女性运动与生殖内分泌调控——EA-HPO轴视角的证据与路径

Exercise and Female Reproductive Endocrine Regulation—Evidence and Pathways from the EA-HPO Axis Perspective

摘要: 目的：综述运动对女性生殖内分泌的双重影响，围绕能量可用性(energy availability, EA)——下丘脑–垂体–卵巢(HPO)轴，分别讨论多囊卵巢综合征(PCOS)与功能性下丘脑性闭经/相对能量缺乏综合征(FHA/RED-S)的证据，并在中医理论框架下给出可实施的处方思路。方法：检索最近20年的中英文文献，兼顾奠基性研究；纳入随机对照研究、系统综述/共识与高质量队列，采用叙述性综合，不做定量荟萃。结果：中等强度有氧联合抗阻训练可改善PCOS的胰岛素抵抗与高雄激素状态，并促进排卵恢复；低EA通过“瘦素/Kiss1-GnRH”主链并受HPA/HPT轴调制抑制HPO功能，能量恢复是FHA/RED-S管理的首要目标。在中医视角下，脾胃运化可解释EA对生殖供给的影响，肾主生殖可解释轴向稳定性，阳气与肝之疏泄可解释代谢与应激对节律与甲状腺功能的干扰。以EA监测为核心的分层评估、个体化处方与多学科协作，有助于在保证安全性的前提下提高疗效与依从性。结论：运动干预的净效应取决于EA与训练负荷的动态平衡。临床上宜遵循“先能量、后负荷”的顺序，PCOS以代谢改善为先，FHA/RED-S以能量恢复为先；结合中医辨证与可检验指标，构建“评估–处方–随访”的一体化管理路径。

Abstract: Objective: To review the dual effects of exercise on female reproductive endocrinology along the energy availability (EA)-hypothalamic-pituitary-ovarian (HPO) axis; to summarize evidence in polycystic ovary syndrome (PCOS) and functional hypothalamic amenorrhea/relative energy deficiency in sport (FHA/RED-S); and to propose implementable prescribing ideas within a Traditional Chinese Medicine (TCM) theoretical framework. Methods: Literature in Chinese and English from the past 20 years was searched, with foundational studies considered. Randomized controlled trials, systematic reviews/consensus statements, and high-quality cohort studies were included. A narrative synthesis was performed without quantitative meta-analysis. Results: Moderate-intensity aerobic exercise combined with resistance training improves insulin resistance and hyperandrogenism in PCOS and promotes ovulatory recovery. Low EA suppresses HPO function primarily via the leptin/Kiss1-GnRH pathway and is further modulated by the HPA/HPT axes; energy restoration is the first-line goal in FHA/RED-S management. From a TCM perspective, spleen (digestive) function explains how EA supports reproductive supply, kidney (reproductive essence) underpins axis stability, and yang/“liver coursing” helps interpret how metabolism and stress disturb rhythm and thyroid state. An EA-centered stratified assessment, individualized prescriptions, and multidisciplinary collaboration can enhance efficacy and safety/adherence. Conclusion: The net effect of exercise depends on the dynamic balance between EA and training load. Clinically, a “energy first, load second” sequence is advised: prioritize metabolic improvement in PCOS and energy restoration in FHA/RED-S. Integrating TCM pattern differentiation with testable indicators supports an “assessment-prescription-follow-up” pathway for care.