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Int J Sports Med
DOI: 10.1055/a-2563-9449
Review

Biological sex differences in fatigue in resistance-trained individuals: A scoping review

ChristianHoumann Amdi 
1   Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand (Ringgold ID: RIN1410)
,
Jackson Fyfe
2   Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia (Ringgold ID: RIN2104)
,
SangHoon Yoon
1   Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand (Ringgold ID: RIN1410)
,
Greg Nuckols
3   Clinical Practice, Stronger by Science LLC, Raleigh, United States
,
Martin Refalo
2   Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia (Ringgold ID: RIN2104)
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Abstract

Females may experience less neuromuscular fatigue and improved recovery following resistance training than males; however, it is unclear whether this applies to resistance-trained individuals. A systematic scoping review was performed to map the evidence on sex differences in fatigue during and following resistance training in trained participants. PubMed, CINAHL and SPORTDiscus were searched following PRISMA-ScR guidelines. The protocol was prospectively registered. Of the 4,020 identified articles, 34 were included. These studies assessed sex differences in fatigue using various measures during single and multiple resistance training sets, performance relative to the baseline at various time points (0–5 min, 1–6 h, 24 h, and 48–96 h after resistance training), and metabolic responses. Substantial heterogeneity in study design and results were observed. Together, most studies found minor-to-no sex differences in neuromuscular fatigue, but some evidence of greater fatigability in males during or immediately following resistance training were found when (1) more complex free-weight exercises were performed with moderate loads, (2) rest periods were shorter, and (3) males were substantially stronger than females in relative terms, among others. Future investigations should explore the impact of training variables and habitual training on fatigue in males and females of comparable relative strength and technical proficiency.

