Background Motor dysfunction caused by stroke not only directly impairs physiological functions but also exerts a negative impact on psychological well-being. Adherence to functional exercises is critical for improving motor function recovery and enhancing the quality of life of stroke survivors. This study aimed to investigate the current status of illness perception, sense of coherence, self-regulatory fatigue, and functional exercise adherence in stroke patients, and to examine the chain mediating effects of sense of coherence and self-regulatory fatigue between illness perception and functional exercise adherence.Methods A cross-sectional descriptive study design was adopted, and convenience sampling was used to recruit stroke patients who attended follow-up visits at the neurology outpatient departments of two general hospitals in Henan Province. All participants completed a set of standardized questionnaires: including the demographic questionnaire, the Brief Illness Perception Questionnaire, the Sense of Coherence Scale, the Self-Regulatory Fatigue Scale, and the Stroke Patients' Functional Exercise Adherence Questionnaire.Results A total of 427 stroke patients were included. The mean scores of illness perception, sense of coherence, self-regulatory fatigue, and functional exercise adherence was (43.15 ± 9.24), (54.77 ± 10.86), (46.99 ± 8.25), and (34.30 ± 6.18), respectively. Multiple linear regression analysis identified that age, monthly household income per capita, primary caregiver, number of strokes episodes, number of chronic conditions, self-care capacity, illness perception, self-regulatory fatigue, and sense of coherence as significant predictors, collectively accounting for 72.3% of the variance in functional exercise adherence. Mediation effect analysis showed that illness perception not only directly influenced functional exercise adherence but also indirectly affected it through sense of coherence and self-regulatory fatigue. The mediating effects of sense of coherence and self-regulatory fatigue were − 0.101 (19.42% of total effect) and − 0.084 (16.15%), respectively, and their chain mediating effect was − 0.095 (18.27%).Conclusion Stroke patients in this study demonstrated moderate levels of illness perception, sense of coherence, and functional exercise adherence, upper-medium levels of self-regulatory fatigue. Sense of coherence and self-regulatory fatigue exhibiting chain-mediating effects between illness perception and functional exercise adherence. Clinical nursing staff should assist patients in establishing appropriate illness perceptions, enhancing their sense of coherence and reducing self-regulatory fatigue to improve functional exercise.