Objective To investigate physical activity insufficiency and sedentary behavior in the elderly stroke patients, and to analyze the influencing factors of insufficient activities. Methods From January to October 2022,302 elderly stroke patients in a tertiary hospital were selected and investigated using general information, disease status, International Physical Activity Questionnaire, International Fall Efficacy Scale, geriatric depression scale-15, timed up and go test. According to the physical activity level, the patients were divided into two groups, and they were compared for the differences in the indicators. SPSS 26.0 was used for data analysis. Comparison between the two groups was performed using t-test or χ²test depending on the data type. Binary logistic regression was used to analyze the independent influencing factors of physical activity insufficiency. Results Among the 302 elderly stroke patients, 115 (38.1%) had inactive physical activity , 225 (74.5%) had sedentary behavior, 124 (41.10%) had fear of falling, 55 (18.21%) had depression, and 212 (70.20%) had impaired mobility. Univariate analysis showed that there were statistically significant differences in age, marital status, polypharmacy, hypertension, diabetes, depression, lower extremities paresthesias, use of walkers, fear of falling, sedentary behavior, and impaired mobility (P＜0.05). Multivariate logistic regression analysis showed that fear of falling (OR=4.66, 95%CI 2.64-8.24), sedentary behavior (OR=4.03,95%CI 1.67-9.74), paresthesia of the lower extremities (OR=2.23,95%CI 1.15-4.33), and depression (OR=2.21,95%CI 1.08-4.53) were independent risk factors of insufficient activities in the elderly stroke patients (P<0.05). Conclusion The elderly stroke patients are mostly physically inactive and sedentary. To address their inactivity, it is not only necessary to improve their physical function, to strengthen lower limb muscles, and to avoid being sedentary by intermittent and mild physical activities, but also necessary to attend their psychological problems. A multi-dimensional intervention program should be formulated to enhance activity for more effective recovery.