This cross-sectional study analyzed the associations between adherence to the 24-hour movement behavior (24-HMB), which includes physical activity (PA), sedentary behavior (SB), and sleep, and the aggregation of cardiovascular risk factors (CVRF) in Brazilian adolescents. The CVRFs analyzed included body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and cardiorespiratory fitness (CRF). Moderate-to-vigorous physical activity (MVPA) was measured using accelerometers, while SB and sleep were self-reported. Sex-stratified linear regression analyses revealed that, among boys, adherence to the MVPA recommendation was directly associated with CRF (β = 0.364; 95% CI = [0.068, 0.659]) and inversely associated with BMI (β = −0.481; 95% CI = [−0.929, −0.033] and CVRF score (β = −0.937; 95% CI = [−1.590, −0.285]. In girls, meeting both MVPA and sleep recommendations was directly associated with CRF (β = 0.323; 95% CI = [0.080, 0.565]). Overall, adherence to both MVPA and sleep recommendations was inversely associated with the CVRF score (β = −0.488; 95% CI = [−0.899, −0.077]). Total adherence to recommendations was inversely associated with BMI (β = −0.346; 95% CI = [−0.668, −0.024], and the number of recommendations met was directly associated with CRF (β = 0.109; 95% CI = [0.005, 0.213]). In conclusion, adherence to 24-HMB was beneficially associated with adiposity and CRF in adolescents, with associations differing by sex.
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