Content uploaded by Sheetal Kalra
Author content
All content in this area was uploaded by Sheetal Kalra on Dec 09, 2024
Content may be subject to copyright.
Content uploaded by Sheetal Kalra
Author content
All content in this area was uploaded by Sheetal Kalra on Oct 19, 2023
Content may be subject to copyright.
Content uploaded by Sheetal Kalra
Author content
All content in this area was uploaded by Sheetal Kalra on Oct 19, 2023
Content may be subject to copyright.
S301
© 2024 Medical Journal of Dr. D.Y. Patil Vidyapeeth | Published by Wolters Kluwer - Medknow
Introduction: The MC’s phases have been shown to inuence various physiological
and psychological aspects, yet their potential impact on physical performance and
psychological well‑being remains less explored. This research study investigates
the intricate interplay between functional capacity, fatiguability, anxiety level,
and static and dynamic balance in young adult females across the MC’s early
follicular and mid‑luteal phases. Materials and Methods: A cross‑sectional
study where 46 healthy eumenorrheic females aged 19–24 years were recruited.
Participants underwent various tests (six‑minute walk test (6MWT), single leg
stance test, and lower quarter Y balance test) and scales (Zung self‑rating anxiety
scale and fatigue severity scale (FSS)) during both the follicular and luteal phases
in a single menstrual cycle (MC). Results: Preliminary ndings suggest that
functional capacity, fatiguability, anxiety levels, and static and dynamic balance
show statistically signicant dierences (P < 0.01), exhibiting improvement
in the mid‑luteal phase as compared to the early follicular phase. A signicant
negative correlation exists between FSS score and 6MWT distance in the early
follicular (r = ‑0.441, P < 0.001) and mid‑luteal phase (r = ‑0.439, P < 0.01).
There is a signicant positive correlation between FSS score and SAS score
during the early follicular (r = 0.479, P < 0.001) and mid‑luteal phase (r = 0.496,
P < 0.01). Conclusion: The relationship between these parameters during the MC
holds implications for optimizing training regimens, injury prevention strategies,
and psychological support tailored to the unique needs of female athletes and
active individuals.
Anxiety, dynamic balance, fatigue, follicular phase, functional
capacity, luteal phase, menstrual cycle, static balance
Relationship between Functional Capacity, Fatiguability, Anxiety Level,
Static, and Dynamic Balance in Young Adult Females During Follicular
and Luteal Phase of Menstrual Cycle
Gauri Sharma, Neha Kumari, Richa H. Rai, Sheetal Kalra, Kashika Bhatia, Tabassum Saher
Access this article online
Quick Response Code:
Website:
https://journals.lww.com/mjdy
DOI:
10.4103/mjdrdypu.mjdrdypu_680_23
Address for correspondence: Prof. Richa H. Rai,
School of Physiotherapy, Delhi Pharmaceutical Sciences and
Research University, Delhi, India.
E‑mail: richarai@dpsru.edu.in
be attributed to a range of factors, including anatomical,
physiological, endocrinological, and psychological
elements. Among these, the menstrual cycle (MC)
holds particular prominence in understanding these
distinctions.
There is a dierence in physical health and health
tness status of females during dierent phases of
Original Article
The participation of women in various sports
activities, whether at amateur or professional levels,
has witnessed an increase. According to the International
Olympic Committee (2023), women’s participation in
sports has grown over the years from just over 13%
at the 1964 Games in Tokyo to more than 48% female
athletes at 2020 Games in Tokyo. As the involvement of
women in sports continues to grow, the exploration of
gender‑related distinctions in exercise performance and
progression has gained signicance. Dierences in the
physical performances of male and female athletes can
School of Physiotherapy,
Delhi Pharmaceutical
Sciences and Research
University, Delhi, India
How to cite this article: Sharma G, Kumari N, Rai RH, Kalra S, Bhatia K, Saher T.
Relationship between functional capacity, fatiguability, anxiety level, static,
and dynamic balance in young adult females during follicular and luteal phase
of menstrual cycle. Med J DY Patil Vidyapeeth 2024;17:S301-7.
