AzTrials
AzTrials

Multiple Sclerosis (MS) - Relapsing-remittingADVICE Phase 1NCT06925022

Educational Programs Based on Healthy Habits to Improve Quality of Life and Psychosocial Profile in Women With Neurodegenerative Diseases: The ADVICE Protocol Study (Phase 1)

A study testing Strength training session during Early Follicular Phase, Strength Training Protocol during Late Follicular Phase and Strength Training during Mid-Luteal Phase in people with Multiple Sclerosis (MS) - Relapsing-remitting, run by Universidad de Almeria at 1 site in Spain.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This phase of the project aims to analyze the interaction between physical exercise and the phases of the menstrual cycle, evaluating its impact on fatigue, functional capacity, and exercise perception in women with and without Multiple Sclerosis. Read more about this study

Who is it for?
Ages 18 to 50 years, women onlyHealthy volunteers can take part
What is being tested?
Strength training session during Early Follicular Phase, Strength Training Protocol during Late Follicular Phase and Strength Training during Mid-Luteal Phase
Could I receive a placebo?
No, everyone receives an active treatment
How many people
20 participants
Where
1 siteSpain
Study dates
15 Dec 2024to 30 Jun 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 50 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Women of reproductive age (18-50 years) with MS will be included, with the upper age limit adjusted to reflect the reproductive phase;.
  • No iron-deficiency anemia.
  • Stable disease phase.
  • Independent walking ability for over 10 meters.
  • Women will be recruited first and later matched with men based on age, EDSS, and lifestyle habits (physical activity, smoking, and alcohol consumption).

Who cannot join

  • Score <1 or >6 on the EDSS.
  • Report a relapse within 12 months before the study begins.
  • Have taken corticosteroid treatment within the last 2 months.
  • Have participated in a structured training program in the previous 6 months.
  • Once all women with MS are recruited, male participants will be recruited following a 1:1 matching methodology based on age, geographic region, and lifestyle habits.

Trial locations and contacts

1 site in 1 country.

Spain1 site

  • Hospital Universitario Virgen de la Arrixaca

    Murcia, Murcia, 30120

Other trials in Spain

About this study

Official title: Educational Programs Based on Healthy Habits to Improve Quality of Life and Psychosocial Profile in Women With Neurodegenerative Diseases: The ADVICE Protocol Study

This phase of the project aims to analyze the interaction between physical exercise and the phases of the menstrual cycle, evaluating its impact on fatigue, functional capacity, and exercise perception in women with and without Multiple Sclerosis. To achieve this, a controlled, single-blind, prospective, 2x3 crossover, randomized clinical trial will be conducted, involving women with Multiple Sclerosis (MS), matched by age, lifestyle habits (smoking, physical activity), and geographic location with a group of women without MS. This study, aligned with previous findings, seeks to deepen the understanding of the role of exercise in managing Multiple Sclerosis symptoms and to promote greater adherence to personalized physical activity programs adapted to the phases of the menstrual cycle.

Being tested
Strength training session during Early Follicular Phase, Strength Training Protocol during Late Follicular Phase, Strength Training during Mid-Luteal Phase
Keywords
Lifestyle Interventions, Menstrual Cycle, Multiple Sclerosis, Exercise, Cognitive-behavioral intervention, Physical Activity, Psychosocial Well-being, Nutrition intervention
Medical subject headings
Multiple Sclerosis, Relapsing-Remitting, Multiple Sclerosis, Motor Activity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Strength training session during Early Follicular PhaseOther

    The strength training sessions follow guidelines and recent meta-analyses to optimize long-term outcomes. Participants will complete a standardized warm-up protocol consisting of 5 minutes on a stationary bike, lower limb mobility exercises, and 5 repetitions at 40% of their 1-RM on each machine before each strength training session. Subsequently, they will perform four exercises for the lower limbs, including bilateral leg press, unilateral leg extension, unilateral hip extension, and plantar flexion, using conventional weight machines (. Session intensity will be set at 70-75% of 1-RM, with a volume of 4 sets of 10 repetitions, leaving 1-2 reps in reserve (RIR), and with 120 seconds of rest between sets.

    This phase occurs at the beginning of the menstrual cycle (days 2-5 after the onset of menstruation).

  • Strength Training Protocol during Late Follicular PhaseOther

    The strength training sessions follow guidelines and recent meta-analyses to optimize long-term outcomes. Participants will complete a standardized warm-up protocol consisting of 5 minutes on a stationary bike, lower limb mobility exercises, and 5 repetitions at 40% of their 1-RM on each machine before each strength training session. Subsequently, they will perform four exercises for the lower limbs, including bilateral leg press, unilateral leg extension, unilateral hip extension, and plantar flexion, using conventional weight machines (. Session intensity will be set at 70-75% of 1-RM, with a volume of 4 sets of 10 repetitions, leaving 1-2 reps in reserve (RIR), and with 120 seconds of rest between sets. This phase occurs approximately between days 11-13 of the menstrual cycle.

  • Strength Training during Mid-Luteal PhaseOther

    The strength training sessions follow guidelines and recent meta-analyses to optimize long-term outcomes. Participants will complete a standardized warm-up protocol consisting of 5 minutes on a stationary bike, lower limb mobility exercises, and 5 repetitions at 40% of their 1-RM on each machine before each strength training session. Subsequently, they will perform four exercises for the lower limbs, including bilateral leg press, unilateral leg extension, unilateral hip extension, and plantar flexion, using conventional weight machines (. Session intensity will be set at 70-75% of 1-RM, with a volume of 4 sets of 10 repetitions, leaving 1-2 reps in reserve (RIR), and with 120 seconds of rest between sets. This phase occurs around days 19-28 of the menstrual cycle, following ovulation.

