This is just the 101 course:
Quote: “If you don’t make time for exercise, you will probably have to make time for illness”
- Robin Sharma, Attorney, Writer, Consultant
What is VO2 Max
Perhaps the most important metric for longevity and health in 2024
V=Volume (actually volume per unit time in this case)
O2= oxygen
VO2 = volume of oxygen that can be utilized per unit time
VO2 Max = the maximum volume of oxygen that can be utilized during maximal exertion
Most often Expressed as:
ml/kg/min (milliliters per kilogram of body weight per minute)
This is the gold standard for measuring cardiorespiratory fitness in medicine, exercise science, and research. The best way to measure VO2 max is with a cardiopulmonary exercise test (CPET test). This is performed by hooking a person up to a closed breathing circuit via a facemask and measuring both inhaled and exhaled O2 and CO2. Other methods for estimating VO2 Max also exist. We will discuss measuring VO2 Max more thoroughly in part 2.
VO2 Max Record Holders
Highest VO2 Man | 97.5 ml/kg/min | Oskar Svendsen | Norwegian cyclist |
Highest VO2 Woman | 76.6 ml/kg/min | Joan Benoit | USA Marathon Olympic Gold Medalist |
Pro we all Know | 84 ml/kg/min | Lance Armstrong | USA cyclist |
Highest Vertebrate Animal | 600 ml/kg/min | Hummingbirds | Super legit bird |
Mans best friend | 240 ml/kg/min | Huskey Dogs | In the Iditarod |
Racehorses, pronghorns, blind shrews, and many other vertebrate animals have very high VO2 Max values. Flying insects have an even higher VO2 Max than the hummingbirds. The size of flying insect and hummingbirds are limited due to their need for high O2 consumption. This may be why giant insects like a dragonfly with a 28-inch (70cm) wingspan were able to survive 300 million years ago when O2 made up 30-35% of the atmosphere (compared to 21% today).
Humans with the highest VO2 max tend to be endurance athletes such as cyclists, long distance runners, swimmers, triathletes, and cross-country skiers. VO2 max is important. But it is how long a certain VO2 can be sustained that most often wins championships in these arenas.
Things that Increase VO2 Max
- male sex
- training
- younger age
- erythropoietin, blood doping (this is what Lance got in trouble for)
Things that Decrease VO2 Max
- increasing age
- sedentary lifestyles
- increasing elevations
- obesity (increasing body fat)
- anemia
- impaired circulation
- lung disease
- heart disease
- toxicities like carbon monoxide poisoning
VO2 Max measures how much oxygen can be consumed by lean body tissue. So more fat increases the denominator and lowers VO2 max. To understand all the things that can effect VO2 max, lets trace O2 journey through the body from inhaled gas to molecular energy.
- O2 is breathed in. Any airway obstruction or reduce flow will lower this
- O2 goes to the alveola of the lungs and must cross into the blood circulation. Lung disease will greatly reduce this process.
- O2 must attach to hemoglobin in red blood cells. Anemia or disease of hemoglobin (e.g. thalassemia) will lower this
- Red blood cells must travel through the circulation to muscles. Any circulatory problems will lower VO2 max. If the pump or heart is not good, VO2 max will be greatly reduced.
- O2 must displace from hemoglobin and enter muscles in need of oxygen. Don’t have much muscle relative to body weight? Then VO2 will go down.
- O2 must enter mitochondria. Don’t have many mitochondria or have sick mitochondria from lack of exercise? Not good for VO2.
- O2 must be utilized in oxidative phosphorylation to produce ATP. Problems with oxidative phosphorylation biochemistry will lower VO2 max.
If any of the above physiologic processes are reduced, VO2 Max will suffer.
In short, a high VO2 max requires:
- open airways
- healthy lung tissue
- a heart that pumps well and can increase with exercise
- enough blood volume, red blood cells, healthy hemoglobin
- open and flowing blood vessels
- muscle tissue
- healthy and abundant mitochondria
- an electron transport chain of protons that all function (oxidative phosphorylation)
- adequate nutrients need to support proton, ATP, and mitochondrial synthesis
Everybody Should Measure their VO2 Max and Work to Improve IT
- Training and regular exercise will increase VO2 max
- Increasing lean body mass (muscle) and decreasing fat will increase VO2 Max
- DO THE ABOVE, PLEASE STOP MAKING ESCUSES
Remember the quote:
“If you don’t make time for exercise, you will probably have to make time for disease”
- In Part 2, we are going to really dive into the numbers on why increasing VO2 Max is so important if you want to remain alive. In short, increasing VO2 Max has a tremendous benefit for reducing one’s chance of dying from all causes.
Here is chart of normal METs ranges by age and sex. Multiple the values by 3.5 ml/kg/min to convert to VO2 Max
In Part 2 we will cover:
- METS or Metabolic Equivalent of Task
- Low, medium, high, and elite values for VO2 Max by age group and sex
- How VO2 max is measured
- the epidemiology, why increasing VO2 Max makes a person MUCH less likely to die.
So, stay tuned and get off your ass
Thanks for listening,
Bill Brandenburg, MD
References
- Laukkanen JA, Isiozor NM, Kunutsor SK. Objectively Assessed Cardiorespiratory Fitness and All-Cause Mortality Risk: An Updated Meta-analysis of 37 Cohort Studies Involving 2,258,029 Participants. Mayo Clin Proc. 2022 Jun;97(6):1054-1073. doi: 10.1016/j.mayocp.2022.02.029. Epub 2022 May 11. PMID: 35562197.
- Strasser B, Burtscher M. Survival of the fittest: VO2max, a key predictor of longevity? Front Biosci (Landmark Ed). 2018 Mar 1;23(8):1505-1516. doi: 10.2741/4657. PMID: 29293447.
- Buttar et al. A Review. Maximal Oxygen Uptake (VO2 max) and its Estimation Methods. Int. Journal of Phy Ed, Sports, Health. 2019
- Herdy AH, Ritt LE, Stein R, Araújo CG, Milani M, Meneghelo RS, Ferraz AS, Hossri C, Almeida AE, Fernandes-Silva MM, Serra SM. Cardiopulmonary Exercise Test: Background, Applicability and Interpretation. Arq Bras Cardiol. 2016 Nov;107(5):467-481. doi: 10.5935/abc.20160171. PMID: 27982272; PMCID: PMC5137392.
- Kokkinos P, Faselis C, Samuel IBH, Pittaras A, Doumas M, Murphy R, Heimall MS, Sui X, Zhang J, Myers J. Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex. J Am Coll Cardiol. 2022 Aug 9;80(6):598-609. doi: 10.1016/j.jacc.2022.05.031. PMID: 35926933.
- Wehrlin JP, Hallén J. Linear decrease in .VO2max and performance with increasing altitude in endurance athletes. Eur J Appl Physiol. 2006 Mar;96(4):404-12. doi: 10.1007/s00421-005-0081-9. Epub 2005 Nov 26. PMID: 16311764.
- Suarez RK. Oxygen and the upper limits to animal design and performance. J Exp Biol. 1998 Apr;201(Pt 8):1065-72. doi: 10.1242/jeb.201.8.1065. PMID: 9510520.
- Wikipedia: VO2 Max. Available at: https://en.wikipedia.org/wiki/VO2_max
- Wikipedia: Metabolic Equivalent of Task. Available at: https://en.wikipedia.org/wiki/Metabolic_equivalent_of_task
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