Sex differences in cardiovascular function during submaximal exercise in humans

Differences in cardiovascular function between sexes have been documented at rest and maximal exercise. The purpose of this study was to examine the sex differences in cardiovascular function during submaximal constant-load exercise, which is not well understood.

Thirty-one male and 33 female subjects completed nine minutes moderate and nine minutes vigorous intensity submaximal exercise (40 and 75% of peak watts determined by maximal exercise test). Measurements included: intra-arterial blood pressure (SBP and DBP), cardiac index (Q_I), heart rate (HR), oxygen consumption (VO₂) and arterial catecholamines (epinephrine = EPI and norepinephrine = NE), and blood gases. Mean arterial pressure (MAP), stroke volume index (SV_I), systemic vascular resistance index (SVR_I), arterial oxygen content (CaO₂), arterial to venous O₂ difference (AVO₂) and systemic oxygen transport (SOT) were calculated.

At rest and during submaximal exercise Q_I, SV_I, SBP, MAP, NE, CaO₂, and SOT were lower in females compared to males. VO₂, AVO₂, EPI were lower in females throughout exercise. When corrected for wattage, females had a higher Q, HR, SV, VO₂ and AVO₂ despite lower energy expenditure and higher mechanical efficiency.

This study demonstrates sex differences in the cardiovascular response to constant-load submaximal exercise. Specifically, females presented limitations in cardiac performance in which they are unable to compensate for reductions in stroke volume through increases in HR, potentially a consequence of a female’s blunted sympathetic response and higher vasodilatory state. Females demonstrated greater cardiac work needed to meet the same external work demand, and relied on increased peripheral oxygen extraction, lower energy expenditure and improvements in mechanical efficiency as compensatory mechanisms.