Neuromuscular fatigue and aging: central and peripheral factors

A limited number of studies have investigated the effect of old age on neuromuscular fatigue, yet a variety of protocols have been used to compare the fatigability of old and young humans. These include voluntary isometric and isokinetic contraction protocols at maximal and submaximal intensities, and electrical stimulation protocols of continuous or intermittent stimulation at a variety of stimulation frequencies. The results of these studies are summarized in this review. Although it seems reasonable to suggest that age-related changes in muscle morphology and motor unit remodeling, as well as the associated loss of strength and slowed contractile properties, may improve the resistance to neuromuscular fatigue in old humans, the collective results suggest that it is not possible to make this generalization. In fact, it cannot be generalized that the muscles of old humans are either more or less fatigable than young adults because the extent of the difference in fatigability relies strongly on the fatigue task performed (task-dependency). Age-related changes that occur within the neuromuscular system may result in some candidate fatigue sites increasing or decreasing their susceptibility to failure under specific task conditions. These candidate fatigue sites include central drive, muscle membrane excitability, excitation-contraction coupling mechanisms, and metabolic capacities. The effect of old age on these various central and peripheral sites is discussed with respect to their relative contribution during different fatigue tasks. Moreover, the impact of the possible confounding effects of subject habituation, physical activity status, and sex on the fatigability comparison is addressed.