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Obesity represents a major modifiable risk factor for cardiovascular disease. However, it is unclear whether body mass index (BMI) is associated with V\u0307\n                    <jats:sub>E<\/jats:sub>\n                    \/V\u0307CO\n                    <jats:sub>2<\/jats:sub>\n                    slope among apparently healthy adults. Therefore, we used the Fitness Registry and the Importance of Exercise National Database (FRIEND) to determine whether BMI is positively associated with V\u0307\n                    <jats:sub>E<\/jats:sub>\n                    \/V\u0307CO\n                    <jats:sub>2<\/jats:sub>\n                    slope in the context of apparently healthy adults. All participants completed a cardiopulmonary exercise test on a cycle ergometer. Linear regressions adjusted for age, sex, and race\/ethnicity were used to compare the V\u0307\n                    <jats:sub>E<\/jats:sub>\n                    \/V\u0307CO\n                    <jats:sub>2<\/jats:sub>\n                    slope between adults with and without obesity (BMI &lt;\/\u2265\u200930\u2009kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    ). Partial correlation adjusted for age, sex, race\/ethnicity, and cardiorespiratory fitness was used to determine the relation between the V\u0307\n                    <jats:sub>E<\/jats:sub>\n                    \/V\u0307CO\n                    <jats:sub>2<\/jats:sub>\n                    slope and BMI. All data are presented as median [IQR]. We set\n                    <jats:italic>\u03b1<\/jats:italic>\n                    a priori to &lt;\u20090.05. The sample (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20093534) characteristics were as follows: (1) age\u2009=\u200940 (17) years; (2) 20% female; (3) cardiorespiratory fitness\u2009=\u200927.8[10.8] mL O\n                    <jats:sub>2<\/jats:sub>\n                    \u25cfkg\n                    <jats:sup>\u22121<\/jats:sup>\n                    \u25cfmin\n                    <jats:sup>\u22121<\/jats:sup>\n                    &amp; 2.3[0.9] L O\n                    <jats:sub>2<\/jats:sub>\n                    \u25cfmin\n                    <jats:sup>\u22121<\/jats:sup>\n                    ; and (4) BMI\u2009=\u200926.1[5.0] kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    . V\u0307\n                    <jats:sub>E<\/jats:sub>\n                    \/V\u0307CO\n                    <jats:sub>2<\/jats:sub>\n                    slope was higher in adults with obesity 25.0[3.5] compared to those without obesity 24.7[3.6] with a negligible effect size (\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090.132, adjusted\n                    <jats:italic>R<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    \u2009=\u20090.131, F\n                    <jats:sub>4,3529<\/jats:sub>\n                    \u2009=\u2009134,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). V\u0307\n                    <jats:sub>E<\/jats:sub>\n                    \/V\u0307CO\n                    <jats:sub>2<\/jats:sub>\n                    slope was weakly associated with BMI across the cohort (\u03c1\u2009=\u20090.079,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Obesity was positively, but negligibly, associated with a higher V\u0307\n                    <jats:sub>E<\/jats:sub>\n                    \/V\u0307CO\n                    <jats:sub>2<\/jats:sub>\n                    slope in the FRIEND Registry.\n                  <\/jats:p>","DOI":"10.1111\/sms.70264","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T19:24:47Z","timestamp":1773948287000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Obesity and Ventilatory Responses During Exercise in the Fitness Registry and the Importance of Exercise National Database (\n                    <scp>FRIEND<\/scp>\n                    )"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9660-043X","authenticated-orcid":false,"given":"Thomas G.","family":"Bissen","sequence":"first","affiliation":[{"name":"Cardiovascular and Applied Physiology Laboratory Florida State University  Tallahassee FL USA"},{"name":"Institute of Sports Sciences and Medicine Florida State University  Tallahassee FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Arena","sequence":"additional","affiliation":[{"name":"Healthy Living for Pandemic Event Protection (HL \u2010 PIVOT) Network  Chicago IL USA"},{"name":"Department of Physical Therapy University of Illinois Chicago  Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew P.","family":"Harber","sequence":"additional","affiliation":[{"name":"Healthy Living for Pandemic Event Protection (HL \u2010 PIVOT) Network  Chicago IL USA"},{"name":"Health Sciences Taylor University  Upland IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonard A.","family":"Kaminsky","sequence":"additional","affiliation":[{"name":"Healthy Living for Pandemic Event Protection (HL \u2010 PIVOT) Network  Chicago IL USA"},{"name":"Fisher Institute of Health and Well\u2010Being Ball State University  Muncie IN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Myers","sequence":"additional","affiliation":[{"name":"Healthy Living for Pandemic Event Protection (HL \u2010 PIVOT) Network  Chicago IL USA"},{"name":"Division of Cardiovascular Medicine VA Palo Alto Health Care System  CA USA"},{"name":"Cardiovascular Institute Stanford University  Stanford CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7840-0643","authenticated-orcid":false,"given":"Joseph C.","family":"Watso","sequence":"additional","affiliation":[{"name":"Cardiovascular and Applied Physiology Laboratory Florida State University  Tallahassee FL USA"},{"name":"Institute of Sports Sciences and Medicine Florida State University  Tallahassee FL USA"},{"name":"Institute for Successful Longevity Florida State University  Tallahassee FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00210-0"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.10.034"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)03138-X"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0187-2020"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/2047487320914435"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2021-319617"},{"key":"e_1_2_12_8_1","first-page":"237","volume-title":"Cardiopulmonary Exercise Testing\u2010Based Risk Stratification in the Modern Era of Advanced Heart Failure Management","author":"Lewis G. 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