 calories every day for six months. I gained 40 pounds and a lot of that showed up as abdominal fat. I was strictly following the calories-in, calories-out model, but it didn’t work for me. My doctors said I had to be sneaking soda on the side and lying on my food journals. I was so discouraged. When I was finally diagnosed with PCOS and found credible resources, I began to understand why my weight loss approach had the opposite effect.
Polycystic Ovarian Syndrome (PCOS) is a chronic, complex metabolic condition that’s on the rise. We know that approximately 1 in 10 women have PCOS, and up to 70% of cases are going undiagnosed (World Health Organization, 2025). Weight gain is a common PCOS symptom and weight loss is often prescribed as a treatment, so it’s crucial to have fitness experts trained in this increasingly common condition. Other issues related to PCOS include acne, infertility, mental health struggles, non-alcoholic fatty liver, insulin resistance/diabetes, low energy, and a laundry list of other complications (Brown, Diehl, Kelley, & Setji, 2014).
PCOS is an ancient condition. We have examples going back thousands of years of people with the classic characteristics of this syndrome. It used to be evolutionarily beneficial, since carrying extra weight and bearing fewer children helped increase survival rates during times of famine and war (Abbott, Chazenbalk, & Dumesic, 2023). The body acts differently when it’s in danger and resources are scarce, and PCOS genetically adapted to survive those conditions.
Clients with PCOS will likely carry a lot of trauma and anxiety around the topic of fitness and weight loss. It’s important they feel understood, taken seriously, and welcomed. They probably already know a lot about weight loss but could use support in putting that into practice in a sustainable way. That’s where you come in!
Here are five things to keep in mind to help these clients succeed:
1. Approach Them with a New Mindset
PCOS is hard to live with and is often misunderstood, even in the medical community. Some people are denied proper care until they lose weight, or are told they have PCOS because they’re overweight. In reality, PCOS makes it far more difficult to lose weight than it is for most of the population; and weight gain is a symptom, not the cause of PCOS.
50-90% of women with PCOS struggle with insulin resistance, and this typically comes with weight battles (Barber, Franks, Hanson, & O Weickert, 2019). When it comes to a metabolic and hormonal condition like this, we can’t rely on the calories-in, calories-out formula. Just like taking certain medications can cause weight gain without adding calories to a diet, so can hormonal imbalances.
Some weight loss plans can actually mirror those survival conditions; putting people in a state of starvation and exertion will only aggravate symptoms. I learned this the hard way. Be willing to adjust your approach to accommodate a lower-stress and lower-intensity style.
PCOS affects a wide range of bodily systems, and symptoms can vary dramatically from person to person. What works for one client may not work for another. Taking the time to listen deeply to what each individual needs and struggles with will be key to your shared success.
2. Squelch the Stress and Prioritize Rest
Even though PCOS bodies are amazingly built for survival through extreme circumstances, our modern lifestyle loses many of the benefits and aggravates the drawbacks. This can be a helpful perspective to keep in mind when working with these clients. Do what you can to help convince the body it’s safe and has access to what it needs, and don’t throw it into a mode of further stress.
Reduced stress and quality sleep are some of the most important pillars of PCOS care. If a client’s time is short, do not encourage them to skip sleep to get to the gym, but rather work with them to find alternatives to their schedule. Sleep issues are very common with PCOS, and it’s likely that an extra hour or two of rest will help them more than an intense workout first thing in the morning (Wang et al., 2022). If appropriate, try to gauge how much (and how well) they’re sleeping. Aiming for 9–10 hours of sleep is ideal for PCOS, and improving sleep quality with tools like a sleep mask and a quiet environment can make a big difference.
When it comes to movement, we want to prioritize longer, more frequent sessions of low-stress activity rather than shorter bursts of intense cardio. Walking, swimming, and yoga are all great PCOS-friendly options. We want to avoid anything that convinces the body it’s in survival mode (like HIIT or marathon training). Meditation can also be a powerful tool for stress management in this population.
3. Focus on Strength Over Cardio First
Strength and resistance training is especially beneficial for PCOS bodies, and it’s a great place to start. They tend to score lower on cardiorespiratory markers, but do well with resistance and strength training. This approach is more likely to show tangible results faster, especially in those with insulin resistance (Li et al., 2022). That’s something worth celebrating, even if the number on the scale isn’t moving yet.
