Exer-WAPA Project: Physical Exercise on Women's Affective and Physical HeAlth
Phase: NA
Conditions: Psychological Distress, Anxiety Symptoms, Depression Symptoms
Sponsor: Universidad de Granada

Official Title: 
Exer-WAPA Project: Physical Exercise on Women's Affective and Physical HeAlth 
NCT Number: 
Pending 
Document Date: 
19 February 2026 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Objective 
This randomized controlled trial aims to determine the effects of a 12-week supervised, 
group-based exercise program incorporating music-synchronized movement on the 
emotional and physical health of physically inactive, middle-aged women experiencing 
psychological distress.  
Design 
The Physical Exercise on Women’s Affective and Physical HeAlth (Exer-WAPA) 
project is a randomised controlled trial (RCT) designed to evaluate the effects of a supervised, 
group-based exercise program incorporating music-synchronized movement on the 
emotional and physical health of physically inactive, middle-aged women experiencing 
psychological distress. A total of 100 participants will be randomized to either the 
experimental group or a waitlist control group. 
 
Methods 
Outcomes 
The primary outcome will be emotional well-being, assessed at baseline and post-
intervention using the Spanish version of the Positive and Negative Affect Schedule 
(PANAS). Secondary outcomes will be assessed at baseline and post-intervention and will 
be grouped into five dimensions: (1) mental health, (2) physical health, (3) lifestyle, (4) 
gender-related outcomes, and (5) socioeconomic impact. Mental health and self-reported 
physical activity outcomes will be evaluated at three-month follow-up. Accordingly, the 
study follows a 2 × 3 statistical design.  
(1) Mental Health: In addition to emotional well-being as the primary psychological 
outcome, the following mental health variables will be assessed: risk of poor mental health, 
using the General Health Questionnaire (GHQ-12); self-esteem, using the Rosenberg Self-
Esteem Scale (RSES); global life satisfaction, using the Satisfaction with Life Scale (SWLS); 
anxiety symptoms, using the Beck Anxiety Inventory (BAI); depressive symptoms, using the 
Beck Depression Inventory-II (BDI-II); and general cognitive status, using the Spanish 
version of the Montreal Cognitive Assessment (MoCA).  
(2) Physical Health: Health-related physical fitness will be assessed through health-
related body composition (bioimpedance) and anthropometric indicators and physical fitness 

components, including cardiorespiratory fitness, using the 6-minute walk test; upper limb 
muscle strength, using handgrip dynamometry; lower limb muscle strength, using the 30 sit-
to-stand test; upper limb flexibility, using the shoulder flexibility test; lower limb flexibility, 
using the chair sit-and-reach test; and agility, using the T-test. Cardiometabolic risk will be 
assessed using systolic and diastolic blood pressure measurements. Autonomic 
cardiovascular function will be assessed using heart rate variability (HRV). Static posture 
will also be assessed using the Fitness for Work Assessment Tool (OSPAT).  
(3) Lifestyle: Sociodemographic variables, including age, sex, educational level, 
marital status, employment status, and annual income, will be assessed. Prescribed and non-
prescribed medication, and exposure to traumatic events will be assessed using a self-
reported questionnaire. Physical activity, sedentary behaviour, and sleep quality will be 
assessed using Axivity triaxial accelerometers (AX3 and AX6). Self-reported physical 
activity and sedentary behaviour will be assessed using the Spanish version of the 
International Physical Activity Questionnaire (IPAQ), short version. Self-reported sleep 
quality will be assessed using the Pittsburgh Sleep Quality Index (PSQI). Commuting 
behaviour will be assessed using a self-administered questionnaire based on the ALPHA 
Environmental Questionnaire, including mode of commuting, reasons for the chosen mode 
of commuting, and whether the trip is made alone or accompanied to different destinations. 
Dietary habits will be assessed using the Mediterranean Diet Adherence Questionnaire 
(PREDIMED). Health-related quality of life will be assessed using the Spanish version of 
the SF-36 questionnaire. In addition, tobacco and alcohol consumption will be assessed using 
the AUDIT-C questionnaire.  
(4) Gender-related outcomes: Gender-related variables that may influence symptoms 
of anxiety and/or depression will be assessed. Sociodemographic variables, including gender, 
sexual orientation, relationship status, relationship satisfaction, parenthood, and caregiving 
responsibilities, will be assessed. Gender norms, including responsibilities at home, at work, 
and in caregiving, as well as social support and reproductive health, will be assessed using 
an adapted Spanish version of the Gender-Related Variables for Health Research (GVHR) 
questionnaire. Quality of life in menopausal women will be assessed using the Spanish 
version of the Menopause Quality of Life Questionnaire (MENQOL).  

