Multiple Sclerosis, Menstrual Cycle and Physical Acivity

Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnarie. The questionnaire includes the following items: a) sleep quality (very poor [1] - very good [5]), b) sleep tranquility (very restless [1] - very calm [5]), c) ease of falling asleep (very difficult [1] - very easy [5]), d) awakenings (awakened much too early [1] - did not wake up early [3]), e) ease of awakening (very difficult [1] - very easy [5]), f) feeling of restfulness (did not rest at all [1] - completely rested [3]), and g) sleep sufficiency (no, definitely too little [1] - yes, definitely enough [5]).

Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnarie. The questionnaire includes the following items: a) sleep quality (very poor [1] - very good [5]), b) sleep tranquility (very restless [1] - very calm [5]), c) ease of falling asleep (very difficult [1] - very easy [5]), d) awakenings (awakened much too early [1] - did not wake up early [3]), e) ease of awakening (very difficult [1] - very easy [5]), f) feeling of restfulness (did not rest at all [1] - completely rested [3]), and g) sleep sufficiency (no, definitely too little [1] - yes, definitely enough [5]).

Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnarie. The questionnaire includes the following items: a) sleep quality (very poor [1] - very good [5]), b) sleep tranquility (very restless [1] - very calm [5]), c) ease of falling asleep (very difficult [1] - very easy [5]), d) awakenings (awakened much too early [1] - did not wake up early [3]), e) ease of awakening (very difficult [1] - very easy [5]), f) feeling of restfulness (did not rest at all [1] - completely rested [3]), and g) sleep sufficiency (no, definitely too little [1] - yes, definitely enough [5]).

Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnarie. The questionnaire includes the following items: a) sleep quality (very poor [1] - very good [5]), b) sleep tranquility (very restless [1] - very calm [5]), c) ease of falling asleep (very difficult [1] - very easy [5]), d) awakenings (awakened much too early [1] - did not wake up early [3]), e) ease of awakening (very difficult [1] - very easy [5]), f) feeling of restfulness (did not rest at all [1] - completely rested [3]), and g) sleep sufficiency (no, definitely too little [1] - yes, definitely enough [5]).

Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnarie. The questionnaire includes the following items: a) sleep quality (very poor [1] - very good [5]), b) sleep tranquility (very restless [1] - very calm [5]), c) ease of falling asleep (very difficult [1] - very easy [5]), d) awakenings (awakened much too early [1] - did not wake up early [3]), e) ease of awakening (very difficult [1] - very easy [5]), f) feeling of restfulness (did not rest at all [1] - completely rested [3]), and g) sleep sufficiency (no, definitely too little [1] - yes, definitely enough [5]).

Actigraphy-based sleep quality will be assessed using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK). This device employs a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower threshold of actigraphic sensitivity will be set at 80 counts/epoch. The Actiwatch sleep analysis software will be utilized. Data analysis will begin at the start of the nocturnal rest (bedtime) and conclude at the beginning of daytime activity (wake time). Sleep efficiency (%), percentage of time spent asleep, time in bed (minutes), actual sleep time (minutes), actual wake time (minutes), number of awakenings, and average duration of each awakening (minutes) will be measured

Actigraphy-based sleep quality will be assessed using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK). This device employs a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower threshold of actigraphic sensitivity will be set at 80 counts/epoch. The Actiwatch sleep analysis software will be utilized. Data analysis will begin at the start of the nocturnal rest (bedtime) and conclude at the beginning of daytime activity (wake time). Sleep efficiency (%), percentage of time spent asleep, time in bed (minutes), actual sleep time (minutes), actual wake time (minutes), number of awakenings, and average duration of each awakening (minutes) will be measured

Actigraphy-based sleep quality will be assessed using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK). This device employs a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower threshold of actigraphic sensitivity will be set at 80 counts/epoch. The Actiwatch sleep analysis software will be utilized. Data analysis will begin at the start of the nocturnal rest (bedtime) and conclude at the beginning of daytime activity (wake time). Sleep efficiency (%), percentage of time spent asleep, time in bed (minutes), actual sleep time (minutes), actual wake time (minutes), number of awakenings, and average duration of each awakening (minutes) will be measured