This is an open access journal, and arcles are distributed under the terms of the Creave
Commons Aribuon‑NonCommercial‑ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is
given and the new creaons are licensed under the idencal terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
Submission: 21‑08‑2023,
Decision: 29‑12‑2023,
Acceptance: 01‑01‑2024,
Web Publication: 27‑11‑2024
Downloaded from http://journals.lww.com/mjdy by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 12/09/2024
Sharma, et al.: Functional capacity, fatigability, anxiety and balance during phases of menstrual cycle
S302 Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
MC. Because of the inuence of distinct hormones
across various phases of the MC, females are prone to
experiencing uctuations in their exercise performance
capabilities across these phases.[1] Several studies have
reported dierences in performance,[2,3] while others
have reported that exercise performance did not dier
during the phases of the MC.[4,5]
Cardiorespiratory tness holds a signicant position
in maintaining overall health and is integral to the
execution of functional tasks. The uctuation in physical
performance throughout the MC is believed to arise from
diverse mechanisms including, altered kinesthetic chain
activation and muscle work, endocrine‑metabolic milieu
of the body. Variations in concentrations of female sex
hormones could potentially account for shifts in force
generation, potentially impacting muscle strength and
power.[6]
Emotional and physical changes have a huge impact
on the activities of daily living of females. In contrast
to men, women tend to report a higher occurrence of
fatigue and chronic fatigue syndrome. Additionally, they
have a heightened likelihood—up to twice as much—
of encountering psychiatric disorders characterized by
fatigue, including conditions like generalized anxiety
disorder.[7] It is reasonable to consider that self‑reported
fatigue could vary throughout the MC. Furthermore,
the alteration of anxiety symptoms in relation to the
MC remains a relatively unexplored phenomenon,
emphasizing the necessity for additional research in this
area.[8]
It is possible to view MC as a signicant variable
that could impact postural control. Static and dynamic
balance along with the feedback and feedforward
physiological responses in the body help to initiate and
complete the tasks during activities of daily livings.
Both static and dynamic postural control are essential
for successfully performing tasks in daily activities. To
date, only a limited number of studies have investigated
the inuence of female gonadal hormone concentrations
on static and dynamic balance across various phases of
the MC.[9]
Based on this argument, MC may in fact inuence
exercise performance and functional outcomes in the
female population. However, research on the impact of
MC on exercise performance has produced a variety of
contradictory ndings.
If results show aection for quality of life, it can be
recommended to the healthcare policymakers to provide
health tness during that phase of the MC and create
awareness. If there is a signicant change in functional
capacity, fatiguability, static and dynamic balance,
as well as anxiety levels of females during follicular
and luteal phases of MC, it is important to take into
consideration while prescribing exercise regimens
for healthy women or when they engage in sport and
recreational activities.
It is crucial to understand whether these cyclical
variations brought on by hormonal inuences have any
impact on a woman’s day‑to‑day activities, i.e. physical
work capacity, in order to prevent any potential negative
repercussions. So, the present study intends to evaluate
various physical and psychological factors like functional
capacity, fatiguability, anxiety level, static and dynamic
balance during the early follicular and mid‑luteal phases
of the MC. In addition, the majority of research studies
that investigate the eect of MC on performance use
athletes as the sample population. For this purpose, this
study aimed to determine the relationship of MC phases
on physical health tness and psychological health
parameters in healthy non‑athletic young adult females.
Participants, setting, and study design
A cross‑sectional study was approved by DPSRU’s
Research Review Development Committee (10/801/
PT/DPSRU/2022/20319) and was conducted between
March and June 2023 in Delhi Pharmaceutical Sciences
and Research University, New Delhi, using a sample
of 46 females, who were recruited using convenience
sampling. Participants were selected on the basis of
an inclusion criteria of being non‑athletic healthy
eumenorrheic females aged 19–24 years and exclusion
criteria of subjects being: use of oral contraceptive pills
in the last six months, history of pregnancy in the past
six months, history of a major surgery that may hamper
with the physical tness of the subject, having no major
neurological or cardiovascular event in the past year,
any known psychological disorder, and smoking, alcohol
consumption, and drug intake in the past six months.
