Does gender affect pulmonary function and exercise capacity?

doi:10.1016/j.resp.2005.10.010

Respiratory Physiology & Neurobiology

Volume 151, Issues 2–3, 28 April 2006, Pages 124-131

https://doi.org/10.1016/j.resp.2005.10.010 Get rights and content

Abstract

It is well established that women exhibit several anatomic and physiologic characteristics that distinguish their responses to exercise from those of men. These factors have been shown to influence the training response and contribute to lower maximal aerobic power in women. Additionally, the reproductive hormones, estrogen and progesterone, can influence ventilation, substrate metabolism, thermoregulation, and pulmonary function during exercise. Pulmonary structural and morphologic differences between genders include smaller vital capacity and maximal expiratory flow rates, reduced airway diameter, and a smaller diffusion surface than age- and height-matched men. These differences may have an effect on the integrated ventilatory response, respiratory muscle work, and in pulmonary gas exchange during exercise. Specifically, recent evidence suggests that during heavy exercise, women demonstrate greater expiratory flow limitation, an increased work of breathing, and perhaps greater exercise induced arterial hypoxemia compared to men. The consequence of these pulmonary effects has the potential to adversely affect aerobic capacity and exercise tolerance in women.

Introduction

Participation in regular physical activity is well recognized as having important health benefits. As a result of increased awareness and emphasis in physical activity, research investigating the effect of exercise on various physiologic systems has dramatically increased over the past several decades. However, the vast majority of this research has investigated the physiologic responses in men while comparatively few articles have focused on women or on sex differences. Consequently, research investigating gender on various components of physical performance and on various physiological systems is still evolving. For example, it is known that there are important sex differences with regard to cardiovascular function (Wiebe et al., 1998, Spina et al., 1993), thermoregulation (Stephenson and Kolka, 1985, Grucza et al., 1993), substrate metabolism (Horton et al., 1998, Tarnopolsky, 2000, Mittendorfer et al., 2002), and pulmonary function (Harms et al., 1998b, Hopkins et al., 2000, McClaran et al., 1998) during exercise which may have implications for exercise tolerance. Specific in regards to the pulmonary system, there has been considerable interest in defining sex-based differences in the pulmonary system's response to exercise. Important sex differences exist in resting pulmonary function that might have an effect on the integrated ventilatory response, respiratory muscle work, and on gas exchange during exercise which may in turn affect exercise capacity in health.

Section snippets

Basis for sex differences in pulmonary function

The basis for sex differences in pulmonary function and exercise tolerance is primarily from two sources; namely hormones (especially progesterone and estrogen), and in structural/morphological differences. This review will address the role of each of these mechanisms and how they can affect pulmonary function.

Gender and chemosensitivity

It is currently believed that endurance athletes commonly have altered respiratory drives, with a decreased ventilatory response to hypoxia (HVR) and hypercapnia (HCVR) (Byrne-Quinn et al., 1971, Schoene et al., 1981). Such changes may benefit these athletes by allowing less ventilation during exercise (providing it does not lead to increased arterial desaturation) and by decreasing the subjective sensation of dyspnea that may be a factor in limiting maximal exercise performance, as well as

Gender and gas exchange

Sufficient studies in young adult men have been conducted to document clearly that untrained subjects normally widen their A-aDO₂ two- to three-fold from rest to maximal exercise, and that they also hyperventilate, which raises alveolar PO₂ sufficiently during strenuous exercise to prevent PaO₂ from falling below resting levels. However, a significant reduction in the arterial partial pressure of oxygen (PaO₂) (<90 mmHg) during heavy exercise, termed exercise induced arterial hypoxemia (EIAH)

Aging

Healthy aging causes reductions in lung elastic recoil, vital capacity, diffusion surface area, and chest wall compliance. Accordingly, in highly fit elderly individuals, significant expiratory flow limitation with an accompanying increase in the EELV and increased ventilatory work begins during submaximal exercise at ${\dot{V}}_{E}$ values in the 70–80 l/min range (Johnson et al., 1991). Furthermore, longitudinal studies shows that habitual physical activity does not alleviate the normal age related

