Autonomous Motivation: Relatedness


Relatedness is defined as the sense of a shared experience (Walsh, 2011). Clients need to feel a warm and welcome atmosphere to stick to an exercise program. However, clients have different preferences, for example some clients like talking while doing exercise, while others prefer doing exercise in a quiet environment. Generally, practitioners need to show care to- and keep connections with- clients.

As mentioned in the Health LEADS Australia model, Leads Self is an important part of the proposed leadership model. Building effective relationships with clients is crucial to improve their motivation. Proposed strategies include arriving early or leaving work late just to have an extra conversation with clients, or simply giving phone calls to check how they are tracking with their exercise programs. These methods are aiming to show more respect and care to clients. Outside clinical time, strategies such as sending a holiday card, or sending an invitation to a clinic event have been shown to be effective in building client-practitioner relatedness (Cross, 2008).

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Practitioners can also engage with patients in designing the actual exercise program. For example, practitioners can ask the client about their preference on an exercise position, or ask what their home environment is like in an attempt to negotiate with clients an exercise design that complements their home environment. In this way, practitioners show respect as well as autonomy as they design an individualised exercise program that relate to the client’s needs.

When communicating with clients, practitioners can talk about the goals perceived by the client. Then, the practitioner can integrate the client’s goal and the treatment goal. This is essential, because ‘Achieving Outcomes’ is the driving force to ensure clients continue the exercise program.

Furthermore, setting a goal together with the client is a process of engagement, and easy for the client to agree to work on.

Finally, don’t forget that it’s a two way street; practitioners need to be open to changes as well. Feedback from clients are useful for practitioners to modify their exercise programs. Innovations are vital in the leadership theory, as we strive for a rehabilitation program that will maximally benefit everyone, and this cannot be achieved without constant modification and improvement. Meanwhile, feedback from clients is helpful for practitioners to understand the exercises from the client’s perspective. Therefore making a change accordingly is a way of showing respect to clients.

To conclude, the leadership theory is useful in improving the competence and relatedness of an exercise program. These two factors are important to increase the motivation of adhering to an exercise program. With the methods mentioned in the two blogs above, motivation will hopefully be enhanced, and a better compliance to exercise will be achieved.

– BH


Cross, K. 2008. Guiding client progress. IDEA Trainer Success, 5 (2), 12–14.

Self-Determination Theory: A Key to Motivation. Walsh, 2011. Retrieved from


Autonomous Motivation: Competence

Autonomous motivation was introduced from the Self-determination theory (Deci & Ryan, 2000); a theory focusing on the intrinsic motivation of a person. In contrast to extrinsic motivation, autonomous motivation is more significant in goal progression (Koestner et al, 2008). Literature found the need satisfaction will predict autonomous motivation, which in turn predicts exercise adherence (Weman-Josefesson et al, 2015). Therefore, in order to improve the compliance to exercise, patients need to build up autonomous motivation. Competence and relatedness were found to have positive relationships with motivation. Consequently, clinicians have to consider the competence of clients and the relatedness of the exercise when prescribing exercise program.



A client has to be able to complete the exercise in order to successfully follow an exercise program. The intensity, dosage, and form of exercise can all affect the competence of a client to complete the exercise. Moreover, clients with particular conditions need extra consideration when prescribing physical activity. For example, a population with chronic pain were found to experience more obstacles to complete the exercise program (Joelsson et al, 2017). Therefore, perceived efforts should be measured when completing an exercise program. The Borg RPE scale, the OMNI scale, the Talk Test and the Feeling Scale are examples of tools that can be used to assess difficulty levels and will aid in modulating  cardiorespiratory and resistance exercises (Garber et al, 2011).


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In clinics, the measures mentioned above should be promoted to monitor the competence of  clients to complete an exercise program, with the aim to improve the motivation to adhere to the program. Practitioners can hand out these measures to clients and encourage clients to use them together with an exercise diary. Practitioners need to explain the significance of those measures to clients, and ensure that they understand these outcome measures. This is crucial as engaging others is necessary to implement a strategy successfully and it is also an inevitable part of the Health LEADS Australia model. In order to successfully engage with clients, practitioners need to communicate with clients with honesty and respect. In practice, we need to understand the difficulties for the client to implement these outcome measures such as a challenging home environment, understanding of the outcome measures or lack of family support. This highlights the importance for practitioners to discuss some strategies to address these difficulties.