Study groups in NCT06925022
Study groupRoleWhat they receive
Women with MSExperimentalThis arm will comprise women diagnosed with relapsing-remitting Multiple Sclerosis (RRMS) according to the McDonald criteria.
Receives: Other: Strength training session during Early Follicular Phase; Other: Strength Training Protocol during Late Follicular Phase; Other: Strength Training during Mid-Luteal Phase
Women without Multiple SclerosisOtherThis arm will comprise women without Multiple Sclerosis, matched with the MS group based on age, lifestyle habits, and geographic location.
Receives: Other: Strength training session during Early Follicular Phase; Other: Strength Training Protocol during Late Follicular Phase; Other: Strength Training during Mid-Luteal Phase

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Satisfaction with Physical Activity

    Satisfaction with Physical Activity will be measured using an 8-item scale. Items are rated on a 5-point Likert scale ranging from 1 (Totally disagree) to 5 (Totally agree). Total scores range from 8 to 40, with higher scores indicating greater satisfaction with physical activity.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  2. Modified Fatigue Impact Scale (MFIS)

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

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  3. Modified Fatigue Impact Scale (MFIS)

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

    Measured: Post-intervention (24 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  4. Modified Fatigue Impact Scale (MFIS)

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

    Measured: Post-intervention (48 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  5. Modified Fatigue Impact Scale (MFIS)

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

    Measured: Post-intervention (72 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  6. Visual Analogue Scale (VAS-F): Fatigue subscale

    The Visual Analogue Scale for Fatigue (VAS-F) assesses subjective perceptions of fatigue on a scale from 0 to 10, where 0 indicates no fatigue at all and 10 indicates extreme fatigue. Higher scores reflect greater perceived fatigue.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  7. Visual Analogue Scale (VAS-F): Fatigue subscale

    The Visual Analogue Scale for Fatigue (VAS-F) assesses subjective perceptions of fatigue on a scale from 0 to 10, where 0 indicates no fatigue at all and 10 indicates extreme fatigue. Higher scores reflect greater perceived fatigue.

    Measured: Post-intervention (24 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  8. Visual Analogue Scale (VAS-F): Fatigue subscale

    The Visual Analogue Scale for Fatigue (VAS-F) assesses subjective perceptions of fatigue on a scale from 0 to 10, where 0 indicates no fatigue at all and 10 indicates extreme fatigue. Higher scores reflect greater perceived fatigue.

    Measured: Post-intervention (48 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  9. Visual Analogue Scale (VAS-F): Fatigue subscale

    The Visual Analogue Scale for Fatigue (VAS-F) assesses subjective perceptions of fatigue on a scale from 0 to 10, where 0 indicates no fatigue at all and 10 indicates extreme fatigue. Higher scores reflect greater perceived fatigue.

    Measured: Post-intervention (72 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  10. Visual Analogue Scale (VAS-E): Energy subscale

    The Visual Analogue Scale for Energy (VAS-E) assesses subjective perceptions of Energy on a scale from 0 to 10, where 0 indicates no energy at all and 10 indicates maximum energy. Higher scores reflect greater perceived energy.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  11. Visual Analogue Scale (VAS-E): Energy subscale

    The Visual Analogue Scale for Energy (VAS-E) assesses subjective perceptions of Energy on a scale from 0 to 10, where 0 indicates no energy at all and 10 indicates maximum energy. Higher scores reflect greater perceived energy.

    Measured: Post-intervention (24 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  12. Visual Analogue Scale (VAS-E): Energy subscale

    The Visual Analogue Scale for Energy (VAS-E) assesses subjective perceptions of Energy on a scale from 0 to 10, where 0 indicates no energy at all and 10 indicates maximum energy. Higher scores reflect greater perceived energy.

    Measured: Post-intervention (48 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  13. Visual Analogue Scale (VAS-E): Energy subscale

    The Visual Analogue Scale for Energy (VAS-E) assesses subjective perceptions of Energy on a scale from 0 to 10, where 0 indicates no energy at all and 10 indicates maximum energy. Higher scores reflect greater perceived energy.

    Measured: Post-intervention (72 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  14. Visual Analogue Scale (VAS-P): Pain subscale

    The Visual Analogue Scale for Pain (VAS-P) assesses subjective perceptions of pain on a scale from 0 to 10, where 0 indicates no pain at all and 10 indicates worst possible pain. Higher scores reflect greater perceived pain.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  15. Visual Analogue Scale (VAS-P): Pain subscale

    The Visual Analogue Scale for Pain (VAS-P) assesses subjective perceptions of pain on a scale from 0 to 10, where 0 indicates no pain at all and 10 indicates worst possible pain. Higher scores reflect greater perceived pain.

    Measured: Post-intervention (24 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  16. Visual Analogue Scale (VAS-P): Pain subscale

    The Visual Analogue Scale for Pain (VAS-P) assesses subjective perceptions of pain on a scale from 0 to 10, where 0 indicates no pain at all and 10 indicates worst possible pain. Higher scores reflect greater perceived pain.

    Measured: Post-intervention (48 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  17. Visual Analogue Scale (VAS-P): Pain subscale

    The Visual Analogue Scale for Pain (VAS-P) assesses subjective perceptions of pain on a scale from 0 to 10, where 0 indicates no pain at all and 10 indicates worst possible pain. Higher scores reflect greater perceived pain.