Actigraphy-based sleep quality will be assessed using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK). This device employs a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower threshold of actigraphic sensitivity will be set at 80 counts/epoch. The Actiwatch sleep analysis software will be utilized. Data analysis will begin at the start of the nocturnal rest (bedtime) and conclude at the beginning of daytime activity (wake time). Sleep efficiency (%), percentage of time spent asleep, time in bed (minutes), actual sleep time (minutes), actual wake time (minutes), number of awakenings, and average duration of each awakening (minutes) will be measured

Actigraphy-based sleep quality will be assessed using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK). This device employs a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower threshold of actigraphic sensitivity will be set at 80 counts/epoch. The Actiwatch sleep analysis software will be utilized. Data analysis will begin at the start of the nocturnal rest (bedtime) and conclude at the beginning of daytime activity (wake time). Sleep efficiency (%), percentage of time spent asleep, time in bed (minutes), actual sleep time (minutes), actual wake time (minutes), number of awakenings, and average duration of each awakening (minutes) will be measured

Heart rate variability (HRV) measurements will be taken using a Polar H10 heart rate sensor to record heartbeats during sleep. Analysis of HRV variables will be conducted using Kubios HRV software. Poincaré plot, time-domain, and frequency-domain analyses will be performed. Analysed time-domain variables include:: mean heart rate, mean R-R interval, standard deviation of consecutive R-R intervals, square root of the mean squared differences of successive R-R intervals, and the proportion of consecutive intervals differing by more than 50 ms. Fast Fourier Transform (FFT) will be employed to calculate frequency-domain spectral components. High-frequency (HF; 0.15-1.0 Hz) and low-frequency (LF; 0.04-0.15 Hz) power components will be computed as integrals of their respective power spectral density curves.

Heart rate variability (HRV) measurements will be taken using a Polar H10 heart rate sensor to record heartbeats during sleep. Analysis of HRV variables will be conducted using Kubios HRV software. Poincaré plot, time-domain, and frequency-domain analyses will be performed. Analysed time-domain variables include:: mean heart rate, mean R-R interval, standard deviation of consecutive R-R intervals, square root of the mean squared differences of successive R-R intervals, and the proportion of consecutive intervals differing by more than 50 ms. Fast Fourier Transform (FFT) will be employed to calculate frequency-domain spectral components. High-frequency (HF; 0.15-1.0 Hz) and low-frequency (LF; 0.04-0.15 Hz) power components will be computed as integrals of their respective power spectral density curves.

Heart rate variability (HRV) measurements will be taken using a Polar H10 heart rate sensor to record heartbeats during sleep. Analysis of HRV variables will be conducted using Kubios HRV software. Poincaré plot, time-domain, and frequency-domain analyses will be performed. Analysed time-domain variables include:: mean heart rate, mean R-R interval, standard deviation of consecutive R-R intervals, square root of the mean squared differences of successive R-R intervals, and the proportion of consecutive intervals differing by more than 50 ms. Fast Fourier Transform (FFT) will be employed to calculate frequency-domain spectral components. High-frequency (HF; 0.15-1.0 Hz) and low-frequency (LF; 0.04-0.15 Hz) power components will be computed as integrals of their respective power spectral density curves.

Heart rate variability (HRV) measurements will be taken using a Polar H10 heart rate sensor to record heartbeats during sleep. Analysis of HRV variables will be conducted using Kubios HRV software. Poincaré plot, time-domain, and frequency-domain analyses will be performed. Analysed time-domain variables include:: mean heart rate, mean R-R interval, standard deviation of consecutive R-R intervals, square root of the mean squared differences of successive R-R intervals, and the proportion of consecutive intervals differing by more than 50 ms. Fast Fourier Transform (FFT) will be employed to calculate frequency-domain spectral components. High-frequency (HF; 0.15-1.0 Hz) and low-frequency (LF; 0.04-0.15 Hz) power components will be computed as integrals of their respective power spectral density curves.

