Configurational patterns associated with relatively higher recent home-based exercise behavior among lung transplant recipients: a fuzzy-set qualitative comparative analysis

BACKGROUND: Home-based exercise supports functional recovery after lung transplantation, yet exercise behavior varies among recipients. Guided by the capability, opportunity, motivation, and behavior (COM-B) model, this study examined configurations associated with relatively higher recent home-based exercise behavior among lung transplant recipients. METHODS: This cross-sectional study included adult lung transplant recipients within the first year after transplantation at a tertiary hospital in Zhejiang, China. Five COM-B-related conditions were assessed: 6-min walk distance, exercise rehabilitation knowledge, perceived social support, exercise self-efficacy, and exercise automaticity. Recent home-based exercise behavior during the previous 7 days was assessed through structured retrospective interviews and calculated as MET-min/week. Fuzzy-set qualitative comparative analysis examined necessary conditions, sufficient configurations, and the negated outcome; exploratory univariate analyses described clinical context. RESULTS: Among 139 lung transplant recipients, no single condition was necessary for relatively higher recent home-based exercise behavior. Four sufficient configurations were identified (solution coverage, 0.675; consistency, 0.827). Exploratory analyses highlighted postoperative stage and pulmonary function; the negated-outcome analysis supported causal asymmetry. The configurations were summarized as motivation-characterized and multi-condition synergistic patterns. Motivation-characterized configurations combined higher exercise self-efficacy and higher exercise automaticity, although one configuration involving relatively limited exercise capacity was calibration-sensitive. Multi-condition synergistic configurations involved favorable combinations of capability-, social opportunity-, and motivation-related conditions. CONCLUSION: Relatively higher recent home-based exercise behavior was associated with multiple COM-B-related configurations rather than any single necessary condition. These findings may inform multidimensional assessment and clinically contextualized rehabilitation support during post-transplant home recovery.