    Measured: Post-intervention (72 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

Secondary outcomes (107)

  1. Muscle oxygen saturation (SMO2)

    Muscle oxygen saturation (SMO2) will be measured in both the right and left lateral quadriceps using the Moxy 3-Sensor Bundle (Fortiori Design LLC, Hutchinson, USA), allowing for the calculation of mean SMO2 across the entire training session.

    Measured: During intervention in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  2. Capillary lactate concentration

    Lactate concentration will be assessed with a lactate analyzer (Lactate Scout system, RedMed, Warsaw, Poland) using fingertip capillary blood samples.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  3. Capillary lactate concentration

    Lactate concentration will be assessed with a lactate analyzer (Lactate Scout system, RedMed, Warsaw, Poland) using fingertip capillary blood samples.

    Measured: During intervention in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  4. Heart rate variability

    HRV measurements will be taken using a Polar H10 heart rate sensor (Kempele, Finland), which will record heartbeats during sleep. The HRV variables will be analyzed using Kubios HRV software (version 3.0). The Poincaré plot and time and frequency domains will be analyzed.

    Measured: During intervention in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  5. Thyroid Stimulating Hormone (TSH)

    Serum TSH will be analyzed to assess thyroid function and hormonal regulation. Unit of measure: μIU/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  6. Interferon-gamma (IFN-γ)

    Serum levels of IFN-γ will be analyzed to assess pro-inflammatory immune response activity. Unit of measure: pg/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  7. Interferon-gamma (IFN-γ)

    Serum levels of IFN-γ will be analyzed to assess pro-inflammatory immune response activity. Unit of measure: pg/mL

    Measured: Post-intervention (30 min after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  8. Cognitive Function

    Brain-Derived Neurotrophic Factor (BDNF) is a protein involved in neuroplasticity, cognitive function, and neuronal survival, serving as a blood biomarker for brain health and adaptability

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  9. Cognitive Function

    Brain-Derived Neurotrophic Factor (BDNF) is a protein involved in neuroplasticity, cognitive function, and neuronal survival, serving as a blood biomarker for brain health and adaptability

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  10. Neurofilament Light Chain (NFL)

    Neurofilament light chain (NFL) is one of the most relevant biomarkers in multiple sclerosis (MS). The Simoa detection technique (ultrasensitive single-molecule array) allows its analysis in serum, providing both the total value and the Z-Score, enabling precise assessment of axonal damage and disease progression.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  11. Neurofilament Light Chain (NFL)

    Neurofilament light chain (NFL) is one of the most relevant biomarkers in multiple sclerosis (MS). The Simoa detection technique (ultrasensitive single-molecule array) allows its analysis in serum, providing both the total value and the Z-Score, enabling precise assessment of axonal damage and disease progression.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  12. Physical Self-Perception (PSP)

    Physical self-perception will be evaluated using the Physical Self-Perception Profile (PSPP), which includes six subscales: sports competence, physical condition, body attractiveness, physical strength, general physical self-perception, and overall self-perception. Each item is rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). Higher scores indicate more positive self-perceptions in the respective domains.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  13. Pain Catastrophizing Scale (PCS)

    Pain catastrophizing will be assessed using the Pain Catastrophizing Scale (PCS), which includes 13 items divided into three subscales: rumination, magnification, and helplessness. Participants respond using a 5-point Likert scale, ranging from 0 (not at all) to 4 (all the time). Higher scores indicate greater levels of pain catastrophizing. The total PCS score ranges from 0 to 52.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  14. Quality of Life questionnaire (MSQOL-54)

    Quality of life will be assessed using the Multiple Sclerosis Quality of Life-54 (MSQOL-54), a multidimensional health-related quality of life instrument developed specifically for individuals with multiple sclerosis. It includes 14 subscales:

    Physical Function (10-100) Role Limitations-Physical (0-100) Role Limitations-Emotional (0-100) Pain (0-100) Emotional Well-being (0-100) Energy (0-100) Health Perceptions (0-100) Social Function (0-100) Cognitive Function (0-100) Health Distress (0-100) Sexual Function (0-100) Sexual Satisfaction (0-100) Change in Health (0-100) Overall Quality of Life (0-100)

    The questionnaire also yields two composite summary scores:

    Physical Health Composite Score Mental Health Composite Score Each subscale score and composite score ranges from 0 to 100, with higher scores indicating better quality of life.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  15. State-Trait Anxiety (STAI)

    State and Trait Anxiety will be assessed using the State-Trait Anxiety Inventory (STAI), a widely used instrument developed by Spielberger et al. It consists of two subscales:

    State Anxiety (STAI-S) - evaluates how respondents feel "right now, at this moment"

    Trait Anxiety (STAI-T) - evaluates how respondents "generally feel"

    Each subscale contains 20 items, rated on a 4-point Likert scale:

    For STAI-S: from 1 (Not at all) to 4 (Very much so)

    For STAI-T: from 1 (Almost never) to 4 (Almost always)

    Scores for each subscale range from 20 to 80, with higher scores indicating greater anxiety levels.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  16. Rate of force development

    Participants will sit in a chair with both legs flexed at a 90-degree angle, and the tested ankle securely attached to a customized device with a load cell (MuscleLab Force Sensor, Ergotest AS, Langesund, Norway). They will perform three maximum contractions, each lasting 2 seconds, with 3 minutes of rest in between. The RFD will be analyzed. Testing will begin with the right leg, and the repetition with the highest recorded value for each leg will be used in the analysis

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  17. Rate of force development