Data collection
An informed consent was obtained from all subjects
before the commencement of the study. The length of the
MC for each participant was determined by averaging the
length of her last six MCs, which allowed us to dene
the phases of the MC. Then, dates for the follicular and
luteal phases of the upcoming MC for every participant
were calculated. Data was collected in the two phases,
that is, the early follicular phase (1st–5th day of the MC)
and the mid‑luteal phase (20th–24th day of the MC), of
the same MC.
Data was then collected using 6MWT (functional
capacity), fatigue severity scale (FSS) (fatiguability),
Zung self‑rating anxiety scale (anxiety levels), single leg
Downloaded from http://journals.lww.com/mjdy by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 12/09/2024
Sharma, et al.: Functional capacity, fatigability, anxiety and balance during phases of menstrual cycle
S303
Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
stance test (static balance), and lower quarter Y balance
test (dynamic balance).
The six‑minute walk test (6MWT) was conducted in
accordance with the guidelines set out by the American
Thoracic Society. It consists of walking back and forth
on a 30 m course. The distance walked is rounded to the
nearest meter. FSS is a nine‑item scale that measures the
severity of fatigue and its eect on a person’s activities
and lifestyle.[10] Zung self‑rating anxiety scale (SAS)
is a self‑report scale whose 20 items cover a variety
of anxiety symptoms, both psychological and somatic
in nature.[11] Single leg stance test (SLS) consists of
standing barefoot and unassisted on one leg with eyes
open and hands on the hips. Test is measured in seconds
from the moment the non‑testing limb is lifted from the
ground until it touches the ground again or the arms
leave the hips. Lastly, in the lower quarter Y balance
test (YBT), participants are asked to stand barefoot
on the center of a Y (made with non‑transparent tape,
with the angles between the anterior stripe and both
posterior stripes being 135°, with 45° between the two
posterior stripes) where all the lines intersected.[12] Then
they maintain their balance on one leg while reaching
as far as possible with the contralateral leg in each
direction, i.e. right anterior (RA), left anterior (LA),
right posteromedial (RPM), left posteromedial (LPM),
right posterolateral (RPL), and left posterolateral (LPL),
with both the lower limbs, with hands placed rmly at
their hips.
Data analysis
The SPSS version 24.0 software (IBM SPSS, Inc.,
Chicago, IL, USA) was used for statistical analysis.
A paired t‑test analysis was used to compare the data
during the early follicular and mid‑luteal phases. The
P < 0.05 was considered as signicant.
Pearson’s correlation coecient was also calculated for
understanding the relationship of the outcome measures
within the phases.
The demographic characteristics are depicted in Table 1.
Normality was established, and correlation was
established between the outcome measures of within
subjects. The means and the standard deviations of
the variables and comparison of the variables in the
two phases, i.e., early follicular (eFP) and mid‑luteal
phases (mLP), are depicted in Table 2.
Statistically signicant dierence (P < 0.01) was seen
within the groups, i.e., between eFP and mLP for all the
variables under study as analyzed by using paired t‑test.
As seen in the correlation matrix Tables 3 and 4, the
study shows that there is a statistically signicant
and low negative correlation between FSS score and
6MWT distance in the early follicular phase (r = ‑0.441,
P < 0.001) and mid‑luteal phase (r = ‑0.439, P < 0.01).
This suggests that as FSS score reduces, the performance
on 6MWT would improve during the respective phases.
Also, there is a statistically signicant and low positive
correlation between FSS score and anxiety score during
the early follicular phase (r = 0.479, P < 0.001) and
mid‑luteal phase (r = 0.496, P < 0.01). This suggests
that as fatiguability increases, the anxiety of the subject
also increases during the respective phases.
The Y balance test score for right and left leg showed
positive correlation respectively as seen in the
correlation matrix Tables 3 and 4 in both the phases.
Also, posteromedial and posterolateral scores also
correlated positively and signicantly.
