Preprint / Version 1

Perceived exertion and pain during aerobic exercise differ by body mass index classification in college-aged women


  • Amanda J Salacinski Department of Sports Medicine and Human Performance, Westfield State University
  • Janelle C. Vaiden Department of Kinesiology and Physical Education, Northern Illinois University
  • Matthew Stults-Kolehmainen Division of Digestive Health, Yale New Haven Hospital, New Haven, CT, United States;Department of Biobehavioral Sciences, Teachers College – Columbia University, New York, NY, United States
  • Marilyn Looney Department of Kinesiology and Physical Education, Northern Illinois University



Rating of perceived exertion, pain, obesity, women, exercise


Purpose: The number of overweight or obese adults in the United States continues to increase. Many diseases are linked to obesity; consequently, there is great need for research to improve prevention and treatment of this condition. The purpose of this study was to compare OMNI ratings of perceived exertion (OMNI-RPE) among normal weight versus obese individuals across stages of an incremental aerobic fitness test. Secondary purposes included determining differences between groups for OMNI-muscle hurt (pain), heart rate (HR) and oxygen consumption (VO2). Methods: Women 28.52(9.69) years of age of normal weight (BMI < 25 kg/m2; n = 17) and obese status (BMI ≥ 30 kg/m2; n = 12) completed two days of testing, including a modified Balke treadmill test. A 2 x 3 mixed model ANOVA (group x stage) was used to detect differences between normal weight and obese groups across all variables. Results: The obese group reported higher OMNI-RPE (p =.002), higher HR (p = 0.003) and significantly lower VO2 (p =.027) than the normal weight group for all stages of the Modified Balke. No group x stage interactions were found for any variables with the exception of muscle pain (p < .004), which was higher for the obese group at higher test stages than the normal weight group. Conclusion: OMNI-RPE, pain, HR, and VO2 data suggest that obese women have different physiological and perceptual responses than normal weight women at the same aerobic exercise intensity. Obese women perceive exercise as harder and more painful than normal weight women during an incremental treadmill test, which suggests the need for modified exercise recommendations for obese women. Further research is needed to determine if these differences explain reduced exercise participation for this population.



ACSM. (2021). ACSM Guidelines for Exercise Testing and Prescription (11th ed.). Wolters Kluwer.

Barreto, P. d. S. (2015). Global health agenda on non-communicable diseases: Has WHO set a smart goal for physical activity? BMJ, 350(jan20 7), h23–h23.

Blair, S. N., & Church, T. S. (2004). The Fitness, Obesity, and Health Equation: Is Physical Activity the Common Denominator? JAMA, 292(10), 1232.

Blair, S. N., Haskell, W. L., Ho, P., Paffenbarger, R. S., Vranizan, K. M., Farquhar, J. W., & Wood, P. D. (1985). ASSESSMENT OF HABITUAL PHYSICAL ACTIVITY BY A SEVEN-DAY RECALL IN A COMMUNITY SURVEY AND CONTROLLED EXPERIMENTS. American Journal of Epidemiology, 122(5), 794–804.

Coquart, J.-B., Tourny-Chollet, C., Lemaître, F., Lemaire, C., Grosbois, J.-M., & Garcin, M. (2012). Relevance of the measure of perceived exertion for the rehabilitation of obese patients. Annals of Physical and Rehabilitation Medicine, 55(9–10), 623–640.

De Lorenzo, A., Romano, L., Di Renzo, L., Di Lorenzo, N., Cenname, G., & Gualtieri, P. (2020). Obesity: A preventable, treatable, but relapsing disease. Nutrition, 71, 110615.

de Souza e Silva, C. G., Franklin, B. A., & de Araújo, C. G. S. (2016). Influence of central obesity in estimating maximal oxygen uptake. Clinics, 71(11), 629–634.

Du, Y., Liu, B., Sun, Y., Snetselaar, L. G., Wallace, R. B., & Bao, W. (2019). Trends in Adherence to the Physical Activity Guidelines for Americans for Aerobic Activity and Time Spent on Sedentary Behavior Among US Adults, 2007 to 2016. JAMA Network Open, 2(7), e197597.

