The aim of this study was to systematically examine patterns and time trends in US adolescents' physical activity (PA) and sedentary behaviours. We examined findings from the nationally representative Youth Risk Behavior Surveillance Surveys during 1991–2007, and fit regression models estimating average annual changes and tested time trends, and age, gender and ethnic differences. US adolescents had less PA but more sedentary behaviours than recommended, but showed no clear evidence of becoming less active. In 2007, 24.9% reported on average spending ≥3 h of screen time per day for non-school work; only 34.7% met the current PA recommendations, and it (25.6%) was even lower in girls. The prevalence of having sufficient vigorous PA changed little between 1993 and 2005 (from 65.8% to 64.1%). Encouraging changes regarding TV viewing time and physical education (PE) were detected. PE daily attendance rate and exercising >20 min during an average PE class increased significantly, while watching TV ≥3 h d−1 decreased significantly in recent years. Considerable sex, age and ethnic differences existed in the patterns and trends. These national data show no clear evidence of declining PA among US adolescents in recent years. Reduced PA is not likely the major explanation of the recent increase in obesity among US adolescents.