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What is VO2 Max and How Is It Calculated?

What is VO2 Max and How Is It Calculated?

March 12, 2024

What is VO2 Max and How Is It Calculated?

By Micah Olson, MD

Founder, Valley Healthspan

Discover the importance of VO2 max for longevity and fitness. Learn how to calculate VO2 max and how to improve it for optimal health and performance.

Table of Contents

 

Introduction

You’ve always known that exercise is good for you, with wide-ranging benefits not just for how you look but also your health, longevity, performance, mood, and quality of life. But you might be surprised by just how good exercise is for you. In fact, a growing body of research demonstrates that your level of fitness does a better job predicting how long you will live than any other modifiable variable that we know of. Yes, you read that right. Your level of fitness is a stronger predictor of mortality than many other well-known risk factors, including smoking, high blood pressure, high cholesterol, or presence of heart disease. 

 

What is VO2 Max?

So how is fitness measured exactly? There are countless methods to quantify someone’s fitness level, but if your goal is predicting longevity a test called VO2 max is clearly the gold standard. VO2 max is a test that measures the maximum amount of oxygen that your body can utilize when undergoing strenuous exercise. Specifically, it is the maximal volume of oxygen an individual can consume in one minute, measured in mL per minute. This value is then normalized to a person’s body weight (a larger person would be expected to utilize a larger amount of oxygen). This is done by dividing the mL of oxygen consumed in one minute by weight in kilograms, which makes mL/kg/min the standard units by which VO2 max is expressed. 

The VO2 max is a functional measure of the combined working capacity of your lungs, heart, and muscles. Oxygen is inhaled into the body by the lungs, then transported to where it needs to go by the heart/circulatory system, then utilized by the muscles in the process of producing the energy that is needed to perform work (exercise). 

 

How is VO2 max calculated?

Man running measuring VO2 max

The most accurate way to measure VO2 max is to measure and calculate it directly. This means directly measuring, via a mask, how much oxygen is consumed during peak intensity exercise. But VO2 max can be measured indirectly through a variety of surrogate methods, some involving exercise, and some involving predictive formulas using metrics such as your age and resting heart rate.

Direct Measure of VO2 Max

The direct measure of VO2 max is the most accurate and standardized, however it is also the most difficult because it requires the test subject to exercise at maximal intensity, and it requires specialized equipment. The direct method involves an exercise test in which the subject exercises to exhaustion, typically done with a treadmill, exercise bike, or rowing machine. The subject wears a mask which measures how much oxygen they consume and carbon dioxide they expire. After a warm-up period, the subject’s level of exercise effort is slowly ramped higher and higher until the volume of oxygen consumption reaches a plateau. The test typically takes about 15-20 minutes once the warm-up period begins. The data collected during the test is analyzed to determine the participant's VO2 max, usually expressed in milliliters of oxygen per kilogram of body weight per minute (mL/kg/min).

Indirect Measure of VO2 Max

An indirect measure of VO2 max can be obtained in a number of ways. With indirect measures the volume of oxygen consumed is not directly measured via a mask, in which case the first estimate ofVO2 max is only an estimation. Indirect measures of VO2 max can be divided into two categories: exercise and non-exercise based estimations.

With exercise based tests, VO2 max is estimated by evaluating physical activity performance with a standardized test. For example, VO2 max can be estimated by measuring the subject’s maximal work rate, expressed in watts, on a cycle ergometer. The protocol for this test involves a 5-min warm-up period, after which the workload is increased at a prespecified amount every 2 minutes until the subject reaches exhaustion. This is called a “maximal” test, referring to maximum physical effort, but numerous “submaximal” tests exist as well. In a submaximal test, an individual’s work output is measured at a prespecified submaximal heart rate. Another method is the Cooper 12-minute run test, named after fitness expert Dr. Kenneth Cooper, in which VO2 max is estimated based on how far a person can run or walk in 12 minutes. 

Non-exercise based VO2 tests involve calculations that utilize metrics such as age, resting heart rate, and maximum heart rate. Many of these calculations can be found online. 

 

Why is VO2 Max Important?

Older couple jogging

Over the last few decades, numerous studies have been conducted in which large populations (sometimes tens of thousands) of research subjects undergo a VO2 max measurement at baseline and then are followed over many years to determine how long they live. Not only are mortality rates calculated, but researchers often study other outcomes such as rates of cardiovascular disease, cancer, or Alzheimer's disease. As a result of these studies, some scientists argue that the VO2 max level is the best single measure of overall and cardiovascular health status.

VO2 Max and Longevity

One notable study, published in JAMA Network Open in 2018, examined the VO2 max levels of 122,007 adults (59% men) with an average age of 53 years. The participants were categorized into four groups based on their baseline VO2 max: "Low," "Below Average," "Above Average," and "High."

Tracking these groups over time revealed striking differences in mortality rates. The Low group had a mortality rate nearly four times higher than the High group. The Low group's mortality rate was also 2.7 times higher than the Above Average group, and 1.9 times higher than the Below Average group.

