Structural equation modeling of exercise intention in patients recovering from stroke: a cross-sectional study

To investigate the factors influencing exercise intention among the people after stroke by developing a comprehensive causal model. This study is the first to examine the factors influencing exercise intention among people after stroke using the Health Action Process Approach (HAPA) theory and structural equation modeling. Data were collected from 299 people after stroke. Perceived benefits and barriers to exercise were evaluated with the Exercise Benefits/Barriers Scale (EBBS). Exercise self-efficacy was assessed using the Exercise self-efficacy scale. Exercise intention was assessed using the Exercise Intention Scale. People after stroke's EBBS score was (112.54 ± 13.67); exercise self-efficacy score was (41.68 ± 10.95); and exercise intention score was (14.41 ± 3.48). The total score of EBBS was positively correlated with the total score of exercise self-efficacy and the total score of exercise intention (r = 0.623, 0.681, both P < 0.05), and the total score of exercise self-efficacy was positively correlated with the total score of exercise intention (r = 0.646, P < 0.05). Structural equation modeling showed several causal pathways. Perceived barriers to exercise had an indirect effect on exercise intentions through exercise self-efficacy (β = -0.183, 95% CI -0.286 to -0.101, P < 0.05). Perceived benefits to exercise not only directly affected exercise intentions (β = 0.246, 95% CI 0.073 to 0.424, P < 0.05), but also indirectly affected exercise intentions through exercise self-efficacy (β = 0.152, 95% CI 0.084 to 0.231, P < 0.05). Additionally, perceived benefits and perceived barriers to exercise negatively influenced each other (β = -0.681, P < 0.05). The perceived benefits and barriers to exercise, exercise intention and exercise self-efficacy level of people after stroke need to be improved. Among them, the influence of exercise self-efficacy on exercise intention is the most significant. Consequently, attention and active measures should be directed toward improving exercise self-efficacy in this population, as this would increase their exercise intention and reduce the risk of relapse.