PM1082: Using Self-determination Theory to Understand Factors Influencing Youth Engagement in Rehabilitative Exercise for Concussion

Background: Approximately 1.9 million youth sustain a concussion each year and up to 30% experience persistent post-concussive symptoms (PPCS), which can cause impairments in social development, cognitive function, and academic success. Research suggests rehabilitative (or subthreshold) exercise may help youth recover more quickly. However, exercise following a concussion is challenging, and no studies have yet applied behavioral theory to youth adherence with exercise recommendations post-concussion. We set out to fill this gap by collecting qualitative data from youth and parents participating in a study of an exercise intervention for concussion (Mobile Subthreshold Exercise Program, MSTEP).

Methods: We conducted virtual semi-structured qualitative interviews with youth with PPCS and their parents, framed using Self-Determination Theory (SDT). SDT describes three basic psychological needs underlying behavioral motivation: autonomy, competence, and relatedness. Satisfying these needs is thought to shift youth from extrinsic to intrinsic motivation.

Results: A total of n=32 individuals (n=17 youth; n=15 parent) participated in the study, and youth were 71% female, mean age 15 (SD 2.04). Three themes appeared to facilitate youth engagement with physical activity, each of which can be tied to basic psychologic needs: social support, goal setting, and the general structure of the MSTEP program. Youth and parents both discussed the importance of social support in providing motivation to continue exercising, noting that social connection helped them stay engaged when feeling discouraged or challenged by concussion symptoms (relatedness). In particular, video conferences with the research coordinator created a sense of accountability for youth which increased motivation to exercise (relatedness & competence). Goal setting was also highlighted by youth; the program included specific exercise goals (primarily increasing duration and intensity of exercise each week), but some youth also entered the study with personal goals, such as returning to their sport. Having study goals provided extrinsic motivation to begin exercise after concussion, but having or developing personal goals created intrinsic motivation for continuing to exercise (autonomy). Youth and parents also mentioned the structure of the MSTEP program which helped relieve their concerns about returning to physical activity, providing them both a starting place and guide for how to advance (competence). Receiving direction about tailoring exercise to their specific concussion recovery experience increased motivation and overall program adherence (autonomy & competence).

Conclusion: Understanding motivational factors for engaging with exercise after concussion can influence youth adherence with exercise recommendations. When prescribing exercise, it may be helpful for clinicians to provide more direction including: 1) encouraging youth and parents to create structured social support; 2) helping youth set goals to monitor progress; and 3) offering structured guidance about how to safely advance physical activity.