The objective of this study is to describe the pattern of participation in leisure activities in an older population in relation to contextual factors as well as to mental and physical health. A cohort of 1,623 participants aged 75 or older living in Stockholm, Sweden was asked to list all the leisure activities they were engaged in. These were successively organised into 31 major categories and further grouped into mental, social, physical, productive and recreational types. The pattern of participation was examined in relation to age, gender, contextual factors (education, social network) and health status (depressive symptoms, cognitive impairment, dementia, somatic diseases and physical limitation). In spite of their advanced age, the majority of the population was active, as 70 per cent had participated in at least one activity. Reading (19%) was the most prevalent individual activity, and mental activities (43%) the most prevalent activity type. Older age, female gender, low education status, having a poor or limited social network, mental disorders, and physical limitation, were all factors correlated with a decreased engagement in ‘at least one activity’. Contextual factors and health-related factors were related to the five activity types in different ways. The pattern of participation in leisure activities is associated with multiple factors and their recognition is essential to the facilitation of an active lifestyle in the older population.