Barriers and facilitators of physical activity in everyday life following supervised exercise-based rehabilitation among people with chronic conditions - a systematic review of qualitative evidence

Background Understanding the behavioral determinants influencing physical activity (PA) in people with chronic conditions and whether they vary across conditions, could inform interventions supporting the maintenance of PA in everyday life. This systematic review of qualitative evidence aimed to synthesize the experienced barriers and facilitators of maintaining PA following supervised exercise-based rehabilitation for people with chronic conditions interpreted through the lens of the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation–Behaviour (COM-B) model. Methods We used meta-aggregation for qualitative synthesis, following the Joanna Briggs Institute (JBI) methodology. We searched four electronic databases from inception to June 2025 for studies including qualitative or mixed methods, adults aged 18 or above with selected chronic conditions, exploring barriers and facilitators to PA in everyday life following exercise-based rehabilitation. Using the JBI Critical Appraisal Checklist for Qualitative Research, we assessed quality. We conducted data synthesis using the JBI meta-aggregation approach and subsequently mapped it to the TDF and COM-B model. Results We included twenty-five studies and identified 10 synthesized findings (SF) consisting of 30 categories and 244 findings. Findings show that the determinants of PA maintenance are shared across conditions. The 10 SFs explored from the perspectives of the TDF and COM-B model reveal a complex interaction of psychological, social, and contextual determinants influencing PA behaviour across conditions. These include the perceived importance of PA (SF1), the role of prior experiences and trustworthy information (SF2), illness understanding and comorbidities (SF3), the need for ongoing professional and family support (SF4), accountability and self-regulation strategies (SF5), social connectedness (SF6), emotional responses and enjoyment (SF7), external life demands (SF8), structural and environmental barriers (SF9), and the empowering effects of self-efficacy and physical feedback (SF10). Conclusion Shared behavioral determinants across chronic conditions were identified and interpreted through the TDF and COM-B model. Barriers to PA maintenance include limited knowledge, skills, and behavioral regulation, while facilitators involve access to PA environments, group-based activities, and social support from professionals, family, and peers. Motivation is shaped by well-being, identity, and emotional factors. These findings support the development of tailored interventions integrating behavior change techniques that enhance self-efficacy, foster accountability, and promote adaptable, inclusive PA environments to maintain long-term PA engagement across conditions. Registry PROSPERO, CRD 42024552815, Registration date: 15 June 2024.