Ekkekakis, P., Lind, E., & Joens-Matre, R. R. (2006). Can Self-Reported Preference for Exercise Intensity Predict Physiologically Defined Self-Selected Exercise Intensity? Research Quarterly for Exercise and Sport, 77(1), 81–90.

Ekkekakis, P., Lind, E., & Vazou, S. (2010). Affective Responses to Increasing Levels of Exercise Intensity in Normal-weight, Overweight, and Obese Middle-aged Women. Obesity, 18(1), 79–85.

Elsangedy, H. M., Krinski, K., Costa, E. C., Haile, L., Fonteles, A. I., Timossi, L. da S., & Gregorio da Silva, S. (2013). The rating of perceived exertion is not different at the ventilatory threshold in sedentary women with different body mass indices. Journal of Exercise Science & Fitness, 11(2), 102–106.

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I.-M., Nieman, D. C., & Swain, D. P. (2011). Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. Medicine & Science in Sports & Exercise, 43(7), 1334–1359.

Haile, L., Gallagher, M., & J. Robertson, R. (2015). Perceived Exertion Laboratory Manual: From Standard Practice to Contemporary Application. Springer New York.

Hargreaves, E. A., & Stych, K. (2013). Exploring the peak and end rule of past affective episodes within the exercise context. Psychology of Sport and Exercise, 14(2), 169–178.

Heymsfield, S. B., Lohman, T. G., Wang, Z., & Going, S. B. (2005). Human Body Composition (2nd ed.). Human Kinetics.

Hills, A. P., Byrne, N. M., Wearing, S., & Armstrong, T. (2006). Validation of the intensity of walking for pleasure in obese adults. Preventive Medicine, 42(1), 47–50.

Hulens, M., Vansant, G., Claessens, A. L., Lysens, R., Muls, E., & Rzewnicki, R. (2002). Health-related quality of life in physically active and sedentary obese women. American Journal of Human Biology, 14(6), 777–785.

Hutchinson, J. C. (2021). Perceived Effort and Exertion. In Essentials of exercise and sport psychology: An open access textbook (pp. 294–315). Society for Transparency, Openness, and Replication in Kinesiology.

Jakicic, J. M., Donnelly, J., Pronk, N., Jawad, A., & Jacobsen, D. (1995). Prescription of exercise intensity for the obese patient: The relationship between heart rate, VO2 and perceived exertion. International Journal of Obesity and Related Metabolic Disorders: : Journal of the International Association for the Study of Obesity, 19(6), 382–387.

Jakicic, J. M., Rickman, A. D., Lang, W., Davis, K. K., Gibbs, B. B., Neiberg, R., & Marcus, M. D. (2015). Time-Based Physical Activity Interventions for Weight Loss: A Randomized Trial. Medicine & Science in Sports & Exercise, 47(5), 1061–1069.

Jin, L., Zhu, X., & Xue, Q. (2022). The Effect of Different Intensity Exercise on Energy Consumption and Metabolism Substrate in Obese Adult Women [Preprint]. In Review.

Khanfir, M. A., Awicha, H. B., Masmoudi, L., Hmadou, F. B., Dardouri, W., Alardan, S., Nouira, S., & Zouch, M. (2022). Effects of Different Low-Intensity Exercise Types on Duration, Energy Expenditure and Perceived Exertion in Obese Individuals. International Journal of Environmental Research and Public Health, 19(8), 4893.

King, N. A., Caudwell, P., Hopkins, M., Byrne, N. M., Colley, R., Hills, A. P., Stubbs, J. R., & Blundell, J. E. (2007). Metabolic and Behavioral Compensatory Responses to Exercise Interventions: Barriers to Weight Loss*. Obesity, 15(6), 1373–1383.

Mercier, C.-S., Maïano, C., Nicol, C., Sepulcre, J., & Brisswalter, J. (2010). Étude des relations entre les valeurs d’anxiété, d’estime globale de soi et la perception de l’effort lors de l’exercice physique chez des adolescentes obèses et non obèses. Science & Sports, 25(6), 323–326.

Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA, 311(8), 806.

