Predictors of Physical Activity Enjoyment in Adults with Cystic Fibrosis: The Role of Quality of Life and Motivation-A Single-Center Study.

Background: Despite the well-documented physical and psychological benefits of regular physical activity (PA) and exercise, participation remains insufficient in adults with cystic fibrosis (pwCF). In the general population, PA enjoyment is a key determinant of sustained engagement, yet its predictors in CF populations remain underexplored. Objective: We aimed to examine associations between clinical parameters, health-related quality of life (HRQoL), motivation and PA enjoyment in adult pwCF. We hypothesised that higher intrinsic motivation and better HRQoL would predict greater enjoyment, independent of clinical parameters. Methods: In this cross-sectional study, 197 adult pwCF (mean age = 36.6 ± 11.9 years) from a single centre completed validated questionnaires assessing PA and exercise enjoyment (Physical Activity Enjoyment Scale, PACES), motivation (Behavioral Regulation in Exercise Questionnaire-2, BREQ-2), and HRQoL (Cystic Fibrosis Questionnaire-Revised, CFQ-R). Hierarchical regression was conducted in three steps: clinical variables (Model 1), added HRQoL domains (Model 2), and motivational variables (Model 3). Results: The complete model explained 68.4% of the variance in PA and exercise enjoyment (R2 = 0.684, p < 0.001). Intrinsic motivation was the strongest positive predictor (β = 6.228, p < 0.001), while external regulation negatively predicted enjoyment (β = -1.932, p = 0.030). Among HRQoL domains, only health perception remained significant (β = 0.081, p = 0.038). Clinical variables alone accounted for minimal variance (R2 = 0.023, p = 0.370). Conclusions: Intrinsic motivation was the most robust predictor of PA and exercise enjoyment, outweighing clinical and most HRQoL factors. These findings support autonomy-supportive strategies to foster internal motivation and enhance long-term PA and exercise participation in adult pwCF.