Association Between Exercise Adherence and Long‐Term Quality of Life in Ischemic Stroke Survivors: A 2‐Year Prospective Cohort Study

Q: What are the key findings of this study?

Exercise adherence was independently associated with better long-term quality of life over 24 months in ischemic stroke survivors (β = 0.82 per 1-point increase, 95% CI 0.69 to 0.95, p < 0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Ischemic stroke (n=355). Intervention: Exercise adherence (measured by the Exercise Adherence Questionnaire [EAQ], per 1-point increase). Primary outcome: Quality of life (measured by the Stroke-Specific Quality of Life Scale [SS-QoL] over 24 months) (β = 0.82 per 1-point increase in exercise adherence, 95% CI 0.69 to 0.95, p=<0.001).

Q: What does this research mean for the field?

Greater exercise adherence is independently associated with better long-term quality of life over a 24-month period in ischemic stroke survivors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate clinical and lifestyle factors associated with quality of life over two years post-discharge among ischemic stroke survivors, focusing specifically on exercise adherence.

Jin Ziyuan; Zhang Hong; Zhili Liu; Yanchun Wu; Lin Hongchun

doi:10.1002/nop2.70965

October 30, 2026Nursing OpenOpen Access

Association Between Exercise Adherence and Long‐Term Quality of Life in Ischemic Stroke Survivors: A 2‐Year Prospective Cohort Study

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Key result

Exercise adherence is linked to ~0.8-point higher long-term quality of life per point in stroke survivors.

β = 0.82 per 1-point increase in exercise adherence
95% CI 0.69 to 0.95
P<0.001
n=355

Why the study?

This study aimed to investigate factors associated with quality of life within 2 years post-discharge among ischemic stroke survivors, with a particular focus on exercise adherence.

Is greater post-discharge exercise adherence independently associated with improved long-term quality of life over 24 months in ischemic stroke survivors?

Key Points

To investigate clinical and lifestyle factors associated with quality of life over two years post-discharge among ischemic stroke survivors, focusing specifically on exercise adherence.
Prospective observational cohort study enrolling 355 ischemic stroke survivors at hospital discharge from The First Affiliated Hospital of Shantou University Medical College (January to August 2021).
Surveys were administered at discharge and at 1, 3, 6, 12, and 24 months post-discharge using structured questionnaires and validated clinical scales.
Linear mixed-effects models incorporating natural cubic splines were applied across 1,795 repeated observations to assess predictors of long-term quality of life.
Of 355 enrolled participants, 242 (68.2%) completed the 24-month follow-up.
Each 1-point increase in exercise adherence score was independently associated with an increase in quality of life (β = 0.82, 95% CI: 0.69 to 0.95, p < 0.001).
Quality of life was negatively associated with family history of stroke (β = −4.50, 95% CI: −7.62 to −1.37, p = 0.005), prior stroke (β = −3.16, 95% CI: −6.02 to −0.31, p = 0.030), and higher NIHSS score (β = −0.80, 95% CI: −1.22 to −0.38, p < 0.001).

Study Design

Type

Cohort (n=355)

Multicenter

No

Structured PICO

Is greater post-discharge exercise adherence independently associated with improved long-term quality of life over 24 months in ischemic stroke survivors?

P

Population

355 adult ischemic stroke survivors (mean age 65.90 years, 36.3% female) discharged from a single center in China, followed prospectively for 24 months.

E

Exposure

Post-discharge functional exercise adherence assessed longitudinally at discharge and 1, 3, 6, 12, and 24 months using the 14-item Exercise Adherence Questionnaire (EAQ, score range 14-56).

O

Outcome

Long-term quality of life (QoL) assessed via the 49-item Chinese version of the Stroke-Specific Quality of Life Scale (SS-QoL, score range 49-245) at discharge and at 1, 3, 6, 12, and 24 months post-discharge.patient reported

Main Result

Effect estimate: β = 0.82 per 1-point increase in exercise adherence (95% CI 0.69 to 0.95)

p-value: p=<0.001

Limitations

Conducted at a single hospital in Guangdong, China, which may limit generalizability
No formal a priori power calculation performed for the linear mixed-effects model
Analytical model did not adjust for potential psychological confounders such as depression and motivation
31.8% overall attrition rate over the 2-year follow-up with non-random dropout (older and more severely disabled patients more likely to drop out), plus selection bias from excluding critically ill or rehabilitation-transferred patients
No exercise adherence-by-time interaction was included in the primary model, limiting assessment of stage-specific associations
Single-center study in Guangdong, China, limiting generalizability to other socioeconomic and cultural settings
Lack of a formal a priori sample size/power calculation for the linear mixed-effects model
Unmeasured confounding due to lack of adjustment for psychological factors such as depression and motivation
Selection bias from excluding critically ill patients and those transferred to rehabilitation hospitals, compounded by a 31.8% attrition rate over 2 years with disproportionate dropout of older and more severely disabled patients
Omission of an exercise adherence-by-time interaction term in the primary model, preventing evaluation of time-varying or stage-specific effects

Implication

Sustained adherence to functional exercise is independently associated with superior quality of life over 2 years post-discharge in ischemic stroke survivors, highlighting the need for long-term behavioral and rehabilitation nursing support.

Abstract

AIMS: This study aimed to investigate factors associated with quality of life within 2 years post-discharge, with a particular focus on exercise adherence. DESIGN: A prospective observational cohort study. METHODS: Participants were enrolled during hospitalisation and followed up at discharge and at 1, 3, 6, 12 and 24 months post-discharge via questionnaires. Linear mixed-effects models were used to identify factors associated with quality of life. DATA SOURCES: Data were collected from ischemic stroke patients (discharged from The First Affiliated Hospital of Shantou University Medical College, January to August 2021) using structured questionnaires, medical records and validated scales. RESULTS: Of 355 enrolled stroke survivors, 242 (68.2%) completed the two-year follow-up. Functional disability, exercise adherence, family history of stroke and prior stroke were independently associated with long-term quality of life. CONCLUSION: Greater exercise adherence is independently associated with better quality of life on average over the 24-month follow-up period among stroke survivors. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses and rehabilitation guidelines should prioritise exercise adherence support during long-term follow-up to sustain post-stroke quality of life.

Discussion

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Cite This Study

Ziyuan et al. (2026) conducted a cohort in Ischemic stroke (n=355). Exercise adherence (measured by the Exercise Adherence Questionnaire [EAQ], per 1-point increase) was evaluated on Quality of life (measured by the Stroke-Specific Quality of Life Scale [SS-QoL] over 24 months) (β = 0.82 per 1-point increase in exercise adherence, 95% CI 0.69 to 0.95, p=<0.001). Exercise adherence was independently associated with better long-term quality of life over 24 months in ischemic stroke survivors (β = 0.82 per 1-point increase, 95% CI 0.69 to 0.95, p < 0.001).

synapsesocial.com/papers/6ae8289b1eea7618b7889a99 https://doi.org/10.1002/nop2.70965

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Association Between Exercise Adherence and Long‐Term Quality of Life in Ischemic Stroke Survivors: A 2‐Year Prospective Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association Between Exercise Adherence and Long‐Term Quality of Life in Ischemic Stroke Survivors: A 2‐Year Prospective Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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