The Relevance of Sex Differences in Performance Fatigability

Performance fatigability differs between men and women for a range of fatiguing tasks. Women are usually less fatigable than men, and this is most widely described for isometric fatiguing contractions and some dynamic tasks. The sex difference in fatigability is specific to the task demands so that one mechanism is not universal, including any sex differences in skeletal muscle physiology, muscle perfusion, and voluntary activation. However, there are substantial knowledge gaps about the task dependency of the sex differences in fatigability, the involved mechanisms, and the relevance to clinical populations and with advanced age. The knowledge gaps are in part due to the significant deficits in the number of women included in performance fatigability studies despite a gradual increase in the inclusion of women for the last 20 yr. Therefore, this review 1) provides a rationale for the limited knowledge about sex differences in performance fatigability, 2) summarizes the current knowledge on sex differences in fatigability and the potential mechanisms across a range of tasks, 3) highlights emerging areas of opportunity in clinical populations, and 4) suggests strategies to close the knowledge gap and understanding the relevance of sex differences in performance fatigability. The limited understanding about sex differences in fatigability in healthy and clinical populations presents as a field ripe with opportunity for high-impact studies. Such studies will inform on the limitations of men and women during athletic endeavors, ergonomic tasks, and daily activities. Because fatigability is required for effective neuromuscular adaptation, sex differences in fatigability studies will also inform on optimal strategies for training and rehabilitation in both men and women

Performance Fatigability: Mechanisms and Task Specificity

Performance fatigability is characterized as an acute decline in motor performance caused by an exercise-induced reduction in force or power of the involved muscles. Multiple mechanisms contribute to performance fatigability and originate from neural and muscular processes, with the task demands dictating the mechanisms. This review highlights that (1) inadequate activation of the motoneuron pool can contribute to performance fatigability, and (2) the demands of the task and the physiological characteristics of the population assessed, dictate fatigability and the involved mechanisms. Examples of task and population differences in fatigability highlighted in this review include contraction intensity and velocity, stability and support provided to the fatiguing limb, sex differences, and aging. A future challenge is to define specific mechanisms of fatigability and to translate these findings to real-world performance and exercise training in healthy and clinical populations across the life span

Sex Differences in Fatigability of Dynamic Contractions

Women are usually less fatigable than men during single-limb isometric contractions, primarily because of sex-related differences in contractile mechanisms. It is less clear whether these sex differences in muscle fatigue occur for dynamic fatiguing tasks. This review highlights new findings that the sex difference in fatigability for dynamic shortening contractions with a single limb is dependent on the contraction velocity and the muscle group involved. Recent studies demonstrate that women are less fatigable than men for a dynamic task as follows: (i) the elbow-flexor muscles at slow- but not high-velocity contractions; and (ii) the knee-extensor muscles when muscle fatigue was quantified as a reduction in the maximal voluntary isometric contraction force after the dynamic fatiguing task. Contractile mechanisms are responsible for the sex difference in muscle fatigue of the dynamic contractions, with no evidence for a sex difference in the reduction in voluntary activation (i.e. central fatigue). Thus, these findings indicate that the sex difference in muscle fatigue of dynamic contractions is task specific. These data also challenge the assumption that men and women respond in a similar manner to training and rehabilitation that involve fatiguing contractions to overload the neuromuscular system. There is, however, a tremendous opportunity for conducting high-impact studies to gain insight into those factors that define the sex-based differences in muscle fatigue during dynamic tasks. Such studies can define the boundaries to human performance in both men and women during athletic endeavours, ergonomic tasks and rehabilitation

Sex Differences and Mechanisms of Task-Specific Muscle Fatigue

Women can be less fatigable than men due to sex-related differences within the neuromuscular system that impact physiological adjustments during a fatiguing task. The involved mechanism(s) for the sex difference, however, is task specific. This review explores the novel hypothesis that variation of the task will alter the magnitude of the sex-difference in muscle fatigue and the contribution of involved mechanisms

Functional Implications of Impaired Control of Submaximal Hip Flexion Following Stroke

Introduction: We quantified sub-maximal torque regulation during low to moderate intensity isometric hip flexion contractions in individuals with stroke and the associations with leg function. Methods: 10 participants with chronic stroke and 10 controls performed isometric hip flexion contractions at 5%, 10%, 15%, 20%, and 40% of maximal voluntary contraction (MVC) in paretic, non-paretic, and control legs. Results: Participants with stroke had larger torque fluctuations (coefficient of variation, CV), for both the paretic and non-paretic legs, than controls (Pr2 =0.45) and Berg Balance Score (r2=0.38). At 5% MVC, there were larger torque fluctuations in the contralateral leg during paretic contractions compared with the control leg. Conclusions: Impaired low-force regulation of paretic leg hip flexion can be functionally relevant and related to control versus strength deficits post stroke

Fatigability and Recovery of Arm Muscles with Advanced Age for Dynamic and Isometric Contractions

