The Effect of Cognitive Exercise Therapy Approach and Yoga in Adolescents With Dysmenorrhoea

In the 10 cm VAS, which is the most widely used, reliable and valid scale in the evaluation of pain intensity all over the world, the left end of the line will be formed as "0 = no pain" and the other end as "10 = unbearable pain". The subjects will be given paper in the form of a pain diary to mark during their menstrual periods and will be asked to mark the point appropriate to the intensity of pain 2 days before, 1 day before, on the 1st, 2nd and 3rd day of menstruation.

Sit-Reach Test: The flexibility of the subjects participating in the study will be evaluated with a standard sit-and-reach box (Sit and Reach Trunk Flexibility Assessment Testing Box, Baseline, NY, USA).

Peripheral Muscle Strength: To evaluate the peripheral muscle strength of the subjects, hip flexors, hip extensors and hip abductors will be evaluated with a hand-held dynamometer in both legs.

Heart Rate Variability: Heart rate variability (HRV) defines the autonomic modulation of heart rate. It reflects parasympathetic activity and sympathetic/parasympathetic nervous system balance. Neuroimaging studies have shown that nociceptive stimulation is closely related to autonomic nervous system activity. Pain can cause a decrease in parasympathetic activity, an increase in sympathetic activity, and sympathovagal imbalance. Autonomic nervous system imbalance caused by sympathetic overactivity may be another cause of primary dysmenorrhea. In response to changes in the external environment, the ANS maintains homeostasis of the internal environment of the human body through the interaction between the sympathetic and parasympathetic nerves. A lack of coordination between the two systems can cause various symptoms. For these reasons, heart rate variability will be measured and recorded in adolescent girls with primary dysmenorrhea using the Polar H10 device.

Pediatric Quality of Life Inventory TM (PedsQL)(Adolescent Form): The PedsQL is a quality of life scale that is suitable for use in both healthy and diseased children and adolescents. The PedsQL consists of child and parent forms aged 2-18 years. Since the adolescent group will be included in this study, the 13-18 years old. Adolescent Form will be used. Scoring is done in 3 areas. Firstly, the total scale score (TSS), secondly, the total physical health score (PHSS), and thirdly, the total psychosocial health score (TPHSS), which consists of the calculation of item scores evaluating emotional, social and school functionality, are calculated. The items are scored between 0-100. If the answer to the question is marked as never, 100 points are scored; if it is marked as rarely, 75 points are scored; if it is marked as sometimes, 50 points are scored; if it is marked as frequently, 25 points are scored; if it is marked as almost always, 0 points are scored.

Adolescents with dysmenorrhea are typically of school age and may miss several days of school due to dysmenorrhea experienced during their menstrual periods. Therefore, the school absences of participants in the study will be monitored throughout the process. School absence rates before and after treatment will be compared.

Depression-Anxiety-Stress Scale Short Form (DASS-21): Both the original 42-item version of the DASS and the shorter 21-item version have been shown to be reliable and valid scales for measuring depression, anxiety and stress levels, through studies conducted with clinical groups, society and different cultural and ethnic groups. 7 items of DASS-21 include questions about depression, 7 items about anxiety, and 7 items about stress. Each subscale (depression, anxiety, stress) has a minimum of 0 and a maximum of 21 points. A low score indicates a good psychological state.

Revised Dysmenorrhea Impact Scale-Short Form (DIS-R): This 13-item scale, which includes cognitive/emotional (8 items) and physiological (5 items) subscales, has been shown to be a valid and reliable measurement tool. The minimum score on the scale is 0 and the maximum score is 65. As the scores increase, the functional and emotional impact level of individuals with dysmenorrhea also increases.

Physical Activity Questionnaire for Adolescents (PAQ-A): Designed to provide a general estimate of physical activity levels among healthy adolescents, assessing sports participation and activities during and after school, self-administered and based on the last week. Later, a modified form for adolescents was published. The Turkish validity and reliability study of the scale was conducted. 8 questions in the scale are scored between 1 and 5, and the 9th question questions the presence of a condition that prevents physical activity during the last week. A score of '1' corresponds to low-intensity physical activity and a score of '5' corresponds to high-intensity physical activity, but the last question is not included in the scoring. The total score is obtained by calculating the average score of all questions.

The question of whether a patient is improving is fundamental in clinical practice, and the information obtained is important in making decisions regarding prognosis and treatment. Global Rating of Change (GROC) scales are widely used in clinical research, especially in the field of the musculoskeletal system. These scales are a rapid, effective method designed to measure a patient's improvement or worsening over time, usually either to determine the effect of an intervention or to chart the clinical course of a condition.

In our study, to measure treatment satisfaction, "-2" means "I am very bad compared to before treatment", "-1" means "I am worse than before treatment", "0" means there is no change compared to before treatment, "1" means I am better than before treatment, "2" means I am very better than before treatment. The Global Rating of Change (GROC) scale will be used in the five-point Likert system.

The Menstrual Symptom Questionnaire (MSQ) is a 22-item, five-point Likert-type scale developed by Chesney et al. to assess menstrual pain and symptoms. The Turkish validity and reliability study of the scale was conducted by Güvenç et al. in 2014. The scale has three sub-dimensions: "Negative Effects/Somatic Complaints", "Menstrual Pain", and "Menstrual Pain Coping Methods". The results obtained from the internal consistency coefficient, test-retest reliability coefficient, exploratory factor analysis, and criterion-related validity analyses show that the validity and reliability findings of the MSQ in Turkish are at a sufficient level and that it can be used to assess menstrual symptoms in Turkish adolescents. The MSQ score is calculated by taking the average total score of the items in the scale.

The Menstrual Attitude Scale (MAS), a Likert-type scale consisting of 33 items and 5 subcategories, was developed by Brooks-Gunn and Ruble (1980). The Turkish validity and reliability study of the scale was conducted by Kulakaç et al. in 2008. Due to the difficulty in adapting the original 7-point Likert-type rating form to Turkish, it was converted into a 5-point rating form ranging from 1 to 5 (1. Strongly disagree, 2. Disagree, 3. Undecided, 4. Agree, 5. Strongly agree) in the Turkish form. While the original scale consisted of 33 items, two items were removed during the Turkish adaptation due to their low factor loadings. As a result, the scale consists of 31 items and five sub-dimensions. Overall, the MAS provides information about how women cope with menstrual situations and their attitudes towards menstruation. A high average score from the subgroups or the entire scale indicates a "positive" attitude towards menstruation.

Pulmonary function was assessed by spirometry in accordance with American Thoracic Society (ATS)/European Respiratory Society (ERS) standards. Forced vital capacity (FVC) was measured and recorded.

Pulmonary function was assessed by spirometry in accordance with ATS/ERS standards. Forced expiratory volume in the first second (FEV1) was measured and recorded.

Pulmonary function was assessed by spirometry in accordance with ATS/ERS standards. The ratio of FEV1 to FVC was calculated and recorded.

Pulmonary function was assessed by spirometry in accordance with ATS/ERS standards. Peak expiratory flow (PEF) was measured and recorded.