Objectives Develop the Markov Index Load State (MILS) model, based on hidden Markov chains, to assess athletes` workload responses and investigate the effects of menstrual cycle (MC)/oral contraception (OC), sex steroids hormones and wellness on elite athletes` training. Methods On a 7-month longitudinal follow-up, daily training (volume and perceived effort, n=2200) and wellness (reported sleep quality and quantity, fitness, mood, menstrual symptoms, n=2509) data were collected from 24 female rowers and skiers preparing for the Olympics. 51 MC and 54 OC full cycles relying on 214 salivary hormone samples were analysed. MC/OC cycles were normalised, converted in % from 0% (first bleeding/pill withdrawal day) to 100% (end). Results MILS identified three chronic workload response states: `easy`, `moderate` and `hard`. A cyclic training response linked to MC or OC (95% CI) was observed, primarily related to progesterone level (p=8.23e-03 and 5.72e-03 for the easy and hard state, respectively). MC athletes predominantly exhibited the `easy` state during the cycle`s first half (8%-53%), transitioning to the `hard` state post-estimated ovulation (63%-96%). OC users had an increased `hard` state (4%-32%) during pill withdrawal, transitioning to `easy` (50%-60%) when on the pill. Wellness metrics influenced the training load response: better sleep quality (p=5.20e-04), mood (p=8.94e-06) and fitness (p=6.29e-03) increased the likelihood of the `easy` state. Menstrual symptoms increased the `hard` state probability (p=5.92e-02). Conclusion The MILS model, leveraging hidden Markov chains, effectively analyses cumulative training load responses. The model identified cyclic training responses linked to MC/OC in elite female athletes. Data availability statement Data may be obtained from a third party and are not publicly available.
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