Prado, R. C. R., Silveira, R., Kilpatrick, M. W., Pires, F. O., & Asano, R. Y. (2021). The effect of menstrual cycle and exercise intensity on psychological and physiological responses in healthy eumenorrheic women. Physiology & Behavior, 232, 113290.

Robertson, R. J., Goss, F. L., Dubé, J., Rutkowski, J., Dupain, M., Brennan, C., & Andreacci, J. (2004). Validation of the Adult OMNI Scale of Perceived Exertion for Cycle Ergometer Exercise: Medicine & Science in Sports & Exercise, 36(1), 102–108.

Sparling, P. B., Howard, B. J., Dunstan, D. W., & Owen, N. (2015). Recommendations for physical activity in older adults. BMJ, 350(jan20 6), h100–h100.

Sperandio, E. F., Arantes, R. L., Matheus, A. C., Silva, R. P., Lauria, V. T., Romiti, M., Gagliardi, A. R. T., & Dourado, V. Z. (2015). Intensity and physiological responses to the 6-minute walk test in middle-aged and older adults: A comparison with cardiopulmonary exercise testing. Brazilian Journal of Medical and Biological Research, 48(4), 349–353.

Stults-Kolehmainen, M. A., Blacutt, M., Bartholomew, J. B., Gilson, T. A., Ash, G. I., McKee, P. C., & Sinha, R. (2020). Motivation States for Physical Activity and Sedentary Behavior: Desire, Urge, Wanting, and Craving. Frontiers in Psychology, 11, 568390.

Stults-Kolehmainen, M. A., & Sinha, R. (2014). The Effects of Stress on Physical Activity and Exercise. Sports Medicine, 44(1), 81–121.

Stults-Kolehmainen, M. A., Stanforth, P. R., & Bartholomew, J. B. (2012). Fat in Android, Trunk, and Peripheral Regions Varies by Ethnicity and Race in College Aged Women. Obesity, 20(3), 660–665.

Stults-Kolehmainen, M. A., Stanforth, P. R., Bartholomew, J. B., Lu, T., Abolt, C. J., & Sinha, R. (2013). DXA estimates of fat in abdominal, trunk and hip regions varies by ethnicity in men. Nutrition & Diabetes, 3(3), e64–e64.

Sui, X., LaMonte, M. J., Laditka, J. N., Hardin, J. W., Chase, N., Hooker, S. P., & Blair, S. N. (2007). Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults. JAMA, 298(21), 2507.

Tompkins, J., Bosch, P. R., Chenowith, R., Tiede, J. L., & Swain, J. M. (2008). Changes in Functional Walking Distance and Health-Related Quality of Life After Gastric Bypass Surgery. Physical Therapy, 88(8), 928–935.

Utter, A. C., Robertson, R. J., Green, J. M., Suminski, R. R., Mcanulty, S. R., & Nieman, D. C. (2004). Validation of the Adult OMNI Scale of Perceived Exertion for Walking/Running Exercise: Medicine & Science in Sports & Exercise, 36(10), 1776–1780.

Wang, J., Sereika, S. M., Styn, M. A., & Burke, L. E. (2013). Factors associated with health-related quality of life among overweight or obese adults. Journal of Clinical Nursing, 22(15–16), 2172–2182.

Watson, M. R., Stanforth, P. R., Talley, E. A., & Stults-Kolehmainen, M. A. (2019). Influence of Age, Ethnicity and Sex on Body Composition Thresholds for the Accumulation of Visceral Adipose Tissue in Adults. American Journal of Sports Science, 7(3), 111.

Williams, D. M., Dunsiger, S., Ciccolo, J. T., Lewis, B. A., Albrecht, A. E., & Marcus, B. H. (2008). Acute affective response to a moderate-intensity exercise stimulus predicts physical activity participation 6 and 12 months later. Psychology of Sport and Exercise, 9(3), 231–245.

Yu, H., Sun, C., Sun, B., Chen, X., & Tan, Z. (2021). Systematic Review and Meta-Analysis of the Relationship between Actual Exercise Intensity and Rating of Perceived Exertion in the Overweight and Obese Population. International Journal of Environmental Research and Public Health, 18(24), 12912.