Self-efficacy, motivation, and perceived barriers as psychological determinants of exercise adherence in clinical healthcare settings: a systematic literature review

Abstract

Addressing the critical healthcare challenge of non-adherence to exercise programs—where dropout rates reach up to two-thirds of participants—this systematic review synthesizes 50 peer-reviewed articles published between 2020 and 2026 from the Scopus database, following PRISMA 2020 and Tranfield et al.'s methodological frameworks. The authors identified three primary psychological drivers of patient adherence: high self-efficacy, which proved to be the single strongest predictor by increasing adherence rates by up to 33 percentage points while mediating the impact of kinesiophobia; autonomous, intrinsic motivation grounded in Self-Determination Theory, which plays a pivotal role in sustaining long-term exercise commitment among cardiac and oncology patients; and perceived barriers—including fear of movement, pain, time constraints, and insufficient provider support—which consistently predict poorer compliance and often exert a greater influence than objective disease severity. To improve clinical outcomes, the review emphasizes the necessity of routine pre-treatment screening for self-efficacy and individual barriers, alongside the implementation of autonomy-supportive rehabilitation protocols. Ultimately, the authors call for future research prioritized around longitudinal randomized controlled trials, studies focusing on underrepresented populations within low- and middle-income countries, and the integration of digital health technologies into established psychological frameworks.