What is VO2 max?

VO2 max is a marker of cardiorespiratory fitness. Specifically, it is the maximum amount of oxygen your body can consume in one minute, measured as millilitres per kilogramme of body weight per minute.

As such, it is distinct from cardiovascular health, which is about the integrity of the cardiovascular system generally, including the heart and blood vessels.

It gets a bit confusing, because we can use cardiorespiratory fitness to improve cardiovascular health – and if you have a high VO2 max, you also have a greater likelihood of good cardiovascular health. However, VO2 max does not in itself guarantee good cardiovascular health. It is a functional measure of the body’s ability to transport and consume oxygen and doesn’t tell you anything about the function of your blood vessels, if you have angina or have had a stroke.

VO2 max is the single best predictor of life expectancy. Every millilitre increase can extend life expectancy by 45 days.

So, why does VO2 max matter?

VO2 max is the single best predictor of life expectancy, over and above blood pressure, cholesterol, glucose levels, smoking or obesity.

Independent of all other factors, every millilitre increase in VO2 max can extend life expectancy by 45 days. This is the headline finding of the Copenhagen study, which has been tracking health outcomes among 155,000 males since 1970; sadly the data set doesn’t yet exist for females.

VO2 max is the biggest determinant of available energy in our bodies, whether that’s energy to run a 10k or fight a virus

Improved VO2 max is also about retaining functionality as we age. If you have a VO2 max of 60 in your 30s, even with an age-related drop-off, you’re still set to be sufficiently functional in your 80s to go to the shops and carry your own bags. If you have a VO2 max of 35 in your 30s and don’t do anything to improve that, you’re the person who can’t perform the basic tasks of daily living by your mid-70s.

Tell us more…

The biggest change we see from improved VO2 max is increased heart strength and stroke volume [the amount of blood ejected from the ventricle in each cardiac cycle and with it, the amount of oxygen being delivered around the body]. This has huge benefits for longevity and general health.

From a disease prevention point of view, we see a correlation between higher VO2 max and a decreased risk of cardiovascular disease, cancer and neurocognitive decline.

Then there are the functional benefits, with VO2 max the biggest determinant of available energy in our bodies.

For the most part, humans combust energy using fuel and oxygen; the better we are at delivering and consuming oxygen, the more effective our machines become. Increasing cardiorespiratory fitness also increases the volume and quality of mitochondria – the energy-producing powerhouses in our cells.

Crucially, this increased energy isn’t just about our ability to run a 10k. It’s about immunity and what happens when a virus comes along that needs energy to fight it. It’s about cognition and virility. And it’s about the basic demands of day-to-day life, which are lessened when the size and capacity of our engines are greater. Just sitting chatting, someone with a higher VO2 max might idle along at 2 per cent of their capacity. Someone with a lower VO2 max might be at 6 per cent of theirs.

What is a good VO2 max?

The highest VO2 max ever recorded was 96, but there are question marks over the methodology. Elite endurance athletes, where VO2 max is really the key determinant of success, are typically in the 70s and 80s. In other sports – football, for example – the ability to consume oxygen is not the defining trait of the world’s best players. Professional footballers also need strength, speed and skill and might have a VO2 max in the 50s.

VO2 max depreciates year on year at a fairly aggressive rate, but we can address this through regular VO2 max training

At the other end of the scale, drop below 30–32 and there’s an increased cardiovascular health risk. Below 20, we would be concerned for the individual’s ability to perform basic tasks or possibly survive complex surgery.

Note that the number is not a percentage. It’s an absolute measurement: millilitres per kilogramme per minute.

Of course, ages and stages are key. We typically have a fairly stable VO2 max until around the age of 30–35, after which – as with most key biological systems – it depreciates year on year, and at a fairly aggressive rate.

From the age of 30–35, VO2 max drops at 10 per cent per decade, then 15 per cent per decade from the age of 50 onwards. However, we can address this natural depreciation by taking part in regular, deliberate VO2 max training.

What exercise should we do?

We’re talking aerobic exercise such as indoor cycling, but only about 20 per cent of your weekly effort needs to be in the top heart rate zones. The rest can be low-intensity steady state, which also helps with sleep, stress management, digestion and so on.

We’re all familiar with high-intensity interval training that features short bursts of work and short recovery periods. VO2 max training uses longer intervals, with the Norwegian protocol a well-established method: four minutes going as hard as you can followed by three minutes recovering sufficiently that the next four minutes of work are the same quality as previously, repeated four times.

The key is to set the right pace for the work intervals, because you need to maintain the intensity throughout. It isn’t about maximum effort, so don’t go off too hard and burn out after a minute. Equally, don’t make it too easy: it should feel like an eight out of 10. The first two minutes won’t be too bad, but by the time you’ve completed four minutes you’re fatigued and wouldn’t be able to do a fifth. This is where indoor bikes are so good, because you can establish the perfect wattage for you to achieve this.

