Influencing factors of functional exercise adherence in stroke survivors: a cross-sectional study based on structural...

Post-stroke rehabilitation exercise plays an important role in functional recovery and secondary prevention. Nevertheless, exercise adherence commonly declines between 6 and 22 weeks after stroke. Guided by the Capability-Opportunity-Motivation-Behavior model, this study assessed exercise adherence among stroke survivors, examined potential pathways of association, and identified major factors linked to adherence during this period. Data on general information, functional exercise adherence, health literacy, rehabilitation motivation, and self-efficacy of stroke survivors were collected. The functional exercise adherence of stroke survivors was described by means and standard deviations. Independent sample t tests, analysis of variance, Pearson's correlation analysis, and structural equation modeling were used to identify the factors influencing functional exercise adherence in stroke survivors. The total score for functional exercise adherence among stroke survivors was 32.58 ± 7.44. The results revealed significant direct associations between health literacy and functional exercise adherence (β = 0.280, 95% CI = [0.118, 0.443], P = 0.001). Health literacy also showed significant indirect associations with adherence via rehabilitation motivation (β = 0.079, 95% CI = [0.035, 0.147], P = 0.001) and self-efficacy (β = 0.107, 95% CI = [0.047, 0.190], P = 0.001). Likewise, social support was directly associated with functional exercise adherence (β = 0.226, 95% CI = [0.086, 0.376], P = 0.003), and presented indirect associations with adherence via rehabilitation motivation (β = 0.078, 95% CI = [0.033, 0.143], P = 0.001) and self-efficacy (β = 0.073, 95% CI = [0.012, 0.149], P = 0.019). Functional exercise adherence among stroke survivors remains suboptimal and requires further improvement. This study demonstrates that rehabilitation motivation and self-efficacy play significant mediating roles in the associations between health literacy, social support, and functional exercise adherence. Clinicians and nursing staff can implement health literacy-focused interventions and foster a supportive social environment to enhance stroke survivors' functional exercise adherence.