Sex differences in human fatigability: mechanisms and insight to physiological responses
Open accessAbstract
Sex-related differences in physiology and anatomy are responsible for profound differences in neuromuscular performance and fatigability between men and women. Women are usually less fatigable than men for similar intensity isometric fatiguing contractions. This sex difference in fatigability, however, is task specific because different neuromuscular sites will be stressed when the requirements of the task are altered, and the stress on these sites can differ for men and women. Task variables that can alter the sex difference in fatigability include the type, intensity and speed of contraction, the muscle group assessed and the environmental conditions. Physiological mechanisms that are responsible for sex-based differences in fatigability may include activation of the motor neurone pool from cortical and subcortical regions, synaptic inputs to the motor neurone pool via activation of metabolically sensitive small afferent fibres in the muscle, muscle perfusion and skeletal muscle metabolism and fibre type properties. Non-physiological factors such as the sex bias of studying more males than females in human and animal experiments can also mask a true understanding of the magnitude and mechanisms of sex-based differences in physiology and fatigability. Despite recent developments, there is a tremendous lack of understanding of sex differences in neuromuscular function and fatigability, the prevailing mechanisms and the functional consequences. This review emphasizes the need to understand sex-based differences in fatigability to shed light on the benefits and limitations that fatigability can exert for men and women during daily tasks, exercise performance, training and rehabilitation in both health and disease.
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Sex-based differences exist in endurance performance such that, relative to body mass and composition, females outperform males during exercise at submaximal intensities.
“Sex-based differences are well known to exist in endurance performance where, relative to body mass and composition, females would outperform males during exercise at submaximal intensities (Hunter et al. 2014).”
From Analysis of sex-based differences in energy substrate utilization during moderate-intensity aerobic exercise (2022) · cites this paper as Hunter et al. 2014
The Physiological Mechanisms section (page not available in our copy) reports that, at the same relative endurance-exercise intensity, women oxidise more fat and that sex differences in muscle properties can contribute to less fatigue in women. It does not establish that women outperform men in submaximal endurance performance after accounting for body mass and composition. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe reduced muscle fatigability and metabolic advantage in women has been attributed to higher lipolytic efficiency and greater relative distribution and activation of fatigue-resistant slow twitch fibers.
“This fact has been attributed to a higher lipolytic efficiency (Bergström and Hultman 1966) and to a greater relative distribution and activation of fatigue resistant slow twitch fibers (Zierath and Hawley 2004; Hunter 2014; Temesi et al. 2015; Tiller et al. 2021).”
From Analysis of sex-based differences in energy substrate utilization during moderate-intensity aerobic exercise (2022) · cites this paper as Hunter 2014
In Physiological Mechanisms (page unavailable), Hunter reports that women have a greater proportional area of slow type I fibres and links these fatigue-resistant fibres to lower fatigability. The passages do not establish greater activation of those fibres in women. The separate claim about lipolytic efficiency is attributed to Bergström and Hultman, not Hunter, in the citing sentence. (LLM, conf=0.84)
Experimental — accuracy not yet measuredWomen possess a greater capacity to resist fatigue.
“women possess a greater capacity to resist fatigue [87]”
From Loading recommendations for muscle strength, hypertrophy, and local endurance: a re-examination of the repetition continuum. (2021) · cites this paper as [87]
The Relevance to Clinical Populations, Training and Rehabilitation section says women are less fatigable than men during many fatiguing tasks. The Single Limb Contractions section also reports tasks with no sex difference. The source supports greater fatigue resistance in many tasks, but not as an unqualified general capacity. (LLM, conf=0.86)
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Test–Retest Reliability of the One-Repetition Maximum (1RM) Strength Assessment: a Systematic Review
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Self-citationCentral and Peripheral Fatigue in Physical Exercise Explained: A Narrative Review
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Men Are More Likely than Women to Slow in the Marathon
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Performance Fatigability: Mechanisms and Task SpecificityPreprint
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Self-citationSex differences in large conducting airway anatomy
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Sex Differences in Endurance Running.
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Sex differences in fatigability and recovery relative to the intensity–duration relationship
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Dominelli, P. B., Render, J. N., Molgat‐Seon, Y., Foster, G. E., Romer, L. M., & Sheel, A. W. (2015) · The Journal of Physiology · doi:10.1113/jphysiol.2014.285965 · Cited by 143 · see citing works
Sex differences in human performance
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Sex Differences in Cancer Cachexia
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Impact of Blood Flow Restriction Exercise on Muscle Fatigue Development and Recovery
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Are Females More Resistant to Extreme Neuromuscular Fatigue?
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“…S. Pietro 43/b, 07100 Sassari, Italy 2 Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy 1 3 and Hultman 1966) and to a greater relative distribution and activation of fatigue resistant slow twitch fibers (Zierath and Hawley 2004; Hunter 2014; Temesi et al.”
BackgroundNeuromuscular Fatigability during Repeated-Sprint Exercise in Male Athletes
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Gender differences in fatigability and muscle activity responses to a short-cycle repetitive task
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Genetic and epigenetic sex-specific adaptations to endurance exercise
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Sex differences with aging in the fatigability of dynamic contractions
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ASIC3 Is Required for Development of Fatigue-Induced Hyperalgesia
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Sex Differences in Mechanisms of Recovery after Isometric and Dynamic Fatiguing Tasks
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The Neuromuscular Fatigue-Induced Loss of Muscle Force Control
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Age and sex differences in steadiness of elbow flexor muscles with imposed cognitive demand
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Self-citationAnaerobic Contribution Determined in Swimming Distances: Relation with Performance
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Woman the hunter: The physiological evidence
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Reproducibility of diaphragmatic thickness measured by M-mode ultrasonography in healthy volunteers
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Sex differences in pacing during half-marathon and marathon race
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Sex Bias in Cohorts Included in Sports Medicine Research
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Self-citationNeuroprotective effects of exercise on the aging human neuromuscular system
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Age-related decline in muscle mass and muscle function in Flemish Caucasians: a 10-year follow-up
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Impaired Trunk Flexor Strength, Fatigability, and Steadiness in Postpartum Women
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Self-citationEffect of diaphragm fatigue on subsequent exercise tolerance in healthy men and women
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- Authors
- Hunter, S. K.
- Affiliations
- Marquette University (US)
- Corresponding author
- Hunter, S. K.
- ORCID
- Hunter, S. K.
- Venue
- Acta Physiologica
- Publisher
- Wiley
- Published
- 2014-02-25
- Volume
- 210
- Issue
- 4
- Pages
- 768-789
- ISSN
- 1748-1708 (ISSN-L)
- PMC
- PMC4111134
- OpenAlex
- W2043456716
- Cited by
- 595
- References
- 208
- Citations by year
- 2026: 76 · 2025: 72 · 2024: 51 · 2023: 61 · 2022: 57 · 2021: 51 · 2020: 53 · 2019: 33 · 2018: 48 · 2017: 29 · 2016: 27 · 2015: 24 · 2014: 12 · 2013: 1
- FWCI
- 15.87
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Acta Physiologica (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- e-Publications@Marquette (Marquette University) (submittedVersion)
- Funders
- National Institute on Aging (R15AG039697)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Muscle activation and electromyography studies
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Keywords
- sex differences, muscle fatigue, fatigability, neuromuscular performance, isometric contraction, motoneuron pools, afferent nerve fibers, muscle blood flow, skeletal muscle metabolism, task specificity, sex bias in research, exercise performance, rehabilitation
- MeSH terms
- Female, Humans, Male, Sex Factors, Stress, Physiological, Muscle, Skeletal, Muscle Fatigue
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