Supporting adolescent menstrual health to improve participation and performance in physical activity: rapid realist review to inform a logic model for intervention development

Cooper, Alison ORCID: https://orcid.org/0000-0001-8660-6721, Mahaiyuddin, Ainah, Sim, Daniel, Davies, Freya ORCID: https://orcid.org/0000-0002-6956-1100, Gillen, Elizabeth ORCID: https://orcid.org/0000-0002-3700-3913, Brown, Natalie, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446 and Boivin, Jacky ORCID: https://orcid.org/0000-0001-9498-1708 2026. Supporting adolescent menstrual health to improve participation and performance in physical activity: rapid realist review to inform a logic model for intervention development. BMJ Open 16 , e118584. 10.1136/bmjopen-2026-118584

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Abstract

Background Insufficient physical activity is higher in women and girls globally, with increased risk of non-communicable diseases. Menstrual (period-related) symptoms are a recognised barrier to adolescents engaging in physical activity. There is a lack of evidence-based guidance to address this barrier. Objective To develop a set of initial programme theories (context-mechanism-outcome configurations, CMOCs) to describe how existing menstrual health support interventions work, for whom, how and in what circumstances to inform a logic model for intervention development. Design Rapid realist review. Methods Formal, double-screened, database (Medline, AMED, Embase, Psycinfo, CINAHL, ERIC, SCOPUS; June 2025) and grey literature searches guided by stakeholder expertise. Articles were selected that met inclusion criteria and contributed to theory development. Explanatory statements were extracted and synthesised into CMOCs using Pawson’s reasoning processes and mapped onto Self-Determination Theory concepts (autonomy, competency, relatedness). Results From 9585 database hits, 63 articles were included. Three generated initial programme theories describe how four identified intervention domains (education; practicalities including toilet facilities, clothing and free accessible period products; menstrual cycle tracking and screening tools; and medical support if needed) could improve menstrual health confidence and understanding (M), communication and trust (M)—to empower individuals to enhance their own menstrual health (M) and potentially improve participation rates and performance in physical activity (O). Alternative causal pathways describe potential adverse outcomes when processes are not in place to: signpost to medical support if needed (M), support user trust in how and why data are collected and used (M) and enable understanding of the limitations of menstrual health support tools (M). Contextual data are needed to further refine these theories that are presented as a logic model. Conclusion The proposed logic model can be used to inform and evaluate future interventions aimed at overcoming menstrual health related barriers with physical activity.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine Schools > Psychology
Publisher:	BMJ Publishing Group
ISSN:	2044-6055
Date of First Compliant Deposit:	3 November 2026
Date of Acceptance:	27 August 2026
Last Modified:	04 Nov 2026 22:15
URI:	https://orca.cardiff.ac.uk/id/eprint/190623

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