During the MC phases, there occur various changes in
the hormonal levels in the female body, the major ones
being estrogen and progesterone (low estrogen and
low progesterone in eFP and, high estrogen and high
progesterone in mLP). In this study, we have tried to
analyze if these hormonal changes in dierent phases of
the MC, eFP, and mLP, in particular, aect functional
capacity, fatiguability, anxiety levels, and static and
dynamic balance in young adult females.
While many previous studies report varying exercise
performance across MC phases, an equal number of
studies conclude that no such variation exists. The
present study which was done on untrained females
shows highly signicant variation (P < 0.001) in
physical and psychological health parameters between
the two phases of the MC.
A comprehensive review of 51 studies by
McNulty et al.[13] suggests that exercise performance
might slightly decrease during the eFP compared to
other phases. They propose several mechanisms through
which lower estrogen and progesterone levels during
the eFP might negatively impact exercise performance:
estrogen, known for its anabolic eects,[14] regulates
substrate metabolism, oers antioxidant and membrane
stabilizer properties,[15] and enhances voluntary
Table 1: Demographic data of the participants
Parameters Minimum Maximum Mean SD
Age (year) 19 24 21 1.193
Height (cm) 147 170 159.496 5.7081
Weight (kg) 40 87 54.837 11.1395
BMI (kg/m2) 14.7 34.2 21.494 3.8445
Downloaded from http://journals.lww.com/mjdy by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 12/09/2024
Sharma, et al.: Functional capacity, fatigability, anxiety and balance during phases of menstrual cycle
S304 Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
activation.[16] These functions suggest that uctuations
in estrogen levels during dierent MC phases could
inuence muscular and exercise performance. Moreover,
progesterone’s anti‑estrogenic eects[17] might amplify
estrogen’s benets during the late follicular and
ovulatory phases when estrogen is high without the
interference of progesterone, compared to the mid‑luteal
phase when both estrogen and progesterone are high.
Functional capacity is dependent on the integrated
functioning of the pulmonary, cardiovascular, and skeletal
muscle systems, which is essential for activities requiring
prolonged aerobic metabolism.[18] The present study
observes a signicant increase in 6MWT distance during the
mLP, indicating improved functional capacity during that
phase as compared to eFP. McNulty et al. in their review,
concluded that aerobic capacity decreased minimally in the
eFP as compared to the other phases, which is consistent
with the results of this study. However, some studies
found no signicant eect of changing hormonal levels
on aerobic capacity.[19] Although there is conicting data
to date, the combined eects of the female sex steroid
hormones on substrate metabolism may theoretically alter
aerobic endurance. which can be attributed to higher levels
of muscle glycogen or lower blood lactate levels.[20]
Table 2: Comparison of the variables in eFP and mLP of MC in young adult females
Variables eFP Mean (SD) mLP Mean (SD) tSig. (2‑tailed)
FSS 3.49 (1.22) 2.79 (1.07) 0.70 4.68 0.000
SAS 43.07 (9.42) 36.09 (9.12) 6.98 5.88 0.000
6MWT 496.54 (87.14) 543.65 (87.15) ‑47.11 ‑4.54 0.000
SLS 61.82 (34.84) 74.43 (38.76) ‑12.61 ‑5.53 0.000
YBT_RA 62.03 (6.52) 65.94 (6.86) ‑3.91 ‑6.13 0.000
