VO₂-max – The greatest predictor of lifespan.

When many think about VO2-max, they think about an exhausting test, there spit out a number, there is only really relevant to elite endurance athlete. Why should the rest of us care about what our VO2-max is? Many, including many doctors, would answer - we don’t! The science shows different, we should be interested and try to rice our VO2-max mainly because: “It is the greatest predictors of our lifespan. More strongly associated with reduced mortality risk than any other metric we know of”¹

So what is VO2-max? VO2-max is the maximum volume of oxygen, in milliliters, our body can utilize in a minute, per Kg body weight. So its a number there says how efficient our body utilize oxygen in a maximum effort situation. Our muscles needs oxygen to work, and the harder we work the more oxygen is needed, we feel this when we do some hard effort there cover more than just a few seconds, we breathe heavier, take more oxygen in.
Normal VO2-max is measured in a laboratory, by covering the subject’s nose and mouth, with a mask there has the capacity to measure oxygen. Then the subject is executing a ramp test to exhaustion, on either a treadmill or bike. Many modern sport watches have the capacity to give a person’s VO2-max, even not that precise as the laboratory test, many tests has shown the watches estimate is normal not fare off what a laboratory test would give.
As your body weight is part of the VO2-max you can raise the number, either by increase your body’s use of oxygen efficiency, trough training, or by reduce your weight. The last idea might not be such a good idea if its only done for rising the VO2-max number.

If your body has the capacity to transport huge amount of oxygen into your muscles, you would have an advantages in a sport event, but also in our everyday life. If your body is able to transport bigger amount of oxygen into your muscles you are able to do more things, that you might not be able to do if you leak this capacity, as the body needs a minimum capacity for doing different tasks. Walking up the stairs, playing with you children and grandchildren, for not talking about running to catch a bus, all request a certain capacity level of transporting oxygen around in your body.
Its shown our body lose between 10 – 15% of our VO2-max every decade after 50. To put this into perspective: A person needs a minimum VO2-max around 16 ml/min/Kg to slowly climb a flight of stairs, so if a person wants to be able to climb a flight of stairs at the age of 90, his or hers VO2-max should be between 24 – 31 ml/min/Kg at the age of 50. That’s around average for a man in his fifties, but clearly above average for a woman. A 17.5 ml/min/Kg VO2-max is often set as a limit for having an independent lifestyle and below this exists an increased risk for mortality.
A study of Octogenarian Lifelong Endurance Athletes² (all men) showed a much better life quality compared to non athletes the same age, it was notably that the athletes had an VO2-max around an average of a 25 year old man, while the control group, non athletes, had a VO2-max around 20 ml/min/Kg, the general health was also much better for the athletes. The athletes exercised 4 – 6 day/week and had been engaged in vigorous aerobic exercise their entire adult life, as octogenarians they still participate in races, while the control group had no history of structured exercise (see figure below).

Octogenarian's VO2-max

Another study of highly trained and competitive elite distance runners, done over 22 years³. The runners were initially tested (T1) when they were all highly trained and competitive, then again after 22 years (T2), where the runners were classified into tree groups: Highly Trained (HT) and still competing. Fitness Trained (FT) still running long slow runs but not competing. And untrained (UT) none or almost none running. The mean age was 46.5 +/- 1.6 year at T2. All groups experienced a significant decrease in there VO2-max from T1 to T2. However, this decrease was related to the amount of training between evaluations: The HT group lost 6% per decade of there VO2-max. The FT group lost 10% per decade of there VO2-max. And the UT group lost 15% per decade of there VO2-max.

