The effect of early knee symptom on stages of change for exercise and its characteristic among young college students: application of the transtheoretical model

To explore the effect of early knee symptoms on the stages of change for regular exercise among young college students and its underlying mechanism using the transtheoretical model (TTM). Electronic questionnaires on chronic and frequent knee symptoms, four constructs of TTM for regular exercise, and other variables were designed and distributed in 2022. Valid data was analyzed for 1111 young college student using descriptive statistics, chi-square tests, independent sample t-tests, MANOVA with post-hoc, and logistic regression models. The prevalence of knee symptoms was 17.37% (95% CI : 15.21 to 19.76). The distribution of exercise stages between students with and without knee symptoms was significantly different ( χ 2 = 13.57, p = 0.01), and the total proportion of action and maintenance in students with knee symptoms (28.50%) was relatively higher than that in those without (19.83%). MANOVA showed ten processes of change, self-efficacy, pros and cons were significantly different across stages in students with knee symptoms (Pillai’s Trace = 0.618, F = 2.516, p < 0.001) and in those without (Pillai’s Trace = 0.317, F = 5.993, p < 0.001), and large effects size were only found for counterconditioning ( η 2 = 0.15), self-liberation ( η 2 = 0.17), self-efficacy ( η 2 = 0.15), and pros ( η 2 = 0.14) among students with knee symptom. This study implied that early knee symptoms might prompt individuals to engage in and maintain regular exercise behaviors, that specifically enhanced the power of psychological and behavioral variables, especially of self-liberation, counterconditioning, self-efficacy and pros. Insights into the different patterns of constructs of TTM for exercise behavior among students with knee symptoms would be valuable for developing interventions. However, considering the relationship was associational rather than causal, and that reverse causality was possible, that was those who exercised regularly was more aware of their symptoms.