The purpose of the current study was to assess the impact of a structured exercise program on student motivation to change and engagement in therapy sessions. Student participants (who were between the ages of 10 and 16) all attended a Therapeutic Day School. They participated in a structured exercise program, which consisted of an exer-gaming stationary bike curriculum during physical education class. Students participated for a minimum of ten minutes twice a week. Two additional measures were used in this study to determine client motivation to change and engagement in therapy. Data was gathered through the Thinking about Working on Challenges Contemplation Ladder completed by participants as well as The Clinician Rating of Therapeutic Engagement completed by clinicians. Measures were completed by students and clinicians during weekly individual therapy sessions. Pre-intervention and post-intervention ratings were obtained for each of the student participants. Data was analyzed for each of the variables: student self-reports of motivation to change, clinician ratings of therapeutic engagement, and the level of agreement between these two variables. The results of this study indicate that there is not a significant increase in client self-reports of motivation to change (p=0.43) following participation in the exercise program. Descriptive statistics reveal an overall increase in clinician ratings of therapeutic engagement, although this finding was also not significant (p=0.14). However, there was a significant increase (p=0.04) in the level of agreement between client ratings of motivation to change and clinician ratings of therapeutic engagement, indicating that client self-reports may be more in line with clinician ratings after participation in the exercise program. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]