Mechanism of continuous exercise intention after sport injury: a chained HBM-TPB mediation model

Sports injuries are prevalent among university students, yet psychological mechanisms of post-injury exercise maintenance intention need further study. Integrating the Health Belief Model (HBM) and Theory of Planned Behavior (TPB), this study examined how risk perceptions and cognitive factors were associated with continuous exercise intention, focusing on the pivotal role of control beliefs regarding exercise rehabilitation in translating risk perception into volition.

A cross-sectional survey sampled 421 university students who had a sports injury in the past 12 months. We integrated HBM and TPB, reconstructing perceived behavioral control and self-efficacy into control beliefs regarding exercise rehabilitation. SPSS 26.0 and AMOS 26.0 were used for SEM and bootstrapping mediation tests.

The model fit well (χ²/df = 2.799, CFI = 0.907, RMSEA = 0.065). Perceived susceptibility and health benefits were positively associated with attitude toward sustained exercise; perceived severity was negatively associated with attitude (β = -0.332, p < 0.001); perceived barriers had no significant direct effect. Mediation analyses revealed a dual-route pattern: perceived health benefits were associated with intention through the chain of attitude → control beliefs [95% CI (0.1135, 0.2500)]. Perceived susceptibility and barriers were indirectly related to lower control beliefs, and this relationship did not operate through attitude. Subjective norm was associated with intention, fully mediated by control beliefs (Effect = 0.3505). Control beliefs showed the largest predictive effect size on intention in the present model (β = 0.824, p < 0.001).

Continuous post-injury exercise intention was associated with a stepwise path of attitude → control beliefs → intention. Perceived health benefits were associated with intention through this chain, while the pattern for perceived severity was consistent with fear-avoidance theory. Control beliefs connected internal values and social norms. The findings suggest that interventions may benefit from shifting from risk intimidation to benefit empowerment, and from reconstructing rehabilitation control through social support networks-though these candidate directions await experimental validation.