Objectives <p>The aim of this study is to compare occupational balance, physical fitness, and body composition parameters according to physical activity levels in older adults and to examine the relationships between occupational balance and other variables.</p> Methods <p>This cross-sectional study included a total of 150 older adults aged 65–75 years. Participants were classified according to their International Physical Activity Questionnaire-Short Form (IPAQ-SF) scores as inactive (<i>n</i> = 51), minimally active (<i>n</i> = 50), and active (<i>n</i> = 49). Occupational balance was assessed using the Occupational Balance Questionnaire-11 Turkish (OBQ11-T). Physical fitness level was assessed using the Timed Up and Go Test (TUG) and hand grip strength measured with a Jamar dynamometer (Sammons Preston, USA). For body composition assessment, skeletal muscle mass and body mass index (BMI) were measured using an InBody 120 device (InBody Co., Ltd., Seoul, Korea). Occupational balance, physical fitness, and body composition parameters were compared among older adults according to their physical activity levels. In addition, the relationships between occupational balance, physical activity, physical fitness, and body composition were examined in all participants.</p> Results <p>According to IPAQ-SF classification, significant differences were found in occupational balance, physical fitness, and body composition among inactive, minimally active, and active older adults (<i>p</i> &lt; 0.001). Older adults with higher levels of physical activity demonstrated higher occupational balance, greater hand grip strength, greater skeletal muscle mass, shorter TUG durations, and lower BMI values. Regression model results showed that physical activity level, functional mobility, and skeletal muscle mass together explained approximately 52% of the total variation in occupational balance level (Adjusted R² = 0.520). In addition, physical activity level, TUG duration, and skeletal muscle mass were found to be independently associated with OBQ11-T scores (<i>p</i> &lt; 0.05).</p> Conclusion <p>Older adults with higher levels of physical activity were found to have higher occupational balance levels, hand grip strength, functional mobility, and skeletal muscle mass, while their BMI values were lower. Furthermore, physical activity level, functional mobility, and skeletal muscle mass were found to be significantly associated with occupational balance. The findings indicate that occupational balance is an important parameter that should be assessed in older adults along with physical health, physical fitness, and activity participation.</p>