做这题的关键词是so
so为连词,连接的句子为并列句,上下文时态必须呼应,因此与下文looked呼应的话,上文必定填入affected
而估计你是把这句理解为主从复合句了,在主从复合句中,先发生的动作用过去完成时,后发生的动作用一般过去时.
如果把这句改为主从复合句可以用had affected
例如：He looked much older because the heavy work_had affected___(affect) his health
the heavy work____(affect) his health ,so he looked much old
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He is not old enough to do the heavy work改为同义句He is（）（）to do