Project Title: Efficacy of a novel web-based physical activity intervention designed to promote adherence to physical activity guidelines in adults with obesity Funding organization: The National Heart, Lung, and Blood Institute (NHLBI) Grant type: R01 Date submitted: Oct 2, 2021 Amount requested: $3,167,589 PI: Kariuki Jacob, PhD Co-investigators: Lora E. Burke, PhD, MPH; Bethany Gibbs, PhD; Erick Erickson, PhD; Andrea Kriska. Consultants: David Ogutu, BS Project Summary/Abstract The National Guidelines recommend that all American adults achieve ≥150 min of moderate to vigorous intensity physical activity weekly. Yet, adherence to the Guidelines is low, with only 24% of adults attaining the recommended physical activity (PA). The low levels of PA increase the risk cardiometabolic disease, especially among individuals with obesity. Although any increase in PA can reduce the risk, these individuals face complex weight-related impediments including stigma, embarrassment, poor fitness, and low self-efficacy that reduce their engagement in PA. To mitigate these barriers, web-based PA interventions have been developed, but their efficacy is often limited by lack of behavioral coaching and generic content that does not address barriers experienced by those with obesity. Our research team and others have reported that culturally diverse individuals with obesity prefer PA programs that are convenient, fun to engage in, and feature people to whom they can relate especially in body size, fitness level, and age. Yet, there is a paucity of PA interventions intentionally designed to incorporate these preferences. In our prior work, we sought the input of individuals with overweight/obesity to inform the development of a technology-based Physical Activity for The Heart (PATH) intervention that leverages openly accessible platforms, such as YouTube, to provide workout videos that match the specific preferences expressed in our formative studies and the extant literature. We have successfully beta tested the PATH platform and have demonstrated excellent retention, intervention engagement and preliminary efficacy in our 12-week feasibility studies. In this application, we propose to test the efficacy of PATH in promoting adherence to the PA Guidelines in a diverse sample of inactive adults with obesity. Our long-term goal is to deploy the PATH intervention as a scalable stand-alone program to increase access, reduce time commitment, avoid weight-related stigma, and lessen the impact of unpredictable barriers to PA such as inclement weather or pandemics like COVID-19. We will conduct a 12-month 2-group randomized controlled trial and equally allocate 450 adults to one of the two intervention conditions: Path intervention or attention control. In Aim 1 we will evaluate the efficacy of PATH for improving short- and long-term adherence to the PA Guidelines. In Aim 2 we will compare the effects of the PATH intervention on risk factors for CVD. In the final Aim, we wi...