Stroke patients often experience psychological distress, which can impact their intimate relationships with spouses, subsequently influencing their treatment and recovery. Physical activity is considered a key rehabilitation method for stroke patients. This paper aims to analyze whether psychological distress affects intimate relationship between spouses through physical activity.

To explore the mediating effect of physical activity between psychological distress and intimate relationship in stroke patients.

A total of 256 stroke patients who underwent treatment at the First People’s Hospital of Shangqiu between July 2021 and July 2022 were enrolled in this study. The participants completed questionnaires, including the Kessler Psychological Distress Scale (K10), the Quality of Relationship Index (QRI), International Physical Activity Questionnaire, and a general information questionnaire. Data analysis were performed using SPSS 23.0. The Harman test was employed to detect common method deviations, and Spearman correlation was used for correlation analysis. The mediating effect was assessed using Process 3.4.1, with significance testing of the regression coefficients conducted using the bias-corrected percentile Bootstrap method (5000 iterations, 95% confidence interval). Statistical significance was set at P < 0.05.

The results showed that patients scored an average of 21.61 ± 6.44 points on the K10, 32.40 ± 6.19 points on the QRI; the median physical activity level according to the International Physical Activity Questionnaire was 1861 (566, 2846) MET·min/w. The level of physical activity (the physical activity intensity of the patients reflected by the International Physical Activity Questionnaire-Long Form scale) negatively correlated with psychological distress and intimacy (P < 0.05), and positively correlated with each other (P < 0.05), with the correlation stronger at lower physical activity levels compared to higher ones. The mediating effect of physical activity between psychological distress and intimate relationship was calculated to be 40.23%. Bootstrap analysis further validated the results. The mediating effect of psychological distress on intimate relationships through physical activity level was -0.284, with a confidence interval of -0.409 to -0.163, excluding 0, confirming a significant mediating effect of psychological distress on intimate relationships.

Physical activity significantly affects relationship between psychological distress and intimate relationships among stroke patients. Addressing the role of physical activity may have implications for improving patient outcomes and rehabilitation strategies.

Stroke is not simply a singular disease; rather, it encompasses a group of conditions resulting from impaired brain function caused by cerebrovascular disease[1]. With its high incidence, disability, mortality and recurrence rate, stroke has become a global health concern, leading to numerous disabilities and deaths in China[2]. During the post-stroke treatment and rehabilitation process, patients often face stigma and significant psychological distress due to disabilities and disruptions in their self-image[3]. Intimate relationships, characterized by communication that fosters intimacy and cooperation within an interdependent framework, play a crucial role in the lives of stroke patients and their spouses[4]. Spouses of stroke patients endure long-term care and economic burdens and experience multiple psychological pressures from family and society, which can negatively impact their relationship and mutual happiness[5]. Research indicates that regular physical activity is a vital preventive measure against stroke, attributed to its potential to improve vascular function and reduce stroke-related risk factors[6]. Therefore, physical activity can potentially aid patient rehabilitation, delay deterioration of their condition, alleviate psychological distress, and mitigate the adverse effects of negative emotions on the relationship between stroke patients and their spouses. However, there is a lack of research on the interplay among physical activity level, psychological distress, and intimacy in the context of stroke patients, both domestically and globally. Therefore, this study aimed to investigate whether the level of physical activity acts as a mediating factor between psychological distress and intimacy in stroke patients. By exploring this relationship, the study seeks to provide novel insights into alleviating the strains within the spousal relationships among stroke patients.

Stroke patients often experience language impairment and motor dysfunction, leading to reduced self-care ability and social adaptability, which can result in psychological distress for both the patients and their partners[10]. As the main caregivers in the family, partners’ attitudes and caregiving abilities directly influence the patient’s mood and rehabilitation progress[11]. Importantly, alleviating psychological distress can enhance the relationship between patients and partners, foster open communication, and improve marital happiness and overall quality of life for spouses[12]. Previous studies have identified hypertension, diabetes, dyslipidemia, and obesity as risk factors associated with stroke, and physical activity can have a positive impact on these risk factors[13,14]. Physical activity can positively impact these risk factors by improving vasodilation, reducing diabetes, hypertension, dyslipidemia, obesity, and depression risk, thus promoting stroke recovery and delaying deterioration. Therefore, moderate physical activity can aid stroke patients’ recovery, reduce their psychological distress, and help restore and improve the relationship between patients and their partners.

The prevalence of psychological distress among stroke patients in China is high, with post-stroke depression and anxiety reported at 84.51% and 75.63%, respectively[15]. Psychological distress significantly hampers treatment, rehabilitation, long-term function, and quality of life for stroke patients, increasing the risk of stroke recurrence and mortality[16]. Physical activity refers to bodily movements that requires energy expenditure, primarily achieved through skeletal muscle contraction. It encompasses both structured and physical exercises as well as daily activity[17]. After illness, patients may have reduced self-care ability and fear of exercise, leading to low physical activity levels. In this study, patients with lower physical activity levels had higher scores for psychological distress (K10) and a lower scores for intimate relationship satisfaction (QRI), consistent with previous research findings[18-20]. Unimproved conditions, poor prognosis, and uncertainty about the illness cause psychological problems that lead to patient self-closure and reluctance to express thoughts and feelings to their partners, affecting the intimate relationship between them. Correlation analysis revealed significant associations among psychological distress (K10), intimate relationship satisfaction (QRI), and physical activity levels (IPAQL) in patients with different physical activity levels. Patients with lower physical activity levels showed stronger correlations, suggesting that lower physical activity levels were associated with more distress and reduced communication with spouses, leading to a greater impact on intimate relationships. Unpleasant emotional experiences can disrupt the maintenance of intimate relationships between spouses.

The mediating effect analysis indicated that physical activity levels significantly mediated the relationship between psychological distress and intimate relationship satisfaction, accounting for 40.23% of the total effect. This suggests that physical activity can alleviate the patients’ psychological distress and indirectly influence the intimate relationship with their spouses. Several studies have highlighted the correlation between psychological distress and physical activity level[21]. Prolonged exposure to severe and complex stress, exceeding an individual’s coping abilities, can not only affect the patient’s emotional responding, but also impact their partner’s well-being and marital satisfaction. Increasing physical activity, such as participating in sports, can help reduce the risk of adverse psychological states, anxiety and depression during such challenging times. In fact, stroke patients often use physical activity as part of their rehabilitation treatment. This approach can stimulate nerve and limb function recovery, regulate the sympathetic nervous system to alleviate anxiety and depression levels, enhance physical functionality, decrease disability rates, and improve daily living activities[22]. However, it is important to note that in this study, physical activity level represents only one of the mediating factors between psychological distress and intimate relationship satisfaction. This implies that physical activity plays a partial role in mediating these factors. To effectively address patients’ psychological distress, a comprehensive consideration of other contributing factors is necessary. Medical professionals play a crucial role in supporting patients during their treatment journey. Encouraging patients to manage their illness correctly, guiding them and their spouses to adopt positive behaviors, and fostering effective coping strategies are essential steps to alleviate psychological distress. Furthermore, enhancing patient cooperation and strengthening the intimacy between spouses can help mitigate both the psychological and physical burdens faced by the couple.

In summary, patients’ psychological distress significantly affects their intimate relationship with their spouses, and the level of physical activity serves as a crucial factor between psychological distress and intimate relationship satisfaction. Therefore, it is imperative to focus on improving patients’ physical activity levels to reduce psychological distress pressure, enhance communication between spouses, and provide mutual support to foster a stronger sense of intimacy and well-being.