Keywords

fatigue - sex differences - resistance training


Publication History

Received: 09 October 2024

Accepted after revision: 20 March 2025

Accepted Manuscript online:
20 March 2025

Article published online:
15 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Refalo MC, Nuckols G, Galpin AJ, Gallagher IJ, Hamilton DL, Fyfe JJ. Sex differences in absolute and relative changes in muscle size following resistance training in healthy adults: a systematic review with Bayesian meta-analysis. PeerJ 2025; 13: e19042
    PubMedSearch in Google Scholar
  • 2 Tornero-Aguilera JF, Jimenez-Morcillo J, Rubio-Zarapuz A, Clemente-Suárez VJ. Central and peripheral fatigue in physical exercise explained: A narrative review. Int J Environ Res Public Health 2022; 19: 3909
    PubMedSearch in Google Scholar
  • 3 Kataoka R, Vasenina E, Hammert WB, Ibrahim AH, Dankel SJ, Buckner SL. Is there evidence for the suggestion that fatigue accumulates following resistance exercise?. Sports Med 2022; 52: 25-36
    PubMedSearch in Google Scholar
  • 4 Peake JM, Neubauer O, Della Gatta PA. et al. Muscle damage and inflammation during recovery from exercise. J Appl Physiol (1985) 2017; 122: 559-570
    CrossrefPubMedSearch in Google Scholar
  • 5 Calderón JC, Bolaños P, Caputo C. The excitation–contraction coupling mechanism in skeletal muscle. Biophys Rev 2014; 6: 133-160
    PubMedSearch in Google Scholar
  • 6 Coutts A, Reaburn P, Piva TJ, Murphy A. Changes in selected biochemical, muscular strength, power, and endurance measures during deliberate overreaching and tapering in rugby league players. Int J Sports Med 2007; 28: 116-124
    PubMedSearch in Google Scholar
  • 7 Williams TD, Esco MR, Fedewa MV, Bishop PA. Inter- and intra-day comparisons of smartphone-derived heart rate variability across resistance training overload and taper microcycles. Int J Environ Res Public Health 2020; 18: 177
    PubMedSearch in Google Scholar
  • 8 Fry AC, Kraemer WJ, van Borselen F. et al. Performance decrements with high-intensity resistance exercise overtraining. Med Sci Sports Exerc 1994; 26: 1165-1173
    PubMedSearch in Google Scholar
  • 9 Hunter SK. Sex differences in human fatigability: Mechanisms and insight to physiological responses. Acta Physiol (Oxf) 2014; 210: 768-789
    CrossrefPubMedSearch in Google Scholar
  • 10 Enns DL, Tiidus PM. The influence of estrogen on skeletal muscle: Sex matters. Sports Med 2010; 40: 41-58
    PubMedSearch in Google Scholar
  • 11 Hunter SK. Performance fatigability: Mechanisms and task specificity. Cold Spring Harb Perspect Med 2018; 8: a029728
    CrossrefPubMedSearch in Google Scholar
  • 12 Ansdell P, Thomas K, Hicks KM, Hunter SK, Howatson G, Goodall S. Physiological sex differences affect the integrative response to exercise: Acute and chronic implications. Exp Physiol 2020; 105: 2007-2021
    CrossrefPubMedSearch in Google Scholar
  • 13 Nuzzo JL. Narrative review of sex differences in muscle strength, endurance, activation, size, fiber type, and strength training participation rates, preferences, motivations, injuries, and neuromuscular adaptations. J Strength Cond Res 2023; 37: 494-536
    CrossrefPubMedSearch in Google Scholar
  • 14 Hunter SK. The relevance of sex differences in performance fatigability. Med Sci Sports Exerc 2016; 48: 2247-2256
    PubMedSearch in Google Scholar
  • 15 Amdi CH, Cleather DJ, Tallent J. Impact of training protocols on lifting velocity recovery in resistance trained males and females. Sports 2021; 9: 157
    PubMedSearch in Google Scholar
  • 16 Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: A pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Glob Health 2018; 6: 1077
    PubMedSearch in Google Scholar
  • 17 Ren Z, Zhang Y, Drenowatz C. et al. How many adults have sufficient muscle-strengthening exercise and the associated factors: A systematic review consisting of 2,629,508 participants. J Exerc Sci Fit 2024; 22: 359-368
    PubMedSearch in Google Scholar
  • 18 Hunter SK, Schletty JM, Schlachter KM, Griffith EE, Polichnowski AJ, Ng AV. Active hyperemia and vascular conductance differ between men and women for an isometric fatiguing contraction. J Appl Physiol 2006; 101: 140-150