Heart rate variability (HRV) measurements will be taken using a Polar H10 heart rate sensor to record heartbeats during sleep. Analysis of HRV variables will be conducted using Kubios HRV software. Poincaré plot, time-domain, and frequency-domain analyses will be performed. Analysed time-domain variables include:: mean heart rate, mean R-R interval, standard deviation of consecutive R-R intervals, square root of the mean squared differences of successive R-R intervals, and the proportion of consecutive intervals differing by more than 50 ms. Fast Fourier Transform (FFT) will be employed to calculate frequency-domain spectral components. High-frequency (HF; 0.15-1.0 Hz) and low-frequency (LF; 0.04-0.15 Hz) power components will be computed as integrals of their respective power spectral density curves.

Heart rate variability (HRV) measurements will be taken using a Polar H10 heart rate sensor to record heartbeats during sleep. Analysis of HRV variables will be conducted using Kubios HRV software. Poincaré plot, time-domain, and frequency-domain analyses will be performed. Analysed time-domain variables include:: mean heart rate, mean R-R interval, standard deviation of consecutive R-R intervals, square root of the mean squared differences of successive R-R intervals, and the proportion of consecutive intervals differing by more than 50 ms. Fast Fourier Transform (FFT) will be employed to calculate frequency-domain spectral components. High-frequency (HF; 0.15-1.0 Hz) and low-frequency (LF; 0.04-0.15 Hz) power components will be computed as integrals of their respective power spectral density curves.

SMO2 of the right and left lateral quadriceps will be measured during sessions using a near-infrared spectroscopy system, the Moxy 3-Sensor Bundle (Fortiori Design LLC, Hutchinson, MN, USA). The average SMO2 will be calculated throughout the entire training session on both legs simultaneously.

A portable lactate analyser (Lactate Scout system, RedMed, Warsaw, Poland) which measures lactate concentration using the principle of enzymatic determination by photometric reflection will be used. During the exercise sessions, capillary blood samples from the will be collected 1) at basal level (before the protocol and warm-up); 2) 1 min post-session (1 min after the end of the last high-intensity bout), 3) 3 min post-session and 4) 30 min post-session.

The maximum oxygen consumption achieved during an incremental test to exhaustion shall be measured using an ergo-spirometer.

Bioimpedance analysis: 100 μA (1 KHz) and 500 μA (5, 5, 50, 250, 500, and 1000 kHz), and a 100-240 V

Bioimpedance analysis: 100 μA (1 KHz) and 500 μA (5, 5, 50, 250, 500, and 1000 kHz), and a 100-240 V

To determine and monitor sexual function according to the menstrual cycle hormone criteria, serum hormone concentrations will be analysed, and 17β-estradiol, progesterone, prolactin, LH, FSH, TSH and testosterone 23 before each training session.

To determine and monitor sexual function according to the menstrual cycle hormone criteria, serum hormone concentrations will be analysed, and 17β-estradiol, progesterone, prolactin, LH, FSH, TSH and testosterone 23 before each training session.

IFN-γ as a marker associated with the pathogenesis of the disease, IL-6, TNF-α as pro-inflammatory markers and IL-10, β1 (TGF-b1) as anti-inflammatory markers will be assessed. All these markers shall be assessed before and at 30 and 60 minutes immediately after the session.

IFN-γ as a marker associated with the pathogenesis of the disease, IL-6, TNF-α as pro-inflammatory markers and IL-10, β1 (TGF-b1) as anti-inflammatory markers will be assessed. All these markers shall be assessed before and at 30 and 60 minutes immediately after the session.

Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family, several studies have found associations between exercise, circulating levels of BDNF, hippocampal volume, and cognitive function in the general population 74 and neurodegenerative disorders.

Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family, several studies have found associations between exercise, circulating levels of BDNF, hippocampal volume, and cognitive function in the general population 74 and neurodegenerative disorders.

the participants will be seated in a chair, with both legs flexed at a 90 degree angle and the ankle of the tested firmly strapped to a customised device with a load cell (MuscleLab Force Sensor, Ergotest AS, Langesund, Norway). Subsequently, participants will be instructed to apply "as much force as possible, as fast as possible" on each trial. Participants will perform three maximal contractions of two seconds each, with a rest of three minutes between contractions.RFD and the time at which the value is observed will be analysed in the following ranges: 0-50 ms: RFDearly, 0-200 ms: RFDlate and peak slope: RFDpeak. The right leg will be tested first, and the repetition in which the highest peak value of each leg is observed will be analysed.

