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Do Sex Differences in Physiology Confer a Female Advantage in Ultra-Endurance Sport?

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Abstract

Ultra-endurance has been defined as any exercise bout that exceeds 6 h. A number of exceptional, record-breaking performances by female athletes in ultra-endurance sport have roused speculation that they might be predisposed to success in such events. Indeed, while the male-to-female performance gap in traditional endurance sport (e.g., marathon) remains at ~ 10%, the disparity in ultra-endurance competition has been reported as low as 4% despite the markedly lower number of female participants. Moreover, females generally outperform males in extreme-distance swimming. The issue is complex, however, with many sports-specific considerations and caveats. This review summarizes the sex-based differences in physiological functions and draws attention to those which likely determine success in extreme exercise endeavors. The aim is to provide a balanced discussion of the female versus male predisposition to ultra-endurance sport. Herein, we discuss sex-based differences in muscle morphology and fatigability, respiratory-neuromechanical function, substrate utilization, oxygen utilization, gastrointestinal structure and function, and hormonal control. The literature indicates that while females exhibit numerous phenotypes that would be expected to confer an advantage in ultra-endurance competition (e.g., greater fatigue resistance, greater substrate efficiency, and lower energetic demands), they also exhibit several characteristics that unequivocally impinge on performance (e.g., lower O2-carrying capacity, increased prevalence of GI distress, and sex-hormone effects on cellular function/injury risk). Crucially, the advantageous traits may only manifest as ergogenic in the extreme endurance events which, paradoxically, are those that females less often contest. The title question should be revisited in the coming years, when/if the number of female participants increases.

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Acknowledgements

The authors wish to thank Professor Sue Ward (University of Leeds, UK) for her guidance in developing the manuscript.

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Authors and Affiliations

  1. Institute of Respiratory Medicine and Exercise Physiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA

    Nicholas B. Tiller

  2. Musculoskeletal Physiology Research Group, Sport, Health, and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK

    Kirsty J. Elliott-Sale

  3. Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland

    Beat Knechtle

  4. Institute of Primary Care, University of Zurich, Zurich, Switzerland

    Beat Knechtle

  5. Department of Human Movement Sciences, Old Dominion University, Norfolk, VA, USA

    Patrick B. Wilson

  6. Cambridge Centre for Sport and Exercise Sciences, School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK

    Justin D. Roberts

  7. Inter-University Laboratory of Human Movement Biology, Univ Lyon, UJM-Saint-Etienne, Saint-Etienne, France

    Guillaume Y. Millet

  8. Institut Universitaire de France (IUF), Paris, France

    Guillaume Y. Millet

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  1. Nicholas B. Tiller
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  2. Kirsty J. Elliott-Sale
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  3. Beat Knechtle
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  4. Patrick B. Wilson
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Correspondence to Nicholas B. Tiller.

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Funding

No funding was received in developing this manuscript. Nicholas B. Tiller is funded by a postdoctoral fellowship from the Tobacco-Related Disease Research Program (TRDRP; award no. T31FT1692).

Conflict of interest

Nicholas B. Tiller, Kirsty J. Elliott-Sale, Beat Knechtle, Patrick B. Wilson, Justin D. Roberts and Guillaume Y. Millet declare that they have no conflicts of interest relevant to the content of this review.

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NBT, GYM, KJES, and PBW drafted the manuscript; JDR and BK provided additional comments and contributions; all authors approved the final version.

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Tiller, N.B., Elliott-Sale, K.J., Knechtle, B. et al. Do Sex Differences in Physiology Confer a Female Advantage in Ultra-Endurance Sport?. Sports Med 51, 895–915 (2021). https://doi.org/10.1007/s40279-020-01417-2

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