What Is VO2 Max? Why Is VO2 Max Important For Longevity?

How VO2 Max Supports Fitness For Longevity

Visit a primary care practitioner for an annual physical exam and you will have an assessment of basic health information like height, weight, and vital signs, including heart rate, blood pressure, and cholesterol, along with perhaps a resting electrocardiogram and basic labs. However, it is well known that this data is insufficient to identify patients at risk for early disease or death nor will it predict functional decline with aging.

Our ability to climb stairs, carry groceries, or walk through an airport is dependent upon the combined function of the heart, the lungs, and the muscles, and that functional capacity can be accurately measured in a test called the VO2 max test. This test can be performed in approximately 15 minutes on a stationary bike or treadmill. The result is reported in milliliters per minute per kg, meaning the peak liters of oxygen that can be transported and utilized per minute, standardized to the weight of the person. The American Heart Association has stated that cardiorespiratory fitness (CRF) is a strong and independent predictor of survival. A mere 3.5 ml/min/kg increase in VO2 max will produce a 10-25% improvement in the chance of survival for a given period looking forward. In real terms, this means that a 70-year-old who, based on their other health factors, has a 10% risk of death in the next year could reduce that risk by ¼ if they got slightly fitter.

If you are curious about your current fitness level, looking to improve your endurance, and/or looking to remain fit and functional into old age, read on to learn more about VO2 Max testing. We are excited to incorporate this test within our Fitness for Longevity module. Appointments for this type of consultation can be requested as of May 1, 2023 by contacting us via our website at https://www.hvlongevity.com/longevity-medical-consulting/.

What Is VO2 Max? 

VO2 max refers to the maximum rate of oxygen flow that an individual’s body can absorb and use during a peak period of effort. It is a measure of an individual’s aerobic capacity and is the best measurement of overall cardiorespiratory fitness, especially as it relates to predicted functional capacity. As you breathe in oxygen during exercise, your cells take in that oxygen and use it to create energy in the form of ATP (Adenosine 5′-triphosphate). This energy is what fuels your body and allows you to keep moving. Your VO2 max measure indicates how quickly your body can take in oxygen from the air into your lungs, get the oxygen into your blood, pump it to your muscles, and then have your muscles use that oxygen in the metabolic processes that keep you moving.

Put simply, VO2 Max gives you a number to gauge how effective your body is in taking in oxygen and producing energy from it, at its highest effort. The higher your VO2 max, the greater your capacity to take in oxygen and create more energy from it, and the more capacity you have to perform tasks. This measurement is distinct from strength (how much you could deadlift, for example) and distinct from muscle “endurance” (how long can you hold a plank position, for example). The reason we are so interested in this metric in longevity medicine is that VO2 max is directly connected to how we move about in the world so as we age into our 70s, 80s, or 90s our VO2 max determines whether we will be independent and able to move about, or will need a wheelchair, walker, or other assistance to complete the tasks of daily living. If we elevate our fitness now, we may still lose ground over time but we actively increase our chances of reaching our 90s in a relatively independent state.

Why Is VO2 Max Important?

In the past, VO2 max has been a tool for elite athletes, to measure and track performance, and plan their training. We now recognize that this test can be beneficial for all of us, even if we have never been an elite athlete and don’t plan to become one. If we have invested time and effort into exercising, was it at the right level of effort? Are we at average fitness for our age, or slightly above our peer group? Knowing your VO2 max provides valuable insights regarding your cardiovascular health, shows your current fitness level, and also provides a baseline measurement for tracking changes.

When it comes to measuring fitness levels, there are many wearable tools out there, but few tools truly provide insight into exact fitness levels, or track how efficiently our bodies are operating or even improving with our workouts. Most wearables can track heart rate and store the type of exercise we do and the length of time spent doing it. There are some D-I-Y fitness tests you can perform at home, such as the Copper 1.5-mile walk-run test, or the Rockport 1-mile walk test (see resources below). However, a VO2 max test will clarify your exact training heart rate training zones and quantify your peak output. These two parameters may not match up with published charts for your age or estimations given by your watch. You might learn that you are training at too high or too low a heart rate for your particular goals, or that your CRF is actually significantly older or younger than your chronological age. Having this information earlier in your life gives you time to take corrective action.

