Enablers and barriers to physical activity during menstruation: a qualitative study using the Theoretical Domains Framework and COM-B model

Menstruation is a biological process that can lead to symptoms including menstrual flow, pain, lethargy, fatigue, and low mood. The accumulation of menstrual symptoms can impact avoidance of activities of daily life, including physical activity. The present study aimed to identify enablers and barriers to physical activity engagement during menstruation.
Design:
This study utilised a qualitative, semi-structured interview design and applied the Theoretical Domains Framework (TDF) and COM-B model to inform the development of behaviour change interventions.
Methods:
Twenty menstruators aged 22 to 47 years participated in semi-structured interviews via video call. Data were analysed using framework analysis including an inductive cycle of coding, followed by a deductive cycle of coding during which codes were mapped onto the domains of the TDF and the components of the COM-B model.
Results:
Five COM-B model domains were identified: physical and social opportunity; psychological and physical capability; and reflective motivation. All 14 TDF domains were reflected in concerns surrounding the environmental context and resources, social norms and influences, beliefs about consequences and capabilities, knowledge, memory and decision-making, reinforcement, and behavioural regulation.
Conclusions:
This study identified enablers and barriers to physical activity during menstruation using established behaviour change theory and frameworks for intervention design. Offering insight into the multidimensional challenges associated with physical activity during menstruation, this study forms the first step in the development of interventions that facilitate physical activity engagement during menstruation and, in turn, positively impact menstrual health and well-being.