Based on the basic reality of China’s aging population and the increasingly severe health problems of the elderly, focusing on the health vulnerability of the elderly, based on the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), a structural equation model is constructed to investigate the impact of leisure and recreational participation on the health vulnerability of the elderly. The research results show that participation in leisure and recreation activities can not only directly alleviate the health vulnerability of the elderly, but also reduce their health vulnerability by improving the self-assessment health level of the elderly. There are multiple intermediary pathways such as “leisure and recreational activity participation →health level →physical health vulnerability →mental health vulnerability”. At the same time, the participation of leisure and recreation activities plays a significant role in alleviating the physical and health vulnerability of urban elderly people, which is more effective in alleviating the mental health vulnerability of the elderly in townships and rural areas. On this basis, the article proposes to focus on improving the aging construction of urban regional public leisure places, establishing a psychological intervention system for the elderly in townships and rural areas, improving the inclusive elderly service system, and narrowing the gap between urban and rural areas.