VO2 stands for "Volume of Oxygen", and represents the rate of oxygen consumption in milliliters that the body can consume per kilogram of body weight, per minute (ml/kg/min). VO2 max is the maximum amount of oxygen the body can consume and use during intense exercise.
This metric reflects the aerobic fitness of the lungs, heart, and muscles to supply and use oxygen. The higher the value of VO2 max, the better endurance and physical performance can be achieved. And as outlined further on in the article, significant improvements in quality of life and longevity.
VO2 max peaks in the early 20s and is estimated to decline by roughly 5-10% per decade after the age of 30. This is driven by reduced heart output, loss of muscle mass, and diminished lung elasticity. This decline, and the ability to reduce its speed, has major implications for longevity.
The FRIEND registry has compiled data from over 20,000 direct cardiopulmonary exercise tests (CPET) done on healthy adults between the ages of 20–79.
The dataset is tailored for men and women across decade-long age groups, and accounts for physiological differences like muscle mass and hemoglobin levels. These tests provide the most reliable benchmark for assessing cardiorespiratory fitness, and reveal the differences in VO2 max norms between men and women. Below are the benchmarks for men and women.
The most common free method for people to get a rough estimate of their VO2 max is to run 2.4km (Cooper 1.5 mile) as fast as possible. Below are the times and a rough estimation of the equivalent VO2 max scores.
The most accurate way of measuring VO2 max is typically done on a bike or treadmill and lasts around 10-20 minutes. The exercise intensity progressively increases over time until the participants reach exhaustion. During the test the participants have to wear a mask that measures the inhaled and exhaled gases.
This test is often performed by athletes that want to improve their performance, and patients that want to assess their heart and lung health. The average cost for a VO2 max test in the US and Europe ranges from $200-$600 depending on the city, facility and type of equipment.
There are also health trackers that monitor heart rate zones and provide VO2 max estimates with 5-10% error margins like Apple watch, Garmin and Fitbit.
Studies in the last 30 years have consistently linked poor cardiorespiratory fitness with increased likelihood of developing cardiovascular disease and a higher overall all cause mortality. All-cause mortality is defined as the total number of deaths from any cause within a specific population over a certain period of time.
A 2020 study published in Circulation researched the long-term impact of VO2 max on mortality risk. The study found that participants in the highest quartile of VO2 max had a 40-50% lower risk of death, compared to those in the lowest quartile.
The great news is that regular exercise can slow down this decline significantly. A landmark 2018 study by cardiologists at UT Southwestern provides compelling evidence that structured exercise can significantly enhance VO2 max and counteract age-related decline in heart health.
The study included 53 healthy but sedentary adults between the ages of 45 to 64. People aged 65 and above were excluded as the heart no longer retains plasticity (ability to change) beyond this age.
The exercise regimen consisted of 4–5 weekly sessions, each approximately 30 minutes excluding warm-up and cool-down.
The protocol included one session of high intensity interval training (HIIT) like the Norwegian 4x4 protocol, one session of moderate activity (1h of tennis), 2-3 moderate aerobic sessions (Zone 2 Training) where the participants can pass the talk test, and finally 1-2 strength training sessions (body weight, weights or machines).
To ensure the safety of the participants, the program progressed gradually with two HIIT workouts incorporated after 10 months. The results of the study were remarkable and showed that this approach improved VO2 max by 18% and heart elasticity by over 25% in two years.
These results prove how capable the body is of improving even in the later stages of life. With dedication to consistent exercise, individuals can unlock substantial longevity benefits that enhance both heart health and overall vitality.
