PURPOSE: Despite an increasing interest in motivational interviewing as a strategy to facilitate behavior change in people with cardiovascular disease, its use in cardiac rehabilitation (CR) appears minimal. Therefore, it is unclear whether the clinical method of motivational interviewing requires modification for the CR population, in which it could be argued that people are motivated and engaged. The purposes of this report are to describe processes in incorporating motivational interviewing in the CR setting and to discuss insights gained regarding the use of this intervention. METHODS: As part of a randomized controlled trial currently recruiting in the CR setting, patients allocated to the intervention group participate in 2 motivational interviewing sessions with a motivational interviewing-trained nurse. To ascertain treatment fidelity, this process review comprised 3 sources: (1) the extant literature on motivational interviewing, (2) reflections of the project team, and (3) data derived from audiotaped interviews. RESULTS: Key observations reflect that the motivational interviewing technique is well received, with patients appreciating the opportunity to "tell their story." Preliminary qualitative data revealed that patients rate "health" and "family" as their most important values, with many commenting on their recovery phase as a "second chance." CONCLUSIONS: This report demonstrates that motivational interviewing is potentially useful and has significant promise in the CR setting. Discussion of pragmatic considerations as well as outcome data should assist clinicians in implementing this model of intervention in the CR setting. �� 2008 Lippincott Williams & Wilkins, Inc.