Behaviour Change Frameworks

Self-determination theory positions motivation on a continuum from intrinsic motivation—pursuing behaviour because it is inherently enjoyable—to amotivation, a complete absence of intention to act. Amotivated patients could adhere to the supervised programme because external structure compensated for absent internal motivation, but this compensation did not persist after the programme ended. Patients who maintained exercise shifted toward autonomous motivation during the intervention, experiencing exercise as genuinely enjoyable and personally meaningful. Frustration and amotivation are established predictors of exercise dropout in the literature, a pattern consistent with what was observed in this study.