Why VO2max is considered a key marker for performance today

For a long time, maximal oxygen uptake, or VO₂max for short, was primarily considered a performance parameter for endurance athletes. Today, it is increasingly becoming a focus of health and longevity research. The reason: VO₂max describes the performance of one of the most important systems in our body, the cardiovascular system, and is closely related to long-term health and physical aging processes. But what does this value actually measure, why is it being discussed more and more frequently in the context of longevity, and what possibilities are there to improve it specifically?

What VO₂max actually measures

VO₂max (maximal oxygen uptake) describes the maximum amount of oxygen that the body can take up, transport, and use in the muscles for energy production during intense physical exertion. It is usually expressed in milliliters of oxygen per kilogram of body weight per minute (ml/kg/min).

Physiologically, VO₂max reflects the performance of several systems:

- oxygen uptake in the lungs
- transport via the heart and circulatory system
- oxygen binding in the blood
- oxygen utilization in the mitochondria of the muscles

VO₂max thus describes the maximum capacity of the body for aerobic energy production. The higher this value, the more efficiently the organism can provide energy through oxidative metabolic processes – a central factor for endurance performance.

VO₂max as a marker for cardiorespiratory fitness

In sports physiology, VO₂max has been considered one of the most important parameters for assessing cardiorespiratory fitness for decades. It shows how efficiently the interaction of the heart, lungs, and muscles works under stress.

In recent years, however, it has become clear that this value is not only relevant for athletic performance. Numerous epidemiological studies indicate that high cardiorespiratory fitness is associated with lower overall mortality and a lower risk of cardiovascular disease.

A large-scale study by the Cleveland Clinic with over 120,000 subjects, for example, showed that high fitness – measured by maximal exercise capacity – is associated with a significantly reduced mortality rate. It was particularly striking that the difference between low and high fitness was greater than that of many classic risk factors for cardiovascular disease.

VO₂max is therefore increasingly considered one of the most robust physiological markers for long-term health.

Relationship between VO₂max and aging processes

Another reason for the growing attention is the connection between VO₂max and biological aging processes.

With increasing age, maximal oxygen uptake naturally decreases. Studies show that without regular training, VO₂max decreases by an average of about 5 to 10 percent per decade.

Several physiological factors contribute to this decline:

- a reduced maximum heart rate
- lower stroke volume performance of the heart
- loss of muscle mass
- decreasing mitochondrial capacity
- changes in oxygen transport in the blood

This decline reflects central aspects of physiological aging. At the same time, numerous studies show that regular endurance training can significantly slow down this process. Well-trained older people often achieve VO₂max values that are significantly higher than those of untrained younger individuals.

VO₂max and the concept of Athletic Longevity

In the context of Athletic Longevity – i.e., the long-term preservation of physical performance over many decades – VO₂max plays a central role.

Athletic Longevity describes the goal of maintaining athletic performance, mobility, and physical resilience for as long as possible. The following physiological factors are particularly in focus:

- an efficient cardiovascular system
- efficient energy production in the muscles
- stable regeneration capacity
- metabolic health

Since VO₂max directly reflects the performance of the cardiovascular system, it is increasingly regarded as a kind of global fitness marker. Some longevity researchers even refer to it as one of the most important "vital signs" of physical performance.

How to improve VO₂max

Although genetic factors determine part of the maximally achievable VO₂max, this value can be significantly influenced by training.

Training forms that intensely challenge the cardiovascular system are particularly effective.

High-Intensity Interval Training (HIIT)

Several studies show that high-intensity interval training is particularly effective in increasing VO₂max. A frequently studied protocol consists of four-minute exercise intervals close to the maximum heart rate, followed by active recovery phases.

Moderate Endurance Training

Continuous training with moderate intensity – such as running, cycling, or swimming – also improves aerobic capacity and increases VO₂max in the long term.

Strength Training and Muscular Adaptation

Although strength training does not primarily aim at VO₂max, it can indirectly contribute to its improvement, as greater muscle mass and better neuromuscular efficiency improve metabolism and resilience.

The decisive factor here is above all training continuity over longer periods.

Common misconceptions about VO₂max

Despite its scientific importance, VO₂max is often interpreted in a simplified way.

A common misconception is that a high VO₂max value automatically guarantees good health. While high cardiorespiratory fitness is a strong health indicator, it does not replace other factors such as diet, sleep, or metabolic health.

Another misconception concerns the measurement itself. Many fitness trackers and smartwatches now provide VO₂max values. However, these are mostly based on estimation algorithms that analyze heart rate and speed during training. The most precise determination is still made via spiroergometric performance diagnostics in the laboratory.

Finally, it should be noted that genetic factors also determine the maximally achievable VO₂max. Training can significantly improve the value, but within individual physiological limits.

VO₂max has evolved from a classic performance parameter in endurance sports to an important marker for health and long-term physical performance. It describes the body's maximum capacity for aerobic energy production and reflects the performance of the cardiovascular system.

In the context of longevity and athletic longevity, this value is becoming increasingly important, as it is closely linked to metabolic health, cardiovascular fitness, and the biological aging process.

Regular training can help to improve or at least stabilize VO₂max – and thereby support not only athletic performance but also long-term health.

Sources

Blair, S. N. et al. (1996). Physical fitness and all-cause mortality. A prospective study of healthy men and women.JAMA.

Myers, J. et al. (2018). Cardiorespiratory fitness and mortality risk: An analysis of more than 120,000 patients.JAMA Network Open.

Bassett, D. R., & Howley, E. T. (2000). Limiting factors for maximum oxygen uptake and determinants of endurance performance. Medicine & Science in Sports & Exercise.

ACSM – American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription.

Joyner, M. J., & Coyle, E. F. (2008). Endurance exercise performance: The physiology of champions. Journal of Physiology.

Hawkins, M. N. et al. (2007). Aging and aerobic capacity: Changes in VO₂max with age. Journal of Applied Physiology.

Garber, C. E. et al. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory fitness. Medicine & Science in Sports & Exercise.