What is the recommended workout regimen for individuals with infertility?

Recommended Workout Regimen for Individuals with Infertility

For individuals with infertility, the recommended workout regimen is at least 150 minutes per week of moderate-intensity aerobic exercise OR 75 minutes per week of vigorous-intensity exercise, combined with muscle-strengthening activities on 2 non-consecutive days per week. 1, 2

Core Exercise Prescription

Aerobic Exercise Component

• Minimum target: 150 minutes/week of moderate-intensity activity OR 75 minutes/week of vigorous-intensity activity (or equivalent combination) 1, 2
• Optimal target for greater benefits: 250 minutes/week of moderate-intensity OR 150 minutes/week of vigorous-intensity 3
• Structure: Accumulate activity over minimum 3 days per week, though daily activity is encouraged 1
• Bout duration: Activities should be performed in at least 10-minute bouts (approximately 1,000 steps), aiming for at least 30 minutes daily on most days 3

Resistance Training Component

• Frequency: Muscle-strengthening activities on 2 non-consecutive days per week 2, 3
• Both aerobic and resistance exercises have demonstrated benefits in PCOS-related infertility 3
• Combined exercise (aerobic plus resistance) shows similar improvements to aerobic alone when sustained for 20 weeks 1

Exercise Intensity Guidelines

Moderate-Intensity Activities (30-60 minutes sustainable)

• Definition: Can conduct uninterrupted conversation; somewhat difficult exertion 1
• Examples: Brisk walking (3-4.5 mph), cycling (5-9 mph), low-impact aerobics, yoga, weight training, swimming, tennis, volleyball 1
• Heart rate target: 50-75% of maximum heart rate 1

Vigorous-Intensity Activities (up to 30 minutes sustainable)

• Definition: Cannot maintain uninterrupted conversation during activity 1
• Examples: Jogging/running, cycling (>10 mph), high-impact aerobics, circuit weight training, competitive basketball, soccer, swimming laps 1
• Emerging evidence suggests vigorous exercise and high-intensity interval training (HIIT) may provide superior outcomes in PCOS-related infertility 1

Critical Evidence for Fertility Outcomes

Benefits Independent of Weight Loss

• Exercise improves reproductive outcomes, insulin sensitivity, and hormonal balance even without significant weight loss 1
• This is particularly important because insulin resistance affects fertility regardless of BMI, including in lean individuals 2, 3
• Moderate aerobic exercise improves insulin sensitivity short-term in PCOS, a major contributor to infertility 1

Male Fertility Considerations

• Moderate physical activity enhances semen quality, hormonal balance, and metabolic health in men 4
• 24 weeks of moderate aerobic exercise significantly improves semen parameters, sperm DNA integrity, and pregnancy rates in infertile men 5
• Critical warning: Excessive or strenuous exercise can adversely affect male fertility through hormonal disruption, oxidative stress, and reduced testosterone production 4, 6

Female Fertility Considerations

• Exercise interventions improve fertility outcomes regardless of technique, intensity, or duration in women with obesity-related infertility 7
• Cyclic exercise (walking, cycling) is most commonly studied, though combination approaches are effective 7
• Exercise reduces inflammation and oxidative stress while improving cardiovascular function and nutrient delivery to reproductive organs 4

Behavioral Strategies for Adherence

Implementation Approach

• Use SMART goal setting (Specific, Measurable, Achievable, Realistic, Timely) and self-monitoring 3
• Incorporate behavioral strategies: goal-setting, stimulus control, problem-solving, reinforcing changes, relapse prevention 3
• Consider comprehensive behavioral or cognitive behavioral interventions to increase engagement and adherence 3

Minimize Sedentary Behavior

• Actively reduce sedentary, screen, and sitting time throughout the day 3
• Sedentary behaviors link to all-cause mortality and adverse health impacts 1

Common Pitfalls to Avoid

Do Not Dismiss Exercise in Normal-Weight Individuals

• Insulin resistance is present irrespective of BMI and affects both lean and overweight individuals with infertility 2, 3
• Lifestyle intervention including exercise is first-line management for ALL patients with PCOS-related infertility, regardless of body weight 2, 3

Avoid Excessive Exercise

• Strenuous training can adversely affect fertility through hormonal disruption, particularly in men 4, 6
• Balance is critical: moderate exercise enhances fertility while excessive exercise can impair it 4, 6

Male-Specific Considerations

• Avoid sports-related factors that may impair fertility: tight-fitting clothes, overheating, testicular trauma 4
• Individual health status, exercise volume, intensity, and duration are co-factors influencing exercise impact on male fertility 6

Duration for Clinical Benefits

• Minimum 12 weeks of regular exercise shows metabolic benefits, with greater benefits observed at 24 weeks 1
• In male infertility, 24 weeks of moderate aerobic exercise significantly improves pregnancy rates 5
• Benefits may persist after cessation, though 4 weeks of detraining is insufficient to reverse all improvements 5

Accessibility and Cost Considerations

• Exercise interventions do not require clinical centers or expensive gyms 1
• Can be delivered in community centers, sporting facilities, in groups, and with minimal equipment 1
• Low-cost e-health and m-health options are viable alternatives 1