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Data from large randomized controlled trials confirming sleep quality improvements with aerobic physical activity have heretofore been lacking for post–primary treatment breast cancer survivors. Our primary purpose for this report was to determine the effects of a physical activity behavior change intervention, previously reported to significantly increase physical activity behavior, on sleep quality in post–primary treatment breast cancer survivors.Post–primary treatment breast cancer survivors (n = 222) were randomized to a 3-month physical activity behavior change intervention (Better Exercise Adherence after Treatment for Cancer [BEAT Cancer]) or usual care. Self-report (Pittsburgh Sleep Quality Index [PSQI]) and actigraphy (latency and efficiency) sleep outcomes were measured at baseline, 3 months (M3), and 6 months (M6).After adjusting for covariates, BEAT Cancer significantly improved PSQI global sleep quality when compared with usual care at M3 (mean between-group difference [M] = −1.4, 95% confidence interval [CI] = −2.1 to −0.7, P < 0.001) and M6 (M = −1.0, 95% CI = −1.7 to −0.2, P = 0.01). BEAT Cancer improved several PSQI subscales at M3 (sleep quality M = −0.3, 95% CI = −0.4 to −0.1, P = 0.002; sleep disturbances M = −0.2, 95% CI = −0.3 to −0.03, P = 0.016; daytime dysfunction M = −0.2, 95% CI = −0.4 to −0.02, P = 0.027) but not M6. A nonsignificant increase in percent of participants classified as good sleepers occurred. No significant between-group difference was noted for accelerometer latency or efficiency.A physical activity intervention significantly reduced perceived global sleep dysfunction at 3 and 6 months, primarily because of improvements in sleep quality aspects not detected with accelerometer.