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• W2892025599 abstract "Do women experience less diaphragmatic fatigue during inspiratory resistance loading? And if so what might be the implications for their exercise capacity? And for their longevity? How and even why do humans experience mental and physical fatigue? Since fatigue is one of the commonest complaints prompting humans to seek medical attention, it is clearly an important topic. Physical exercise is the most reproducible method for inducing fatigue in humans. As a result, research into exercise-induced fatigue tends to direct our understanding of this phenomenon. With remarkable insight, in 1904 the Italian physiologist Angelo Mosso (Mosso, 1904) wrote that exercise fatigue has two components: “The first is the diminution of the muscular force. The second is fatigue as a sensation. That is to say, we have a physical fact which can be measured and compared, and a psychic fact which eludes measurement” (p. 154). Such clarity of analysis was unfortunately way ahead of its time; it would take another 100 years before Mosso's core truth would be acknowledged. In the interim a simpler, more reductionist model – termed by some (Noakes, 2005) the cardiovascular anaerobic (catastrophic) model – would become the globally preferred explanation. This model, which originated from the laboratory studies and powerful advocacy of two British Nobel Laureates, Archibald Vivian Hill and Frederick Hopkins, posits that exercise fatigue results from the failure of an adequate blood and oxygen supply to the exercising muscles, leading to skeletal muscle anaerobiosis and lactic acidosis. The latter, they argued, is the ultimate cause of the physical component of fatigue. Since neither Hill nor Hopkins was a neuroscientist, both ignored any role for the nervous system in the development of either the physical or psychic manifestations of fatigue. Regardless, their model gained immediate ascendancy which it has retained even when, in time, neuroscientists (Gandevia, 2001) began to establish a determining role for the nervous system in fashioning fatigue. Almost exactly 100 years after Mosso, a more inclusive model – the central governor model of exercise (Noakes et al. 2004) – reinstated the nervous system at the centre of this exercise regulation. It proposes that the nervous system controls the exercise performance to ensure the protection of homeostasis during all forms of physical activity, regardless of intensity or duration. This model (Venhorst et al. 2017) distinguishes between the measurable reduction in skeletal muscle contractile function that develops during exercise and the brain-related changes in the sensations of perceived physical and mental strain in core effect and in the volitional cognitive–evaluative processes determining whether the original goal will continue to be pursued or whether the athlete will choose to disengage, also known as ‘quitting’. This issue of The Journal of Physiology includes another fine example of how novel research findings continue to fashion our understanding of these concepts. For their report, Welch et al. (2018) studied the development of diaphragmatic fatigue – the diminution in contractile force according to Mosso's definition – in response to inspiratory resistance loading in men and women. Such inspiratory loading increases the work of breathing and if sufficiently severe, will produce measurable changes in diaphragmatic force production. Unlike the exercise-induced reduction in force output in skeletal muscle that is not life-threatening – the tired athlete simply quits – any progressive failure of diaphragmatic force output, uncompensated by recruitment of accessory inspiratory muscles, could theoretically produce inadequate alveolar ventilation leading to hypercapnia and anoxaemia, potentially establishing a vicious cycle of progressive diaphragmatic failure. So it is rather important that the ‘central governor’ be fully informed at all times of the extent to which the diaphragm is under duress. Perhaps this is why another feature of diaphragmatic ‘fatigue’, so defined, is the development of a powerful sympathetically mediated metaboreflex that increases peripheral vascular resistance, heart rate and mean arterial blood pressure, whilst reducing limb blood flow. The theory would be that in times of physiological stress or in the presence of disease, this powerful metaboreflex acts to redirect blood flow from the periphery to the diaphragm. But equally this reflex will also provide powerful information to the ‘central governor’ about the state of diaphragmatic force production. The questions posed by the authors were (i) does this metaboreflex exist in women since its presence has yet to be sought in women; and (ii) is the response similar in both sexes? Their elegantly conducted studies have established, perhaps expectedly, that women do indeed show this response. However, not only is the response blunted in women but they are also able to continue breathing against resistance for significantly longer than can men before both ‘quit’ at the same degree of diaphragmatic ‘fatigue’. The authors did not report whether the psychic responses to this exercise were the same in both sexes. The authors acknowledge that the study has limitations but nevertheless wonder whether this apparent evidence for superior ‘fatigue’ resistance and a lessened metaboreflex response might provide women with an advantage during exercise. Even though this sounds attractive and is in line with other laboratory-based studies showing sex-related differences in skeletal muscle fatigue (Hunter, 2014), such differences are not apparent in real-world athletic competitions. The gap between the running performances of the best men and women does not lessen as the racing distance increases, remaining approximately 10–12% at all running distances (Coast et al. 2004). So the question remains unresolved. But what if women do indeed show greater diaphragmatic “fatigue” resistance? Surely this would have substantial benefits in any disease processes that increases the work of breathing. Especially when such conditions become increasingly prevalent for those approaching the end of life. None declared. All persons designated as authors qualify for authorship, and all those who qualify for authorship are listed. None declared." @default.
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• W2892025599 title "Do women experience less diaphragmatic fatigue during inspiratory resistance loading?" @default.
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