“It’s an emergency!” delegates declared in 2011 at the Pacific Island Forum in Fiji, convened by the Secretariat of the Pacific Community and the World Health Organization Office of the South Pacific.2 The emergency referred to the ever-increasing burden of non-communicable diseases (NCDs) in the Pacific Islands. The Pacific region is experiencing among the highest prevalence of NCD risk factors in the world.3–6 American Samoa, Tokelau and Nauru have overweight and obesity rates of 93.5%,7 86.2%,8 and 82.2%9 and diabetes rates are 47.3% in American Samoa,7 33.6% in Tokelau,8 and 32.1% in Micronesia.10 A total of 70% of the global increase in diabetes is expected to occur in the Asia Pacific region. The Pacific Island countries and areas are predicted to experience among the greatest increases in diabetes prevalence worldwide.11,12 Urbanisation, westernisation, and rapid changes in food supply and security have contributed to obesogenici environments in the PICs. These environments support poor diets and high levels of physical inactivity. Supporting the good health of Pacific populations by encouraging and facilitating the adoption of healthier lifestyles is therefore of utmost importance. This doctoral work is the first in the specific area of physical activity health promotion in the Pacific Islands that seeks to understand and increase PA levels and reduce NCD risk.