POTS (Postural Orthostatic Tachycardia Syndrome) is becoming more common in people who have had COVID-19 (Johns Hopkins Medicine, 2025). While research is still emerging linking it to PCOS, many people in the community are reporting struggling with it now. POTS makes it harder for the body to regulate heart rate, especially during transitions like sitting to standing. This is another reason why lower-intensity, mindful movement is a better choice.
When working with clients, watch for symptoms like dizziness, blacking out when standing, temporary hearing loss, or trouble regulating heart rate. These are signs to back off and could mean it’s time to try a different approach. Horizontal exercises, avoiding rapid up-down transitions, and taking frequent breaks can help significantly.
4. Be Patient and Respect Their Experience
Since weight challenges are such a large part of PCOS, clients may have spent years (if not decades) cycling through diets and workout plans. Struggling to lose weight is rarely due to a lack of knowledge or effort.
It might be tempting to assume they’re not following your plan if results aren’t showing, but don’t go the route of shame or blame. They’ve likely heard that their entire lives. PCOS bodies may respond differently than what you’re used to, but that doesn’t mean your client is deceiving you. This group tends to be incredibly mentally determined.
Take time to ask what has or hasn’t worked in the past, and be flexible enough to pivot if needed. Understand that their exhaustion might be higher than your other clients’. They may deal with more intense sugar and carb cravings, and they may feel hopeless about ever improving their health.
This group is often high on the “I’ve tried everything, and nothing worked” scale. Centering your coaching around caring for the whole body, rather than chasing numbers, can help release some of that pressure. With PCOS, it’s often more effective to focus on being kind and consistent, and to trust the body to adjust accordingly.
5. Set Them Up for Long-Term Success
PCOS is a lifelong condition. It will ebb and flow, flare up and calm down, but it doesn’t go away. Help your clients set realistic goals and expectations, and support them in pursuing those goals with consistency and compassion.
Higher rates of anxiety, depression, and extreme exhaustion are common with PCOS (PCOS Sisters Telehealth Clinic, 2025). Create backup plans for the days when movement and self-care feel impossible. Even if that means taking a break, being supportive and nonjudgmental makes it far more likely they’ll return when they’re feeling better.
Tackling PCOS from multiple angles is the best approach. Ideally, you’re one part of a broader wellness team. Nutrition, mental health, and community all play huge roles in their wellbeing. Encourage your clients to invest in these areas and check in about them. It’s even better if you’re able to collaborate with other providers who understand PCOS.
Having someone in their corner who takes the time to learn how their body works, and cares enough to work through the complexities with them, can make all the difference in your clients’ health and success. Listening deeply, being open to new approaches, and staying aware of their unique challenges builds trust and safety.
It’s great to continue learning about PCOS for your clients, but it’s also a complicated and far-reaching condition. Don’t feel like you have to take it all on by yourself. Build a network of trusted professionals who specialize in PCOS care, and don’t hesitate to loop them in when needed. This syndrome can run someone’s whole life, but it doesn’t have to. You can be a key part of their journey towards peace and alignment with their body.
Works Cited
World Health Organization. (2023). Polycystic ovary syndrome. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
PubMed Central. (2025). Review of nonalcoholic fatty liver disease in women with polycystic ovary syndrome. https://pmc.ncbi.nlm.nih.gov/articles/PMC4202347/
PubMed Central. (2025). An evolutionary model for the ancient origins of polycystic ovary syndrome. https://pmc.ncbi.nlm.nih.gov/articles/PMC10573644/
Oxford Academic. (2025). Why are women with polycystic ovary syndrome obese? https://academic.oup.com/bmb/article/143/1/4/6547855
PubMed Central. (2023). Obesity and polycystic ovary syndrome: Implications for pathogenesis and novel management strategies. https://pmc.ncbi.nlm.nih.gov/articles/PMC6734597/
Frontiers in Physiology. (2022). A meta-analysis of the relationship between polycystic ovary syndrome and sleep disturbances. https://www.frontiersin.org/articles/10.3389/fphys.2022.957112/full
PubMed Central. (2022). Time to load up–Resistance training can improve the health of women with polycystic ovary syndrome (PCOS): A scoping review. https://pmc.ncbi.nlm.nih.gov/articles/PMC9590069/
Johns Hopkins Medicine. (2025). COVID-19 and POTS: Is there a link? https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/covid19-and-pots-is-there-a-link
PCOS Sisters Telehealth Clinic. (2025). PCOS and mental health: Understanding the connection in today's women's health landscape. https://pcossisters.com/pcos-and-mental-health-understanding-the-connection-in-todayswomens-health-landscape/
Share this
Hiring a Gym Manager
5 Design Tips for Your Fitness Business Website