    PubMedSearch in Google Scholar
  • 19 Tricco AC, Lillie E, Zarin W. et al. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med 2018; 169: 467-473
    CrossrefPubMedSearch in Google Scholar
  • 20 Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol 2018; 18: 143
    CrossrefPubMedSearch in Google Scholar
  • 21 Peters M, Godfrey C, McInerney P. et al. Chapter 11: Scoping reviews. In: Aromataris E, Munn Z, Hrsg. JBI Manual for Evidence Synthesis. JBI; 2020
    Search in Google Scholar
  • 22 Santos Junior ERT, de Salles BF, Dias I, Ribeiro AS, Simão R, Willardson JM. Classification and determination model of resistance training status. Strength Cond J 2021; 43: 77-86
    CrossrefPubMedSearch in Google Scholar
  • 23 Jukic I, Prnjak K, McGuigan MR, Helms ER. One velocity loss threshold does not fit all: Consideration of sex, training status, history, and personality traits when monitoring and controlling fatigue during resistance training. Sports Med Open 2023; 9: 80
    CrossrefPubMedSearch in Google Scholar
  • 24 Tinsley GM, Hamm MA, Hurtado AK. et al. Effects of two pre-workout supplements on concentric and eccentric force production during lower body resistance exercise in males and females: A counterbalanced, double-blind, placebo-controlled trial. J Int Soc Sports Nutr 2017; 14: 46
    PubMedSearch in Google Scholar
  • 25 Refalo MC, Helms ER, Hamilton DL, Fyfe JJ. Influence of resistance training proximity-to-failure, determined by repetitions-in-reserve, on neuromuscular fatigue in resistance-trained males and females. Sports Med Open 2023; 9: 10
    PubMedSearch in Google Scholar
  • 26 Pullinen T, Mero A, Huttunen P, Pakarinen A, Komi PV. Resistance exercise-induced hormonal responses in men, women, and pubescent boys. Med Sci Sports Exerc 2002; 34: 806-813
    PubMedSearch in Google Scholar
  • 27 Voskuil CC, Dudar MD, Carr JC. Sex differences in fatiguability during single-joint resistance exercise in a resistance-trained population. Eur J Appl Physiol 2024; 124: 2261-2271
    CrossrefPubMedSearch in Google Scholar
  • 28 Benitez B, Kwak M, Succi PJ, Mitchinson C, Bergstrom HC. No sex differences in time-to-task failure and neuromuscular patterns of response during submaximal, bilateral, isometric leg extensions. Eur J Appl Physiol 2024; 124: 2993-3004
    CrossrefPubMedSearch in Google Scholar
  • 29 Gentil P, Campos MH, Soares S. et al. Comparison of elbow flexor isokinetic peak torque and fatigue index between men and women of different training level. Eur J Transl Myol 2017; 27: 7070
    PubMedSearch in Google Scholar
  • 30 Dello Iacono A, Watson K, Jukic I. The autoregulation rest-redistribution training method mitigates sex differences in neuromuscular and perceived fatigue during resistance training. Int J Sports Physiol Perform 2024; 19: 685-695
    CrossrefPubMedSearch in Google Scholar
  • 31 Monteiro ER, Steele J, Novaes JS. et al. Men exhibit greater fatigue resistance than women in alternated bench press and leg press exercises. J Sports Med Phys Fitness 2019; 59: 238-245
    PubMedSearch in Google Scholar
  • 32 Marshall PW, Metcalf E, Hagstrom AD, Cross R, Siegler JC, Enoka RM. Changes in fatigue are the same for trained men and women after resistance exercise. Med Sci Sports Exerc 2020; 52: 196-204
    PubMedSearch in Google Scholar
  • 33 Latella C, Hendy A, Vanderwesthuizen D, Teo WP. The modulation of corticospinal excitability and inhibition following acute resistance exercise in males and females. Eur J Sport Sci 2018; 18: 984-993
    PubMedSearch in Google Scholar
  • 34 Ha PL, Dalton BE, Alesi MG. et al. Isometric versus isotonic contractions: Sex differences in the fatigability and recovery of isometric strength and high-velocity contractile parameters. Physiol Rep 2021; 9: e14821
    PubMedSearch in Google Scholar
  • 35 Davies RW, Carson BP, Jakeman PM. Sex differences in the temporal recovery of neuromuscular function following resistance training in resistance trained men and women 18 to 35 years. Front Physiol 2018; 9: 1480
    CrossrefPubMedSearch in Google Scholar