This study determined whether age-related mechanisms can increase fatigue of arm muscles during maximal velocity dynamic contractions, as it occurs in the lower limb. We compared elbow flexor fatigue of young (n = 10, 20.8 ± 2.7 years) and old men (n = 16, 73.8 ± 6.1 years) during and in recovery from a dynamic and an isometric postural fatiguing task. Each task was maintained until failure while supporting a load equivalent to 20% of maximal voluntary isometric contraction (MVIC) torque. Transcranial magnetic stimulation (TMS) was used to assess supraspinal fatigue (superimposed twitch, SIT) and muscle relaxation. Time to failure was longer for the old men than for the young men for the isometric task (9.5 ± 3.1 vs. 17.2 ± 7.0 min, P = 0.01) but similar for the dynamic task (6.3 ± 2.4 min vs. 6.0 ± 2.0 min, P = 0.73). Initial peak rate of relaxation was slower for the old men than for the young men, and was associated with a longer time to failure for both tasks (P \u3c 0.05). Low initial power during elbow flexion was associated with the greatest difference (reduction) in time to failure between the isometric task and the dynamic task (r = − 0.54, P = 0.015). SIT declined after both fatigue tasks similarly with age, although the recovery of SIT was associated with MVIC recovery for the old (both sessions) but not for the young men. Biceps brachii and brachioradialis EMG activity (% MVIC) of the old men were greater than that of the young men during the dynamic fatiguing task (P \u3c 0.05), but were similar during the isometric task. Muscular mechanisms and greater relative muscle activity (EMG activity) explain the greater fatigue during the dynamic task for the old men compared with the young men in the elbow flexor muscles. Recovery of MVC torque however relies more on the recovery of supraspinal fatigue among the old men than among the young men

Girls in The Boat: Sex Differences in Rowing Performance and Participation

Men outperform women in many athletic endeavors due to physiological and anatomical differences (e.g. larger and faster muscle); however, the observed sex differences in elite athletic performance are typically larger than expected, and may reflect sex-related differences in opportunity or incentives. As collegiate rowing in the United States has been largely incentivized for women over the last 20 years, but not men, the purpose of this study was to examine sex differences in elite rowing performance over that timeframe. Finishing times from grand finale races for collegiate championship on-water performances (n = 480) and junior indoor performances (n = 1,280) were compared between men and women across 20 years (1997–2016), weight classes (heavy vs. lightweight) and finishing place. Participation of the numbers of men and women rowers were also quantified across years. Men were faster than women across all finishing places, weight classes and years of competition and performance declined across finishing place for both men and women (P\u3c0.001). Interestingly, the reduction in performance time across finishing place was greater (P\u3c0.001) for collegiate men compared to women in the heavyweight division. This result is opposite to other sports (e.g. running and swimming), and to lightweight rowing in this study, which provides women fewer incentives than in heavyweight rowing. Correspondingly, participation in collegiate rowing has increased by ~113 women per year (P\u3c0.001), with no change (P = 0.899) for collegiate men. These results indicate that increased participation and incentives within collegiate rowing for women vs. men contribute to sex differences in athletic performance

The Aging Neuromuscular System and Motor Performance

Age-related changes in the basic functional unit of the neuromuscular system, the motor unit, and its neural inputs have a profound effect on motor function, especially among the expanding number of old (older than ∼60 yr) and very old (older than ∼80 yr) adults. This review presents evidence that age-related changes in motor unit morphology and properties lead to impaired motor performance that includes 1) reduced maximal strength and power, slower contractile velocity, and increased fatigability; and 2) increased variability during and between motor tasks, including decreased force steadiness and increased variability of contraction velocity and torque over repeat contractions. The age-related increase in variability of motor performance with aging appears to involve reduced and more variable synaptic inputs that drive motor neuron activation, fewer and larger motor units, less stable neuromuscular junctions, lower and more variable motor unit action potential discharge rates, and smaller and slower skeletal muscle fibers that coexpress different myosin heavy chain isoforms in the muscle of older adults. Physical activity may modify motor unit properties and function in old men and women, although the effects on variability of motor performance are largely unknown. Many studies are of cross-sectional design, so there is a tremendous opportunity to perform high-impact and longitudinal studies along the continuum of aging that determine 1) the influence and cause of the increased variability with aging on functional performance tasks, and 2) whether lifestyle factors such as physical exercise can minimize this age-related variability in motor performance in the rapidly expanding numbers of very old adults

Rates of Performance Loss and Neuromuscular Activity in Men and Women During Cycling: Evidence for A Common Metabolic Basis of Muscle Fatigue

The durations that muscular force and power outputs can be sustained until failure fall predictably on an exponential decline between an individual’s 3-s burst maximum to the maximum performance they can sustain aerobically. The exponential time constants describing these rates of performance loss are similar across individuals, suggesting that a common metabolically based mechanism governs muscle fatigue; however, these conclusions come from studies mainly on men. To test whether the same physiological understanding can be applied to women, we compared the performance-duration relationships and neuromuscular activity between seven men [23.3 ± 1.9 (SD) yr] and seven women (21.7 ± 1.8 yr) from multiple exhaustive bouts of cycle ergometry. Each subject performed trials to obtain the peak 3-s power output (Pmax), the mechanical power at the aerobic maximum (Paer), and 11–14 constant-load bouts eliciting failure between 3 and 300 s. Collectively, men and women performed 180 exhaustive bouts spanning an ~6-fold range of power outputs (118–1116 W) and an ~35-fold range of trial durations (8–283 s). Men generated 66% greater Pmax (956 ± 109 W vs. 632 ± 74 W) and 68% greater Paer (310 ± 47 W vs. 212 ± 15 W) than women. However, the metabolically based time constants describing the time course of performance loss were similar between men (0.020 ± 0.003/s) and women (0.021 ± 0.003/s). Additionally, the fatigue-induced increases in neuromuscular activity did not differ between the sexes when compared relative to the pedal forces at Paer. These data suggest that muscle fatigue during short-duration dynamic exercise has a common metabolically based mechanism determined by the extent that ATP is resynthesized by anaerobic metabolism