Byline: Cindy K. Blair (1), Kim Robien (2), Maki Inoue-Choi (3), Wendy Rahn (4), DeAnn Lazovich (1,5) Keywords: Quality of life; Physical activity; Survivorship; Cohort; Cancer survivors Abstract: Purpose Few studies have examined lifestyle factors and quality of life (QOL) in cancer survivors compared to a cancer-free group. Compared to active cancer-free women, we examined the association between physical inactivity and QOL in elderly cancer survivors and similar-aged women without cancer. Methods Participants included 1776 cancer survivors and 12,599 cancer-free women enrolled in the Iowa Women's Health Study in 1986 who completed the SF36 QOL assessment in 2004 (ages 73--88 years). The odds of poor QOL were computed for each SF36 subscale ( 0.5 SD below mean score of cancer-free women) associated with physical inactivity (moderate-vigorous activity Results Compared with the referent group, inactive cancer survivors were significantly more likely to report poor QOL for each SF36 subscale (odds ratios 1.8 to 4.7), independent of age, comorbidity, body mass index (BMI), and diet quality. The greatest odds for poor QOL occurred for general health, vitality, and physical function. These increased odds occurred regardless of whether survivors were inactive at both baseline (1986) and follow-up or became inactive sometime after baseline. Among physically active women, cancer survivors had similar QOL as cancer-free women. Conclusion These findings provide evidence on the importance of leisure-time physical activity in older women and support the need for interventions to help older women maintain or regain a physically active lifestyle. Implications for Cancer Survivors Survivors who remain or become physically active as they age report better mental and physical QOL. Author Affiliation: (1) Division of Epidemiology & Community Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, USA (2) Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, USA (3) Division of Cancer Epidemiology and Genetics, National Cancer Institute/National Institute on Minority Health and Health Disparities, Washington, DC, USA (4) Department of Political Science, University of Minnesota, Minneapolis, MN, USA (5) Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA Article History: Registration Date: 13/05/2015 Received Date: 05/12/2014 Accepted Date: 12/05/2015 Online Date: 26/05/2015 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s11764-015-0456-9) contains supplementary material, which is available to authorized users.