Background <p>Dizziness is a prevalent complaint in clinical settings; however, its relationship with physical activity remains unclear. This cross-sectional study aimed to explore the link between physical activity levels and symptomatic dizziness in a cohort of adult participants.</p> Methods <p>We used data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) in the United States. Activity and dizziness data were obtained using physical activity and balance questionnaires. The participants were divided into three subgroups, Group 1 (sedentary: almost no engagement in any form of aerobic or anaerobic exercise in the past 30 days), Group 2 (moderate: at least 10 minutes of moderate-intensity physical activity in the past 30 days, which results in light perspiration or a minor-to-moderate rise in heart and breathing rates), and Group 3 (vigorous: engaging in at least 10 minutes of vigorous-intensity exercise over the last 30 days, which leads to substantial sweating or a pronounced increase in both breathing and heart rates). Multivariable logistic regression and stratified interaction analyses were used to examine the association between physical activity and symptomatic dizziness.</p> Results <p>A total of 6815 participants were enrolled, comprising 3446 males (50.6%) and 3369 females (49.4%), with a median age of 60.6±13.3 years. Our study revealed a negative association between physical activity and the prevalence of symptomatic dizziness after multivariate adjustment (Group 2, OR 0.76, 95% CI 0.66-0.87, <i>p</i>&lt;0.001; Group 3, OR 0.76, 95% CI 0.64-0.90, <i>p</i>=0.001). Further exploratory subgroup analysis showed no statistical significance (all <i>P</i>-values for interaction were greater than 0.05).</p> Conclusion <p>The study found that physical activity is negatively associated with the prevalence of symptomatic dizziness in the US adult population.</p>