No abstract

Masks are an effective tool in combatting the spread of COVID-19, but some people still resist wearing them and mask-wearing behavior has not been experimentally studied in the United States. To understand the demographics of mask wearers and resistors, and the impact of mandates on mask-wearing behavior, we observed shoppers (n = 9935) entering retail stores during periods of June, July, and August 2020. Approximately 41% of the June sample wore a mask. At that time, the odds of an individual wearing a mask increased significantly with age and was also 1.5x greater for females than males. Additionally, the odds of observing a mask on an urban or suburban shopper were~4x that for rural areas. Mask mandates enacted in late July and August increased mask-wearing compliance to over 90% in all groups, but a small percentage of resistors remained. Thus, gender, age, and location factor into whether shoppers in the United States wear a mask or face covering voluntarily. Additionally, mask mandates are necessary to increase mask wearing among the public to a level required to mitigate the spread of COVID-19.

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 fatigue 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 neuron pool from cortical and subcortical regions, synaptic inputs to the motor neuron 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 emphasises the need to understand sex-based differences in fatigability in order 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.

Women are capable of longer endurance times compared with men for contractions performed at low to moderate intensities. The purpose of the study was 1) to determine the relation between the absolute target force and endurance time for a submaximal isometric contraction and 2) to compare the pressor response and muscle activation patterns of men [26.3 +/- 1.1 (SE) yr] and women (27.5 +/- 2.3 yr) during a fatiguing contraction performed with the elbow flexor muscles. Maximal voluntary contraction (MVC) force was greater for men (393 +/- 23 vs. 177 +/- 7 N), which meant that the average target force (20% of MVC) was greater for men (79.7 +/- 6.5 vs. 36.7 +/- 2.0 N). The endurance time for the fatiguing contractions was 118% longer for women (1,806 +/- 239 vs. 829 +/- 94 s). The average of the rectified electromyogram (%MVC) for the elbow flexor muscles at exhaustion was similar for men (31 +/- 2%) and women (30 +/- 2%). In contrast, the heart rate and mean arterial pressure (MAP) were less at exhaustion for women (94 +/- 6 vs. 111 +/- 7 beats/min and 121 +/- 5 vs. 150 +/- 6 mmHg, respectively). The target force and change in MAP during the fatiguing contraction were exponentially related to endurance time (r(2) = 0.68 and r(2) = 0.64, respectively), whereas the change in MAP was linearly related to target force (r(2) = 0.51). The difference in fatigability of men and women when performing a submaximal contraction was related to the absolute contraction intensity and was limited by mechanisms that were distal to the activation of muscle.

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.

Endurance time, muscle activation, and mean arterial pressure were measured during two types of submaximal fatiguing contractions that required each subject to exert the same net muscle torque in the two tasks. Sixteen men and women performed isometric contractions at 15% of the maximum voluntary contraction (MVC) force with the elbow flexor muscles, either by maintaining a constant force while pushing against a force transducer (force task) or by supporting an equivalent inertial load while maintaining a constant elbow angle (position task). The endurance time for the force task (1402 +/- 728 s) was twice as long as that for the position task (702 +/- 582 s, P < 0.05), despite a similar reduction in the load torque at exhaustion for each contraction. The rate of increase in average electromyographic activity (EMG, % peak MVC value) for the elbow flexor muscles was similar for the two tasks. However, the average EMG was greater at exhaustion for the force task (22.4 +/- 1.2%) compared with the position task (14.9 +/- 1.0%, P < 0.05). In contrast, the rates of increase in the mean arterial pressure, the rating of perceived exertion, anterior deltoid EMG, and fluctuations in motor output (force or acceleration) were greater for the position task compared with the force task (P < 0.05). Furthermore, the rate of bursts in EMG activity, which corresponded to the transient recruitment of motor units, was greater for the brachialis muscle during the position task. These results indicate that the briefer endurance time for the position task was associated with greater levels of excitatory and inhibitory input to the motor neurons compared with the force task.

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 over the last 20 years. 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.

Studies of non-elite distance runners suggest that men are more likely than women to slow their pace in the marathon. Purpose This study determined the reliability of the sex difference in pacing across many marathons, and after adjusting women’s performances by 12% to address men’s greater maximal oxygen uptake and also incorporating information on racing experience. Methods Data was acquired from 14 U.S. marathons in 2011, and encompassed 91,929 performances. For 2,929 runners, we obtained experience data from a race-aggregating website. We operationalized pace maintenance as percentage change in pace observed in the second half of the marathon relative to the first half. Pace maintenance was analyzed as a continuous variable and as two categorical variables: “maintain the pace,” defined as slowing < 10%; and “marked slowing,” defined as slowing ≥30%. Results The mean change in pace was 15.6% and 11.7% for men and women, respectively (P<0.0001). This sex difference was significant for all 14 marathons. The odds for women were 1.46 (95% CI: 1.41 to 1.50, P<0.0001) times higher than men to maintain the pace and 0.36 (95% CI: 0.34–0.38; P<0.0001) times that of men to exhibit marked slowing. Slower finishing times were associated with greater slowing, especially in men (interaction, P<.0001). However, the sex difference in pacing occurred across age and finishing-time groups. Making the 12% adjustment to women’s performances lessened the magnitude of the sex difference in pacing but not its occurrence. Although greater experience was associated with lesser slowing, controlling for the experience variables did not eliminate the sex difference in pacing. Conclusions The sex difference in pacing is robust. It may reflect sex differences in physiology, decision making, or both.