Applying the Behavior Change Wheel to design physical activity interventions for women undergoing the menopause transition

OBJECTIVE: Physical activity (PA) is critical for mitigating cardiovascular disease risk during the menopause transition, yet participation often declines during this life stage. This study applied the Behavior Change Wheel (BCW), a comprehensive framework for designing evidence-based interventions, to identify determinants of PA and develop tailored strategies to support women in meeting UK PA guidelines. METHODS: We conducted a behavioral diagnosis by integrating primary data from three focus groups with perimenopausal and postmenopausal women (n=14, 51.5±2.2 years) and findings from six qualitative studies. Data were coded using the Theoretical Domains Framework and the COM-B model (Capability, Opportunity, Motivation-Behavior). We then used the BCW to systematically select intervention functions, policy categories, and behavior change techniques (BCTs) to address identified determinants. RESULTS: We identified 14 behavioral determinants across all COM-B domains. Interventions should address menopause-related physical capabilities and self-efficacy, caregiving identities that de-prioritize personal health, and anxiety regarding public exercise environments. Intervention functions including Training, Education, and Enablement can build confidence and skills, while modeling, and persuasion can be used to elevate positive role models and reframe PA as health-promoting behavior compatible with caregiving roles. CONCLUSIONS: This study outlines a theory-informed intervention package that provides recommendations to support PA engagement during midlife. Recommendations include providing menopause-specific technical support for safe PA, creating inclusive, nonjudgmental environments, and using BCTs like action planning and graded tasks to build sustainable habits. These findings offer an actionable foundation to develop future PA interventions that reflect the specific needs and lived experiences of women undergoing the menopause transition.