A Pilot Feasibility and Acceptability Study of Remote ExerciSe Training mOdalities (PRESTO)

Inclusion Criteria:

1. >45 years

2. At risk for CVD (participants must have one or more of the following risk factors:hypertension, hyperlipidemia, Type 2 Diabetes Mellitus, smoking, obesity, familyhistory of premature CVD)

3. Not meeting AHA physical activity guidelines for at least 3 months prior toscreening

• Hypertension:

• Systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or

• Use of anti-hypertensive medication

• Hyper / dyslipidemia

• LDL cholesterol levels ≥160 mg/dL and/or

• HDL cholesterol <50mg/dL for women, <40mg/dL for women, in addition tofasting triglycerides >150mg/dL

• Diabetes Mellitus:

• Hemoglobin A1c levels ≥6.5%, fasting glucose levels ≥126 mg/dL, or 2-hourglucose levels ≥200 mg/dL after an oral glucose tolerance test and/or

• Use of any diabetes medication

• Smoking:o Current regular tobacco use.

• Obesity:o BMI ≥30 kg/m².

• Family History of Premature Cardiovascular Disease:

• Having a first-degree relative (parent, sibling) who developed CVD beforeage 55 for biological males or age 65 for biological females.

Exclusion Criteria:

1. Established diagnosis of atherosclerotic CVD

2. Presence of any serious medical conditions that would not allow safe participationin exercise according to the American College of Sports Medicine (ACSM) and the AHA (56-58)

3. Pregnant or anticipating pregnancy

4. Plan to be away for >2 weeks during the intervention period

5. Presence of any biopsychosocial factors that the principal investigator deems ashaving significant potential to interfere with effective study participation