Background: Aerobic exercise has been associated with improved QOL in the general population, but has not been studied in non-Hodgkin lymphoma (NHL) survivors. Methods: Newly diagnosed patients with aggressive lymphoma were prospectively enrolled in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource and systematically followed. Patient reported exercise patterns and QOL (FACT-G) were assessed at 3 years after diagnosis; patients with active disease or recent treatment were excluded from this analysis. QOL scores were normalized to a 0-100 scale for analysis. Results: From 2002-2009, 625 eligible patients completed the 3 year questionnaire.Themedian age was 62 years (range 18-87), 59% were male, and diagnoses included DLBCL (60%), FL grade III (11%), mantle cell (12%), other B-cell (7%), and T-cell (10%) lymphomas. Overall, 49% of 3-year survivors met CDC exercise recommendations defined as 30 minutes of moderate activity at least 5 days/week, which was comparable to the general population estimate (50%). Since their diagnosis of lymphoma, 10% of patients reported an increase in exercise and 49% reported a decrease in exercise. Males were more likely to meet exercise recommendations than females (54% v 41%, p = 0.002). Young patients (18-39 years) were more likely to increase physical activity after diagnosis than patients age > 70 (16% vs. 4%; p = 0.002). Those meeting exercise recommendations had higher median functional well-being (WB) (89 vs.75), physical WB (93 vs. 88), emotional WB (88 vs. 83), social/family WB (89 vs. 86), and overall QOL (89 vs. 80) (all p < 0.0001). Similarly, compared to those who reported decrease in exercise since diagnosis, patients with increased physical activity had higher median functional WB (89 vs. 75), physical WB (96 vs. 86), emotional WB (88 vs. 83), social/family WB (88 vs. 86) and total QOL (90 vs. 81) (all p < 0.0001). Conclusions: In this cohort, half of aggressive lymphoma survivors are meeting recommendations for exercise, similar to the general population. Meeting exercise recommendations and increasing exercise are associated with significantly higher QOL. Lymphoma patients should be counseled on exercise, and studies of activity interventions and outcomes are needed.