  • 36 Emanuel A, Rozen Smukas II, Halperin I. The effects of lifting lighter and heavier loads on subjective measures. Int J Sports Physiol Perform 2021; 16: 176-183
    PubMedSearch in Google Scholar
  • 37 Emanuel A, Rozen Smukas I, Halperin I. How one feels during resistance exercises: A repetition-by-repetition analysis across exercises and loads. Int J Sports Physiol Perform 2021; 16: 135-144
    PubMedSearch in Google Scholar
  • 38 Orssatto LBR, Diefenthaeler F, Vargas M, Rossato M, Freitas CR. Dissimilar perceptual response between trained women and men in resistance training to concentric failure: A quasi-experimental study. J Bodyw Mov Ther 2020; 24: 527-535
    PubMedSearch in Google Scholar
  • 39 Flanagan SD, Mills MD, Sterczala AJ. et al. The relationship between muscle action and repetition maximum on the squat and bench press in men and women. J Strength Cond Res 2014; 28: 2437-2442
    PubMedSearch in Google Scholar
  • 40 Vilaça-Alves J, Geraldes L, Fernandes HM. et al. Effects of pre-exhausting the biceps brachii muscle on the performance of the front lat pull-down exercise using different handgrip positions. J Hum Kinet 2014; 42: 157-163
    PubMedSearch in Google Scholar
  • 41 Gabriel DA. Fatigue patterns for accommodating hydraulic resistance exercise. J Strength Cond Res 1991; 5: 6-10
    PubMedSearch in Google Scholar
  • 42 Mochizuki Y, Saito M, Homma H. et al. Does resistance exercise lifting velocity change with different rest intervals?. J Sports Med Phys Fitness 2023; 63: 402-408
    PubMedSearch in Google Scholar
  • 43 Häkkinen K. Neuromuscular fatigue in males and females during strenuous heavy resistance loading. Electromyogr Clin Neurophysiol 1994; 34: 205-214
    PubMedSearch in Google Scholar
  • 44 Häkkinen K. Neuromuscular fatigue and recovery in male and female athletes during heavy resistance exercise. Int J Sports Med 1993; 14: 53-59
    PubMedSearch in Google Scholar
  • 45 Lewis MH, Siedler MR, Lamadrid P. et al. Sex differences may exist for performance fatigue but not recovery after single-joint upper-body and lower-body resistance exercise. J Strength Cond Res 2022; 36: 1498-1505
    PubMedSearch in Google Scholar
  • 46 Ratamess NA, Chiarello CM, Sacco AJ. et al. The effects of rest interval length manipulation of the first upper-body resistance exercise in sequence on acute performance of subsequent exercises in men and women. J Strength Cond Res 2012; 26: 2929-2938
    PubMedSearch in Google Scholar
  • 47 Hooper DR, Szivak TK, Comstock BA. et al. Effects of fatigue from resistance training on barbell back squat biomechanics. J Strength Cond Res 2014; 28: 1127-1134
    PubMedSearch in Google Scholar
  • 48 Walker S, Häkkinen K, Virtanen R, Mane S, Bachero-Mena B, Pareja-Blanco F. Acute neuromuscular and hormonal responses to 20 versus 40% velocity loss in males and females before and after 8 weeks of velocity-loss resistance training. Exp Physiol 2022; 107: 1046-1060
    PubMedSearch in Google Scholar
  • 49 Häkkinen K. Neuromuscular responses in male and female athletes to two successive strength training sessions in one day. J Sports Med Phys Fitness 1992; 32: 234-242
    PubMedSearch in Google Scholar
  • 50 Heavens KR, Szivak TK, Hooper DR. et al. The effects of high intensity short rest resistance exercise on muscle damage markers in men and women. J Strength Cond Res 2014; 28: 1041-1049
    PubMedSearch in Google Scholar
  • 51 Mackey CS, Thiele RM, Schnaiter-Brasche J, Smith DB, Conchola EC. Acute recovery responses of maximal velocity and angular acceleration of the knee extensors following back squat exercise. Isokinet Exerc Sci 2018; 26: 281-290
    PubMedSearch in Google Scholar
  • 52 Metcalf E, Hagstrom AD, Marshall PW. Trained females exhibit less fatigability than trained males after a heavy knee extensor resistance exercise session. Eur J Appl Physiol 2019; 119: 181-190
    PubMedSearch in Google Scholar
  • 53 Carr JC, Ye X. Strength and electromyographic responses of upper and lower limbs during maximal intermittent contractions in males and females. J Strength Cond Res 2022; 36: 2403-2409
    PubMedSearch in Google Scholar
