Exploring motivational readiness for adapted physical activity in older adults with chronic illness: patterns of self-care behaviors, engagement, and psychological distress

Introduction: In clinical settings, adapted physical activity (APA) is increasingly prescribed to older adults with chronic conditions, yet adherence remains low and motivational readiness varies widely at the time of prescription. While the Transtheoretical Model (TTM) describes stages of change for health behaviors, less is known about how motivational stage relates to broader psychological dimensions relevant to healthy aging, such as self-care behaviors, engagement in healthy aging promotion, and psychological distress. Methods: A cross-sectional study within the Age.it Project was conducted with 74 older adults (mean age ≈ 70.82 years) attending outpatient clinics at the University Hospital Federico II and prescribed APA. Motivational stage was assessed through the MAC2-R AF. Self-care behaviors were measured with the Self-Care Inventory; Engagement in healthy aging promotion with the EHAPS; Psychological distress with the K10. Group differences across motivational stages were tested using Kruskal–Wallis analyses with Dunn–Bonferroni posthoc comparisons and epsilon squared effect sizes. Results: Most participants were classified in Contemplation (59.5%), followed by Determination (23%) and Precontemplation (17.6%). No participants were in Action or Maintenance stages. Motivational stage was significantly associated with self-care monitoring, engagement, and distress, with large effects. Contemplation showed higher self-care monitoring and higher distress, alongside lower engagement. Engagement was higher in Precontemplation and Determination compared to Contemplation, whereas distress increased progressively from Precontemplation to Determination. Discussion: Findings suggest distinct, non-linear psychological configurations within the motivational stages at the time of APA prescription. Contemplation emerges as a vulnerable phase characterized by symptom surveillance and emotional burden without engagement in healthy aging promotion; Determination combines higher engagement with heightened distress; Precontemplation may reflect stable self-care routines and low distress but potential resistance to integrating exercise into self-care identity. Integrating motivational stage assessment with psychological–clinical indicators may support more personalized, motivated, and sustainable APA prescriptions for older adults.