A meta-analysis of indoor cycling studies found an 8–15 per cent improvement in VO2 max from two to three sessions a week

If you do one Norwegian protocol a week and two low-intensity steady states, although I can’t guarantee it, I would expect to see an improvement in VO2 max over time.

Of course, any little bit more exercise is better. But to defy ageing, physical activity has to move from a hobby to a fundamental part of your daily and weekly routines – and in all likelihood, you will need to work a little harder each year just to stand still.

How much can we improve VO2 max?

We’ve seen individuals aged 50+ improve their VO2 max by 17 per cent in the space of a year and individuals in their 80s and 90s with VO2 max scores in the high 30s.

Even with training, there will be some loss of VO2 max as we age; the body of data isn’t quite there yet to show the exact extent to which this can be reversed and stabilised with a regime of deliberate VO2 max training.

Improvements in VO2 max will also vary by individual, with the stiffening of the heart a key variable that’s influenced by a multitude of factors, some genetic. For some people, improvements will be smaller.

Historically, fitness professionals have learned about VO2 max as a performance metric. It’s time for a modern day narrative.

However, we do know we can improve VO2 max and reduce the rate of drop-off at pretty much any age. Say you’re in your early 50s. The perfect time to start might have been 15 years ago, but the next best time is today. If, rather than losing 15 per cent this decade, you can retain your current VO2 max into your next decade and so on, your fitness level at 80 years old will be fantastic.

For indoor cycling specifically, we can also refer to a Spanish meta-analysis of indoor cycling studies which found an 8–15 per cent improvement in VO2 max, a 6 per cent decrease in LDL and total cholesterol, improvements in systolic and diastolic blood pressure and a 5–6 per cent decrease in triglycerides – all directly related to two to three indoor cycling sessions a week.

Losing weight can significantly improve VO2 max, too, because it’s measured in millilitres per kilogramme of body weight. You would want to be losing fat, though, not lean muscle mass.

How do you use VO2 max with clients?

I’ve spent my life trying to convince people to be more physically active, but what do I have to offer them if they’re comfortable with the way they look and their ability to perform the tasks of their daily lives? Body composition – weight loss – has certainly been a very ineffective tool and a dramatic undersell of what exercise has to offer.

VO2 max is the strongest argument for exercise that I’m aware of. Of course, people don’t care about ‘VO2 max’ in itself. They care about finding solutions to whatever’s bothering them – and it’s a rare situation in which improving VO2 max won’t in some way address their concerns, whether that’s quality of sleep, rest, immune function and more. I start with their problem and I use VO2 max to solve it.

VO2 max allows me to talk energy, healthspan and lifespan. It gives me a tool to engage a disengaged audience, reinvigorate lapsed exercisers and encourage those who have overly narrowed their focus – getting really good at CrossFit or tennis, for example – to look again at their body’s biological requirements.

The fitness industry has doubled down on strength training and neglected cardio recently, but these are separate biological systems and we need to train both, as well as recovery and mobility. VO2 max helps us bring cardio back onto the menu.

Can we use VO2 max in group exercise?

In this scenario, VO2 max is more of a language play. As a group fitness instructor, you might not offer VO2 max assessments, but if you’re teaching cardio classes you can certainly embrace the narrative of VO2 max. You can talk to participants about immunity, energy, longevity – about changing the structure and shape of their lives by improving their cardiorespiratory fitness.

As an indoor cycling instructor specifically, you can also talk about the Spanish meta-analysis: you have an intervention that’s proven to increase VO2 max by 8–15 per cent. Make this relevant to your participants by linking it to their goals. And start thinking creatively about your audience, because with this impact you can also talk to GP surgeries, care homes and corporates looking to reduce absenteeism.

Tell us about your VO2 max course.

Historically, fitness professionals have learned about VO2 max as a performance metric. Now, with the longevity boom spearheaded by clinicians such as Peter Attia – who has made VO2 max his primary health marker – it’s time for a modern day narrative.

Indirect VO2 max and lifestyle coaching is a new course we’ve launched through FuturePractice – a quick, bite-sized way to become an expert in VO2 max: what drives it, how to measure it, ways to commoditise this knowledge. It gives fitness professionals a new opportunity to prove their worth and stretch their service proposition to a broader audience, including longevity.

About Oli Patrick

Oli Patrick is a physiologist and world-leading expert in lifestyle management. He speaks widely on the application of contemporary wellbeing strategies, consults to businesses and individuals globally and, through clinical wellbeing academy FuturePractice, seeks to elevate the skillset of health and fitness professionals via education in key areas such as sleep, stress and VO2 max.

Formerly head of physiology at Nuffield Hospitals and a Harley Street clinician, Patrick has been instrumental in establishing professional recognition for applied physiology in the UK, working closely with professional and government bodies as well as major teaching institutions.

He is also a sought-after speaker and podcast host.