BackgroundAlthough many studies have reported the association between moderate-to-vigorous physical activity (MVPA), sedentary time (ST), and the built environment (BE) among older adults, little is known about these associations in the Chinese older adult population. The purpose of this study was to investigate how various factors in the built environment of Nanjing's communities influence leisure moderate-tovigorous physical activity and sedentary time among the elderly. MethodsA multilevel cross-sectional study was conducted from November 2016 to April 2017. Altogether, thirty neighborhoods were selected and 586 individuals aged 60 years or older living in the urban zone of NanJing in Southern China were surveyed. Physical activity was measured using Actigraph GT3 Accelerometer. Built environment variables were measured using ArcGIS software. A multivariate linear regression method was used to analyze the factors influencing leisure moderate-to-vigorous physical activity and sedentary time among the elderly. ResultsThe percentage of moderate-to-vigorous physical activity of urban elderly within a 1000-m distance reached 76.12%, indicating this zone as appropriate for the study of urban elderly moderate-tovigorous physical activity. We found that land-use mix (β=8.800, p=0.001) and distance to fitness venue (β=-5.876, p=0.004) influenced moderate-to-vigorous physical activity. Population density (β=13.998, p=0.004) and land-use mix (β=-21.62, p=0.033) use influenced sedentary time. ConclusionsOur findings provide support for the association between the built environment and physical activity among the Chinese elderly. Some characteristics of the built environment including land-use mix and distance to fitness venue may affect MVPA, while other characteristics including population density and land-use mix may impact ST. In formulating urban planning policies, the above factors should be taken into account to promote physical activity in older people, encouraging them to modify their sedentary lifestyle and improving their overall health.