YBT_LA 63.35 (6.56) 65.55 (6.73) ‑2.20 ‑3.83 0.000
YBT_RPM 73.22 (14.19) 81.73 (11.16) ‑8.51 ‑6.81 0.000
YBT_LPM 72.29 (13.21) 80.12 (10.60) ‑7.83 ‑5.72 0.000
YBT_RPL 84.04 (14.59) 87.35 (12.08) ‑3.30 ‑3.07 0.004
YBT_LPL 82.54 (14.34) 87.01 (11.46) ‑4.48 ‑4.44 0.000
Table 3: Correlation matrix table between variables in eFP
FSS_P1 SAS_
P1
6MWT_
P1
SLS_
P1
YBT_
RA_P1
YBT_
LA_P1
YBT_
RPM_P1
YBT_
LPM_P1
YBT_
RPL_P1
YBT_
LPL_P1
FSS_P1 1 0.479** ‑0.441** 0.108 0.181 0.051 0.174 0.133 0.260 0.373*
SAS_P1 1 ‑0.152 0.207 0.050 0.043 0.022 ‑0.028 0.024 0.069
6MWT_P1 1 0.248 ‑0.189 ‑0.154 ‑0.227 ‑0.226 ‑0.073 ‑0.072
SLS_P1 1 0.216 0.291* 0.186 0.121 0.230 0.202
YBT_RA_P1 1 0.897** 0.310* 0.332* 0.258 0.361*
YBT_LA_P1 1 0.262 0.328* 0.153 0.265
YBT_RPM_P1 1 0.886** 0.575** 0.616**
YBT_LPM_P1 1 0.491** 0.563**
YBT_RPL_P1 1 0.851**
YBT_LPL_P1 1
Table 4: Correlation matrix table between variables in mLP
FSS_
P2
SAS_
P2
6MWT_
P2
SLS_P2 YBT_
RA_P2
YBT_
LA_P2
YBT_
RPM_P2
YBT_
LPM_P2
YBT_
RPL_P2
YBT_
LPL_P2
FSS_P2 1 0.496** ‑0.439** 0.161 0.238 0.296* 0.292* 0.180 0.414** 0.329*
SAS_P2 1 ‑0.181 0.199 0.085 0.068 0.259 0.137 0.311* 0.094
6MWT_P2 1 0.217 ‑0.110 ‑0.140 ‑0.021 0.105 ‑0.003 0.085
SLS_P2 1 0.364* 0.251 0.334* 0.159 0.226 0.251
YBT_RA_P2 1 0.850** 0.243 0.220 0.286 0.276
YBT_LA_P2 1 0.313* 0.274 0.317* 0.339*
YBT_RPM_P2 1 0.815** 0.532** 0.485**
YBT_LPM_P2 1 0.492** 0.456**
YBT_RPL_P2 1 0.843**
YBT_LPL_P2 1
**Correlation is signicant at the 0.01 level (2‑tailed). *Correlation is signicant at the 0.05 level (2‑tailed)
Downloaded from http://journals.lww.com/mjdy by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 12/09/2024
Sharma, et al.: Functional capacity, fatigability, anxiety and balance during phases of menstrual cycle
S305
Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
Static and dynamic balance signicantly dier between
eFP and mLP in this study. Improved balance during
the mLP could be attributed to two factors. Firstly,
changes in central nervous system function due to
estrogen and progesterone uctuations during MC. The
homeostasis of labyrinthine uids may be compromised
by hormonal changes, which could aect the balance.[21]
Secondly, variations in connective tissue elasticity are
driven by hormonal changes.[22,23] The synthesis of
collagen during MC phases is inuenced by estrogen,
which may compromise joint laxity.[24] The result of the
current study is consistent with the previous literature;[25]
however, there are studies in which no change in static
and dynamic balance was observed during dierent
phases of the MC.[26,27]
Understanding the psychological impact of MC on
females is just as important as analyzing the dierent
ways they are aected physically. In the present study,
there was remarkable improvement noted in fatigue
severity scale (FSS) (fatigability), zung self rating anxiety
scale (anxiety levels) (SAS) during mLP in comparison
with eFP. Women commonly report more fatigue and
are more prone to conditions featuring fatigue.[7] In a
study conducted by Pallavi LC et al.,[28] the fatigue rate
expressed as a percentage was highest during the eFP
among other phases. The researchers attributed this to
the psychological makeup of the subjects, noting that
the subjects’ performance was negatively impacted by
the bleeding itself since they were predisposed to nd
it distressing. As blood loss may also have an impact on
the same, it can also be related to physical performance.
