Introduction: Our study aims were to describe physical activity patterns and associations with fatigue and depressive symptoms among rural breast cancer survivors. Methods: Population-based, mailed survey of 483 rural breast cancer survivors including the International Physical Activity Questionnaire (IPAQ). Results: With regard to type and intensity, domestic/gardening and moderate intensity accounted for the largest percentage of total energy expenditure (i. e., 60% and 69%, respectively). MET-mins/week variables were categorized as 0, > 0 to < 500, and ≥ 500 to reflect sedentary, insufficient, and meets current public health recommendations. After adjustment, fatigue was significantly associated with domestic/gardening (mean fatigue for sedentary, insufficient, and meets recommendations were 18.9, 16.4, and 13.4, respectively; p =.0019), leisure activity (means were 16.0, 14.5, and 11.8, respectively; p =.047), moderate intensity (means were 18.4, 16.7, and 13.7, respectively; p=.011), and daily minutes sitting (means for ≤ 120 min, > 120 to ≤ 360 min, and > 360 min of sitting were 12.5, 14.2, and 17.2, respectively; p=.0029). Fatigue was not associated with occupational, transportation, walking, or vigorous activity. After adjustment, only leisure activity was associated with depressive symptoms (means for sedentary, insufficient, and meets recommendations were 7.8, 7.7, and 6.2, respectively; p=.039). Conclusions: Physical activity measurement tools that do not include domestic/gardening activities may underestimate physical activity in rural breast cancer populations. Physical activity associations with fatigue and depressive symptoms differed based on physical activity type and intensity suggesting hypotheses related to exercise effects on fatigue and depressive symptoms. © 2010 Springer Science+Business Media, LLC.