Practitioners’ then need to monitor patient outcomes. As stated in the Health LEADS model, achieving outcomes is a key component for successful leadership. Practitioners can assess clients’ measures when there is a need to progress the exercise program. Moreover, questionnaires designed to assess motivation can be used. Continually monitoring the results is good to assess the success of the exercise program as well as motivate clients to adhere with the exercises.

Finally, practitioners can involve the family to monitor the outcome measures. For example, clinician can explain the BORG scale to the family and ask them to monitor the client while the client is exercising. The Health LEADS model promotes a systems based thinking approach, and so in practice, practitioners can think about the involvement of other individuals important to the client, in order to improve motivation.

Hence, outcome measures can be utilized to ensure client competence in order to improve motivation. Engaging others, Achieving Outcomes and Shaping Systems in the leadership model are useful in implementing the change.

– BH


Deci, E. L., & Ryan, R. M. (2000). The” what” and” why” of goal pursuits: Human needs and the self-determination of behavior. Psychological inquiry, 11(4), 227-268.

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., … & Swain, D. P. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine & Science in Sports & Exercise, 43(7), 1334-1359.

Joelsson, M., Bernhardsson, S., & Larsson, M. E. (2017). Patients with chronic pain may need extra support when prescribed physical activity in primary care: a qualitative study. Scandinavian journal of primary health care, 35(1), 64-74.

Koestner, R., Otis, N., Powers, T. A., Pelletier, L., & Gagnon, H. (2008). Autonomous motivation, controlled motivation, and goal progress. Journal of personality, 76(5), 1201-1230.

Weman-Josefsson, K., Lindwall, M., & Ivarsson, A. (2015). Need satisfaction, motivational regulations and exercise: moderation and mediation effects. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 67.

Introduction and Welcome

This is the post excerpt.

Rehabilitation post cardiovascular (CV) events with appropriate physical activity can stimulate significant changes in pulmonary, respiratory, skeletal muscle and CV systems (Lavie et al, 2015). Although the wide range of benefits have been shown, surveys in many countries have shown a less than 50% participation rate in rehabilitation (Bethell 2001; Blackburn 2000; Bunker 1999). Many factors reported poor adherence is the major reason. In order to achieve a better outcome, practitioners need to address not only the physical problems, but also issues with psychosocial perspectives. The International Classification of Functioning, Disability and Health (ICF) model further highlights the major influence of personal and environmental factors on the impact of “health”. Therefore, we have prepared a series of blogs that will analyse not only the physical, but also the environmental and personal factors that contribute towards the inadequate adherence to exercise rehabilitation. The barriers we have focused on include access, self efficacy, cost of time/money, social support, motivation, health literacy, and physical function.

Within each blog, we have also proposed solutions to the barriers in rehabilitation/exercise adherence, with our final blog promoting a brand new tool that could be incorporated into research and clinical practice in an attempt to improve compliance to rehabilitation.  The Health LEADS model was introduced by the Australian Health Ministers’ Advisory Council and is utilised widely among health professionals today. It consists of 5 parts, which are leads self, engage others, achieve outcomes, drive innovations and shaping systems. It defines five important areas as key factors that must be adopted by leaders in order to implement a successful and sustainable change in the healthcare sector. This leadership theory will therefore be discussed and applied throughout the blogs in an attempt to reach out to and empower all stakeholders; inclusive of patients, healthcare professionals and government bodies, in an attempt to  collaboratively and innovatively lead a meaningful change to this current issue that is low exercise compliance, that exists within the physiotherapy profession.

Prosperous Growth and Healthy Living

– AD, BH, JH, RJ


Bethell, H. J., Turner, S. C., Evans, J. A., & Rose, L. (2001). Cardiac rehabilitation in the United Kingdom: How complete is the provision?. Journal of Cardiopulmonary Rehabilitation and Prevention, 21(2), 111-115.

Blackburn, G. G., Foody, J. M., Sprecher, D. L., Park, E., Apperson-Hansen, C., & Pashkow, F. J. (2000). Cardiac rehabilitation participation patterns in a large, tertiary care center: evidence for selection bias. Journal of Cardiopulmonary Rehabilitation and Prevention, 20(3), 189-195.

Bunker, S., McBurney, H., Cox, H., & Jelinek, M. (1999). Identifying participation rates at outpatient cardiac rehabilitation programs in Victoria, Australia. Journal of Cardiopulmonary Rehabilitation and Prevention, 19(6), 334-338.

Lavie, C. J., Arena, R., Swift, D. L., Johannsen, N. M., Sui, X., Lee, D., …& Blair, S. N. (2015). Exercise and the Cardiovascular System: Clinical Science and Cardiovascular Outcomes. Circulation Respiratory, 117(2): 207–219