The researchers linked this to the psychological of the
subjects, noting that the subjects’ performance was
negatively impacted by the bleeding itself since they
were predisposed to nd it distressing. Since blood loss
may also have an impact on physical performance, it is
also relevant to that.
Sophie H Li et al.[29] stated that periods of low sex
hormones intensify anxious symptoms. The role of
estrogen in the metabolism of serotonin may be the
cause of heightened feelings of fatigue and anxiety
during the early follicular phase. A decreased estrogen
concentration facilitates higher serotonin metabolism,
and lower levels of serotonin therefore have a
detrimental eect.[30] This could contribute to increased
stress during phases of low estrogen levels. A study
on 13 healthy females found that decreased levels of
serotonin were associated with participants’ increased
perception of tension anxiety and fatigue in the late
luteal phase, suggesting that reduced estrogen levels
were accountable for this serotonin decrease.[31] It is
possible that serotonin levels and fatigue are elevated
during the early follicular phase since estrogen levels
remain relatively low during this time.
While the initial impression might lean towards
perceiving these outcomes as unfavorable, the
variations in reproductive hormones actually oer
signicant benets. The absence of a regular MC
can have detrimental eects on bone health, cortisol
levels, neuromuscular health, and cardiovascular risk.
Moreover, despite a higher occurrence of ACL ruptures
among females compared to males, they encounter fewer
muscular injuries.[32] To prevent injuries, female athletes
should incorporate stability exercises into their training
regimen, regardless of their MC phase.
Given the signicant variability in how the MC aects
physical and psychological health parameters among
individuals, it is crucial for each woman to monitor her
responses and document the times when she performs
optimally. Recognizing and comprehending the MC’s
impact can lead to optimized training strategies and
improved performance outcomes. Females should
be educated about the MC’s relation to performance
parameters and psychological well‑being, the
considerable individual variability, and the potential
therapeutic approaches. By tailoring training regimens
to align with these hormonal changes, females can
capitalize on their body’s natural tendencies and make
informed decisions about training intensity and recovery
strategies.
Limitations
In this study, evaluation of hormonal levels was not
done which would have signicantly enhanced the
dierentiation of various MC phases. Techniques like
serum tracking and proling, and ovulation kits, which
had demonstrated eectiveness in prior investigations,
might be better options for detecting the precise timing
of MC phases; but we could not use these techniques
due to the limited resources.
Future scope
Longitudinal studies with larger sample sizes that
incorporate hormonal measurements and tracking across
the cycle could provide a more nuanced understanding
of these dynamics. In future studies, it’s important that
the research follows the latest recommendations by
examining outcomes across three distinct phases: early
follicular, ovulatory, and mid‑luteal. These phases oer
distinct hormonal environments, increasing the chances
of spotting uctuations. Notably, there’s a lack of
research focused on untrained collegiate, elite athletes,
and eld‑based team sports. Thus, further research in
these groups could ll this gap in the literature. Other
gaps in the literature pertaining to the eectiveness of
Downloaded from http://journals.lww.com/mjdy by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 12/09/2024
Sharma, et al.: Functional capacity, fatigability, anxiety and balance during phases of menstrual cycle
S306 Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
frequently employed ergogenic aids across the MC,
the impact of MC phases on agility performance, and
performance variations under diverse environmental
conditions.
This study underscores the interconnectedness of
physical and psychological well‑being across MC
phases. Interventions should address the eect of
hormonal uctuations on performance, tailoring
strategies to enhance functional capacity and alleviate
anxiety. Young women with higher fatiguability exhibit
elevated anxiety, suggesting a link between physical
fatigue and psychological distress. This connection
should inform interventions targeting endurance and
resilience. Notably, MC‑related changes can inuence
exercise performance, necessitating consideration in
training and rehabilitation. Women should be aware of
injury risks during specic MC phases in sports. While a
universal blueprint is unlikely due to individual variation,
understanding hormonal eects can guide personalized
exercise, psychological support, and wellness strategies
for optimized performance and mental well‑being.
Availability of data and materials
The datasets used and/or analyzed during the current
study are available from the corresponding author on
reasonable request.
