Introduction:
Sex-based differences in self-perception of effort are documented in rehabilitation and exercise science but remain unexplored in voice therapy context. This study investigated whether biological sex influences how adults describe perceived effort, comfort, and self-monitoring during structured voice therapy tasks.

Methods:
Audio recordings from 32 participants (17m, 15f; mean age = 71.3 ± 4.2 years; range 65–82) were analyzed quantitatively. Segments captured voice exercise training, exercise execution, and immediate post execution feedback. An inductive approach identified recurring concepts in participants’ descriptions, organized hierarchically (domain–theme–code) to ensure analytical transparency. Verbatim quotes preserved data fidelity.

Results:
Five domains emerged describing vocal effort conceptualization: (1) Physiological – physical/aerodynamic work of phonation (e.g., “pushing air,” “running out of breath”); (2) Sensory – throat/ pharyngeal awareness (dryness, tightness, discomfort); (3) Cognitive–Affective – self-monitoring, uncertainty, emotional reactions (e.g., “wasn’t sure if I was doing it right”); (4) Execution – technique, control, motor precision (e.g., “remember to breathe first,” “tried to make it smoother”); and (5) Task Context – perceived difficulty differences (e.g., “the one with water was easier”). Across participants, effort was described primarily as physical–aerodynamic, emphasizing breath pressure and airflow regulation. Both sexes perceived exercises as effortful yet manageable, showing comparable performance and tolerance. However subtle differences emerged: females more often used sensory and evaluative language, while male emphasized mechanical control and execution.

Conclusion:
Sex did not influence the perceived physiological load but shaped how effort was verbalized and interpreted. Both groups described exertion primarily through physical–aerodynamic terms, yet females incorporated slightly more evaluative and self-monitoring expressions, while males emphasized technical control. These framing differences parallel findings in other rehabilitation contexts, where females report greater perceived effort despite comparable physiological load. Recognizing such tendencies may help clinicians refine communication and feedback strategies during voice therapy to enhance engagement and clarity across sexes. Future studies will explore whether perceived effort in this data set aligns with physiological metrics, to better understand the connection between perception and biomechanics.

Hannah Rigler, MA CCC-SLP, University of Iowa
Adrián Castillo-Allendes, SLP, MSc, PhD, University of Iowa
Eric Hunter, MS, PhD, University of Iowa