VO2 Max: not just for athletes!

In our quest for healthspan, we often overlook the importance of physiological measures such as VO2 Max, a number mainly only associated with high-level athletes. Yet, this data has profound implications for our health and longevity. Let’s together overview the science behind VO2 Max and its impact on mortality rates.


The VO2 Max, or maximal oxygen consumption in ml/kg/min, represents the maximum amount of oxygen your body can use when pushed to its limit. It is a crucial indicator of cardiovascular fitness and endurance. The process involves the respiratory system, blood circulation, and mitochondria, which work in tandem to provide and utilize oxygen.

VO2 Max values can vary significantly from one individual to another, with top-level athletes displaying values above 90 ml/kg/min, while older people may have values below 15 ml/kg/min. Aging has a gradual impact on the functioning of all organs involved in the supply and use of oxygen, which affects your VO2 max.


A study conducted by Mandsager et al. in 2018, involving more than 122,000 patients, highlighted a clear link between VO2 Max and all-cause mortality. The participants, with an average age of 53 years, were divided into five groups based on their VO2 max score: low, below average, above average, high, and elite.

JAMA Netw Open. 2018;1(6):e183605. doi:10.1001/jamanetworkopen.2018.3605

The results are striking. A clear trend shows a direct relationship between the level of physical fitness (measured by VO2 Max) and all-cause mortality. The largest gap was observed between the bottom 25% (low physical fitness) and all other groups. Simply moving from the “low physical fitness” category to the “below average” category results in a 50% reduction in mortality over 10 years. This improvement in physical fitness is absolutely achievable for the vast majority of the population with minimal, well-structured and specific training (subject for a future article!). The benefits continued to increase each time the level of physical fitness improved.

JAMA Netw Open. 2018;1(6):e183605. doi:10.1001/jamanetworkopen.2018.3605

It is remarkable to note that the risk of mortality difference between the low fitness group and the elite group was reduced by a factor of 5X, which corresponds to a 500% difference. To put this substantial figure in context, let’s compare it to the increase in mortality risk associated with certain health problems.

For example, smoking leads to a 41% increase in mortality over a decade. Coronary heart disease increases this risk by 29%. Diabetes and high blood pressure increase mortality by 40% and 21% respectively. The most significant mortality factor among these health issues, end-stage renal failure, leads to a mortality increase of about 180%.

Comparing these figures to the 500% mortality difference between the low fitness groups and the elite groups, the impact of improving physical fitness, and therefore VO2 Max, on extending life is quite clear. In fact, the decrease in mortality associated with moving from weak cardiorespiratory fitness to above-average fitness is comparable to the mortality risk associated with end-stage renal failure!


With age, VO2 Max naturally decreases, even if we maintain a constant level of physical activity. Sorry, it’s just like that! Studies indicate that VO2 Max decreases by about 10% per decade after the age of 30 or 40. This decrease can be attributed to physiological changes, such as a decrease in cardiac function and muscle mass. In other words, the higher we start from, the less our decline affects our functional level in the last decades of our life.

Front. Biosci. (Landmark Ed) 2018, 23(8), 1505–1516; https://doi.org/10.2741/4657

This graph illustrates it well. The dotted line represents the functional threshold for being independent, i.e. a VO2 Max of 17.5 ml/kg/min and a grip strength of 30kg for men and 18kg for women. With my patients, I aim well beyond simply being independent, so this graph is the absolute minimum. We see that a trained individual drastically delays this functional decline. The good news is that it’s never too late to start.


In the grand scheme of health and longevity, VO2 Max plays an indispensable role. It is a crucial indicator of the physiological health of your body and your healthspan. By understanding its importance and adopting measures to improve it, you can actively contribute to your well-being.