  • 54 Judge LW, Burke JR. The effect of recovery time on strength performance following a high-intensity bench press workout in males and females. Int J Sports Physiol Perform 2010; 5: 184-196
    PubMedSearch in Google Scholar
  • 55 Raeder C, Wiewelhove T, Simola RÁ. et al. Assessment of fatigue and recovery in male and female athletes after 6 days of intensified strength training. J Strength Cond Res 2016; 30: 3412-3427
    PubMedSearch in Google Scholar
  • 56 Maughan RJ, Harmon M, Leiper JB, Sale D, Delman A. Endurance capacity of untrained males and females in isometric and dynamic muscular contractions. Eur J Appl Physiol Occup Physiol 1986; 55: 395-400
    PubMedSearch in Google Scholar
  • 57 Nuzzo JL, Pinto MD, Nosaka K, Steele J. Maximal number of repetitions at percentages of the one repetition maximum: A meta-regression and moderator analysis of sex, age, training status, and exercise. Sports Med 2024; 54: 303-321
    PubMedSearch in Google Scholar
  • 58 Drouin PJ, Kohoko ZIN, Mew OK, Lynn M, Fenuta AM, Tschakovsky ME. Fatigue-independent alterations in muscle activation and effort perception during forearm exercise: Role of local oxygen delivery. J Appl Physiol (1985) 2019; 127: 111-121
    PubMedSearch in Google Scholar
  • 59 Vargas-Molina S, Martín-Rivera F, Bonilla DA. et al. Comparison of blood lactate and perceived exertion responses in two matched time-under-tension protocols. PLoS One 2020; 15: e0227640
    CrossrefPubMedSearch in Google Scholar
  • 60 Torres-Peralta R, Morales-Alamo D, González-Izal M. et al. Task failure during exercise to exhaustion in normoxia and hypoxia is due to reduced muscle activation caused by central mechanisms while muscle metaboreflex does not limit performance. Front Physiol 2015; 6: 414
    PubMedSearch in Google Scholar
  • 61 Nuzzo JL. Sex differences in skeletal muscle fiber types: A meta-analysis. Clin Anat 2024; 37: 81-91
    PubMedSearch in Google Scholar
  • 62 Romero-Parra N, Cupeiro R, Alfaro-Magallanes VM. et al. Exercise-induced muscle damage during the menstrual cycle: A systematic review and meta-analysis. J Strength Cond Res 2021; 35: 549-561
    CrossrefPubMedSearch in Google Scholar
  • 63 Glenner-Frandsen A, With C, Gunnarsson TP, Hostrup M. The effect of monophasic oral contraceptives on muscle strength and markers of recovery after exercise-induced muscle damage: A systematic review. Sports Health 2023; 15: 318-327
    PubMedSearch in Google Scholar
  • 64 Pereira HM, Larson RD, Bemben DA. Menstrual cycle effects on exercise-induced fatigability. Front Physiol 2020; 11: 517
    PubMedSearch in Google Scholar
  • 65 Oxfeldt M, Pedersen AB, Hørmann D. et al. Influence of second-generation oral contraceptives on muscle recovery after repeated resistance exercise in trained females. Med Sci Sports Exerc 2024; 56: 499-510
    PubMedSearch in Google Scholar
  • 66 Dragutinovic B, Moser F, Notbohm HL, Ihalainen JK, Bloch W, Schumann M. Influence of menstrual cycle and oral contraceptive phases on strength performance, neuromuscular fatigue, and perceived exertion. J Appl Physiol 2024; 137: 919-933
    PubMedSearch in Google Scholar
  • 67 Romero-Parra N, Rael B, Alfaro-Magallanes VM. et al. The effect of the oral contraceptive cycle phase on exercise-induced muscle damage after eccentric exercise in resistance-trained women. J Strength Cond Res 2021; 35: 353-359
    PubMedSearch in Google Scholar
  • 68 Romero-Parra N, Barba-Moreno L, Rael B. et al. Influence of the menstrual cycle on blood markers of muscle damage and inflammation following eccentric exercise. Int J Environ Res Public Health 2020; 17: 1618
    PubMedSearch in Google Scholar
  • 69 Margaritelis NV, Theodorou AA, Chatzinikolaou PN, Kyparos A, Nikolaidis MG, Paschalis V. Eccentric exercise per se does not affect muscle damage biomarkers: Early and late phase adaptations. Eur J Appl Physiol 2021; 121: 549-559
    PubMedSearch in Google Scholar
  • 70 Kataoka R, Spitz RW, Wong V. et al. Sex segregation in strength sports: Do equal-sized muscles express the same levels of strength between sexes?. Am J Hum Biol 2023; 35: e23862
    PubMedSearch in Google Scholar