VO2 Max And Fitness Age

As we age, the amount of physical activity required to stay fit varies based on genetics, health, and fitness status, among other factors. There is mounting evidence that lower fitness levels are linked to a higher risk of cardiovascular disease, developing chronic illness, and even all-cause mortality. Peak VO2 Max inevitably declines with age. Ideally, we want VO2 max to measure as high as possible now so that we can set ourselves up for the future and protect ourselves against the inevitable decline. A 40-year-old who is in the fittest 5% and then has a natural age-related decline over 35 years, can still end up at age 75 being as fit as an average young adult, able to jog at 5 mph. Conversely, a woman in the lowest 5% of fitness at age 40 is highly likely not to be able to walk up a flight of stairs by age 70 and will struggle with walking up even a slight incline at a slow speed. We have the tools to measure CRF and the field of exercise physiology has studied and collated the methods needed to improve our metrics. At a certain point, it can be too late to begin a training program, so we want to capture this data at an earlier time in the life cycle. Tuning up your fitness level has also been shown to improve your immune system function, produce less shortness of breath with activity, and reduce stress.

How Is VO2 Max Measured?

To measure VO2 max we place a soft flexible mask over the nose and mouth, through which you can breathe comfortably. We connect a heart rate monitor and ask you to jog or cycle on a machine. The mask is connected to a device that measures both oxygen inhaled and carbon dioxide exhaled. During the test, exercise intensity is progressively increased and the amount of oxygen inhaled and air exhaled are simultaneously measured through the mask. 

Eventually, typically within 6-8 minutes, as effort continues to increase, an individual’s oxygen consumption will level off and their body will not be able to use more. Fuel sources switch over to lactate and stored glucose from the muscle. This is the VO2 max and shows the limit of the aerobic system. The test is not painful, although for the last minute or two the heart rate is very fast and you might feel a shortness of breath briefly. 

Can I Improve My VO2 Max?

The promising news about fitness is that it can be improved through training. Once baseline VO2 max levels are documented, we can work on improving them through regular exercise and training. To achieve long-term improvements in VO2 max, high-intensity interval training is best. We will touch more on this in a subsequent blog, explaining the frequency and variations of HIT that are successful. We can provide initial training recommendations for increasing your CRF, and we are able to retest in 3-6 months to track progress. High-level athletes typically test four times a year.

How Can Hudson Valley Longevity Medicine Help?

If you are curious about your current fitness level, looking to improve your endurance, and/or looking to remain fit and functional into old age, VO2 max testing should be part of your optimal wellness plan. We are excited to incorporate this test within our Fitness for Longevity module. Book a Fitness for Longevity Consultation with us at Hudson Valley Longevity Medicine and we’ll measure your VO2 max at our first meeting in our office to assess your current fitness level. Then we’ll sit down together and create a customized plan for physical activity based on your current VO2 max with the goal of improving personal fitness in a way that can be maintained over time. Your VO2 max will serve as a metric for tracking progress. We’ll set up a follow-up visit for 3-4 months, at which time we’ll repeat your VO2 max and check in on your progress. Appointments for this type of consultation can be requested as of May 1, 2023, by contacting us via our website at https://www.hvlongevity.com/longevity-medical-consulting/.

Resources

Podcasts:

The Peter Attia Drive Podcast: #217 ‒ Exercise, VO2 Max, and Longevity | Mike Joyner, M.D. – August 8th, 2022 https://peterattiamd.com/mikejoyner/ 

References:

Breaking down VO2 max: Definition, history, why it plateaus, and whether it really matters I Peter Attia MD – May 16th, 2022 https://peterattiamd.com/breaking-down-vo2-max/ 

Not Testing VO2 Max in Your Older Patients? Here’s Why You Should I Kaitlin Sullivan I Medscape Medical News https://www.medscape.com/viewarticle/988303 

How to Measure VO2 Max (And Why You Should Be Measuring It) I Michael Click – May 19th, 2021 https://www.styku.com/blog/measure-vo2-max 

Cooper 1.5 Mile, How to Calculate The Results, Find Your VO2 Max and How You Rank https://fitness-networking.com/cooper-1-5-mile/ 

Tools:

Fitness Testing Calculator https://exrx.net/Calculators/Rockport