VO2max and lifespan: what the cohort studies found

The short answer

In large cohorts, people with higher aerobic fitness died less often over the following years, and the fittest groups had the lowest risk. These studies show an association in middle-aged and older adults, which is different from proof that raising your VO2max will lengthen your life. The training that raises VO2max is mostly easy, with 1 or 2 harder interval sessions a week.

What VO2max is

VO2max is the most oxygen your body can use per minute, per kilogram of body weight, during hard exercise. It sets the ceiling on how much aerobic work you can do. A lab measures it with a mask on a treadmill or bike. The large study below used a close stand-in, the peak workload each person reached on a treadmill test.

VO2max tends to fall with age. In US reference data from lab tests on adults 20 to 79, the middle value dropped about 10% per decade, from 48.0 mL per kg per minute in men in their 20s to 24.4 in men in their 70s, and from 37.6 to 18.3 in women (Kaminsky 2015). Those numbers come from different people at different ages, so they describe a population rather than how fast any 1 person declines.

What the cohort studies found

The largest study here followed 122,007 adults referred to 1 US academic medical center for a treadmill test between 1991 and 2014 (Mandsager 2018). Their average age was 53, give or take about 13 years, and 59% were men. Over a median of 8.4 years, 13,637 of them died.

The researchers ranked everyone against people of the same age and sex. "Elite" meant the top 2.3%, at or above the 97.7th percentile. After adjusting for other risk factors, the elite group had about 1/5 the death rate of the lowest quarter. They also had a lower rate than the "high" group just below them, the 75th to 97.7th percentile. The authors saw no upper limit to the benefit, and the gap between elite and high held in people 70 or older.

Adults in the top 2.3% for their age and sex had about 1/5 the risk-adjusted death rate of the lowest quarter over a median of 8.4 years.

A scientific statement from the American Heart Association reached a similar view from a wider body of research. Low fitness is associated with higher rates of heart disease and death, adding fitness to the usual risk factors improves how well doctors can classify risk, and the authors recommend measuring fitness in clinical practice (Ross 2016).

What these studies can and cannot say

All of these studies are observational in design. Fitter people died less often over the following years, even after the researchers adjusted for known risks such as smoking and diabetes. They cannot fully separate fitness from the things that travel with it, such as general health, genetics, and how much someone was able to exercise in the first place. Everyone in the largest study had been referred for a treadmill test, so that group may differ from the general public.

Higher aerobic fitness goes with a lower risk of dying over the following 8 or so years, in adults whose average age was in the 50s. That association is strong and consistent, which makes it a good reason to build fitness, while the size of the benefit for any 1 person stays unknown. The findings say less about people under 40, who were a smaller share of these groups.

How to raise it

Nationally and internationally competitive endurance athletes do about 80% of their sessions at an easy effort and about 20% hard (Seiler 2010). That describes how they train, and the trials below test the hard share directly.

For the hard share, a few interval formats have good trials behind them:

• 4 x 4 minutes. In 40 moderately trained men, 4 minute intervals at 90 to 95% of max heart rate, 3 times a week for 8 weeks, raised VO2max 7.2%. That was more than the same total work done at 70% of max heart rate or at threshold (Helgerud 2007).
• 4 x 8 minutes. In 35 trained recreational cyclists over 7 weeks, 3 groups did 2 interval sessions a week and a 4th rode easy only. 8 minute intervals at about 90% of peak heart rate gave larger overall gains than 4 or 16 minute intervals, or easy riding alone (Seiler 2013).
• 30 seconds on, 15 seconds off. In 16 cyclists, 2 sessions a week of short intervals for 10 weeks raised VO2max 8.7%, against 2.6% for long intervals at a matched effort (Rønnestad 2015).

These trials ran for 7 to 10 weeks in small groups, mostly of men who already trained, so your own gain may be larger or smaller. If you lift heavy as well, 1 hard session a week is a reasonable starting point, because the endurance trials did not include heavy leg work as an extra stress. That starting point is coaching practice rather than a tested rule.

How Peak Hybrid estimates your VO2max

Peak Hybrid estimates VO2max from training you already do, with no lab test. There are 2 estimates, and the headline is the higher of the 2, since each sport only shows as much of your ceiling as your skill in it allows.

• From rides with power. Your best 5 minutes of power from a genuine maximal effort in the last 12 months, divided by your body weight. It reads rides with a power meter only.
• From runs with heart rate. How fast you ran for how much of your heart-rate reserve you used, read on the best 12 minute window of each run. It needs a resting heart rate from Apple Health.

A percentile then places your estimate against people your age and sex, using the lab-test reference values above (Kaminsky 2015). Since VO2max is an estimate, the percentile is shown as a range. Both estimates and the percentile are on the Body tab, which is free. The full formulas are on the method page.

Plans that fit

The 5K / 10K plan is 3 runs a week beside your strength plan. Most of the running is easy, with a heart rate ceiling when your heart rate is set, plus a long run and 1 key run that builds to strong 5 minute reps. Durability adds 2 short sessions a week of calves, single-leg work, jumps, hips, and trunk, which suits runners and riders who want sturdier legs under the extra running. The details are on the plans page.