the participants will be seated in a chair, with both legs flexed at a 90 degree angle and the ankle of the tested firmly strapped to a customised device with a load cell (MuscleLab Force Sensor, Ergotest AS, Langesund, Norway). Subsequently, participants will be instructed to apply "as much force as possible, as fast as possible" on each trial. Participants will perform three maximal contractions of two seconds each, with a rest of three minutes between contractions. RFD and the time at which the value is observed will be analysed in the following ranges: 0-50 ms: RFDearly, 0-200 ms: RFDlate and peak slope: RFDpeak. The right leg will be tested first, and the repetition in which the highest peak value of each leg is observed will be analysed.

the participants will be seated in a chair, with both legs flexed at a 90 degree angle and the ankle of the tested firmly strapped to a customised device with a load cell (MuscleLab Force Sensor, Ergotest AS, Langesund, Norway). Subsequently, participants will be instructed to apply "as much force as possible, as fast as possible" on each trial. Participants will perform three maximal contractions of two seconds each, with a rest of three minutes between contractions.

the participants will be seated in a chair, with both legs flexed at a 90 degree angle and the ankle of the tested firmly strapped to a customised device with a load cell (MuscleLab Force Sensor, Ergotest AS, Langesund, Norway). Subsequently, participants will be instructed to apply "as much force as possible, as fast as possible" on each trial. Participants will perform three maximal contractions of two seconds each, with a rest of three minutes between contractions.

To measure neural drive, sEMG activity of the vastus lateralis of the right leg will be recorded during the MVIC. The preparation of the skin will involve shaving, abrasion, and cleansing with alcohol. Following SENIAM Guidelines, the upper electrode of each pair (Ambu Blue Sensor SP, Ambu A/S, Denmark) will be placed over the largest part of the vastus lateralis. Transparent paper will be used to map exact electrode placements for subsequent measurements. EMG activity will be analysed using the following time intervals: 0-50 ms (EMG 0 to 50), 0 to 200 ms (EMG 0 to 200), peak of EMG and EMG time-to-peak. The EMG peak during MVIC will represent maximal neural drive.

To measure neural drive, sEMG activity of the vastus lateralis of the right leg will be recorded during the MVIC. The preparation of the skin will involve shaving, abrasion, and cleansing with alcohol. Following SENIAM Guidelines, the upper electrode of each pair (Ambu Blue Sensor SP, Ambu A/S, Denmark) will be placed over the largest part of the vastus lateralis. Transparent paper will be used to map exact electrode placements for subsequent measurements. EMG activity will be analysed using the following time intervals: 0-50 ms (EMG 0 to 50), 0 to 200 ms (EMG 0 to 200), peak of EMG and EMG time-to-peak. The EMG peak during MVIC will represent maximal neural drive.

Two bipolar stimulating electrodes (10 × 15 cm) will be positioned and secured on the proximal and distal portions of the quadriceps of the right leg. Signal 6.0 software (CED, Cambridge, England) will control the electrical stimulation characteristics, which will be 100 Hz, 50 pulses, length 0.009 s, and interval 0.01 s. The stimulus intensity will be established at 40-50% of MVIC

Two bipolar stimulating electrodes (10 × 15 cm) will be positioned and secured on the proximal and distal portions of the quadriceps of the right leg. Signal 6.0 software (CED, Cambridge, England) will control the electrical stimulation characteristics, which will be 100 Hz, 50 pulses, length 0.009 s, and interval 0.01 s. The stimulus intensity will be established at 40-50% of MVIC

): Participants will stand with their elbows fully extended and separated from the trunk. In this position, isometric handgrip strength will be measured for 5 seconds using the electronic hand dynamometer (TL-LSC100, Trailite, Ahaus, Germany). Participants will perform three trials in each hand (right and left), and a rest interval of 60 seconds will be given between attempts. The highest value achieved will be recorded.

): Participants will stand with their elbows fully extended and separated from the trunk. In this position, isometric handgrip strength will be measured for 5 seconds using the electronic hand dynamometer (TL-LSC100, Trailite, Ahaus, Germany). Participants will perform three trials in each hand (right and left), and a rest interval of 60 seconds will be given between attempts. The highest value achieved will be recorded.