Summary

Traditionally, the lung is not thought to limit exercise tolerance. However, increasing evidence suggests that the pulmonary system may not always exceed the metabolic demand of exercise. Pulmonary limitations to exercise are found in individuals of varying fitness levels and both genders. However, women may be more prone to pulmonary limitations during heavy exercise (and perhaps submaximal intensities) than men due to the influence of the reproductive hormones (estrogen and progesterone)

References (52)

S.J. England et al.
Fluctuations in alveolar CO₂ and in base excess during the menstrual cycle
Resp. Physiol.
(1976)
B.D. Johnson et al.
Impact of the aging pulmonary system on the response to exercise
Clin. Chest Med.
(1994)
M.L. Aitken et al.
Influence of body size and gender on control of ventilation
J. Appl. Physiol.
(1986)
M.A. Babcock et al.
Contribution of diaphragmatic power output to exercise-induced diaphragm fatigue
J. Appl. Physiol.
(1995)
D.A. Bayliss et al.
Central neural mechanisms of progesterone action: application to the respiratory system
J. Appl. Physiol.
(1992)
Brown, K.R., Murphy, J.D., Ferguson, C.S., Harms, C.A. Unpublished. The effect of menstrual cycle phase on ventilation...
E. Byrne-Quinn et al.
Ventilatory control in the athlete
J. Appl. Physiol.
(1971)
K.A. Carlberg et al.
Effects of chronic estrogen treatment on water exchange in rats
Am. J. Physiol.
(1984)
R.O. Crapo et al.
Reference values for pulmonary tissue volume, membrane diffusing capacity, and pulmonary capillary blood volume
Bull. Eur. Physiolopathol. Respir.
(1982)
J.A. Dempsey et al.
Exercised-induced arterial hypoxaemia in healthy human subjects at sea level
J. Physiol.
(1984)

T.J. Horton et al.

Fuel metabolism in men and women during and after long-duration exercise

J. Appl. Physiol.

(1998)

Cited by (124)

