VO2max - the ultimate healthspan biomarker

VO2max: The Best Integrated Measure of Longevity

VO2max, or maximal oxygen uptake, is a key indicator of cardiovascular fitness and overall health and longevity. It represents the maximum rate at which an individual can consume oxygen during intense exercise and is widely regarded as the best integrated measure of longevity.

This article explores why VO2max is such a valuable metric, how it can be measured, and effective strategies for improving it.

I first became exposed to VO2max in 1993 at the 新西兰坎特伯雷大学 Sports Lab when I started training for this crazy new sport called Triathlon. My natural physiology lends itself poorly to speed & power but quite well to VO2max - at the time, I was 19 years of age, swimming 15kms a week, riding 200kms & running 40kms a week so was in reasonable nick… I jumped on the running treadmill, put the oxygen mask on & ran until I couldn’t… turns out back them my VO2max was in the early 70s.

I thought that was pretty good until I met Dr David Martin who let slip that Australia’s Tour de France champion Cadel Evans’ VO2max was 86!

Why VO2max is the Best Measure of Longevity

1. Predictive Power: Numerous studies have shown a strong correlation between VO2max and life expectancy. Higher VO2max levels are associated with lower risk of cardiovascular diseases, stroke, diabetes, and even certain cancers. This makes it a powerful predictor of overall health and longevity.
2. Comprehensive Fitness Indicator: VO2max reflects the efficiency of multiple physiological systems, including the cardiovascular, respiratory, and muscular systems. This makes it a comprehensive measure of physical fitness and overall health.
3. Adaptability: Unlike some genetic markers, VO2max can be significantly improved through lifestyle changes, particularly through exercise. This makes it a practical and actionable measure for individuals looking to enhance their health and longevity.
4. Early Detection: VO2max testing can help detect early signs of cardiovascular and respiratory problems. Identifying these issues early allows for timely intervention, which can improve health outcomes and extend lifespan.

Professor Andy Galpin from Cal State University says, ‘VO2max is the biggest health optimization opportunity—a measure that nearly everyone can and should push higher. VO2 max is one of, if not the most, significant predictors of how long and how well you’re going to live. It consistently outpredicts smoking, diabetes, and coronary artery disease’

Do you know your VO2max? Check out where you sit within your age bracket above:

How to Measure VO2max

Measuring VO2max typically involves a graded exercise test (GXT) performed in a clinical or laboratory setting. Here’s a breakdown of the process:

1. Graded Exercise Test (GXT): The most common method involves exercising on a treadmill or stationary bike while gradually increasing the intensity. The test continues until exhaustion, while oxygen consumption and carbon dioxide production are measured through a mask connected to a metabolic cart.
2. Direct vs. Indirect Measurement: Direct measurement, using a metabolic cart, is the most accurate but requires specialized equipment and trained personnel. Indirect methods, such as submaximal exercise tests or predictive equations, are less accurate but more accessible.
3. Field Tests: For those without access to lab testing, field tests like the Cooper 12-minute run test or the beep test (multi-stage fitness test) can provide an estimate of VO2max. These tests are less precise but still useful for tracking changes in fitness over time.
4. Wearables: 30 years on from my treadmill test, predicted VO2max can be measured from heart rate & motion data from a watch - amazing! To have a daily record of what is widely regarded as the best integrated metric of longevity is hugely powerful given it can be measured passively & longitudinally.

For the record, my predicted VO2max today, collected via my 苹果 watch & surfaced inside my Sahha mobile app is mid 50’s which makes sense given general rule of thumb that you lose around 10% per decade…

How to Improve VO2max

Improving VO2max involves enhancing the efficiency of the cardiovascular and respiratory systems. Here are some effective strategies:

1. High-Intensity Interval Training (HIIT): HIIT involves short bursts of intense exercise followed by periods of rest or low-intensity exercise. Studies show that HIIT is highly effective at improving VO2max in a relatively short period.
2. Endurance Training: Regular, moderate to high-intensity endurance exercise, such as running, cycling, or swimming, can significantly boost VO2max. Aim for at least 150 minutes of moderate-intensity or 75 minutes of high-intensity exercise per week.
3. Strength Training: While primarily known for building muscle, strength training can also improve cardiovascular efficiency and support VO2max improvements. Incorporate resistance exercises into your routine two to three times a week.
4. Consistency and Progression: Consistency is key. Gradually increasing the intensity and duration of your workouts will continue to challenge your body and improve your VO2max over time.
5. Lifestyle Factors: Adequate sleep, nutrition, and stress management are crucial for overall fitness and VO2max improvement. A balanced diet rich in nutrients, proper hydration, and sufficient recovery time can enhance your exercise performance and VO2max.

Conclusion

VO2max stands out as the best integrated measure of longevity due to its predictive power, comprehensive nature, adaptability, and role in early detection of health issues. Measuring VO2max can be done through various methods, with direct laboratory tests being the most accurate but highest friction and wearables being ‘good enough’ and virtually no friction (apart from charging said wearable).

Improving VO2max is achievable through high-intensity interval training, endurance training, strength training, and maintaining a healthy lifestyle. By focusing on enhancing your VO2max, you can significantly boost your overall health and increase your chances of a longer, healthier life.