Correlates and Lived Experiences of Aerobic Exercise Adherence Among Indonesian Menopausal Women: A Mixed-Methods Study Using Pender's Model

Abstract

Aerobic exercise adherence among menopausal women is shaped by personal, interpersonal, and situational factors, yet evidence from Indonesia is limited. This study aimed to examine the associations of Pender's Health Promotion Model (HPM) constructs with commitment to an aerobic exercise plan and to explore the lived experiences behind adherence among Indonesian menopausal women. A mixed-methods design was used. In the quantitative strand, 153 women in Palembang completed a 19-item HPM-based questionnaire, and Pearson correlations were computed. In the qualitative strand, 20 women were interviewed, and the transcripts were analysed thematically, guided by the HPM. Self-efficacy shows the strongest correlation with commitment (r = 0.66, p < 0.001), followed by interpersonal influences (r = 0.49) and perceived benefits (r = 0.33); perceived barriers (r = 0.12) and competing demands (r = −0.08) are not significantly related to commitment. The interviews yield seven themes. Women understand the health value of exercise but are constrained by multigenerational caregiving, household duties, menopausal symptoms, and communal religious and social obligations. Family support is passive and conditional, whereas peers actively encourage one another. Exercise occurs mainly on Sundays and holidays and when an instructor or companions are available, so adherence is opportunity-dependent rather than self-sustained. Strengthening self-efficacy and offering instructor-led group exercise with peer support appear to be promising targets for nurse-led programmes. These findings come from a single city and cross-sectional correlations, so causal inference is not possible.