The effect of trait self-control on dyspnoea and tolerance to a CO<inf>2</inf> rebreathing challenge in healthy males and females
2022, Physiology and Behavior
High trait self-control is associated with greater tolerance of unpleasant sensations including effort and pain. Dyspnoea and pain have several commonalities and this study aimed to investigate for the first time whether trait self-control influences responses to a hypercapnic rebreathing challenge designed to induce dyspnoea. As sex also influences tolerance to dyspnoea, we also sought to investigate whether this moderated the role of trait self-control.
Participants (n = 65, 32 females) scoring high or low for trait self-control, performed a standardised rebreathing challenge, in which inspired carbon dioxide (CO₂) gradually increased over a period of 6 min or until an intolerable level of dyspnoea. Air hunger (AH) intensity – a distinctive quality of dyspnoea, was measured every 30 s. The multidimensional dyspnoea profile (MDP) was completed after the rebreathing challenge for a more complete overview of breathing discomfort.
Males high in trait self-control (SCHIGH) (302 ± 42 s), tolerated the rebreathing challenge for longer than males low in self-control (SCLOW) (252 ± 66 s, P = 0.021), experienced slower increases in AH intensity during the rebreathing challenge (0.03 ± 0.01 cm^.s ⁻ ¹ vs. 0.04 ± 0.01 cm^.s ⁻ ^1, P = 0.045) and reported lower perceived mental effort on the MDP (4.94 ± 2.46 vs. 7.06 ± 1.60, P = 0.007). There was no difference between SCHIGH and SCLOW females for challenge duration. However, SCHIGH females (9.29 ± 0.66 cm) reported greater air hunger at the end of the challenge than SCLOW females (7.75 ± 1.75 cm, P = 0.003). It is possible that SCLOW females were unwilling to tolerate the same perceptual intensity of AH as the SCHIGH females.
These results indicate that individuals high in trait self-control are more tolerant of dyspnoea during a CO₂ rebreathing challenge than low self-control individuals. Tolerance of the stimulus was moderated by the sex of the participant, presenting an interesting opportunity for future research.
Evacuation speed of human beings in road tunnels at different altitudes
2022, Tunnelling and Underground Space Technology
There is an increasing number of road tunnels constructed in high-altitude areas of China. Generally, a tunnel is long and narrow. Therefore, when a fire breaks out in a tunnel, it is difficult to get rid of the smoke and the heat, which poses a threat to stranded people. The walking speed of people is the critical factor determining the evacuation time, particularly in high-altitude areas where the ambient pressure is low. In this study, a series of field tests were conducted by considering the environmental parameters to explore the effects of altitude on the people’s walking speed, and the considered parameters include the blood oxygen saturation of people, their heart rate and its variability parameters, ratings of perceived exertion, and walking speed. The results show that ambient pressure, which is about 97 kPa at an altitude of 500 m, decreases to approximately 64 kPa at an altitude of around 3850 m. In other words, the ambient pressure decreases with the increase in the altitude, and the difference in illumination between the internal tunnel and open environment is obvious. More specifically, several factors, including gender, age, tunnel environment, and altitude influence the walking speed, and corresponding reduction coefficients are introduced to reflect the influence of the factors on the walking speed. Finally, based on the field data, a reliable formula is proposed to predict the walking speed at different altitudes.
Association of obesity-related inflammatory pathways with lung function and exercise capacity
2021, Respiratory Medicine
Citation Excerpt :
These findings are in agreement with a prior study demonstrating women with higher CRP regardless of body fat composition demonstrated a greater degree of restrictive lung disease in comparison to men, and are also in keeping with female-predominant prevalence of PAH [38,39]. Women may also be more susceptible to exercise induced arterial hypertension in comparison to men placing a larger strain on the pulmonary vasculature[40]. Our study has several limitations.
Obesity has multifactorial effects on lung function and exercise capacity. The contributions of obesity-related inflammatory pathways to alterations in lung function remain unclear.
Research Question:
To examine the association of obesity-related inflammatory pathways with pulmonary function, exercise capacity, and pulmonary-specific contributors to exercise intolerance.
We examined 695 patients who underwent cardiopulmonary exercise testing (CPET) with invasive hemodynamic monitoring at Massachusetts General Hospital between December 2006–June 2017. We investigated the association of adiponectin, leptin, resistin, IL-6, CRP, and insulin resistance (HOMA-IR) with pulmonary function and exercise parameters using multivariable linear regression.
Obesity-related inflammatory pathways were associated with worse lung function. Specifically, higher CRP, IL-6, and HOMA-IR were associated with lower percent predicted FEV₁ and FVC with a preserved FEV₁/FVC ratio suggesting a restrictive physiology pattern (P ≤ 0.001 for all). For example, a 1-SD higher natural-logged CRP level was associated with a nearly 5% lower percent predicted FEV₁ and FVC (beta −4.8, s.e. 0.9 for FEV1; beta −4.9, s.e. 0.8 for FVC; P < 0.0001 for both). Obesity-related inflammatory pathways were associated with worse pulmonary vascular distensibility (adiponectin, IL-6, and CRP, P < 0.05 for all), as well as lower pulmonary artery compliance (IL-6 and CRP, P ≤ 0.01 for both).
Our findings highlight the importance of obesity-related inflammatory pathways including inflammation and insulin resistance on pulmonary spirometry and pulmonary vascular function. Specifically, systemic inflammation as ascertained by CRP, IL-6 and insulin resistance are associated with restrictive pulmonary physiology independent of BMI. In addition, inflammatory markers were associated with lower exercise capacity and pulmonary vascular dysfunction.
Using heart rate to estimate the minute ventilation and inhaled load of air pollutants
2021, Science of the Total Environment
The health effects of air pollution are associated with the concentration of pollutants and ventilation (VE). VE is difficult to measure directly and has been predicted by heart rate (HR). However, it is unclear whether equations between HR and VE obtained from a laboratory cardiopulmonary exercise test (CPET) can be extended to external groups and there is still a gap in their relationship for a Chinese population.
To establish an association between HR and VE in young Chinese individuals and verify the external validity of the model.
Eighty non-smoking participants aged 16–21 years underwent incremental tests using a bicycle ergometer, where the HR and minute VE were measured simultaneously. Linear mixed models were constructed with data obtained from a CPET. Ten individuals were chosen randomly as the external validation group. The predictive performance was assessed using an eight-fold cross-validation procedure. Air pollution concentration was monitored during the CPET and the inhaled load was calculated.
The overall estimation of the intercept and slope for all participants was 0.585 ± 0.013 and 0.007 ± 0.00002, respectively. The overall fitted R squared (R²) was 0.84. The median difference between the measured VE and the predicted VE was 0.3 L/min, and the difference between the inhaled load based on the fitted VE and the measured VE was 0.0–0.3 μg across all the participants. The eight folds cross-validation R² value was 0.78, suggesting high predictive accuracy.
This is the first study to derive a novel equation for the relationship between HR and VE in a young Chinese population and verify its external validity. This will be important in the assessment of the inhaled load in future epidemiology studies. However, inter-individual variations should also be considered when VE is estimated at an individual level.
The effects of custom-made mouthguard design on physiological parameters and players' perception in rugby union
2024, European Journal of Sport Science
The International Olympic Committee framework on fairness, inclusion and nondiscrimination on the basis of gender identity and sex variations does not protect fairness for female athletes
2024, Scandinavian Journal of Medicine and Science in Sports

