Autonomy Support, Self-Determined Motivation, and Exercise Adherence in Cardiac Rehabilitation

Abstract

<p>Despite the known benefits of regular exercise for cardiac patients (Jolliffe et al., 2001) and the delivery of cardiac rehabilitation programs to facilitate exercise participation in this population, exercise adherence remains a challenge for these individuals as evidenced by the reported decline in exercise participation over time (e.g., Moore et al., 2006). Investigating cardiac patients' motivation or willingness to engage in exercise may provide a better understanding of why some patients are better maintainers of exercise and others are not. Using self-determination theory (Deci & Ryan, 1985; 2002), the present study investigated changes in need satisfaction and selfdetermined motivation, as well as the role of perceived autonomy support relative to patient motivation, in the early months of participation in cardiac rehabilitation. It was hypothesized that need satisfaction and autonomous forms of behavioural regulation would increase over time, and that perceived autonomy support (ratings of exercise leaders' tendencies to acknowledge patients' perspectives, provide choices and contingent feedback, etc.) would positively predict changes in behavioural regulation, mediated by changes in psychological need satisfaction. Another aim of the study was to examine how autonomous forms of behavioural regulation related to cardiac patients' exercise intentions and self-managed exercise behaviour, and it was hypothesized that this relationship would be positive for both exercise intentions and behaviour. Fifty-three male participants (Mage= 62.83 ± 10.78) who were enrolled in a hospital-based cardiac rehabilitation program completed assessments of perceived autonomy support, need satisfaction and behavioural regulation at weeks 4, 8, and 12 of program participation. At week 14, participants' self-managed exercise behaviour and their exercise intentions to engage in independent exercise for the next 4 weeks were assessed. In general, participants' scores for all variables of interest were relatively high. Consistent with hypotheses, autonomy and relatedness need satisfaction, along with integrated and intrinsic regulation increased from week 4 to week 12 during cardiac rehabilitation. However, perceived autonomy support was not related to changes in need satisfaction or behavioural regulation, and thus, support for mediation was not obtained. Nonetheless, the high ratings of perceived autonomy support reflect the exercise leaders' natural tendency to use an autonomy supportive teaching style with patients. In addition, a positive relationship was found between autonomous forms of behavioural regulation (i.e., integrated and intrinsic) and exercise intentions, lending support to the SDT framework. The positive findings for need satisfaction, autonomous regulation, exercise intentions, and behaviour reflect a highly self-determined group of cardiac patients who are choosing to engage in self-managed exercise while still participating in the supervised cardiac rehabilitation program. These findings are promising in terms of regular exercise adoption in this population.</p>