Muscle strength is sex-related and declines with advancing age yet, a comprehensive comparative evaluation of age-related strength loss in human females and males has not been undertaken. To do so, segmented piecewise regression analysis was performed on aggregated data from studies published 1990-2018 and available in CINAHL, EMBASE, MEDLINE, and PsycINFO databases. The search identified 5613 articles which were reviewed for physical assessment results stratified by sex and age. Maximal isometric and isokinetic 60°s-1 contractions of the KE and KF from 57 studies and 15,283 subject (N=7918 females) had sufficient data reported on females and males for meaningful statistical evaluation to be undertaken. The analysis revealed that isometric KE and KF strength undergo similar rapid declines in both sexes late in the 6th decade of life. Yet, there is an abrupt age-related decline in KE 60°s-1 peak torque earlier in females (41.8 years) than males (66.7 years). In the assessment of KF peak torque, an age-related acceleration in strength loss was only identified in males (49.3 years). The results suggest that age-related isometric strength loss is similar between sexes while the characteristics of KE and KF peak torque decline are sex-related which likely explains the differential rate of age-related functional decline. Novelty • Inclusion of muscle strength and torque of KE and KF data from >15 000 subjects • Isometric KE and KF strength loss are similar between sexes • Isokinetic 60°s-1 KE torque decline accelerates 25 years earlier in females and female age-related KF peak torque decline does not accelerate with age

Neuromuscular noise is a determining factor in the control of isometric force steadiness (FS), quantified as coefficient of variation (CV) of force around a preestablished target output. In this paper we examine sex-related differences of neural, muscular, and tendon influences on neuromuscular noise to understand FS in females and males. We use evidence from the literature to identify that CV of force is higher in females compared with males in the upper and lower body, with sex-related differences becoming less apparent with increasing age. Evaluation of sex-related physiology in tandem with results from FS studies indicate that differences in fibre type, contractile properties, and number of motor units (MUs) are unlikely contributors to differences in FS between females and males. MU type, behaviour of the population (inclusive of number of active MUs from the population), agonist-antagonist activity, maximal strength, and tendon mechanics are probable contributors to sexually dimorphic behaviour in FS. To clearly determine underlying causes of sex-related differences in FS, further study and reporting between females and males is required. Females and males are included in many studies; however, rich data on sexually dimorphic behaviour is lost when data are collapsed across sex or identified as nonsignificant without supporting values. This poses a challenge to identifying the underlying cause of females having higher CV of force than males. This review provides evidence of sexually dimorphic behaviour in FS and suggests that physiological differences between females and males effect neuromuscular noise, and in-turn contribute to sex-related differences in FS.

The labour force of Medical Physics is one of the most gender diverse in the field of Physics, as it has attained the proportional achievement of ~30% women worldwide 1. While great strides have been made towards a gender diverse workforce, women still comprise an underrepresented group. Many strategies have been suggested to increase the participation of underrepresented persons by addressing unconscious biases, increasing opportunities, dedicated hiring policies and providing support networks in science and medicine 2,3 , yet the personnel landscape remains largely uniform. Herein, the conditions, strategies, and approaches that facilitated gender diversity in Medical Physics are considered as a means to further the inclusion of other underrepresented groups through exemplars of mentorship, addressing unconscious biases and the implementation of inclusive practices. Furthermore, the potential for gender diversity to act as a catalyst to create an environment that is more accepting of diversity and supports and encourages inclusive practices for the participation and inclusion of other underrepresented groups in Medical Physics is discussed.