Effects of Yoga on Balance, Cognition, Posture, and Body Awareness in Premenstrual Syndrome (PMS)

The Personal Information Form is a tool created by the researcher to gather data from female participants included in the study, consisting of three sections.

1. Symptoms Related to PMS

The setup is arranged such that the angle between the anterior and posterior directions is 135˚, and the angle between the posteromedial and posterolateral directions is 90˚. Participants start the test by placing their feet at the center. The individual is instructed to maintain the position of their hands on their hips, keep their feet in contact with the ground, and perform reaches in these three directions while standing on one leg. Traditionally, the test begins with the right foot in the anterior direction, followed by the left foot anterior, right foot posteromedial, left foot posteromedial, right foot posterolateral, and left foot posterolateral directions.Prior to each reach, participants perform 6 practice trials to learn the movement. They are then asked to reach in the anterior, posteromedial, and posterolateral directions three times each. The average reach distance for each direction is calculated, then divided by the leg length and multiplied by 100 to obtain the score.

The PostureScreen Mobile application is a validated and reliable tool developed for posture assessment using a camera system on devices with iOS and Android operating systems. The application allows for posture analysis by determining pivot points on photographs taken from the anterior, posterior, and lateral views of the participants. These points are calculated in centimeters and used to display postural deviation values on the phone's screen.

The difficulty level in the test is provided by increasing and decreasing the number n. The participant is expected to respond by using the specified buttons when the given stimuli are seen again in a certain order. The N-back test is used to examine working memory processes. Working memory allows information to be temporarily held in the mind with its perceptual, cognitive and emotional aspects and thus to direct behavior. Using the dual n-back task involves remembering a sequence of letters spoken simultaneously and the sequence of positions of a square and determining whether a letter or position matches the one seen before. In addition, optional extended game modes such as Triple N-Back and Arithmetic N-Back can be used for extra difficulty. It also includes features such as statistical tracking, graphics and configurability. The adaptation of the task to Turkish and its transfer to the computer environment were done by Altun and Çevik (2012).

The Jamar hand dynamometer is recommended by the American Society of Hand Therapists (ASHT) and is considered the gold standard due to its high reliability. According to the procedure, the participant will be seated on a chair without a backrest, with the arm to be evaluated positioned in adduction close to the body, the elbow flexed at 90°, and the forearm and hand in mid-rotation. The participant's hand will be placed on the dynamometer, and they will be instructed to squeeze the dynamometer with full force for three seconds without holding their breath. During this time, the evaluator will provide standard verbal cues such as "Stronger!" and "Continue!" At the end of three repetitions, the highest result will be accepted as the maximum grip strength. A 15-second rest period will be given between each trial to prevent muscle fatigue, and the grip strength will be recorded in kilograms on the data recording form.

The 5-level core stabilization test developed by Sahrmann is used to assess participants' core stability levels. Participants will be trained to follow the standard protocol by Aggarwal et al. In this study, they will start in a supine hook-lying position with the stabilizer aligned to the natural lordotic curve and inflated to 40 mmHg. After learning abdominal curling, participants must maintain abdominal pressure within a 10 mmHg deviation. To advance to the next level, pressure must not exceed a 10 mmHg deviation from 40 mmHg. If the deviation exceeds 10 mmHg, the test will end. Three attempts will be made per level, with a 1-minute rest between transitions to account for fatigue.

Cough strength will be assessed using a peak cough flow meter (PEF meter) (ExpiRite Peak Flow Meter, China) while participants are seated in a supported chair. Participants will first be instructed and shown how to cough as forcefully as possible into the PEF meter after taking a deep breath. The peak flow rate (PEF) achieved during the coughing maneuver will then be recorded. The test will be repeated at least three times, and the highest value will be recorded for analysis. A disposable mouthpiece will be used for each participant, and a 30-second rest period will be provided between measurements to prevent participant fatigue. The peak cough flow meter measures values between 60 and 800 L/min. The normal value for adults is >360 L/min. Values <270 L/min are considered indicative of ineffective coughing, and the use of cough assistive devices is recommended. If the measurement is <160 L/min, airway clearance is considered not to have occurred .

The joint position sense measurement will be conducted using a digital goniometer, targeting hip joint angles of 30°, 45°, and 60°. The test will take place in a controlled, quiet environment with participants positioned in the supine posture. To eliminate visual cues of leg movements, participants' eyes will be covered with a black band during the measurement process. When the participant's knee is in extension, the rotation center of the goniometer will be positioned at the rotation center of the knee joint. The target angle for each measurement will be stated before the test, and the specific angle will be demonstrated to the participant twice before each measurement. Following this, the participant will be asked to replicate the target angles three times, and the deviation from the target angle will be recorded for all angle values. Measurements will be taken for both lower extremities.

The Premenstrual Symptoms Impact Survey (PMSIS) was developed by Wallenstein et al. in 2008 to assess the impact of premenstrual symptoms on quality of life. It consists of six questions and uses a five-point Likert scale. The total score obtained from the scale ranges from 6 to 30, which is then converted to a score between 0 and 100. Higher scores indicate a worsening of quality of life. The validity and reliability study of the scale was conducted by Güler et al. in 2015. The Cronbach's alpha value for the scale, as determined by Güler et al., is 0.89.