If you read any health stories online, I can almost guarantee you’ve seen the buzzwords “resistance training,” “lean mass,” and “protein intake.” While growing your skeletal muscle mass is incredibly important for living a long, independent life, there’s one muscle in particular we need to remember: the heart.
Your heart’s health represents your cardiovascular fitness, and the best way to measure that is by testing for VO₂ max. Your VO₂ max is the maximum amount of oxygen your body can use during intense exercise. This metric indicates how efficiently your heart, lungs, and muscles work together to supply oxygen, making it a powerful indicator of athletic performance and, more importantly, longevity.
Worth sat down with Nicholas DiMeglio, a certified strength and conditioning specialist from Performance Optimal Health, to explain the importance of VO₂ Max for longevity and why you should test it.
How VO₂ Max is Measured & Why What You Choose Is Important
“The gold standard for testing VO₂ max would be the Bruce Protocol,” explained DiMeglio. The Bruce Protocol is where you run or walk on a “graded treadmill that increases speed and inclines across multiple stages. It’s the most accurate test we can do but requires access to lab equipment and a team of trained clinicians who can run the test and interpret the results,” he explained.
For this story, I had my own VO₂ max tested by Amy Julien at Longevity Westport by Dexafit using the Bruce Protocol. After a quick onboarding, she connected me to a metabolic cart with a face mask and chest heart rate monitor. Once I was all hooked up, we were off to the races.
As the test went on and my effort increased, the metabolic cart measured the amount of oxygen I inhaled and how much carbon dioxide I exhaled. The heart rate monitor assessed my cardiovascular efficiency. I ran until I hit my VO₂ max, which meant my body could no longer use extra oxygen to fuel my muscles, so it switched over to anaerobic energy sources, which resulted in lactic acid accumulation and that feeling of gasping for air.
I was happy to find out that my current training regime allowed my VO₂ max results to put me in a healthy standing for my age and gender, even though I never run and didn’t prep for the test. It made me wonder how I’d perform on a different modality.
My background is in rowing, and I still jump on an erg a few times a week. I questioned how using a treadmill rather than a rowing machine could have affected my performance. “Depending on your experience with certain exercise modalities, your results could vary based on the implement you use,” said DiMeglio. “If you’re a cyclist, your test results on a bike could look very different than if you run on a treadmill, so the person’s experience level should be considered when choosing which test to run,” he explained.
After I showed DiMeglio my results and spoke about my rowing, he asked for my recent best 2000m test time, gender, and body weight and input those numbers into Concept 2’s VO₂max Calculator for Indoor Rowing. The resulting numbers were more reminiscent of when I was competitive.
But why do these numbers matter beyond athletic performance?
How VO₂ Affects Your Longevity
Peter Attia has long preached the importance of VO₂ max testing and its connection to longevity. In an episode of his podcast, “The Drive,” he explained how there is a clear relationship between VO₂ max and all-cause mortality. Moving from a low VO₂ max (bottom 25th percentile) to a below-average level (25th to 50th percentile), you can lower your mortality risk by 50%. If you were to take it to an above-average level (50th to 75th percentile), you would have an even more significant risk reduction of around 70%.
Barbara Strasser and Martin Burtscher’s study, “Survival of the fittest: VO₂max, a key predictor of longevity?,” published in Frontiers in Bioscience-Landmark in 2018, strongly echoes Attia, stating, “[VO₂ max] is the strongest independent predictor of future life expectancy in both healthy and cardiorespiratory-diseased individuals,” regardless of either sex or race. The study also highlights that a higher VO₂ max is associated with a lower risk of chronic diseases, including cardiovascular disease, metabolic disorders, and certain cancers.
Furthermore, the American Heart Association has stated that “CRF (cardiorespiratory fitness),” as tested through VO₂ max, “is a stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus.”
But beyond survival, VO₂ max also plays a role in the quality of life over time, aka health span.
Strasser and Burtscher pointed out in their study that your VO₂ max declines by 7-10% per decade after age 30, accelerating in those who live a mostly sedentary lifestyle. However, research suggests that endurance training focused on expanding your VO₂ can slow this decline, allowing a trained 70-year-old to have the cardiovascular fitness of an untrained 50-year-old. This leads to an extended health span as mobility is preserved, enabling long-term activity and independence in advanced years.
Training Your VO₂ Max
By incorporating VO2 max training, you can maintain cardiovascular fitness and mitigate its inevitable decline into old age. But how do you train to support a healthy VO₂ max? DiMeglio detailed two main training options, depending on your wants and needs.
- Low-Intensity Steady State (LISS): This is one of the best and most sustainable ways to improve VO₂. Using standard cardio equipment (treadmill, stationary bike, rowing machine, etc.), you can create a periodized program to improve VO₂. The best way to progress is by increasing total time, distance, or speed. For this protocol, you should maintain a heart rate of about 60-70% of your max heart rate. Since this is a sub-heart rate max protocol, you can do this more frequently than other methods. LISS methods can be used 3-7 times per week. Beginners can start with 15-20 minutes per session and increase each session to 45+ minutes as they gain experience and improve their fitness levels.
- Interval-Based Training: Perform an exercise maximally for a short burst and then rest for a set amount of time. An example would be Tabata training, which is eight rounds of 20 seconds of work followed by 10 seconds of rest. This method takes significantly less time than the LISS method (typically 10-30 minutes) but is highly fatiguing, and the recovery takes much longer. This protocol shouldn’t be performed as frequently throughout your training week. To perform the interval method correctly, you must work within 85-100% of your maximal heart rate. You can use interval-based training 2-4 times per week. Beginners should start with 2x per week and monitor their recovery between sessions before increasing their frequency.
Tracking for Longevity
Now that my VO₂ max baseline has been set, I plan to add it to my annual physical to help keep track of my heart health as I age—beyond the typical cardiac blood tests. While cholesterol levels and blood pressure are necessary metrics, VO₂ max directly measures how well my body delivers and utilizes oxygen—a key factor in my longevity and health span.
“For anyone looking to live a healthier and more fulfilling life,” said DiMeglio, “a higher VO₂ max will make daily tasks much easier. Leaving you with more energy to spend with family and friends [over time].”
Improving my ability to run a mile or row 2000m means more than how fast I can do it. It indicates the health of my VO₂ max and my heart, which, in turn, makes it more than a fitness performance metric. Instead, it measures how well I prepare my body for a long, active, and independent life.