View all citing articles on Scopus

^☆: This paper is part of the Special Issue entitled “New Directions in Exercise Physiology”, guest-edited by Susan Hopkins and Peter D. Wagner.

View full text

Does gender affect pulmonary function and exercise capacity?☆

Abstract

Introduction

Section snippets

Basis for sex differences in pulmonary function

Gender and chemosensitivity

Gender and gas exchange

Aging

Summary

Resp. Physiol.

Clin. Chest Med.

Influence of body size and gender on control of ventilation

J. Appl. Physiol.

Contribution of diaphragmatic power output to exercise-induced diaphragm fatigue

J. Appl. Physiol.

Central neural mechanisms of progesterone action: application to the respiratory system

J. Appl. Physiol.

Ventilatory control in the athlete

J. Appl. Physiol.

Effects of chronic estrogen treatment on water exchange in rats

Am. J. Physiol.

Reference values for pulmonary tissue volume, membrane diffusing capacity, and pulmonary capillary blood volume

Bull. Eur. Physiolopathol. Respir.

Exercised-induced arterial hypoxaemia in healthy human subjects at sea level

J. Physiol.

Is the lung built for exercise?

Med. Sci. Sports Exerc.

Exercise-induced arterial hypoxemia

J. Appl. Physiol.

Effects of menstrual phase and amenorrhea on exercise performance in runners

Med. Sci. Sports. Exerc.

Exercise performance and ventilatory response in the menstrual cycle

Med. Sci. Sports Exerc.

Exercise-induced intrapulmonary arteriovenous shunting in healthy humans

J. Appl. Physiol.

Influence of the menstrual cycle and oral contraceptives on thermoregulatory responses to exercise in young women

Eur. J. Appl. Physiol. Occup. Physiol.

Low chemoresponsiveness and inadequate hyperventilation contribute to exercise-induced hypoxemia

J. Appl. Physiol.

Respiratory muscle work compromises leg blood flow during maximal exercise

J. Appl. Physiol.

Effects of respiratory muscle work on cardiac output and its distribution during maximal exercise

J. Appl. Physiol.

Exercise-induced arterial hypoxaemia in healthy young women

J. Physiol. (Lond.)

Effects of respiratory muscle work on exercise performance

J. Appl. Physiol.

Effect of exercise-induced arterial O2 desaturation on VO2max in women

Med. Sci. Sports. Exerc.

Pulmonary gas exchange during exercise in athletes. I. Ventilation-perfusion mismatch and diffusion limitation

J. Appl. Physiol.

Pulmonary gas exchange during exercise in women: effects of exercise type and work increment

J. Appl. Physiol.

Gender and pulmonary gas exchange during exercise

Exerc. Sport Sci. Rev.

Fuel metabolism in men and women during and after long-duration exercise

J. Appl. Physiol.

Effect of exercise-induced arterial O₂ desaturation on VO_2max in women