The pendulum test will be used for spasticity assessment. Metrics including the relaxation index (RI), the count of oscillations, duration of oscillations, and the extent of the first swing excursion will be computed.

The pendulum test will be used for spasticity assessment. Metrics including the relaxation index (RI), the count of oscillations, duration of oscillations, and the extent of the first swing excursion will be computed.

Gait speed will be measured using the 10-meter walk test (10-MWT), where 2 photocells (Ergotest Technology AS, Langesund, Norway) will be placed at 6 and 10 meters to record the time. Participants will perform the test as fast as possible without running, completing it twice with a 2-minute rest in between. Participants will be consistently encouraged throughout the 10-MWT. The recorded time for the slowest walking trial (in seconds) will be utilized for analysis

Gait speed will be measured using the 10-meter walk test (10-MWT), where 2 photocells (Ergotest Technology AS, Langesund, Norway) will be placed at 6 and 10 meters to record the time. Participants will perform the test as fast as possible without running, completing it twice with a 2-minute rest in between. Participants will be consistently encouraged throughout the 10-MWT. The recorded time for the slowest walking trial (in seconds) will be utilized for analysis

during the static balance measurements, participants will stand quietly on a portable force platform (Ergotest Technology AS, Langesund, Norway) while being barefoot, maintaining a shoulder-width stance, and letting their arms hang at their sides. Each participant will perform two trials lasting 30 seconds each, with both eyes open, and another two trials of the same duration with their eyes closed.

during the static balance measurements, participants will stand quietly on a portable force platform (Ergotest Technology AS, Langesund, Norway) while being barefoot, maintaining a shoulder-width stance, and letting their arms hang at their sides. Each participant will perform two trials lasting 30 seconds each, with both eyes open, and another two trials of the same duration with their eyes closed.

Participants will be positioned in an upright manner on an adjustable chair (considering lower limb length; 90º knee flexion) with arms crossed over the chest. They will be instructed to rise to a standing position as swiftly as possible. Video recording with iphone 14 will be employed to determine the conclusion of the movement when both the participant's trunk and knees are fully extended. This test will be conducted twice, and the most successful trial will be utilized for analysis.

Participants will be positioned in an upright manner on an adjustable chair (considering lower limb length; 90º knee flexion) with arms crossed over the chest. They will be instructed to rise to a standing position as swiftly as possible. Video recording with iphone 14 will be employed to determine the conclusion of the movement when both the participant's trunk and knees are fully extended. This test will be conducted twice, and the most successful trial will be utilized for analysis.

In a prompt manner, participants will transition from a seated to a standing position. They will then walk a distance of 3 meters forward, execute a turn, walk back, and resume the seated posture. This test will be repeated twice. A video recording will be used to ascertain the fastest time among the two trials, which will subsequently be used for analysis

In a prompt manner, participants will transition from a seated to a standing position. They will then walk a distance of 3 meters forward, execute a turn, walk back, and resume the seated posture. This test will be repeated twice. A video recording will be used to ascertain the fastest time among the two trials, which will subsequently be used for analysis

Participants will be instructed and familiarized with the use of the RPE scale during the familiarization phase. RPE will be assessed before, during (after each of the proposed exercises within the session), and after the training session using the Borg 6-20 RPE

Participants will be instructed and familiarized with the use of the RPE scale during the familiarization phase. RPE will be assessed before, during (after each of the proposed exercises within the session), and after the training session using the Borg 6-20 RPE

a 10-point Likert scale will be employed to evaluate pain, where 1 = no pain and 10 = unbearable pain.

a 10-point Likert scale will be employed to evaluate pain, where 1 = no pain and 10 = unbearable pain.

an algometer FPIX (Wagner's instruments, USA) will be used to quantify pain sensitivity in specific muscle regions (same anatomical areas where spasticity is measured). The algometer will be calibrated according to the manufacturer's guidelines. Participants will be instructed to indicate their initial pain threshold. The rounded tip of the algometer will ensure an even application of pressure

an algometer FPIX (Wagner's instruments, USA) will be used to quantify pain sensitivity in specific muscle regions (same anatomical areas where spasticity is measured). The algometer will be calibrated according to the manufacturer's guidelines. Participants will be instructed to indicate their initial pain threshold. The rounded tip of the algometer will ensure an even application of pressure

The percentage of body fat (%) and the kilograms of fat mass (kg) of the participants will be obtained using the ISAK method of anthropometric profiling.

