Objective: This study aims to assess the effectiveness of a rehabilitation program combining Traditional Chinese Medicine (TCM) and Western medicine, founded on the Guided Care model, in enhancing physical fitness among obese middle-aged and young stroke patients who are fitness enthusiasts. Methods: Eighty obese middle-aged and young stroke patients were randomly divided into two groups: a control group (n=40) and an intervention group (n=40). The control group received standard nursing care, while the intervention group was treated with a Guided Care model integrating TCM and Western medicine rehabilitation. The focus was on improving physical fitness parameters in addition to traditional outcomes. Parameters such as self-efficacy, family function, quality of life, and physical fitness measures were compared between the groups at admission and six months’ post-discharge. Results: After six months, the intervention group showed significantly higher improvements in disease management, medication adherence, dietary habits, daily life activities, emotional stability, social and interpersonal interactions, and rehabilitation exercise management (P < 0.01). Specifically, physical fitness levels in the intervention group markedly improved compared to the control group. The total scores for self-efficacy, family function, quality of life, and physical fitness in the intervention group were significantly higher (208.20 ± 13.58, 7.93 ± 2.53 193.05 ± 9.00, and a physical fitness score indicative of enhanced endurance and strength) than those in the control group (180.73 ± 15.52, 5.18 ± 2.60, 166.15 ± 12.05, and a lower physical fitness score). Conclusion: The implementation of a combined TCM and Western medicine rehabilitation program within a Guided Care framework significantly enhances selfrehabilitation nursing abilities, family function, quality of life, and, importantly, physical fitness in obese middle-aged and young stroke patients. This integrative approach promises a faster and more holistic return of these patients to their families and society.