    Participants will sit in a chair with both legs flexed at a 90-degree angle, and the tested ankle securely attached to a customized device with a load cell (MuscleLab Force Sensor, Ergotest AS, Langesund, Norway). They will perform three maximum contractions, each lasting 2 seconds, with 3 minutes of rest in between. The RFD will be analyzed. Testing will begin with the right leg, and the repetition with the highest recorded value for each leg will be used in the analysis

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  18. Maximum Voluntary Isometric Contraction

    Participants will sit in a chair with both legs flexed at a 90-degree angle, and the tested ankle securely attached to a customized device with a load cell (MuscleLab Force Sensor, Ergotest AS, Langesund, Norway).Participants will perform three 5-second MVIC, with 3 minutes of rest in between. Testing will always begin with the right leg, and the contraction with the highest recorded MVIC value will be used in the analysis Time Frame: Before the first training session

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  19. Maximum Voluntary Isometric Contraction

    Participants will sit in a chair with both legs flexed at a 90-degree angle, and the tested ankle securely attached to a customized device with a load cell (MuscleLab Force Sensor, Ergotest AS, Langesund, Norway).Participants will perform three 5-second MVIC, with 3 minutes of rest in between. Testing will always begin with the right leg, and the contraction with the highest recorded MVIC value will be used in the analysis Time Frame: Before the first training session

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  20. Maximal neural drive

    To measure neural drive, the electromyographic activity (sEMG) of the right leg's vastus lateralis will be recorded during the MVIC (Delsys Trigno, Delsys Inc., Boston, MA) with skin prepared and electrode positioning following SENIAM guidelines. EMG peak will be analyzed. The EMG peak during MVIC will represent the maximum neural drive

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  21. Maximal neural drive

    To measure neural drive, the electromyographic activity (sEMG) of the right leg's vastus lateralis will be recorded during the MVIC (Delsys Trigno, Delsys Inc., Boston, MA) with skin prepared and electrode positioning following SENIAM guidelines. EMG peak will be analyzed. The EMG peak during MVIC will represent the maximum neural drive

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  22. Central activation ratio

    Two bipolar electrodes (10×15 cm) will be placed on the right quadriceps, with electrical stimulation controlled by Signal 6.0 software (CED, Cambridge, England) at 100 Hz frequency, 50 pulses, 0.009 s pulse duration, and 0.01 s interval, set to 40-50% of MVIC. Central activation ratio (CAR) will be assessed through a sequence of one supramaximal twitch, a 100 Hz tetanic train, an MVIC with superimposed tetanic train, followed by a potentiated tetanic train and a potentiated supramaximal twitch. This sequence will be repeated twice with 2-minute rests, and twitch-to-tetanus ratio, MVIC peak, and maximum force values will be calculated for CAR. The CAR will be calculated using the following formula: "CAR= " "Force during MVIC" /"Force during MVIC + supramaximal stimulation"

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  23. Central activation ratio

    Two bipolar electrodes (10×15 cm) will be placed on the right quadriceps, with electrical stimulation controlled by Signal 6.0 software (CED, Cambridge, England) at 100 Hz frequency, 50 pulses, 0.009 s pulse duration, and 0.01 s interval, set to 40-50% of MVIC. Central activation ratio (CAR) will be assessed through a sequence of one supramaximal twitch, a 100 Hz tetanic train, an MVIC with superimposed tetanic train, followed by a potentiated tetanic train and a potentiated supramaximal twitch. This sequence will be repeated twice with 2-minute rests, and twitch-to-tetanus ratio, MVIC peak, and maximum force values will be calculated for CAR. The CAR will be calculated using the following formula: "CAR= " "Force during MVIC" /"Force during MVIC + supramaximal stimulation"

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  24. Upper Limb Maximum Strength

    Isometric grip strength will be measured with an electronic dynamometer (K-Force Grip, Kinvent, Montpellier, France) as participants stand with elbows extended. Each hand will perform 3 trials, with 30 seconds rest between attempts

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  25. Upper Limb Maximum Strength

    Isometric grip strength will be measured with an electronic dynamometer (K-Force Grip, Kinvent, Montpellier, France) as participants stand with elbows extended. Each hand will perform 3 trials, with 30 seconds rest between attempts

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  26. Spasticity

    The Pendulum Test is used to assess the level of spasticity by evaluating the resistance to passive movement in the affected limb. The test involves moving the limb in a pendulum-like motion and observing the fluidity of the movement, with increased resistance indicating higher spasticity levels

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  27. Spasticity

    The Pendulum Test is used to assess the level of spasticity by evaluating the resistance to passive movement in the affected limb. The test involves moving the limb in a pendulum-like motion and observing the fluidity of the movement, with increased resistance indicating higher spasticity levels

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  28. Intrinsic muscle characteristics: Tone (F)

    Tone assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition: Oscillation frequency [Hz] that characterizes the intrinsic tension of biological soft tissues at the cellular level.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  29. Intrinsic muscle characteristics: Tone (F)

    Tone assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition: Oscillation frequency [Hz] that characterizes the intrinsic tension of biological soft tissues at the cellular level.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  30. Gait speed

    Gait speed will be determined with the 10-meter walk test using two photocells (Ergotest Technology AS, Langesund, Norway) at 5 and 10 meters; participants will complete two maximum-speed trials, with the slower time recorded

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  31. Gait speed

    Gait speed will be determined with the 10-meter walk test using two photocells (Ergotest Technology AS, Langesund, Norway) at 5 and 10 meters; participants will complete two maximum-speed trials, with the slower time recorded

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  32. Static balance with eyes open

    Balance is measured with static trials on a force platform (Ergotest Technology AS, Langesund, Norway), where participants stand barefoot with arms at their sides for two 30-second trials each

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  33. Static balance with eyes open