The percentage of muscle mass (%) and the kilograms of muscle mass (kg) of the participants will be obtained using the ISAK method of anthropometric profiling.

The percentage of bone mass (%) and the kilograms of bone mass (kg) of the participants will be obtained using the ISAK method of anthropometric profiling.

Following the outlined schedule for dietary assessment, participants will be guided through the core elements of the "Dietary and Nutritional Monitoring Protocol."

The International Physical Activity Questionnaire (IPAQ) will be administered. The telephone short version consisting of 7 items will be utilized. This version provides information about the time spent on performing moderate and vigorous-intensity activities, time dedicated to walking, and time spent sitting during a workday. It is designed for use with young people and adults aged 15-69 years. Physical activity will be recorded in METs (Metabolic Equivalent of Task or METs Units)

The International Physical Activity Questionnaire (IPAQ) will be administered. The telephone short version consisting of 7 items will be utilized. This version provides information about the time spent on performing moderate and vigorous-intensity activities, time dedicated to walking, and time spent sitting during a workday. It is designed for use with young people and adults aged 15-69 years. Physical activity will be recorded in METs (Metabolic Equivalent of Task or METs Units)

Participants will undergo the 6-minute walk test (6-MWT), during which they will walk at their self-selected preferred speed to assess walking endurance. The testing track will be rectangular, with corners marked by cones. Participants will be allowed to rest during the test if needed, but the time will not pause during these resting periods. The total distance covered (in meters) will be recorded. An investigator will be present during the test to accompany the participants, though no conversation will occur. This test will only be performed during baseline evaluations.

The evaluation of physical self-perception will comprise six subscales aimed at gauging self-perception in various dimensions, including sports competence, physical condition, attractive body, physical strength, general physical self-perception, and general self-perception. Participants' responses will be organized using a 5-point Likert scale, with each subscale score having the potential to span from 6 to 36 points. A higher score will indicate a positive physical self-perception.

The Catastrophizing Pain Scale will be used to assess feelings of catastrophizing related to pain (such as painful experiences). Subscale scores encompassing rumination and helplessness will be examined. Each of the 13 questions will be rated on a 5-point scale, with the endpoints ranging from <0> "not at all" to <4> "all the time." A lower score will indicate minimal or no pain catastrophizing.

The perception of fatigue will be measured using the MFIS, this scale is a 21-item multidimensional questionnaire that assesses the physical, cognitive, and psychosocial effects of fatigue on a five-point ordinal scale (with a maximum total score of 84).

Participants will be filled out the Multiple Sclerosis Quality of Life-54 (MSQoL-54) questionnaire. The MSQoL-54 is a structured, self-report questionnaire comprising 14 sub-scales: physical function, physical role limitations, emotional role limitations, pain, emotional well-being, energy, health perceptions, social function, cognitive function, health distress, sexual function, satisfaction with sexual function, change in health, and overall quality of life. Two summary scores, the physical health composite summary and the mental health composite summary, can be derived from the MSQoL-54 questionnaire. Elevated scores in each subscale or summary score will indicate an improved quality of life.

The STAI will be used to measure state and trait anxiety. This questionnaire assesses and discriminates the temporary psychological state in a given situation (state anxiety; 20 items), as well as the more stable character trait of attitudes and temperaments (trait anxiety; 20 items). This questionnaire is especially useful for the diagnosis of anxiety problems in non-psychiatric patients. It is based on a 4-point Likert scale, with a range of scores on each subscale from 10 to 40 points. A higher score on each of the subscales reflects higher state or trait anxiety, respectively.

To capture thermal images, a PIR UC 605 thermographic camera (Infratec, Barcelona, Spain) will be used, equipped with an impressive infrared resolution of 640 x 480 pixels and an impressive thermal sensitivity of less than 0.06 ºC. Calibration of the camera will be conducted according to the manufacturer's recommendations, as well as recommendations from previous studies. The camera will be connected at least 30 min prior to all evaluations to allow stabilisation of its thermal sensor.

Three measurements shall be performed following the Glamorgan protocol, designed to provide accurate measurements of body thermography