Obesity blunts the ventilatory response to exercise in men and women

Bryce N. Balmain, Quinn M. Halverson, Andrew R. Tomlinson, Timothy Edwards, Matthew S. Ganio, Tony G. Babb

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Rationale: Obesity presents a mechanical load to the thorax, which could perturb the generation of minute ventilation (VE) during exercise. Because the respiratory effects of obesity are not homogenous among all individuals with obesity and obesity-related effects could vary depending on the magnitude of obesity, we hypothesized that the exercise ventilatory response (slope of the VE and carbon dioxide elimination [VCO2] relationship) would manifest itself differently as the magnitude of obesity increases. Objectives: To investigate the VE/VCO2 slope in an obese population that spanned across a wide body mass index (BMI) range. Methods: A total of 533 patients who presented to a surgical weight loss center for pre–bariatric surgery testing performed an incremental maximal cycling test and were studied retrospectively. The VE/VCO2 slope was calculated up to the ventilatory threshold. Patients were examined in groups based on BMI (category 1: 30–39.9 kg/m2, category 2: 40–49.9 kg/m2, and category 3: >50 kg/m2). Because the respiratory effects of obesity could be sex and/or age specific, we further examined patients in groups by sex and age (younger:,50 yr and older: ≽50 yr). Differences in the VE/VCO2 slope were then compared between BMI category, age, and sex using a three-way ANOVA. Results: No significant BMI category by sex by age interactions was detected (P = 0.75). The VE/VCO2 slope decreased with increases in BMI (category 1, 29.1 ± 4.0; category 2, 28.4 ± 4.1; and category 3, 27.1 ± 3.3) and was elevated in women (28.9 ± 4.1) compared with men (26.7 ± 3.2) (BMI category by sex interaction, P< 0.05). No age-related differences were observed (BMI category by age interaction, P = 0.55). The partial pressure for end-tidal CO2 was elevated at the ventilatory threshold in BMI category 3 compared with BMI categories 1 and 2 (both P< 0.01). Conclusions: These findings suggest that obesity presents a unique challenge to augmenting ventilatory output relative to CO2 elimination, such that the increase in the exercise ventilatory response becomes blunted as the magnitude of obesity increases. Further studies are required to investigate the clinical consequences and the mechanisms that may explain the attenuation of exercise ventilatory response with increasing BMI in men and women with obesity.

Original languageEnglish (US)
Pages (from-to)1167-1174
Number of pages8
JournalAnnals of the American Thoracic Society
Issue number7
StatePublished - Jul 2021


  • Breathing mechanics
  • Ventilatory constraint
  • Ventilatory efficiency

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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