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

Muscle Function and Fatigability of Trunk Flexors in Males and Females

Background Optimal function of the abdominal muscles is necessary for several life functions including lifting and carrying tasks. Sex differences in strength and fatigability are established for many limb muscles and back extensor muscles, but it is unknown if sex differences exist for the abdominal muscles despite their functional importance. Methods Eighteen females (24.3 ± 4.8 years) and 15 males (24.1 ± 6.6 years) performed (1) isometric trunk flexion maximal voluntary contractions (MVCs) in a range of trunk positions to establish a torque-angle curve and (2) submaximal (50% MVC), intermittent isometric contraction (6 s on, 4 s off) until task failure to determine fatigability of the trunk flexor muscles. Dual X-ray absorptiometry quantified body fat and lean mass. Physical activity levels were quantified with a questionnaire. Torque-angle curves, electromyography (EMG), MVC torque, and torque steadiness were compared with repeated measures ANOVA with sex as a between-subjects factor. Results For the torque-angle curve, MVC torque was reduced as the trunk angle increased toward flexion (p \u3c 0.001). Males had greater MVC torque than females at the extended positions (31% difference), with no sex differences in torque in upright sitting (p \u3e 0.05). Time-to-task failure for the submaximal fatigability task in upright sitting was similar between males and females (12.4 ± 7 vs 10.5 ± 6 min). Time-to-task failure was positively associated with strength (r = 0.473, p = 0.005) and self-reported physical activity (r = 0.456, p = 0.030). Lean mass in the trunk was positively associated with trunk flexor strength (r = 0.378, p = 0.011) and self-reported physical activity (r = 0.486, p = 0.007). Finally, torque steadiness [coefficient of variation of torque (CV)] during submaximal isometric contractions decreased with contraction intensity and was similar for males and females across all intensities. Conclusions Unlike many limb muscle groups, males and females had similar fatigability and torque steadiness of the trunk flexor muscles during isometric contractions. Stronger individuals, however, exhibited less fatigability. Lower self-reported physical activity was associated with greater fatigability of trunk flexor muscles. The relationship between strength and fatigability of the trunk flexor muscles and physical activity supports the importance of abdominal muscle strengthening to offset fatigability in both males and females

Mechanisms for the Age-related Increase in Fatigability of the Knee Extensors in Old and Very Old Adults

The mechanisms for the age-related increase in fatigability during high-velocity contractions in old and very old adults ({greater than or equal to}80 yrs) are unresolved. Moreover, whether the increased fatigability with advancing age and the underlying mechanisms differ between men and women are not known. The purpose of this study was to quantify the fatigability of knee extensor muscles and identify the mechanisms of fatigue in 30 young (22.6 {plus minus} 0.4 yrs; 15 men), 62 old (70.5 {plus minus} 0.7 yrs; 33 men), and 12 very old (86.0 {plus minus} 1.3 yrs; 6 men) men and women elicited by high-velocity concentric contractions. Participants performed 80 maximal velocity contractions (1 contraction per 3 s) with a load equivalent to 20% of the maximum voluntary isometric contraction. Voluntary activation and contractile properties were quantified before and immediately following exercise (\u3c10 \u3es) using transcranial magnetic stimulation and electrical stimulation. Absolute mechanical power output was 97% and 217% higher in the young compared to old and very old adults, respectively. Fatigability (reductions in power) progressively increased across age groups, with a power loss of 17% in young, 31% in old, and 44% in very old adults. There were no sex differences in fatigability among any of the age groups. The age-related increase in power loss was strongly associated with changes in the involuntary twitch amplitude (r=0.75,

Sex Differences with Aging in the Fatigability of Dynamic Contractions

This study determined the sex difference with aging in fatigability of the elbow flexor muscles during a dynamic fatiguing task, and explored the associated mechanisms. We compared fatigability of the elbow flexor muscles in 18 young (20.2 ± 1 years: 9 men) and 36 old adults (73.5 ± 1 years: 16 men) during and in recovery from repeated dynamic contractions (~ 60°/s) with a load equivalent to 20% of maximal voluntary isometric contraction (MVIC) torque until failure. Transcranial magnetic stimulation (TMS) was used to assess supraspinal fatigue (an increase in the superimposed twitch, SIT) and the peak rate of muscle relaxation. Time to failure was briefer for the men than the women (6.1 ± 2.1 vs. 9.7 ± 5.5 min, respectively; P = 0.02) with no difference between young and old adults (7.2 ± 2.9 vs. 8.4 ± 5.2 min, respectively, P = 0.45) and no interaction (P \u3e 0.05). The relative decline in peak relaxation rate with fatigability was similar for young and old adults (P = 0.11), but greater for men than women (P = 0.046). Supraspinal fatigue increased for all groups and was associated with the time to failure (P \u3c 0.05). Regression analysis however, indicated that the time to failure was best predicted by the peak relaxation rate (baseline values and slowing with fatigability) (r2 = 0.55). Rate-limiting contractile mechanisms (e.g. excitation–contraction coupling) were responsible for the increased fatigability of the elbow flexors of men compared with women for a dynamic fatiguing task of slow angular velocity, and this sex difference was maintained with aging. The age difference in fatigability for the dynamic task was diminished for both sexes relative to what is typically observed with isometric fatiguing contractions

