Using the COM-B model to identify barriers and facilitators towards adoption of a menstrual cycle aligned training approach (MCATA)

Background
Women are significantly underrepresented in Sport and Exercise Science research due to exclusion from studies related to the impact of the menstrual cycle. However, increasing research recognises stages of the menstrual cycle may influence adaptation to training and could be linked with injury risk. Consequently, more research is needed to determine why most athletes and coaches do not adopt a menstrual cycle aligned training approach (MCATA).

Aims
This study aimed to investigate the barriers and facilitators to adoption a MCATA in endurance athletes and coaches.

Methods
Nineteen competitive female endurance athletes and fifteen experienced endurance coaches (men and women) participated in the study. Participants were recruited via email, social media and face-to-face and partook in an online interview. Data analysis followed the framework approach, drawing on the TDF and the capability, opportunity, motivation and behaviour (COM-B) model.

Results
Initial content analysis revealed some of the recurring perceived barriers to the adoption of MCATA in athletes were: knowledge (own and coaches), social influences and a belief that the menstrual cycle did not impact training. Some of the facilitators were: support from social networks and utilising period track apps. In coaches, some perceived barriers to adapting training were: knowledge, social barriers and lack of research on the menstrual cycle and training adaptation. Conversely, some of the facilitators were: attending training courses and using period tracking software themselves.

Conclusion
This study provides insight into the physical, psychological and social factors that endurance athletes and coaches report as barriers and facilitators to the adoption of a MCATA. Many more barriers than facilitators were reported in athletes and coaches. Therefore, future interventions that increase capability, opportunity and motivation may be beneficial. Results from this study will be used inform a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.