Objective: To investigate the association between usual moderate-to-vigorous leisure-time physical activity (MVLTPA) and longitudinal trajectories of BMI and waist-to-height ratio (WHtR), as well as the incidence of obesity (BMI >=30 kg/m2) and central adiposity (WHtR >=0.6), in older adults at high cardiovascular risk. Methods: In PREDIMED participants aged 60-80 years (61% women; n=5,273 for BMI, n=4,940 for WHtR), MVLTPA was assessed using the Minnesota questionnaire (MET-min/day, cumulative mean). Mixed-effects models with cubic splines were used to estimate BMI and WHtR trajectories according to MVLTPA levels (>=100 [adequate] vs =100 MET-min/day showed lower BMI and WHtR values compared with less active individuals (differences ranging from -1.27 to -1.48 kg/m2 and -0.021 to -0.026, respectively), and slower declines in BMI. Adequate MVLTPA was associated with a 34% lower risk of central adiposity (HR 0.66 [0.56; 0.77]) and a 24% lower risk of obesity only in women (HR 0.76 [0.57; 1.00], p-interaction = 0.084). Nonlinear analyses suggested that central adiposity risk decreased up to 400 MET-min/day and plateaued thereafter. Conclusions: Higher MVLTPA is associated with favourable adiposity trajectories and lower central adiposity risk in older adults at high cardiovascular risk.