To develop an exercise adherence scale for maintenance hemodialysis(MHD) patients based on behavioral change theory and test its reliability and validity,aiming to provide a tool for measuring exercise adherence in MHD patients.

Guided by the Capability-Opportunity-Motivation Behavior(COM-B) model and the Theoretical Domains Framework(TDF),an initial item pool was constructed through literature review and semi-structured interviews.The initial version of the scale was determined after two rounds of Delphi expert consultations(n=20).Item selection was conducted based on survey results from 293 MHD patients,followed by validity and reliability testing in another sample of MHD patients.

The developed exercise adherence scale for maintenance hemodialysis patients consisted of two parts:Part 1 is the exercise adherence process subscale for MHD,including three dimensions(capability,opportunity,motivation) with 35 items;Part 2 is the exercise adherence outcome subscale for MHD,a single dimension with 12 items.Exploratory factor analysis extracted three common factors,with a cumulative variance contribution rate of 57.706%;confirmatory factor analysis showed good model fit;the Cronbach's α coefficient for the process subscale was 0.954,split-half reliability was 0.712,and test-retest reliability was 0.907;the test-retest reliability for the outcome subscale was 0.932.

The developed exercise adherence scale for maintenance hemodialysis patients demonstrates good reliability and validity and can be used to assess exercise adherence in MHD patients.