Introduction: Physical activity has been shown to be beneficial for the prevention of obesity and non-communicable diseases. Our contemporary way of life that is technology dependent has significantly reduced physical activity. This study aimed to determine accelerometer-measured physical activity (moderate-to-vigorous physical activity (MVPA)) among adults in high and low walkability neighbourhoods in Penang and Kota Bharu, Malaysia. Methods: Participants (n=490) were sampled using multistage sampling method from neighbourhoods with varied levels of walkability using Geographical Information System (GIS). Physical activity was measured objectively using Actigraph GT3X+ accelerometers, worn by the participants on their waists for a period of 5 to 7 days. Results: The participants had a mean of 13.5 min/day of MVPA. Total MVPA was significantly higher among participants in high walkability neighbourhoods (19.7 min/day vs. 9.1 min/ day). Results from t-test showed that the time spent on MVPA per day was significantly lower among participants residing in low walkability neighbourhoods. The final model of the MIXED model statistical tests showed that total MVPA was significantly associated with BMI, but not with WC measurements, after adjusting for covariates. Conclusion: Most of the participants had very low MVPA and did not achieve the current physical activity recommendations, implying that Malaysian adults residing in these two cities were not physically active to achieve health benefits. Results are suggestive of the importance of the walkability concept in neighbourhoods in encouraging physical activity and healthy body weight among Malaysians.