Objective To investigate the effects of a transtheoretical model-based zero-time exercise intervention on pelvic floor muscle training adherence and symptom improvement among patients to receive surgery for benign gynecological diseases complicated with mild-to-moderate stress urinary incontinence （SUI）. Methods A quasi-experimental study was conducted. Eligible patients were assigned to either a control group (n=48) or an intervention group (n=48) based on the time period of hospitalization. The control group received routine guidance on pelvic floor muscle training, whereas the intervention group received a stage-based zero-time exercise intervention grounded in the Transtheoretical Model in addition to routine guidance. Patients′ self-efficacy and adherence regarding pelvic floor muscle training were assessed at admission, discharge, and 1 and 3 months after surgery. Urinary incontinence questionnaire scores were evaluated at admission and 3 months postoperatively. Results The intervention group demonstrated significantly higher self-efficacy scores and the rates of patients with moderate-to-high level of adherence for pelvic floor muscle training at discharge and at 1 and 3 months after surgery compared with the control group (all P<0.05). Furthermore, urinary incontinence questionnaire scores at 3 months postoperatively were significantly lower in the intervention group than in the control group (P<0.05). Significant group, time, and group-by-time interaction effects were observed for pelvic floor muscle training self-efficacy between the two groups (all P<0.05). Conclusion The Transtheoretical Model-based zero-time exercise intervention effectively enhanced self-efficacy and adherence to pelvic floor muscle training among patients with SUI. It also alleviated urinary incontinence symptoms and improved patients′ quality of life.