In conclusion, the qualitative aspects of the respiratory sensations during exercise were significantly different between obese women with strong or weak DOE. Women with an elevated intensity of dyspnea reported an increased sensation of the work of breathing compared with women without dyspnea. The lack of significant physiologic differences and the lack of association of dyspnea with ventilatory demand and exercise intensity are suggestive of the importance of the individual’s symptom perception. This differential symptom perception may occur at any point, from neural activation to interpretation of the respiratory stimulus,7 which our study does not address. Future studies on the underlying mechanism of DOE are warranted, which may lead to better treatment avenues alleviating the individual’s dyspnea symptoms