Authors contributions
GS: conceptualization, data collection, methodology,
resources, roles/writing‑original draft, writing‑review,
and editing
NK and TS: conceptualization, original draft review
RR: statistical analysis, report writing and editing,
manuscript editing and review
SK: manuscript preparation and editing
KB: conceptualization, data collection, manuscript
review
All authors read and approved the nal manuscript
Acknowledgements
The authors acknowledge all the subjects for their
voluntary participation in the study.
Ethics approval and consent to participate
The DPSRU’s Research Review Development Committee
gave its approval to conduct the study (10/801/PT/
DPSRU/2022/20319). Informed consent was obtained
from the participants.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
1. Smruthi V, Ramakrishnan P. Eect of dierent phases of
menstrual cycle on cardiorespiratory tness (vo2 max) in young
females. Indian J Appl Res 2019;9:54‑5.
2. Dokumacı B, Hazır T. Eects of the menstrual cycle on running
economy: Oxygen cost versus caloric cost. Res Q Exerc Sport
2019;90:318–26.
3. Gordon D, Hughes F, Young K, Scruton A, Keiller D, Caddy O,
et al. The eects of menstrual cycle phase on the development
of peak torque under isokinetic conditions. Isokinet Exerc Sci
2013;21:285–91.
4. Romero‑Moraleda B, Coso JD, Gutiérrez‑Hellín J,
Ruiz‑Moreno C, Grgic J, Lara B. The inuence of the menstrual
cycle on muscle strength and power performance. J Hum Kinet
2019;68:123–33.
5. Somboonwong J, Chutimakul L, Sanguanrungsirikul S. Core
temperature changes and sprint performance of elite female
soccer players after a 15‑minute warm‑up in a hot‑humid
environment. J Strength Cond Res 2015;29:262–9.
6. Neill S, Maclean A, Farage M. Physiological changes associated
with the menstrual cycle. Obstet Gynecol Surv 2009;64:58‑72.
[doi: 10.1097/OGX.0b013e3181932a37].
7. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender
dierences in anxiety disorders: Prevalence, course of illness,
comorbidity and burden of illness. J Psychiatr Res 2011;45:1027–
35.
8. Pestana JE, Islam N, Van der Eyk NL, Graham BM. What
pre‑clinical rat models can tell us about anxiety across the
menstrual cycle in healthy and clinically anxious humans. Curr
Psychiatry Rep 2022;24:697–707.
9. Emami F, Kordi Yoosenejad A, Motealleh A. Comparison of
static and dynamic balance during early follicular and ovulation
phases in healthy women, using simple, clinical tests: A cross
sectional study. Gynecol Endocrinol 2019;35:257–60.
10. Physiopedia. Fatigue Severity Scale. Available from: https://
www.physio‑pedia.com/Fatigue_Severity_Scale. [Last accessed
on 2023 Aug 21].
11. Dunstan DA, Scott N. Norms for Zung’s self‑rating anxiety
scale. BMC Psychiatry 2020;20:90.
12. Y‑Balance Test | Postural Control | Return to Play (RTP) Testing.
Physiotutors. Available from: https://www.physiotutors.com/wiki/
y‑balance‑test/. [Last accessed on 2023 Aug 21].
13. McNulty KL, Elliott‑Sale KJ, Dolan E, Swinton PA, Ansdell
P, Goodall S, et al. The Eects of Menstrual Cycle Phase on
Exercise Performance in Eumenorrheic Women: A Systematic
Review and Meta‑Analysis. Sports Med 2020;50:1813‑27. doi:
10.1007/s40279‑020‑01319‑3.
14. Lowe DA, Baltgalvis KA, Greising SM. Mechanisms behind
estrogen’s benecial eect on muscle strength in females. Exerc
Sport Sci Rev 2010;38:61‑7.
15. Isacco L, Boisseau N. Sex hormones and substrate metabolism
during endurance exercise. In: Sex hormones, exercise and
women; 2017. p. 35‐58. [doi: 10.1007/978‑3‑319‑44558‑8_3].
