Background <p>Rapid life rhythms have seen an increased participation in the weekend warrior pattern, but its impact on mortality risk in adults with metabolic dysfunction-associated steatotic liver disease (MASLD) is unclear. This investigation aims to explore the link between physical activity (PA) patterns, along with leisure-time and occupational physical activity (LTPA/OPA), as well as mortality in adults with MASLD.</p> Methods <p>This prospective cohort study employed data sourced from National Health and Nutrition Examination Survey (NHANES), and mortality data were collected through December 31, 2019. PA was self-reported and divided into four classifications: inactive, insufficiently active, weekend warrior, along with regularly active.</p> Results <p>Among 13,831 MASLD participants [mean (SD) age, 51.09 (16.63) years; 48.82% male], 1,191 deaths occurred in a median follow-up spanning 6.42 years. Compared to inactive participants, HR (95% CI) for all-cause mortality associated with LTPA and OPA were 0.66 (0.44 to 0.99) and 0.50 (0.30 to 0.84) in the weekend warriors, 0.63 (0.50 to 0.79) and 0.56 (0.43 to 0.72) in the insufficiently active, and 0.55 (0.43 to 0.71) and 0.62 (0.49 to 0.79) in the regularly active. Joint analyses revealed that LTPA and OPA had synergistic advantages in reducing the hazard of all-cause mortality with inactive group as the reference.</p> Conclusions <p>Adults engaging in active PA patterns — whether classified as insufficient, weekend warriors, or regularly active — exhibited lower all-cause mortality rates compared to inactive participants with MASLD. For those who can’t adhere to daily exercise regimens, adopting a “weekend warrior” approach provides a practical and feasible strategy to curb the progression of MASLD and reduce the risk of premature mortality linked to it. Furthermore, public health guidelines should integrate both LTPA and OPA to achieve sustainable improvements in health outcomes across the population.</p>