    Balance is measured with static trials on a force platform (Ergotest Technology AS, Langesund, Norway), where participants stand barefoot with arms at their sides for two 30-second trials each

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  34. Static balance with eyes closed

    Balance is measured with static trials on a force platform (Ergotest Technology AS, Langesund, Norway), where participants stand barefoot with arms at their sides for two 30-second trials each

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  35. Static balance with eyes closed

    Balance is measured with static trials on a force platform (Ergotest Technology AS, Langesund, Norway), where participants stand barefoot with arms at their sides for two 30-second trials each

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  36. Sit-to-stand

    The sit-to-stand test requires participants to rise as quickly as possible from a seated position with 90º knee flexion and arms crossed

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  37. Sit-to-stand

    The sit-to-stand test requires participants to rise as quickly as possible from a seated position with 90º knee flexion and arms crossed

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  38. Timed Up-and-Go test

    In the Timed Up-and-Go test, participants move from sitting to standing, walk 3 meters, turn, return, and sit

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  39. Timed Up-and-Go test

    In the Timed Up-and-Go test, participants move from sitting to standing, walk 3 meters, turn, return, and sit

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  40. Delayed onset muscle soreness

    To measure delayed onset muscle soreness (DOMS), a 10-point visual analogue scale shall be used, where 1 = no pain and 10 = intolerable pain

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  41. Delayed onset muscle soreness

    To measure delayed onset muscle soreness (DOMS), a 10-point visual analogue scale shall be used, where 1 = no pain and 10 = intolerable pain

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  42. Delayed onset muscle soreness

    To measure delayed onset muscle soreness (DOMS), a 10-point visual analogue scale shall be used, where 1 = no pain and 10 = intolerable pain

    Measured: Post-intervention (24 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  43. Delayed onset muscle soreness

    To measure delayed onset muscle soreness (DOMS), a 10-point visual analogue scale shall be used, where 1 = no pain and 10 = intolerable pain

    Measured: Post-intervention (48 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  44. Delayed onset muscle soreness

    To measure delayed onset muscle soreness (DOMS), a 10-point visual analogue scale shall be used, where 1 = no pain and 10 = intolerable pain

    Measured: Post-intervention (72 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  45. Subjective Perception of Effort (RPE)

    Participants will be instructed and familiarized with the use of the Borg Rating of Perceived Exertion scale during the familiarization phase. Subjective perception of effort will be assessed before, during (after each exercise within the session), and after the training session using the Borg Rating of Perceived Exertion Scale (6-20 points). On this scale, 6 indicates "no exertion at all" and 20 indicates "maximal exertion". Higher scores represent greater perceived effort.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  46. Subjective Perception of Effort

    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 exercise within the session), and after the training session using the Borg 6-20 RPE scale

    Measured: Post-intervention (24 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  47. Subjective Perception of Effort

    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 exercise within the session), and after the training session using the Borg 6-20 RPE scale

    Measured: Post-intervention (48 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  48. Subjective Perception of Effort

    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 exercise within the session), and after the training session using the Borg 6-20 RPE scale

    Measured: Post-intervention (72 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  49. Fatigue Visual Analog Scale (VAS-F)

    The VAS-F will be used to measure fatigue. This scale, is subdivided into two subscales: fatigue and energy. The VAS-F features a 100 mm long horizontal line, with the term "none" at one end and "very severe" at the opposite end. Participants are required to mark the point on the line corresponding to their perception of the severity of fatigue between these two endpoints.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  50. Visual Analogue Scale for Fatigue (VAS-F)

    The VAS-F will be used to measure fatigue. This scale, is subdivided into two subscales: fatigue and energy. The VAS-F features a 100 mm long horizontal line, with the term "none" at one end and "very severe" at the opposite end. Participants are required to mark the point on the line corresponding to their perception of the severity of fatigue between these two endpoints.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  51. Fatigue Visual Analog Scale (VAS-F)

    The VAS-F will be used to measure fatigue. This scale, is subdivided into two subscales: fatigue and energy. The VAS-F features a 100 mm long horizontal line, with the term "none" at one end and "very severe" at the opposite end. Participants are required to mark the point on the line corresponding to their perception of the severity of fatigue between these two endpoints.

    Measured: Post-intervention (24 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  52. Fatigue Visual Analog Scale (VAS-F)

    The VAS-F will be used to measure fatigue. This scale, is subdivided into two subscales: fatigue and energy. The VAS-F features a 100 mm long horizontal line, with the term "none" at one end and "very severe" at the opposite end. Participants are required to mark the point on the line corresponding to their perception of the severity of fatigue between these two endpoints.

    Measured: Post-intervention (48 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  53. Fatigue Visual Analog Scale (VAS-F)

    The VAS-F will be used to measure fatigue. This scale, is subdivided into two subscales: fatigue and energy. The VAS-F features a 100 mm long horizontal line, with the term "none" at one end and "very severe" at the opposite end. Participants are required to mark the point on the line corresponding to their perception of the severity of fatigue between these two endpoints.

    Measured: Post-intervention (72 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  54. Body Weight

    Body weight will be measured using a calibrated digital scale. The participant will be barefoot and wearing light clothing.

