Abstract Purpose With the growing availability and implementation of wearable activity trackers (WATs) as motivational tools for tracking and managing physical activity, the purpose of this study is to investigate the relationship between motivations for exercise (guilt, pressure, appearance, and enjoyment), WAT usage, and meeting the recommended amount of physical activity (>= 150 minutes per week) among a cohort of cancer survivors. Methods Data on WAT users with a history of cancer diagnosis were analyzed from the National Cancer Institute’s Health Information National Trends Survey (HINTS) 5 Cycle 3. Complete survey data from a total of 608 HINTS respondents were used for analyses. Multivariate logistic regression models were used to assess motivational predictors of WAT use and examine the association between WAT use and meeting the recommended amount of physical activity. A cluster analysis was conducted using participants’ responses to identify motivational profiles that were associated with using WATs. Results After adjusting for all covariates in a multivariate logistic regression model, cancer survivors who reported not feeling any guilt as a motivation for exercise were 73% less likely to use a WAT (OR: 0.274, 95% CI: 0.139, 0.543) (p =0.0002). Three motivational profiles (autonomous with high introjected regulation, autonomous with low introjected regulation, and amotivation) emerged from the cluster analysis which differed significantly across motivation and class membership. WAT users had an increased probability of membership in the autonomous with high introjected regulation group (n = 119 86%) characterized as being motivated to exercise by guilt, appearance, and enjoyment. Additionally, after adjusting for all covariates in a multivariate logistic regression model, cancer survivors who used WATs were 1.6 times more likely to meet physical activity recommendations (>=150 mins per week) compared to those who did not use WATs (OR: 1.649, 95% CI: 1.026, 2.648) (p = 0.0386). Conclusions When exercise motivations were assessed independently, only guilt was significantly associated with WAT usage among this cohort of cancer survivors. However, when assessing clusters of exercise motivations, three distinct motivational profiles emerged with distinctly different class memberships. WAT users were significantly more likely to be in a class characterized by being motivated by guilt, appearance, and enjoyment. The cluster analysis provides a unique examination on not just how a single exercise motivation influences WAT usage, but how a combination of motives can be identified. Additionally, using a WAT was significantly associated with meeting physical activity recommendations in this cohort of cancer survivors. Given the health benefits of physical activity for cancer survivors, WATs may be a useful tool for physical activity interventions aimed at increasing motivation and exercise engagement. Citation Format: Steven De La Torre, Albert Farias, Donna Spruijt-Metz. Examining the association of wearable activity tracker usage, exercise motivation, and physical activity in a cohort of cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-145.