Administrative information
Title {1} | Impact of menstrual cycle-based periodized training on aerobic capacity, a clinical trial study protocol—the IMPACT study |
Trial registration {2a, 2b} | ClinicalTrials.gov: NCT05697263. Registered on 25 Jan 2023 |
Protocol version {3} | Version 1.2 issue date 5 January |
Funding {4} | The Swedish Olympic Committee Oura Health Oy Folksam Research Foundation |
Author details {5a} | Linda Ekenros*1, Philip von Rosen1, Jessica Norrbom2, Hans-Christer Holmberg2,3, Carl Johan Sundberg2, Cecilia Fridén**1,4,5, Angelica Lindén Hirschberg**4,6 1: Department of Neurobiology, Care Sciences and Society. Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83 Huddinge, Sweden 2: Department of Physiology and Pharmacology, Molecular Exercise Physiology, Karolinska Institutet, 171 77 Stockholm, Sweden 3: Department of Health Sciences, Lulea University of Technology, 971 87 Lulea, Sweden 4: Department of Women’s and Children’s Health, Karolinska Institutet, 171 76 Stockholm, Sweden 5: Department of Healthcare and Welfare, Malardalens University, 721 23 Vasteras, Sweden 6: Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden * corresponding author ** shared last authorship |
Name and contact information for the trial sponsor {5b} | Investigator-initiated trial: Angelica Lindén Hirschberg (principal investigator), email: angelica.hirschberg.linden@ki.se |
Role of sponsor {5c} | This study is initiated by the authors (the investigators), and the sponsor is thereby the institution where the primary investigator is appointed: Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden. The sponsor holds the indemnity insurance and legal liability. The funders play no role in the study design; the collection, analysis, and interpretation of the data; and the writing of the manuscript. |
Introduction
Background and rationale {6a}
Objective {7}
Trial design {8}
Methods: participants, intervention, and outcomes
Study setting {9}
Eligibility criteria {10}
Inclusion criteria | Exclusion criteria |
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Females aged 18–35 years | Chronic disease |
Regular menstruation (26–32 days interval) | Neurological disorder |
Having a BMI within the interval of 19–26 kg/m2 | Musculoskeletal injury in the last 6 months |
Exercising ≤ three times/week the last 6 months | Irregular menstruation |
Being able to fulfill the intervention period | Pregnancy or lactation in the last 6 months |
Use of hormonal contraceptives the last 3 months | |
Use of regular medication for the last 3 months |
Who will take informed consent? {26a}
Additional consent provision for collection and use of participant data and biological specimens {26b}
Run-in cycle
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Early follicular phase (EFP), cycle days (CD) 3–5 (low levels of E2 and P-4)
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Late follicular phase (LFP), CD 11–13 (high levels of E2)
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Mid luteal phase (MLP), CD 20–22 (high levels of E2 and P-4)
Run-in cycle 1st visit/baseline
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A fasting blood sample of 25 ml and a urine sample will be collected in the morning between 08:00 and 10:00 AM before breakfast and after refraining from alcohol, caffeine consumption, and any intense physical activity or sports practice 24 h prior to the testing day for analysis of hormones and binding proteins.
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A light breakfast will be served.
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Physical performance tests including aerobic performance and aerobic capacity, peak power output, isokinetic muscle strength, and jumping performance will be performed.
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Body composition will be measured by dual-energy X-ray absorptiometry (DXA).
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Subjective rating of menstrual cycle-related symptoms, e.g., dysmenorrhea and PMS, will be performed every day from baseline and during the entire study period.
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Registration of daily physical activity, sleeping pattern, heart rate, and heart rate variability will be monitored by the Oura smart ring (Oura Health Ltd., Oulu, Finland).
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Muscle biopsy will be obtained under local anesthesia from the m. vastus lateralis in a subgroup of participants (n = 45). The muscle biopsies will be collected at EFP, the day after the physical assessments.
Run-in cycle 2nd visit
Run-in cycle 3rd visit
Intervention
Explanation for the choice of comparators {6b}
Intervention description {11a}
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Group A: follicular phase-based training (spinning and strength training) five sessions per week during the follicular phase (approx. 14 days) and thereafter once a week during the luteal phase (approx. 14 days)
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Group B: luteal phase-based training (spinning and strength training) once a week during the follicular phase (approx. 14 days) and thereafter five sessions per week during the luteal phase (approx. 14 days)
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Group C: regular training (spinning and strength training) three times a week throughout the study period (control group)
Criteria for discontinuing or modifying allocated intervention {11b}
Strategies to improve adherence to intervention {11c}
Relevant concomitant care permitted or prohibited during the trial {11d}
Provisions for post-trial care {30}
Outcomes {12}
The primary and secondary outcomes assessed at baseline and at follow-up at week 17
Outcome | Instrument | Domains | Unit |
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Laboratory test | |||
Time to exhaustion (TTE)* | Incremental cycle ergometer test | Aerobic capacity and exhaustion | Time in min:s |
VO2max | COSMED, incremental cycle ergometer test | Aerobic capacity, and gas exchange | ml O2/kg/min |
Submaximal VO2max | Åstrands test | Aerobic capacity | Estimated ml O2/kg/min |
4000-m cycling time trial | 4000-m cycle ergometer test | Aerobic capacity | Time in min:s |
Isokinetic muscular strength | Biodex at 60°/s | Muscular strength, knee extensors, and knee flexors | Newton meter (Nm) peak torque |
Fat mass, fat-free mass, mineral density | Dual-energy X-ray absorptiometry (DXA) | Body composition | Mass and density |
Muscle morphology | Weil-Blakesley conchotome, muscle biopsy | Muscle morphology | |
Blood markers | Blood sampling | Blood cells, genetics, biochemistry, and hormonal levels | |
Capillary blood lactate | Blood sampling | Lactate | mmol/l |
Clinical test | |||
Hop function | Countermovement jump | Explosive muscular function | Centimeters (cm) |
Questionnaires | |||
Effort perception | Borg scale | Scale number of perceived exhaustion (6–20) | |
Premenstrual symptoms | Daily Record of Severity of Problems (DRSP) | Scale number of severity (1–6) | |
Dysmenorrhea | Numerical Pain Rating Scale (NRS) | Scale number of severity (0–10) | |
Free-living assessment | |||
Numbers of daily steps | Oura smart ring | Physical activity | Numbers (n) |
Quality of sleep | Oura smart ring | Sleep pattern |