Factors associated with exercise adherence among stroke survivors: a cross-sectional study using the COM-B model

Exercise adherence plays a critical role in lowering physical disability and mortality rates among stroke survivors. Previous research indicates that exercise adherence among stroke survivors is generally low, influenced by various factors, the mechanisms of which remain not yet fully understood. This study aimed to explore the factors affecting exercise adherence in stroke survivors using the Capability, Opportunity, Motivation, and Behavior (COM-B) model in a cross-sectional study. Using convenience sampling, 359 participants were recruited from a tertiary hospital, and they filled out the demographic questionnaire, the Connor-Davidson Resilience Scale, and the Social Support Rating Scale, Stroke Rehabilitation Motivation Scale, and Stroke Functional Exercise Adherence Questionnaire Scale. Structural equation modeling (SEM) was used for data analysis. The average scores for psychological resilience, social support, rehabilitation motivation and exercise adherence were 67.86 ± 16.26, 36.60 ± 6.17, 107.70 ± 15.18, and 41.76 ± 6.13, respectively. The SEM showed a satisfactory fit (χ²/df = 2.097 < 3, RMSEA = 0.055, SRMR = 0.0376, CFI = 0.979, TLI = 0.974, IFI = 0.980, GFI = 0.933, AGFI = 0.902, and NFI = 0.951). Direct path analyses revealed that psychological resilience (β = 0.174, p < 0.01), social support (β = 0.184, p < 0.01), and rehabilitation motivation (β = 0.517, p < 0.001) significantly affected exercise adherence. Furthermore, both psychological resilience (β = 0.142, p < 0.001) and social support (β = 0.218, p < 0.001) exerted indirect effects on exercise adherence through their impact on rehabilitation motivation. Enhancing exercise adherence among stroke survivors requires attention to psychological resilience, social support, and particularly, rehabilitation motivation. The mediating influence of rehabilitation motivation in linking psychological resilience and social support to adherence is especially noteworthy. Interventions targeting these factors may effectively improve exercise adherence and optimize post-stroke recovery outcomes.