Applying self-determination theory in clinical practice for successful long-term lifestyle change: lessons from a case report
DOI:
https://doi.org/10.59856/arch.soc.chil.med.deporte.v70i1.88Keywords:
exercise , motivation, weight managementAbstract
Adherence to lifestyle changes, such as physical activity and nutrition, is crucial for reducing morbidity and mortality from noncommunicable diseases. However, the quality of motivation plays a key role in sustaining these behaviors, particularly in clinical settings such as sports medicine and preventive healthcare. According to the Self-Determination Theory (SDT), motivation exists on a continuum ranging from amotivation (lack of intent) to extrinsic motivation—which varies in autonomy (external, introjected, identified, and integrated regulation)—and intrinsic motivation, where behavior is fully self-determined. The Behavioral Regulation in Exercise Questionnaire (BREQ-3), based on SDT, quantifies these motivational types and serves as a clinical tool for tailoring interventions.
A 29-year-old man with obesity sought telemedicine consultation for exercise and nutrition guidance. Initial BREQ-3 assessment revealed predominant introjected regulation (13/16 points), suggesting motivation driven by guilt and social expectations. A structured SDT-based intervention was implemented, integrating aerobic and resistance training, step-count targets, nutritional modifications, and behavioral strategies, specifically designed to shift motivation toward autonomous forms. At 14 months, a reassessment with BREQ-3 showed a shift towards intrinsic (+4) and integrated regulation (+3), along with decreases in introjected (-2) and external regulation (-5), reflecting improved alignment between exercise and personal values. Seventeen months after the intervention, despite the absence of professional supervision, motivation remained highly autonomous, with maximum scores in intrinsic regulation (16/16) and high scores in integrated regulation (13/16), indicating sustained behavior change.
This case underscores the clinical utility of BREQ-3 in assessing and guiding motivation-based interventions. The observed transition from controlled to autonomous motivation highlights the effectiveness of SDT-informed strategies in promoting long-term behavior change. These findings suggest that integrating motivation assessments into routine practice could enhance adherence across diverse clinical populations, ultimately optimizing patient outcomes in lifestyle interventions.
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