VO2 Max

Compelling epidemiological data: the Mandsager et al. study (2018, JAMA Network Open) with 122,007 patients who performed exercise testing confirmed that VO2 max is the most powerful predictor of mortality — going from the 25th to the 75th percentile reduces risk of death by 60%, and from low to elite reduces 80%. There is no upper limit identified: the higher the VO2 max, the better the prognosis.

Normative values by age and sex (Cooper Institute, ml/kg/min):

Men 30-39: <30 very low, 30-40 average, 41-50 good, >50 excellent, >57 athletic Men 50-59: <26 very low, 26-32 average, 33-39 good, >40 excellent Women 30-39: <26 very low, 26-33 average, 34-40 good, >40 excellent Women 50-59: <22 very low, 22-28 average, 29-35 good, >35 excellent

Measurement methods: Gold standard: cardiopulmonary exercise test (CPET) with gas analysis. Available in hospitals and specialised sports centres. Price: €100-250. Submaximal estimation: 1.5-mile tests, Rockport walk test, formulas with heart rate reserve. Less accurate but useful for follow-up. Wearables: Garmin, Apple Watch, Polar estimate VO2 max with algorithms based on HR + running pace. Reasonably reliable as a trend, less so as an absolute value.

Improvement strategies: Norwegian 4×4 HIIT: 4 min at 90-95% HRmax + 3 min recovery, repeated 4 times. 2-3 sessions/week. Most documented VO2 max improvement protocol (+15-20% in 8 weeks). Structural Zone 2: 3-4 sessions/week of 45-90 min at 60-70% HRmax. Improves the aerobic base on which HIIT adds peaks. 80/20 polarisation: 80% Zone 2 training, 20% HIIT. Optimal distribution for elite athletes and applicable to non-athletes.

Longevity goal: reach and maintain percentile >75 for your age and sex. Each sustained 1 ml/kg/min VO2 max increment is associated with measurable cardiovascular risk and mortality reduction.