Abstract
BACKGROUND: Older adults who have undergone percutaneous coronary intervention (PCI) face a heightened risk of major adverse cardiovascular and cerebrovascular events (MACCE). While physical activity is known to lower MACCE risk, improve long-term prognosis, and enhance quality of life, studies consistently report inadequate physical activity levels in this population. The relationships and potential mechanisms linking physical activity with its influencing factors remain incompletely understood, limiting the development of effective interventions. Therefore, this study aimed to identify key factors affecting physical activity and examine their underlying pathways in elderly post-PCI patients. METHODS: A cross-sectional study was conducted in Zhengzhou, China, from December 2024 to May 2025. Four hundred and eighty elderly individuals aged over 60 years who had undergone PCI completed the International Physical Activity Questionnaire-Long Form, Coronary Heart Disease Patients' Rehabilitation Exercise Questionnaire, Cardiac Rehabilitation Exercise Self-efficacy Scale, 7-item Generalized Anxiety Disorder Scale, Patient Health Questionnaire-9, and a socio-demographic data sheet. Data analysis was performed using SPSS 25.0 for descriptive statistics, Spearman correlation, and binary logistic regression. Mediation analysis was conducted via structural equation modeling (SEM) in MPLUS 8.3. RESULTS: 52.90% of participants did not meet the recommended physical activity guidelines. Physical activity self-efficacy significantly mediated the relationship between physical activity knowledge and physical activity (β = 0.730, P < 0.001). Although anxiety and depression symptoms were not directly associated with physical activity (P > 0.05), they exerted significant indirect negative effects through reduced physical activity self-efficacy(anxiety: β=-0.287, 95% confidence interval [-0.553,-0.118]; depression: β=-0.394, 95% confidence interval [-0.683,-0.204]). CONCLUSION: This study found that the prevalence of being physically inactive was high in elderly adults after PCI. The present study's findings suggested that healthcare providers should try to enhance physical activity self-efficacy, knowledge, and positive emotions of elderly adults after PCI to improve their physical activity with a focus on physical activity self-efficacy. TRIAL REGISTRATION NUMBER: Registry: The Central China Cardiovascular Hospital in Fuwai, TRN: 2025 No. 29, Registration date: 12 March 2025. Registry: The First Affiliated Hospital of Henan University of Traditional Chinese Medicine's Ethics Committee, TRN:2025HL-030-01, Registration date: 13 February 2025.