The VO2-max is such a good predictor because it tells how fit a person is and its NOT a number you can change over night by going to the gym. The science shows, the fitter you are the longer you will live all things considered and with a better life quality.
Of the fire longevity strategies there are most used today, (1) exercise, (2) sleep, (3) nutrition, (4) medication & supplements and (5) distress tolerance. Of the first fore, exercise is the one there is most important, it is so significative than going from a sedentary lifestyle to an active, will extend your life more than stop smoking, or put in another way, it's better you start smoking then you stop exercising.
It's proven that exercises help on at least three of the four main chronic disease their course 80% of deaths in people over 50 who do not smoke. These are: (1) atherosclerotic disease (comprised of cardiovascular disease and cerebrovascular disease), (2) neurodegenerative disease (Alzheimer’s disease being the most common), and (3) metabolic disease (a spectrum of everything from hyperinsulinemia to insulin resistance to fatty liver disease to type 2 diabetes), (4) cancer.

What different researches show are: Exercise a little is good, more is better and VO2-max reflex this over time. The higher your VO2-max is, the better your form is, the heather your life is and the longe you life probably will be.

So what is a good VO2-max? The table below is a classification of VO2-max by age and sex.
Many health specialist advice to people over fifty is: They should be in the Elite classification for a decade below what the actual are in or or better two decades below e.g.: A 55 year old man should aim for a VO2-max around 53 ml/min/Kg.
This sound almost impossibly, but is achievable with the right training, the earlier you start the easier it is to keep a high VO2-max. Even if you start late, it is never to late to try to rise this value, try to maintain your current value or slow the decline.
A research done on a 101 years old elite cyclist, where the cyclist followed a structured training plan⁵, saw a rice of his VO2-max from 31 to 35 ml/min/Kg over 2 years (age 103), a 13% increase!

Classification of VO2-max by age and sex^*

	Low	Below Average	Above Average	High	Elite
Men Ages	VO2-max	VO2-max	VO2-max	VO2-max	VO2-max
20 - 29	< 36	36 - 42	43 - 48	49 - 55	≥ 56
30 - 39	< 35	35 - 39	40 - 45	46 - 52	≥ 53
40 - 49	< 34	34 - 38	39 - 43	44 - 51	≥ 52
50 - 59	< 29	29 - 35	36 - 40	41 - 49	≥ 50
60 - 69	< 25	25 - 29	30 - 35	36 - 45	≥ 46
70 - 79	< 21	21 - 24	25 - 29	30 - 40	≥ 41
≥ 80	< 18	18 - 22	23 - 25	26 - 35	≥ 36
women Ages
20 - 29	< 28	28 - 35	36 - 40	41 - 50	≥ 51
30 - 39	< 27	27 - 33	34 - 38	39 - 48	≥ 49
40 - 49	< 26	26 - 31	32 - 36	37 - 46	≥ 47
50 - 59	< 25	25 - 28	29 - 35	36 - 45	≥ 46
60 - 69	< 21	21 - 24	25 - 29	30 - 39	≥ 40
70 - 79	< 18	18 - 21	22 - 24	25 - 35	≥ 36
≥ 80	< 15	15 - 19	20 - 22	23 - 29	≥ 30

Exercising bring up your fitness level, a high fitness level is good for your health, a good health means a longer life, if nothing else, and the best indicator we have of a person's fitness level is VO2-max.
The best way to raise a person's VO2-max (and the fitness level) is following a structured training plan, there contain around 80% aerobic training and around 20% anaerobic training, at different levels. The plan should contain the right amount a training sessions and recovery time. Souch plans can be very intimidating as they often request lot of time and might be difficult to follow in a modern stressed life style, but what is the alternative?
Last, exercising is not the only strategy for a long life, but shoult be part of a set of strategies used, even exercising might be the most important strategy.

Henrik Baastrup 2024



References:
(1) Peter Attia, MD. Is a Canadian-American author, physician, and researcher known for his work in longevity medicine.
(2) "New Records In Aerobic Power Among Octogenarian Lifelong Endurance Athletes" research paper.
(3) "Aging among elite distance runners: a 22-yr longitudinal study"
(4) "Exercise capacity and mortality among men referred for exercise testing" Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE.
(5) "Case Studies in Physiology: Maximal oxygen consumption and performance in a centenarian cyclist"

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