BACKGROUND: This study assessed the perceived benefits and barriers to exercise participation in overweight and obese women with polycystic ovary syndrome (PCOS) and monitored changes in response to a lifestyle intervention. METHODS: Forty-three overweight/obese PCOS women (age 30.3 (6.2) yrs; BMI 36.4 (5.6) kg/m2) were randomised to one of three 20-week lifestyle programs: diet only (DO, n = 13), diet and aerobic exercise (DA, n = 11) and diet and combined aerobic-resistance exercise (DC, n = 19). Exercise Benefits/Barriers Scale (EBBS), weight, aerobic fitness, depression and PCOS specific health-related quality of life were measured. RESULTS: Barriers score was related to depression (r = 0.45, p = 0.002) and aerobic fitness (r = -0.32, p = 0.04), while benefits score was related to aerobic fitness (r = 0.41, p = 0.007). EBBS, benefits and barriers scores improved overtime (p < 0.001). Benefits subscales psychological outlook and social interaction increased (p < 0.001) and life enhancement and preventative health did not change (p > 0.3). Physical performance increased only in DA (p = 0.009). There were no differences between treatments for any of the other subscales (p > 0.2). Barriers subscales exercise milieu, time expenditure and physical exertion reduced (p < 0.003) and family discouragement did not change (p = 0.6). CONCLUSIONS: This study demonstrated that lifestyle modification consisting of an energy-restricted diet with or without exercise training improved the perceived benefits from and barriers to exercise. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Register ACTRN12606000198527, registered 26 May 2006.

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