To examine employees' self-reported physical activity and metabolic syndrome (MetS) risks and their association with health-related workplace outcomes. Employees participated in a health risk appraisal in 2010. Generalized Linear Modeling was used to test the association between MetS risk factors, physical activity, and the outcome measures while controlling for confounders. MetS was found in 30.2% of employees. Health care costs for employees with MetS who reported sufficient exercise (150 or more minutes/week) totaled $2770 compared with $3855 for nonsufficient exercisers. The percentage of employees with MetS who had absenteeism and presenteeism was also significantly lower for employees achieving sufficient physical activity. All risk factors for MetS were mitigated for regular exercisers. Employers should consider programs and services to support regular aerobic exercise to address the growing prevalence and costs of MetS in the workforce.