The roles of self-efficacy and motivation in the prediction of short- and long-term adherence to exercise among patients with coronary heart disease

Health Psychol. 2014 Nov;33(11):1344-53. doi: 10.1037/hea0000094. Epub 2014 Aug 18.


Objectives: Poor adherence to regular exercise is a documented challenge among people with heart disease. Identifying key determinants of exercise adherence and distinguishing between the processes driving short- and long-term adherence to regular exercise is a valuable endeavor. The purpose of the present study was to test a model of exercise behavior change, which incorporates motivational orientations and self-efficacy for exercise behavior, in the prediction of short- and long-term exercise adherence.

Method: Male and female patients (N = 801) hospitalized for coronary heart disease were recruited from 3 tertiary care cardiac centers and followed for a period of 1 year after hospital discharge. A prospective, longitudinal design was used to examine the roles of motivation and self-efficacy (measured at recruitment and at 2 and 6 months after discharge) in the prediction of exercise behavior at 6 and 12 months. Baseline measures of exercise and clinical and demographic covariates were included in the analyses.

Results: Structural equation modeling showed that both autonomous motivation and self-efficacy were important determinants of short-term (6-month) exercise behavior regulation, but that only autonomous motivation remained a significant predictor of long-term (12-month) exercise behavior. Self-efficacy partially mediated the relationship between motivation for exercise and 6-month exercise behavior.

Conclusions: This research confirmed the roles of autonomous motivation and self-efficacy in the health behavior change process and emphasized the key function of autonomous motivation in exercise maintenance. Theoretical and cardiac rehabilitation program applications of this research are discussed.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Coronary Disease / psychology
  • Coronary Disease / rehabilitation*
  • Exercise / psychology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Motivation*
  • Patient Compliance / psychology*
  • Patient Compliance / statistics & numerical data
  • Prospective Studies
  • Self Efficacy*
  • Time Factors