A study on the influencing factors of exercise adherence in patients with chronic heart failure: from a configuration perspective

Objective: The study aims to investigate the configuration path of influencing factors of exercise adherence in chronic heart failure (CHF) patients based on the Capability, Opportunity, Motivation-Behavior (COM) model. Background: The effectiveness of exercise rehabilitation in patients with CHF depends upon their sustained adherence over the long term. Exercise adherence is influenced by a combination of antecedent conditions; however, the mechanisms underlying adherence to exercise in CHF patients remain unclear. Design: Cross-sectional study. Method: Convenience sampling was used to recruit patients with CHF from 3 tertiary-level hospitals in China, between January and May 2024. Latent profile analysis (LPA) was conducted to identify the latent profile of exercise adherence in patients with CHF. Fuzzy-set qualitative comparative analysis (fsQCA) was then employed by conducting necessity and sufficiency analysis. Results: A total of 219 patients with CHF participated in the study. The LPA results categorized exercise adherence among these patients into three profiles: low (28.3%), moderate (54.3%), and high (17.4%) adherence. The necessity analysis revealed that the perception of benefits was a necessary condition for achieving high exercise adherence, whereas no singular factor was deemed necessary for low exercise adherence. Furthermore, the sufficiency analysis identified four distinct configurational pathways leading to high exercise adherence and two pathways leading to low exercise adherence. Conclusion: Patients with CHF display varied exercise adherence behaviors, influenced by a range of antecedent conditions that interact synergistically, leading to diverse adherence patterns. Enhancing intrinsic motivation is essential for improving exercise adherence in this population. The exercise adherence behaviors of patients with CHF reflect distinct preferences, suggesting that healthcare providers can implement targeted interventions based on specific configurational pathways. Patient or public contribution: In the data collection phase, patients with CHF were recruited to participate in the survey.