16. Ansdell P, Brownstein CG, Škarabot J, Hicks KM, Simoes DCM,
Thomas K, et al. Menstrual cycle‑associated modulations in
neuromuscular function and fatigability of the knee extensors in
eumenorrheic women. J Appl Physiol 2019;126:1701–12.
17. Frankovich RJ, Lebrun CM. Menstrual cycle, contraception, and
performance. Clin Sports Med 2000;19:251–71.
Downloaded from http://journals.lww.com/mjdy by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 12/09/2024
Sharma, et al.: Functional capacity, fatigability, anxiety and balance during phases of menstrual cycle
S307
Medical Journal of Dr. D.Y. Patil Vidyapeeth ¦ Volume 17 ¦ Supplement 2 ¦ November 2024
18. Gurses HN, Zeren M, Denizoglu Kulli H, Durgut E. The
relationship of sit‑to‑stand tests with 6‑minute walk test in
healthy young adults. Medicine (Baltimore) 2018;97:e9489.
19. Oğul A, Ercan S, Ergan M, İnce Parpucu T, Çetin C. The
eect of menstrual cycle phase on multiple performance test
parameters. Turk J Sports Med 2021;56:159–65.
20. Bemben DA, Salm PC, Salm AJ. Ventilatory and blood lactate
responses to maximal treadmill exercise during the menstrual
cycle. J Sports Med Phys Fitness 1995;35:257–62.
21. Ishii C, Nishino LK, Campos CAH de. Vestibular characterization
in the menstrual cycle. Braz J Otorhinolaryngol 2009;75:375–80.
22. Janicka A, Wren TAL, Sanchez MM, Dorey F, Kim PS,
Mittelman SD, et al. Fat mass is not benecial to bone in
adolescents and young adults. J Clin Endocrinol Metab
2007;92:143–7.
23. Pollock NK, Laing EM, Baile CA, Hamrick MW, Hall DB,
Lewis RD. Is adiposity advantageous for bone strength? A
peripheral quantitative computed tomography study in late
adolescent females. Am J Clin Nutr 2007;86:1530–8.
24. Deie M, Sakamaki Y, Sumen Y, Urabe Y, Ikuta Y. Anterior knee
laxity in young women varies with their menstrual cycle. Int
Orthop 2002;26:154–6.
25. Özer Kaya D, Toprak Çelenay Ş. Fluctuations of state anxiety,
spinal structure, and postural stabilityacross the menstrual cycle
in active women. Turk J Med Sci 2016;46:977–84.
26. Ericksen H, Gribble PA. Sex dierences, hormone uctuations, ankle
stability, and dynamic postural control. J Athl Train 2012;47:143–8.
27. Rai Richa H, Narang K, Walia H. Balance score assessment
in menstrual phase vs late follicular phase of the reproductive
cycle. Indian J Physiother Rehabil Sci 2022;1:8–14.
28. Pallavi LC. Assessment of musculoskeletal strength and levels
of fatigue during dierent phases of menstrual cycle in young
adults. J Clin Diagn Res 2017;11:CC11‐3. [doi: 10.7860/
JCDR/2017/24316.9408].
29. Li SH, Graham BM. Why are women so vulnerable to anxiety,
trauma‑related and stress‑related disorders? The potential role of
sex hormones. Lancet Psychiatry 2017;4:73–82.
30. Amin Z, Canli T, Epperson CN. Eect of estrogen‑serotonin
interactions on mood and cognition. Behav Cogn Neurosci Rev
2005;4:43–58.
31. Kikuchi H, Nakatani Y, Seki Y, Yu X, Sekiyama T, Sato‑Suzuki I,
et al. Decreased blood serotonin in the premenstrual phase
enhances negative mood in healthy women. J Psychosom Obstet
Gynecol 2010;31:83–9.
32. Doan C. The Impact of the Menstrual Cycle on Female
Performance in Athletics. Senior Honors Thesis; 2021. Available
from: https://digitalcommons.liberty.edu/honors/1137/.
Downloaded from http://journals.lww.com/mjdy by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 12/09/2024