    Unit of Measure: Kilograms (kg)

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  55. Physical Activity Level assessed by the International Physical Activity Questionnaire (IPAQ)

    Physical activity will be assessed using the IPAQ (short form), adapted for people with multiple sclerosis. The questionnaire captures frequency and duration of physical activity in walking, moderate, and vigorous domains over the last 7 days. MET values will be adjusted for the functional limitations commonly present in this population. Unit of Measure: MET-minutes per week

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  56. Adherence to the Mediterranean Diet assessed by MEDAS

    Adherence to the Mediterranean Diet will be assessed using the MEDAS (Mediterranean Diet Adherence Screener), a validated 14-item questionnaire designed to evaluate dietary patterns. The questionnaire measures adherence based on the consumption of key food groups associated with the Mediterranean diet. Unit of Measure: Score on the MEDAS questionnaire (range: 0-14; higher scores indicate greater adherence)

    Measured: Baseline (pre-intervention)

  57. Adherence to the Mediterranean Diet assessed by MEDAS

    Adherence to the Mediterranean Diet will be assessed using the MEDAS (Mediterranean Diet Adherence Screener), a validated 14-item questionnaire designed to evaluate dietary patterns. The questionnaire measures adherence based on the consumption of key food groups associated with the Mediterranean diet. Unit of Measure: Score on the MEDAS questionnaire (range: 0-14; higher scores indicate greater adherence)

    Measured: Post-intervention (48 hours after the last session)

  58. The Kurtzke Disability Scale

    The Kurtzke Disability Scale (EDSS) is divided into 8 functional systems (FS); four primary: pyramidal function, cerebellar function, sensory function, and brainstem function; and four secondary: sphincters, vision, mental, and others. For each FS, a severity score is provided, ranging from 0 to 6 or 7. The overall score of the scale is measured on a 20-item scale (from 0 to 10 points, increasing in half-point increments). Up to 3.5, the score obtained in each FS and the number of affected FS automatically determine the EDSS score. From 4 to 7, the definition of each level is also given by the ability to walk (ability to walk without stopping, need for assistance) Time Frame: Before the first session of the intervention program

    Measured: Baseline (pre-intervention).

  59. The Kurtzke Disability Scale

    The Kurtzke Disability Scale (EDSS) is divided into 8 functional systems (FS); four primary: pyramidal function, cerebellar function, sensory function, and brainstem function; and four secondary: sphincters, vision, mental, and others. For each FS, a severity score is provided, ranging from 0 to 6 or 7. The overall score of the scale is measured on a 20-item scale (from 0 to 10 points, increasing in half-point increments). Up to 3.5, the score obtained in each FS and the number of affected FS automatically determine the EDSS score. From 4 to 7, the definition of each level is also given by the ability to walk (ability to walk without stopping, need for assistance) Time Frame: Before the first session of the intervention program

    Measured: Post-intervention (48 hours after the last session).

  60. Subjective Sleep Quality Questionnaire

    Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnaire [73]. 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 (woke up too early [1] - did not wake up early [3]), e) ease of waking up (very difficult [1] - very easy [5]), f) feeling of rest (did not rest at all [1] - fully rested [3]), and g) sufficient sleep (no, definitely too little [1] - yes, definitely enough [5]).

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  61. Subjective Sleep Quality Questionnaire

    Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnaire [73]. 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 (woke up too early [1] - did not wake up early [3]), e) ease of waking up (very difficult [1] - very easy [5]), f) feeling of rest (did not rest at all [1] - fully rested [3]), and g) sufficient sleep (no, definitely too little [1] - yes, definitely enough [5]).

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  62. Subjective Sleep Quality Questionnaire

    Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnaire [73]. 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 (woke up too early [1] - did not wake up early [3]), e) ease of waking up (very difficult [1] - very easy [5]), f) feeling of rest (did not rest at all [1] - fully rested [3]), and g) sufficient sleep (no, definitely too little [1] - yes, definitely enough [5]).

    Time Frame: Before the first session of the intervention program

    Measured: Post-intervention (24 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  63. Subjective Sleep Quality Questionnaire

    Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnaire [73]. 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 (woke up too early [1] - did not wake up early [3]), e) ease of waking up (very difficult [1] - very easy [5]), f) feeling of rest (did not rest at all [1] - fully rested [3]), and g) sufficient sleep (no, definitely too little [1] - yes, definitely enough [5]).

    Time Frame: Before the first session of the intervention program

    Measured: Post-intervention (48 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  64. Subjective Sleep Quality Questionnaire

    Subjective sleep quality will be measured using the Karolinska Sleep Diary questionnaire [73]. 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 (woke up too early [1] - did not wake up early [3]), e) ease of waking up (very difficult [1] - very easy [5]), f) feeling of rest (did not rest at all [1] - fully rested [3]), and g) sufficient sleep (no, definitely too little [1] - yes, definitely enough [5]).

    Time Frame: Before the first session of the intervention program

    Measured: Post-intervention (72 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  65. Sleep Quality Measured by Actigraph

    Sleep quality based on actigraphy will be evaluated using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK) [74]. This device uses a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower sensitivity threshold for actigraphy will be set at 80 counts/epoch. Data analysis will begin at the start of the nighttime rest period (bedtime) and conclude at the start of daytime activity (wake-up time)

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  66. Sleep Quality Measured by Actigraph

    Sleep quality based on actigraphy will be evaluated using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK) [74]. This device uses a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower sensitivity threshold for actigraphy will be set at 80 counts/epoch. Data analysis will begin at the start of the nighttime rest period (bedtime) and conclude at the start of daytime activity (wake-up time)

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  67. Sleep Quality Measured by Actigraph

    Sleep quality based on actigraphy will be evaluated using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK) [74]. This device uses a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower sensitivity threshold for actigraphy will be set at 80 counts/epoch. Data analysis will begin at the start of the nighttime rest period (bedtime) and conclude at the start of daytime activity (wake-up time)

    Measured: Post-intervention (24 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  68. Sleep Quality Measured by Actigraph

