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Objective This study aimed to investigate the factors for increasing sedentary time during neoadjuvant chemotherapy (NAC) in older patients with locally advanced oesophageal cancer (LAEC) and to elucidate potential clinical mechanisms.Methods We conducted a single-centre exploratory prospective cohort study. Between October 2021 and December 2023, consecutive 80 patients with LAEC aged ≥65 years were scheduled for curative oesophagectomy after NAC. The change in sedentary time (Δ=after NAC – before NAC; expressed in min/week) was calculated from sedentary time measured by the Global Physical Activity Questionnaire. Factors associated with the change in sedentary time were investigated using a multivariate regression model. Two-tailed statistical significance was accepted at p<0.05.Results A total of 69 patients were included in the analysis. The mean age was 72.9 years, and docetaxel+cisplatin + fluorouracil, cisplatin+fluorouracil and oxaliplatin+leucovorin + fluorouracil regimens were administered to 46 (67%), 4 (6%) and 19 (27%) patients, respectively. The mean sedentary times before and after chemotherapy were 3235±1477 min/week and 3557±1598 min/week, and the mean change in sedentary time during chemotherapy was 322±736 min/week. Worsening fatigue was a significant factor influencing increased sedentary time during chemotherapy (vs non-worsening fatigue, adjusted coefficient 531.111, 95% CI 104.960 to 957.261, p=0.015).Conclusions The clinical mechanism of increasing sedentary time during chemotherapy may be associated with worsening fatigue. In older adults with LAEC, a physical activity intervention during NAC may improve clinical outcomes.