To put these findings into perspective, consider the mortality rates associated with other well-known risk factors in the study: smokers had a mortality rate 1.4 times higher than nonsmokers, and individuals diagnosed with heart disease had a mortality rate 1.3 times higher than those without heart disease. While these numbers are significant, they are overshadowed by the profound impact of VO2 max on our health.

Other large studies have shown that an increase in VO2 max level of 1 MET (which is equivalent of 3.5 mL/kg/min) is associated with a 10% to 20% decrease in mortality rate. An increase in VO2 max level of 3.5 mL/kg/min is highly achievable through a dedicated training program, and in many cases your VO2 max can be increased much higher than this. In addition to mortality rates, VO2 max level has been shown to be highly predictive of other important outcomes, including diagnosis of cancer or Alzheimer's disease. 

Benefits of Increasing VO2 Max

For those who are not in great shape, there is good news and bad news. First the bad news: as you have probably surmised already, your mortality risk prediction is not as favorable as those who have higher fitness levels. But here is the good news: you have the most to gain from increasing your fitness level.

Most of the reduction in risk of mortality and other health outcomes that occurs from increasing VO2 max levels occurs between the least fit group and the next least fit group. In other words, the biggest bang for your buck occurs in going from the lowest aerobic capacity category to the second lowest category of VO2 level. In addition, those in the least fit group will experience a larger percentage increase in VO2 max for the same amount of exercise training compared to the higher fit categories. Therefore, you do not need to be in great shape to experience health benefits from improvements in your fitness level. On the contrary, you will experience more benefit the lower your starting level of fitness.

 

How Can You Improve Your VO2 max?

Man doing a HIIT workout

It is estimated that about 50% of your VO2 max score is determined by your genetics, and the other 50% is determined by your level of physical activity/training. VO2 max can be increased by at least 15-20% from baseline with a dedicated training program. Any type of working out, including resistance/strength training, low-to-moderate intensity aerobic training, or high intensity interval training (HIIT), can improve your VO2 max level. This is especially true for those who are starting with a low aerobic level at baseline.

HIIT Workouts For VO2 max

While it’s true that any form of working out can improve VO2 max, research studies consistently show that HIIT leads to the biggest increases. HIIT programs generally involve repeated, short (3-8 minutes) intervals of near maximum intensity effort, followed by short periods of rest. A HIIT training routine also can be done with a wide variety of exercises, including running, biking, elliptical, and rowing.

A classic protocol, and one that has a considerable amount of research behind it, is the 4x4 protocol. This approach involves exercising for 4 minutes at a heart rate of 90-95% of your maximum heart rate, resting for 3-4 minutes, then repeating for 4 intervals. There are numerous other HIIT protocols that you can find with a quick internet search.

HIIT is an attractive way to train because you can achieve tremendous health benefits in a short amount of time. But don’t let the short time commitment mislead you. A HIIT workout is very difficult. If you are just starting out, it is recommended to spend 3-4 months doing lower intensity aerobic exercise to build up a reserve before starting a HIIT program. Start with one HIIT workout per week. If you build up to 2-3 HIIT workouts per week, you are doing really well.

A Strong Foundation is Key

One last recommendation regarding HIIT. Although it is true that HIIT has consistently been shown to be the most effective way to increase VO2 max, it does not stand to reason that your exercise program should consist only of HIIT workouts. There is still very much a role for strength training and low-to-moderate intensity aerobic training. Strength training provides increased muscle mass, increased bone strength, and sets us up to maintain a higher degree of physical function, balance, and stability as we age. Lower intensity aerobic workouts provide the foundation by which we can push our VO2 max higher.

An analogy from engineering is that if you are going to build a tall building, you must ensure the foundation is solid. The stronger the foundation (low-to-moderate aerobic exercise), the higher you can build the tower (VO2 max). This is evidenced in that elite athletes in sports that require the highest VO2 max levels spend as much or more time training with longer, moderate intensity cardio workouts than they spend doing shorter, higher level intensity intervals. 

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What Should Your VO2 Max Levels Be?

The optimal VO2 max value varies depending on factors such as age, sex, fitness level, and overall health. Generally, higher VO2 max values are associated with better cardiovascular fitness and endurance. Here are some general ranges for VO2 max based on age and sex:

  • Excellent: Men: More than 50 mL/kg/min, Women: More than 40 mL/kg/min

  • Good: Men: 43-50 mL/kg/min, Women: 33-40 mL/kg/min

  • Average: Men: 35-43 mL/kg/min, Women: 27-33 mL/kg/min

  • Poor: Men: Less than 35 mL/kg/min, Women: Less than 27 mL/kg/min

These ranges are approximate and may vary depending on the source and specific population studied. It's essential to interpret VO2 max values in the context of an individual's age, sex, and overall health status.

 

Conclusion

There are a ton of great reasons to invest in your cardiovascular fitness. It’s fun. It keeps us looking and feeling our best. It gives us more energy. It can be a great social outlet. It’s good for our mood. It’s good for our brain. And on top of all that, it can increase our lifespan as much as anything else we know of. And not only does it increase lifespan, undoubtedly it also increases health span. Because we can probably all agree, living longer is not as important as giving those years more life!




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