    Sleep quality based on actigraphy will be evaluated using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK) [74]. This device uses a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower sensitivity threshold for actigraphy will be set at 80 counts/epoch. Data analysis will begin at the start of the nighttime rest period (bedtime) and conclude at the start of daytime activity (wake-up time)

    Measured: Post-intervention (48 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  69. Sleep Quality Measured by Actigraph

    Sleep quality based on actigraphy will be evaluated using the Actiwatch wGT3X-BT activity monitoring system (Cambridge Neurotechnology, Cambridge, UK) [74]. This device uses a piezoelectric accelerometer to measure activity. Participants will wear the Actiwatch on their non-dominant wrist. The lower sensitivity threshold for actigraphy will be set at 80 counts/epoch. Data analysis will begin at the start of the nighttime rest period (bedtime) and conclude at the start of daytime activity (wake-up time)

    Measured: Post-intervention (72 hours after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  70. Progesterone (PG)

    Serum progesterone levels will be measured to confirm luteal phase and ovulatory patterns. Unit of measure: ng/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  71. Luteinizing Hormone (LH)

    LH will be measured to detect the ovulatory surge and determine phase timing. Unit of measure: mIU/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  72. Follicle-Stimulating Hormone (FSH)

    FSH levels will be assessed to evaluate ovarian function. Unit of measure: mIU/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  73. Estradiol (E2)

    Serum estradiol will be analyzed to confirm hormonal variation across the menstrual cycle. Unit of measure: pg/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  74. Testosterone (T)

    Serum testosterone will be measured to examine androgen levels. Unit of measure: ng/dL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  75. Interleukin-6 (IL-6)

    Serum IL-6 will be measured to evaluate systemic inflammation. Unit of measure: pg/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  76. Interleukin-6 (IL-6)

    Serum IL-6 will be measured to evaluate systemic inflammation. Unit of measure: pg/mL

    Measured: Post-intervention (30 min after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  77. Tumor Necrosis Factor-alpha (TNF-α)

    TNF-α levels will be assessed as an indicator of inflammatory status. Unit of measure: pg/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  78. Tumor Necrosis Factor-alpha (TNF-α)

    TNF-α levels will be assessed as an indicator of inflammatory status. Unit of measure: pg/mL

    Measured: Post-intervention (30 min after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  79. Interleukin-10 (IL-10)

    IL-10 will be measured to evaluate anti-inflammatory responses. Unit of measure: pg/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  80. Interleukin-10 (IL-10)

    IL-10 will be measured to evaluate anti-inflammatory responses. Unit of measure: pg/mL

    Measured: Post-intervention (30 min after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  81. Transforming Growth Factor Beta 1 (TGF-β1)

    TGF-β1 levels will be analyzed as part of the immunomodulatory and regulatory response profile.

    Unit of measure: ng/mL

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  82. Transforming Growth Factor Beta 1 (TGF-β1)

    TGF-β1 levels will be analyzed as part of the immunomodulatory and regulatory response profile. Unit of measure: ng/mL

    Measured: Post-intervention (30 min after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  83. Intrinsic muscle characteristics: Stiffness (S)

    Stiffness assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition: dynamic stiffness (N/m) characterizes the resistance of biological soft tissues to a force of deformation

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  84. Intrinsic muscle characteristics: Stiffness (S)

    Stiffness assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition: dynamic stiffness (N/m) characterizes the resistance of biological soft tissues to a force of deformation

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  85. Intrinsic muscle characteristics: Elasticity (D)

    Elasticity assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition elasticity: logarithmic decrement (arb) characterizes the dampening of tissue oscillation.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  86. Intrinsic muscle characteristics: Elasticity (D)

    Elasticity assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition elasticity: logarithmic decrement (arb) characterizes the dampening of tissue oscillation

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  87. Intrinsic muscle characteristics: Relaxation (R)

    Relaxation assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition relaxation: Mechanical stress relaxation time (ms) characterizes tissue´s recovery time from displacement.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  88. Intrinsic muscle characteristics: Relaxation (R)

    Relaxation assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition relaxation: Mechanical stress relaxation time (ms) characterizes tissue´s recovery time from displacement.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  89. Intrinsic muscle characteristics: Creep (C)

    Creep assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition creep: ratio of relaxation and deformation time (arb) characterizes creep, the gradual elongation of tissue over time when placed under constant tensile stress.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  90. Intrinsic muscle characteristics: Creep (C)

    Creep assessed with MyotonPRO (MyotonPRO, Myoton AS, Estonia). Definition creep: ratio of relaxation and deformation time (arb) characterizes creep, the gradual elongation of tissue over time when placed under constant tensile stress.

    Measured: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  91. Height

    Height will be measured using a wall-mounted stadiometer with the participant barefoot and standing upright.

    Unit of Measure: Meters (m)

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  92. Body Mass Index (BMI)

    BMI will be calculated as weight in kilograms divided by the square of height in meters (kg/m²). Body weight and height will be assessed using a calibrated digital scale and stadiometer, respectively.

