Athletes, especially those who engage in endurance activities are typically familiar with VO₂max because it’s a useful predictor of their performance in races. As we age, VO₂max is also a good predictor of what physical activities we will be able to engage in, so I think it’s useful for everyone to be aware of.

What is VO₂max?

VO₂max is a measurement of a person’s ability to take in and use oxygen.  It is impacted by how effective their lungs are to transfer O₂ from the air to blood, how effective the heart is to deliver the blood to muscles  (volume per beat and maximum heart rate are the keys), and the muscles ability to utilize the oxygen. It’s worth noting that often VO₂max is described as milliliters of oxygen per minute per kilogram of body weight so losing weight will often raise someone’s VO₂max.

What is a “Normal” VO₂max

I think it’s useful to know what “normal” is, and to see how it changes generally in people. I think we should select a target based on the activities we want to be able to engage in rather than settling for “average”.

Humans who have been training throughout their lives tend to have their VO₂max peak when they are around 30 years old. After 30, VO₂max has a tendency to drop. The individuals health and training determine how quickly VO₂max drops. For people who have not trained before they were 30, it is possible to increase VO₂max beyond what they achieved at 30. Once an individual is trained, their VO₂max will drop over time.

• 10% / decade after someone is 30 is the common figure if an individual is not training
• 5% / decade is what is often cited for people maintaining training. 
• Recorded data from training individuals suggests that well trained individuals lose around 5% / tens years between ages 30-60, after 60 even with continued training people loss 8-10% / decade. 
• VO2max can spiral down more quickly toward the end of life because people aren’t active, their VO2max drops, which makes it harder for them to be active, and the cycle continues.

To have a sense of a VO2max required for other activities, you can consult the Compendium of Physical Activities (PDF) or their website which lists the approximate METs generated by activity. Multiple METs by 3.5 to get VO2max required.

How to Measure VO₂max

The gold standard is performed in a sports performance laboratory by measuring oxygen consumption via Indirect Calorimetry. This involves wearing a mask which measure the O₂ you breath in, and the CO₂ that you exhale while running on a treadmill or riding a bicycle as quickly as you are able. This test typically costs >$200 and has to be done in a lab. In the Bay Area DexaFit has an office in San Carlos, Silicon Valley Sports Medicine in Campbell,  and the UCSF Human Performance Center do VO₂max tests. Calibre makes a mask that claims to be nearly as accurate as lab equipment.

There are a number of methods which are pretty accurate that don’t require the expensive laboratory equipment.  A number of methods and the accuracy are described in the show notes from podcast #223 Peter Attia AMA #39 VO2 max and more. A few methods I would recommend considering

• Peak power output predicts maximal oxygen uptake and performance time in trained cyclists | SpringerLink
  • 5 minute self-paced warm up
  • Start at an exercise intensity equivalent to 3.33 w/kg (men) and 2 W/kg (women)
  • Maintain exercise intensity for 150 s
  • Increase intensity by 50 W for another 150 s
  • Increase intensity by 25 W every 150 s until fatigue (<10 rpm)
  • Wpeak = Wfinal +(25*t /150)
    • where Wfinal is the last completed interval power, and t is the time (s) sustained in the last uncompleted interval
  • V0₂max(L/min) = 0.01141*Wpeak(W) +0.435
• Cooper 12 Minute Run Test
  • Run as far as you can in 12 minutes.
  • Measure the distance.
  • VO₂max = (36 x miles ran) – 11.3
  • VO₂max = (22.4 x km ran) – 11.3
• Garmin (FirstBeat) method of VO2max… e.g. let your watch estimate it for you. Apple Watch also estimates VO2max… I have no idea how it’s accuracy compares, though online posts in 2023 by people who did treadmill tests compared to the Apple Watch suggest it’s less accurate than Garmin.

While not as accurate as the proceeding three tests, the Rockport Walk Test is easy to perform, especially by people who haven’t been regularly training.

• Warm up for around 10 minutes
• Walk as quickly as you can on a flat surface or treadmill for 1 mile. Don’t jog!
• Record the time it took and your heart rate at the end
• enter these numbers into the Rockport Calculator and get an estimated VO₂Max (+/- 10%).

How to Increase VO₂Max

A meta analysis of training to increase VO₂max found the biggest gains over multiple months were several intervals of 3-5 minutes with an active rest in-between.  A recent study found HIIT training was the most effective way to increase VO2max in the cohort they trained. Closely related, a meta analysis found sprint intervals (SIT) to be the most effective method to increase mitochondrial density / function. The protocol discussion on Attia’s AMA suggested 4 cycles of 4 minutes exercise at VO₂max followed by 4 minutes of active rest.

FirstBeat has a list of issues which might be preventing you from increasing your vo2max.

For cyclists, using power is the easiest way to plan workouts.  See an introduction to training with power  by Dr. Andrew Coggan, one of the experts in this field.

I have been starting to look into how training your breathing could significantly improve VO₂max and endurance. There are several devices such as the o2trainer might be useful as well as breathing training.

There is some evidence that suggests that rowing might be the best way exercise to maintain VO₂max in the later years.  I suspect this is because it provides a more complete (full body) workout when compared to a number of endurance activities while being low impact and having a very low incidences of accidents which might require someone to stop training for a period of time.

Setting a VO₂max Goal

Peter Attia encourages most people to train for  the centenarian olympics. In AMA 39  he discussed  how VO₂max is often something that limits what people are able to do as they age. 

So lets say someone wants to be able to climb stairs and speed walk when they hit 100 which would require a VO₂max of 32.  Assuming they regularly train the following is what  their VO₂max needs to be in the proceeding decades.

Age	VO2max	Possible Activities
30	58	Run 10mph
40	55
50	52
60	50	jog 6mph up a hill
70	45	run 8mph on level ground, carry heavy objects up stairs
80	40
90	36	Run 6mph
100	32	briskly climb stairs, walk 3mph up steep hill

Other References

• Age-related Decline In VO2max: When Activities of Daily Living Become Athletic Events Video by Jayson Gifford
• Determinants of VO2 max decline with aging: an integrated perspective – PubMed – Betik, Hepple
• Aging Performance for Masters Records in Athletics, Swimming, Rowing, Cycling, Triathlon, and Weightlifting – Baker, Tang
• Effect of training on the decline of VO2max with aging – PubMed – Hagberg
• Fast After 50
• VO2 Max, Lactate Threshold, Heart Rate, What?
• VO2 max: can veteran athletes prevent a decline in aerobic capacity?.  
• Joe friel’s fast after 70, part 8: vo2max