Aging and Muscle Fatigability in the Upper Extremity

Aging is accompanied by reductions in strength and contraction velocity, and increased fatigability of limb muscles during high-velocity dynamic contractions. These age-related changes affect functional tasks and are well described for the lower limb, with less known about the upper limb muscles. The aims of the thesis were to compare in young and old men and women: (1) maximal torque and power of the elbow flexor muscles across a range of isokinetic velocities, and (2) the neural (supraspinal) and muscular mechanisms of fatigue induced by high-velocity dynamic contractions of the elbow flexor muscles. 28 young (23.2 ± 2.6 years) men (n = 14) and women (n = 14) and 33 (72.6 ± 5.6 years) old men (n = 18) and women (n = 15) with the elbow flexor muscles performed: (1) maximal isokinetic contractions at 15 velocities to assess strength and power (0-450°/s), and (2) a dynamic fatiguing task involving 80 fast, maximal-effort contractions with a load equivalent to 20% of maximal voluntary isometric torque (MVIC). Before and after the fatiguing task the following were assessed: voluntary activation using motor cortical stimulation as a measure of supraspinal fatigue, and contractile properties evoked with electrical stimulation as a measure of muscular mechanisms. The elbow flexor muscles of the old adults were weaker and less powerful than young adults across all the velocities assessed (P\u3c0.01), although voluntary activation was similar between the age groups (P\u3e0.05). Some young and old adults were not able attain higher contraction velocities, primarily driven by the women. Old adults were more fatigable than young adults (P\u3c0.001, 15% difference) with now sex differences (P\u3e0.05). Old adults exhibited a larger reduction in voluntary activation (P=0.036, 7.5% age difference) and greater increase in relaxation in the old adults (55%) than the young (36%) following the fatiguing task. The elbow flexor muscles of old men and women were weaker and less powerful than young, but this was not due to differences in voluntary activation. The greater fatigability of elbow flexor muscles in the old adults however, was due to both supraspinal mechanisms and slowing of the muscle that occurs with aging

Mechanisms for the Increased Fatigability of the Lower Limb in People with Type 2 Diabetes

Fatiguing exercise is the basis of exercise training and a cornerstone of management of type 2 diabetes mellitus (T2D), however, little is known about the fatigability of limb muscles and the involved mechanisms in people with T2D. The purpose was to compare fatigability of knee extensor muscles between people with T2D and controls without diabetes and determine the neural and muscular mechanisms for a dynamic fatiguing task. Seventeen people with T2D (10 men, 7 women: 59.6{plus minus}9.0 years) and 21 age-, BMI- and physical activity-matched controls (11 men, 10 women: 59.5{plus minus}9.6 years) performed 120 high-velocity concentric contractions (1 contraction/3 s) with a load equivalent to 20% maximal voluntary isometric contraction (MVIC) torque with the knee extensors. Transcranial magnetic stimulation (TMS) and electrical stimulation of the quadriceps were used to assess voluntary activation and contractile properties. People with T2D had larger reductions than controls in power during the fatiguing task (39.9{plus minus}20.2% vs. 28.3{plus minus}16.7%, P2=0.364, P=0.002). Although neural mechanisms contributed to fatigability, contractile mechanisms were responsible for the greater knee extensor fatigability in men and women with T2D compared with healthy controls

Sex Differences in Mechanisms of Recovery after Isometric and Dynamic Fatiguing Tasks

Purpose The purpose of this study was to determine whether supraspinal mechanisms contribute to the sex difference in fatigability during and recovery from a dynamic and isometric fatiguing task with the knee extensors. Methods: Transcranial magnetic stimulation and electrical stimulation were used to determine voluntary activation and contractile properties of the knee extensors in 14 men and 17 women (20.8 ± 1.9 yr) after a 1) 60-s sustained, maximal voluntary isometric contraction (MVIC), and 2) dynamic fatiguing task involving 120 maximal voluntary concentric contractions with a 20% MVIC load. Results: There were no differences between men and women in the reduction of maximal torque during the sustained MVIC (54.4% ± 18.9% vs 55.9% ± 11.2%, P = 0.49) or in the decrease in power during the dynamic fatiguing task (14.7% ± 20.1% vs 14.2% ± 18.5%, P = 0.92). However, MVIC torque recovered more quickly for women than men after the sustained MVIC and the dynamic task (P \u3c 0.05). The transcranial magnetic stimulation–elicited superimposed twitch was larger for men than for women during the sustained MVIC and in recovery (immediately post, R0.1: 4.7% ± 3.3% vs 2.4% ± 1.9% MVIC; P = 0.02), with no sex difference after the dynamic task (P = 0.35). The reduction in resting twitch amplitude was larger for men than for women immediately after the dynamic task (37% ± 22% vs 23% ± 18%; P = 0.016) with no sex difference after the sustained MVIC (64% ± 16% vs 67% ± 11%; P = 0.46). Conclusions: Supraspinal fatigue contributed to fatigability of the knee extensors more for men than for women after a maximal isometric task, whereas contractile mechanisms explained the sex difference in torque recovery after the fast-velocity dynamic task. The mechanisms for the sex difference in fatigability are task dependent