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  93. Physical Activity Level assessed by Triaxial Accelerometer

    Objective physical activity will be measured using a triaxial accelerometer, which captures movement in three planes (vertical, lateral, and anterior-posterior). Variables include time spent in light, moderate, and vigorous physical activity, as well as step count. This tool enables detailed quantification of low-intensity movements common in individuals with MS. Unit of Measure: Minutes per day in activity categories; steps per day

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  94. Nutrient Intake assessed by 3-Day Food Diary

    Dietary intake will be assessed using a 3-day food diary, including two weekdays and one weekend day. Participants will record all food and beverages consumed, and a registered dietitian will analyze macronutrient and micronutrient intake using nutrition software. Unit of Measure: Daily intake in grams (carbohydrates, proteins, fats) and milligrams/micrograms (vitamins, minerals), as appropriate

    Measured: Baseline (pre-intervention)

  95. Nutrient Intake assessed by 3-Day Food Diary

    Dietary intake will be assessed using a 3-day food diary, including two weekdays and one weekend day. Participants will record all food and beverages consumed, and a registered dietitian will analyze macronutrient and micronutrient intake using nutrition software. Unit of Measure: Daily intake in grams (carbohydrates, proteins, fats) and milligrams/micrograms (vitamins, minerals), as appropriate

    Measured: Post-intervention (48 hours after the last session)

  96. Lean Mass (%)

    Lean mass will be evaluated using BIA and DXA, both for the entire body and segmentally (arms, legs, trunk). Unit of Measure: %

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  97. Lean Mass (kg)

    Lean mass will be evaluated using BIA and DXA, both for the entire body and segmentally (arms, legs, trunk). Unit of Measure: kilograms

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  98. Bone Mineral Content (BMC)

    Bone Mineral Content will be measured using DXA, both globally and at specific body segments (e.g., spine, hips, limbs). BMC indicates the total mineral content in bones and is essential for assessing bone health in MS. Unit of Measure: Grams (g)

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  99. Bone Mineral Density (BMD)

    Bone Mineral Density will be assessed with DXA, capturing whole-body and segmental (lumbar spine, femoral neck, etc.) density in g/cm². BMD reflects bone strength and fracture risk.

    Unit of Measure: g/cm²

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  100. Body Water

    Total body water will be measured using BIA, evaluating both intracellular and extracellular compartments. Segmental analysis (e.g., limbs and trunk) will also be included to reflect fluid distribution patterns. Unit of Measure: Liters (L)

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  101. Phase Angle

    Phase angle will be assessed with BIA for both total and segmental body regions. It reflects cellular health and membrane integrity, and is an important marker of nutritional and physiological status in MS patients. Unit of Measure: Degrees (°)

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  102. Heart rate variability

    HRV measurements will be taken using a Polar H10 heart rate sensor (Kempele, Finland), which participants will be instructed to wear when going to bed. The sensor will record heartbeats during sleep, and the data will be analyzed using Kubios HRV software (version 3.0). The Poincaré plot and time and frequency domains will be analyzed.

    Measured: Post-intervention (first night) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  103. Heart rate variability

    HRV measurements will be taken using a Polar H10 heart rate sensor (Kempele, Finland), which participants will be instructed to wear when going to bed. The sensor will record heartbeats during sleep, and the data will be analyzed using Kubios HRV software (version 3.0). The Poincaré plot and time and frequency domains will be analyzed.

    Measured: Post-intervention (24 hours after, i.e., the second night) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  104. Heart rate variability

    HRV measurements will be taken using a Polar H10 heart rate sensor (Kempele, Finland), which participants will be instructed to wear when going to bed. The sensor will record heartbeats during sleep, and the data will be analyzed using Kubios HRV software (version 3.0). The Poincaré plot and time and frequency domains will be analyzed.

    Measured: Post-intervention (48 hours after, i.e., the third night) in each menstrual phase: early follicular (Days 2-5), late follicular (Days -2 to 0, LH peak), and mid-luteal (Days 6-9 after LH peak).

  105. Heart rate variability

    HRV measurements will be taken using a Polar H10 heart rate sensor (Kempele, Finland), which participants will be instructed to wear when going to bed. The sensor will record heartbeats during sleep, and the data will be analyzed using Kubios HRV software (version 3.0). The Poincaré plot and time and frequency domains will be analyzed.

    Measured: Post-intervention (72 hours after, i.e., the fourth night) in each menstrual phase: early follicular (Days 2-5), late follicular (Days -2 to 0, LH peak), and mid-luteal (Days 6-9 after LH peak).

  106. Fat Mass (kg)

    Fat mass will be measured using bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). Both whole-body and segmental (arms, legs, trunk) fat mass will be assessed. Unit of Measure: Kilograms

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

  107. Fat Mass (%)

    Fat mass will be measured using bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA). Both whole-body and segmental (arms, legs, trunk) fat mass will be assessed. Unit of Measure: %

    Measured: Pre-intervention (immediately before) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Apr 2025
  2. Study start15 Dec 2024
  3. Primary completion30 May 2026
  4. Study completion30 Jun 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Crossover
Model description
Women with and without multiple sclerosis will participate in a strength training session during three phases of the menstrual cycle: early follicular phase, late follicular phase, and mid-luteal phase. Before and after each session, various measurements will be taken to assess physiological and performance responses.
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
20 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06925022
Sponsor's protocol ID
UALBIO2021/026
Other IDs
PID2021-123447OA-I00
Acronym
ADVICE Phase 1
Status last verified
Jul 2026
First submitted
20 Feb 2025
Last updated
29 Jul 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Strength training session during Early Follicular Phase, Strength Training Protocol during Late Follicular Phase and Strength Training during Mid-Luteal Phase in people with Multiple Sclerosis (MS) - Relapsing-remitting, run by Universidad de Almeria at 1 site in Spain.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Spain. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Satisfaction with Physical Activity (time frame: Post-intervention (immediately after) in each menstrual phase: Early follicular (Days 2-5), Late follicular (Days -2 to 0, LH peak), and Mid-luteal (Days 6-9 after LH peak).). The study lists 17 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06925022.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jul 2026.

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