Sex Dimorphism of VO2max Trainability: A Systematic Review and Meta-analysis
Increases in maximal oxygen uptake (VO2max) are strongly associated with improved cardiovascular health.
The aim was to perform a systematic review and meta-analysis to determine whether VO2max responses to endurance training (ET), the most effective intervention to improve VO2max, are influenced by sex.
We conducted a systematic search of MEDLINE and Web of Science since their inceptions until February 2019 for articles assessing the VO2max response to a given sex-matched dose of ET in healthy age-matched men and women. Meta-analyses were performed to determine the mean difference between VO2max responses in men versus women. Subgroup and meta-regression analyses were used to assess potential moderating factors.
After systematic review, eight studies met the inclusion criteria. All studies implemented common modalities of ET in healthy untrained individuals, comprising a total of 175 men and women (90 ♂, 85 ♀). ET duration and intensity were sex-matched in all studies. After data pooling, ET induced substantially larger increases in absolute VO2max in men compared with women (mean difference = + 191 ml·min−1, 95% CI 99, 283; P < 0.001). A greater effect of ET on relative VO2max was also observed in men versus women (mean difference = + 1.95 ml·min−1·kg−1, 95% CI 0.76, 3.15; P = 0.001). No heterogeneity was detected among studies (I2 = 0%, P ≥ 0.59); the meta-analytical results were robust to potential moderating factors.
Pooled evidence demonstrates greater improvements in VO2max in healthy men compared with women in response to a given dose of ET, suggesting the presence of sexual dimorphism in the trainability of aerobic capacity.
Compliance with Ethical Standards
David Montero is funded by the Discovery Grant from the Natural Sciences and Engineering Research Council of Canada (NSERC) (Grant no. RGPIN-2019-04833). Candela Diaz-Canestro is the recipient of the Early Postdoc Mobility Grant from the Swiss National Foundation (SNF). No specific sources of funding were used to assist in the preparation of this article.
Conflict of interest
David Montero and Candela Diaz-Canestro declare that they have no conflicts of interest relevant to the content of this review.
- 1.Lundby C, Robach P. Performance enhancement: what are the physiological limits? Physiology (Bethesda). 2015;30(4):282–92.Google Scholar
- 18.Tarnopolsky MA, Rennie CD, Robertshaw HA, Fedak-Tarnopolsky SN, Devries MC, Hamadeh MJ. Influence of endurance exercise training and sex on intramyocellular lipid and mitochondrial ultrastructure, substrate use, and mitochondrial enzyme activity. Am J Physiol Regul Integr Comp Physiol. 2007;292(3):R1271–8.CrossRefGoogle Scholar
- 22.Higgins JPT, Green S, (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. http://www.cochrane-handbook.org. Accessed Mar 2019.
- 44.Whyte GP, George K, Sharma S, Firoozi S, Stephens N, Senior R, et al. The upper limit of physiological cardiac hypertrophy in elite male and female athletes: the British experience. Eur J Appl Physiol. 2004;92(4–5):592–7.Google Scholar