Background <p>Participation in leisure activities is associated with better health, greater life satisfaction, and improved quality of life in older persons, yet it tends to decline with age. Although health-promotion interventions positively influence such participation, evidence is limited for persons aged 80 years and older. This study aimed to examine whether a preventive home visit or senior meetings affect participation in leisure activities among community-dwelling persons aged 80 years or older.</p> Methods <p>The study was conducted in Gothenburg, Sweden, applying an exploratory, randomised, three-armed, single-blind, controlled trial with a parallel-group design. Participants were 459 independent, community-dwelling persons aged 80 years or older, randomly assigned to one of two interventions or an inert control group using opaque envelopes. A total of 178 participants were randomised to the preventive home visit group, 199 to the senior meetings group, and 114 to the control group. Participants analysed were 174, 171, and 114 respectively. Interventions included either a preventive home visit or senior meetings. The primary outcome was participation in leisure activities at 12- and 24-months post-baseline. Outcome assessors were blinded after assignment.</p> Results <p>At 12-months, the senior meetings group sustained participation in senior activities (OR 1.77, 95% CI 1.05–2.99), reading (OR 1.83, 95% CI 1.03–3.25), and hobbies (OR 1.95, 95% CI 1.14–3.33), compared with controls. The preventive home visit group sustained participation in hobbies (OR 1.74, 95% CI 1.03–2.94), compared with controls. At 24-months, the senior meetings group sustained participation in study circles (OR 1.99, 95% CI 1.09–3.66), reading (OR 1.79, 95% CI 1.07-3.00) and hobbies (OR 1.87, 95% CI 1.12–3.12), compared with controls. The preventive home visit group sustained participation in reading (OR 2.09, 95% CI 1.24–3.52), compared with controls. No adverse effects were reported.</p> Conclusions <p>Senior meetings supported sustained participation in several leisure activities among persons aged 80 and older over 24 months. Tailoring support to individual needs and adapting to changing abilities may enhance long-term participation and well-being. Key elements of effective interventions may include providing information, fostering positive attitudes, and encouraging open dialogue about leisure.</p> Trial registration <p>The study was registered 08/04/2009 at ClinicalTrials.gov, registration number NCT00877058.</p>