(5) Socioeconomic Impact: The socioeconomic impact of the intervention will be 
evaluated through a cost-effectiveness analysis.  
In addition, adherence and compliance variables related to the exercise intervention 
will be assessed. Attendance and punctuality at sessions will be assessed using session 
attendance records. Additional physical activity outside the training sessions will be assessed 
using self-reported questionnaire. Mood before and after each exercise session will be 
assessed using the Feeling Scale. Perceived exhaustion prior to the start of each session will 
be assessed using item 8 of the HPHEE Scale. Adverse events will be assessed using 
standardised incident reporting forms. Subjective session effort will be assessed using the 
Borg Rating of Perceived Exertion scale (RPE 0–10). Furthermore, immediately after 
completion of the intervention, participants in the experimental group will complete the 
Physical Activity Enjoyment Scale (PACES) to assess perceived enjoyment of physical 
activity during the program. In addition, a focus group will be conducted with a purposive 
subsample of participants from the experimental group to qualitatively explore their 
experiences, perceptions, and satisfaction with the intervention program. 
Recruitment 
A total of 100 middle-aged women (35–60 years) with mild-to-moderate anxiety and/or 
depression symptoms will be recruited from Granada (Spain) and surrounding areas through 
local media, university communication channels, and social media platforms. Interested 
individuals will complete an online screening questionnaire, followed by a telephone 
screening to confirm eligibility based on inclusion and exclusion criteria.  
Table 1. Inclusion and exclusion criteria for Exer-WAPA study. 
Inclusion criteria 
Exclusion criteria 
− Women from Granada and nearby areas 
aged 35 to 60 years 
− Serious acute or terminal illness 
− Presence of mild psychological distress 
or dysthymia symptoms 
− Severe psychiatric illness 
− Physically 
inactive 
(not 
regularly 
engaging in physical-sport activities 
<150 min/week of MVPA) 
− Diagnosed chronic cardiac, pulmonary, 
or metabolic disease 
− No previous participation in physical 
conditioning or sports programs, or no 
participation within the past six months 
− Disabling 
osteo-muscular 
pathology 
(e.g., fracture, sprain) or neuromuscular 
disorder preventing physical activity 

− No 
disabling 
or 
high-risk 
health 
condition 
that 
contraindicates 
participation in a supervised exercise 
program 
− Pregnancy  
− Provide informed consent to participate 
− Taking 
prescribed 
medication 
for 
dysthymia or sleep disorders, unless on 
treatment for more than one year with no 
symptom improvement 
− Availability to attend the training 
program sessions at one of the scheduled 
times 
− Disagreement with the study conditions 
(e.g., group randomization, attendance at 
evaluations, etc.) 
 
− Not signing the informed consent and/or 
the participation commitment form 
Intervention 
Participants allocated to the experimental group will undertake a supervised 12-week 
concurrent exercise intervention combining aerobic and resistance training, delivered 
through group-based fitness classes with musical and choreographed support. Sessions will 
be conducted three times per week, lasting 60 minutes each (180 minutes per week), in 
accordance with World Health Organization recommendations for physical activity in adults. 
Exercise intensity will be individually prescribed and monitored using heart rate reserve 
(HRR), targeting intensities ranging from >50% to 85% HRR. Sessions will be conducted in 
groups and supervised by a graduate in Sports Science or a student enrolled in this degree 
program with experience in musically choreographed group fitness classes.  
Session Structure and Monitoring 
Each training session will follow a standardized structure comprising a 5-minute warm-
up, a main concurrent training phase combining resistance and endurance exercises, and a 
10-minute mindfulness-based cool-down. The main phase will be driven by musical cadence. 
All sessions will be accompanied by music delivered through an integrated sound system 
using wireless headphones with zero latency (Silent System), allowing for individual volume 
control. Musical tempo (beats per minute) will serve as the primary guide for exercise 
intensity and movement speed, structured as follows: Resistance Component: Each music 
track will target one or two specific muscle groups. The BPM will dictate the repetition 
velocity, controlling the cadence of concentric and eccentric phases. Aerobic Component: 

This phase will involve global movements and displacements performed as moderate-to-high 
intensity intervals (HIIT), where whole-body exercise speed is synchronized with the musical 
rhythm. To ensure protocol adherence and safety, all sessions will be directly supervised by 
a certified trainer. The trainer’s role is to monitor technical execution and ensure that 
participants strictly maintain the prescribed rhythm and movement velocity dictated by the 
music track, thereby validating the training intensity. A familiarization phase will be 
implemented at the beginning of the program to ensure correct exercise technique and 
execution. Exercise intensity will be progressively increased every three weeks by adjusting 
both the external load (kg) and the prescribed percentage of HRR. 
Waitlist control group 
Participants assigned to the waitlist control group will be invited to attend a series of 
educational sessions aimed at promoting healthy lifestyle and physical activity 
recommendations. These participants will not receive the exercise intervention during the 
study period and will be offered the exercise program after completion of the follow-up 
assessments.