- Background: Spina bifida (SB) is the most common birth defect, affecting approximately 1 to 2 in 10,000 live births. SB is a complex disability with many associated, secondary, and chronic conditions that require lifelong medical care. Individuals with spina bifida (SB) are living longer with advances in medical care, and the majority of the estimated 166,000 individuals in the US living with SB are adults. Consequently, secondary conditions (SC) are more apparent and healthcare costs to treat SC are high. The National Center on Birth Defects and Developmental Disabilities' approach to decrease SC is to increase the number of accessible health promotion programs (HPP) available and increase levels of physical activity (PA). For persons with SB, a sedentary lifestyle is common, thus placing individuals at greater risk of experiencing SC. Furthermore, there is a lack of PA HPP for individuals with SB and there is a significant need to find approaches to increase PA behaviors in this population. However, if HPP are to effectively increase PA behaviors they have to be well designed, include the target population, and use previous research to guide development. Consequently, the first step in creating a PA HPP for individuals with SB is a needs assessment. Therefore, PA needs assessment was developed and implemented for adults with SB. Methods: The needs assessment included information about (1) demographics, environment, current PA behaviors, attitudes and motivation; (2) the individuals PA stage of change (SOC); and (3) perceived PA barriers (personal and environmental). A mixed method approach was used to collect data for the needs assessment that included a national, online survey (quantitative) and 1-1 interviews (qualitative). Results: Adults with SB lead a sedentary lifestyle. From the quantitative study, barriers, self-efficacy, and being female predicted participants PA levels. Main themes identified from the qualitative study included (1) a lack of PA knowledge, (2) facing personal barriers, and (3) a strong intention to become active. Conclusion: Future research needs to focus on developing PA interventions to educate adults with SB about the health benefits and ways to increase activity. The results from the needs assessment will guide the development of a future PA HPP that will aim to facilitate the adoption and maintenance of PA behaviors in adults with SB.