Effects of Tai Chi combined with dietary intervention on health-promoting lifestyle and metabolic and reproductive outcomes in female college students with polycystic ovary syndrome: a randomized controlled trial

IntroductionPolycystic ovary syndrome (PCOS) affects 5–20% of adolescent females worldwide, yet scalable non-pharmacological interventions remain scarce. Tai Chi, a traditional Chinese mind-body exercise, may address the complex metabolic, reproductive, and psychosocial dimensions of PCOS, but robust randomized controlled trial evidence is lacking.MethodsThis 6-month, single-center, parallel-group randomized controlled trial (February–July 2025, Zhengzhou, China) enrolled 120 female college students (aged 18–22 years) meeting Rotterdam PCOS criteria, randomized 1:1 to dietary adjustment alone (control, n = 60) or dietary adjustment plus 24-style simplified Tai Chi (intervention, n = 60; 60 min, 5×/week). The primary outcome was the Health-Promoting Lifestyle Scale total score. Secondary outcomes included BMI, menstrual cycle length, and serum testosterone. Complete-case analysis (n = 86) used repeated-measures ANOVA, independent t-tests, and Cohen's d effect sizes. Intention-to-treat analysis with last observation carried forward (ITT-LOCF, n = 120) was performed as a sensitivity analysis.ResultsThe combined intervention produced a large between-group difference in the primary outcome (total lifestyle score improvement: 15.49 points, 95% CI: 13.00–17.98, P < 0.001; d = 2.62), with the exercise dimension showing the largest effect (d = 2.69). However, the exercise subscale effect size partly reflects measurement overlap between the Tai Chi intervention and the self-reported exercise items. Secondary outcomes showed modest improvements favoring the combined intervention: post-intervention BMI (21.35 ± 1.76 vs 22.51 ± 2.08 kg/m², P = 0.005), menstrual cycle duration (38.49 ± 6.37 vs 50.19 ± 12.04 days, P < 0.001), and testosterone reduction (16.7% vs 6.4%, between-group P = 0.033). Significant time × group interactions were observed for all indicators (partial η² = 0.066–0.494) except dietary nutrition. ITT-LOCF analysis confirmed the primary finding (MD = 10.90, P < 0.001, d = 0.64). Exploratory subgroup analyses suggested, but could not confirm, greater benefit in participants with severe menstrual irregularities (>60 days; interaction P = 0.028–0.042).DiscussionTai Chi combined with dietary adjustment may serve as a useful adjunctive exercise modality within lifestyle-based management for young women with PCOS. The large behavioral effect sizes should be interpreted with caution, as they partly reflect structured participation and measurement overlap. The absence of an active exercise comparator precludes attribution of benefits specifically to Tai Chi. Multi-center trials with active exercise comparators, comprehensive metabolic profiling, and long-term follow-up are needed to confirm these preliminary findings.