Background: The role of physical activity (PA) in mitigating fall risk among adults with cardiovascular disease (CVD) is unclear. Purpose: We examined the associations of CVD-PA phenotypes with falls. Methods: Adults [greater than or equal to] 45 years (n = 295,282; N = 130,103,093) from the 2018 Behavioral Risk Factor Surveillance System who self-reported CVD, leisure-time PA, and falls were examined. The weighted prevalence ratio (PR) of any, recurrent, and injurious falls across CVD-PA phenotypes (no CVD-PA, no CVD-no PA, CVD-PA, CVD-no PA) was estimated. Results: The likelihood of any, recurrent, and injurious falls was higher across unhealthier CVD-PA phenotypes in fully adjusted models. In the total sample, no CVD-no PA (PR: 1.30; 95% CI: 1.10, 1.50), CVD-PA (PR: 1.35; 95% CI: 1.10, 1.60), and CVD-no PA (PR: 1.39; 95% CI: 1.11, 1.67) phenotypes were more likely to report injurious falls than no CVD-PA phenotype. Discussion: Engaging in leisure-time PA may be an important lifestyle strategy for fall prevention in midlife and older adults who are at risk of CVD. Translations to Health Education Practice: Our findings could be useful for health education in providing evidence on future fall prevention programs in adults who are at risk for CVD and falls.