The purpose of this study was to explore aspects of engagement in physical activity in persons with obstructive sleep apnea and overweight. Seven women and 8 men were interviewed, and transcribed data were analyzed according to qualitative content analysis. Two themes evolved reflecting influences on engagement in physical activity: (a) incentives strong enough and (b) facilitators for success and challenges to overcome. Strong incentives to change seem crucial for engagement in physical activity. The identified challenges and facilitators concerned a spectrum of emotional and contextual aspects, as well as diseases and physical symptoms. Exploring the patient's expectations on physical activity behavior change and the perceived facilitators and barriers for engagement may be helpful when tailoring behavioral support strategies.