Want To Live A Longer Life? You Need to Understand V02 Max And How To Improve It

The physiology and benefits of a high V02 max.

V02 Max is the variable most closely related to longevity.

Sure, longevity is a complex multifactorial process with a good sprinkling of luck involved.

However, those with the highest V02 Max tend to have the lowest risk of dying early compared to those with low V02 Max levels¹.

But what is V02 Max & How Can You Improve It?

V02 Max is, by definition:

“The maximum rate of oxygen consumption attainable during physical exertion.”

First, we need to do a little math, and as my 3-year-old son likes to say when he’s jumping off the bed, “Don’t get scared now”.

Scary eh…

It’s not. Let’s break it down to make it simple.

Q = Cardiac Output (CO) => How Much blood is ejected from your heart multiplied by your heart rate.

CO = Stroke Volume X Heart rate.

Stroke volume is the amount of blood ejected from the heart on each beat.

If you want to increase V02 max, you need to increase this number.

We will discuss the scarier (C_aO₂ – C_vO₂) another day, but the simple answer is improved mitochondrial efficiency and increased blood vessel formation.

Cardiac Output

In simple terms, this is how much blood you can get to shoot out of your heart over a set time period.

More blood. More oxygen.

More oxygen. More fuel.

More fuel. More energy to…. do the work.

Let’s focus on Stroke Volume - The amount of blood that leaves the heart on each beat.

During each heartbeat, the heart will relax to fill (Diastole) and then squeeze to contract (Systole).

It doesn’t take a rocket scientist to figure out that if you want to eject more blood from the heart, you need to fill it up with as much blood as possible when it relaxes (Diastole).

Therefore, you need to make the heart's main pumping chamber bigger (dilate) to accept all that blood before it shoots out.

How do you do that?

Simple. You do things that dilate your heart to its maximal capacity.

Then you do it again.

And then again, for years, and years, and years and years.

The reason V02 max is such a great predictor of longevity is because it is a measure of decades of activity rather than a 3-week ‘health kick’.

Let's look at the hearts of a range of elite athletes - endurance versus weightlifters.

In a study that did this, the average control (non-elite athlete) had a V02 max of 44.5 ml/Kg/min and a left ventricular size (LVEDD) when fully relaxed of 5.19 cm².

Not bad.

But the elite athletes?

• Endurance - V02 Max 74.7 ml/Kg/min & 5.72cm LVEDD

• Weightlifters - V02 Max 45.3 ml/Kg/min & 5.29cm LVEDD

The endurance athletes have significantly higher V02 max and left ventricular dilation figures than the controls or the weightlifters.

i.e. their hearts are more dilated to eject more blood, which translates into a higher V02 max.

There is a clear relationship between exercise training, increased left ventricular volumes (dilation) and V02 Max³.

The above graph shows the continual increase in V02 max and left ventricular volumes with training over a 3-year period.

Some studies have even demonstrated a doubling of cardiac volume in those training from a novice baseline to world-class standard⁴.

But What Type Of Training?

The quickest way to increase V02 max is interval training⁵.

But it’s not the best way of achieving a very high V02 max.

Let me explain.

Interval training will increase V02 max, but it will be a quick bump in your overall aerobic fitness and is often referred to as ‘sharpening’.

But to achieve substantial increases that are sustained over time, you need to build your aerobic base.

As the line goes, if you want to build a big pyramid, you need a really big base.

And to build that aerobic base, you must do endless reps of dilating your heart to its maximum dimensions to eject the most amount of blood per heartbeat.

i.e. Increase Stroke Volume.

But what activity level is that at?

Stroke volume and left ventricular dilation are at their maximum between 40 - 60% of V02 Max⁶.

Above 60% of V02 Max, stroke volume decreases, and the heart does not reach its full dilation capacity (LVEDD).

For most people, 40 to 60% of V02 Max is a relatively low intensity.

Usually a good big serving of Zone 1 and some Zone 2.

As you train these zones, your resting heart rate will decrease.

Therefore, for each heartbeat, your heart will fill even more, and the heart will dilate even more.

This intensity is where most people should be spending most of their time.

Nice and easy.

For most people, even going for an easy run will take them out of this zone, so don't be afraid to walk fast or cycle easily.

Lots and lots and lots of that.

This is not to say that interval training does not play a role in increasing V02 max, but it should only occupy about 5-10% of your training time per week and is also best kept for those ‘sharpening’ periods when performance needs to be optimised.

For interval training, many variations have shown benefit, but a good approach if you have a reasonable degree of fitness are 4X4 repeats.

After a warm-up, you do 4 minutes of very hard intensity with about 3 minutes of active recovery. Repeat this four times and do a warm-down.

Doing this once per week is usually sufficient.

For aerobic base building, do as much as possible.

Lots and lots of volume.

Lots and lots of reps at a low intensity to get that heart dilated to its maximum capacity.

Measuring V02 Max

This is one of the most common questions I get, and I break it down this way.

If you are doing all of this for fun and don’t plan on taking it very seriously, you can do a Cooper Test to work out your V02 max.

All it takes is 12 minutes and a simple Google search for the calculator to input how far you ran over these 12 minutes, and your V02 Max will be calculated.

To be fair, it’s pretty good.

But if you are serious about this, you need to do a formal V02 max test as part of a cardiopulmonary exercise test with a metabolic cart.

These tests are available in most sports medicine or universities. Just search for one in your area, and you will find a centre that does them.

Summary

V02 max is the marker most closely linked to longevity.

Building your V02 max to high levels is a lifelong endeavour.

To do this, you must build a BIG aerobic base by repeatedly dilating your heart to its maximum dimensions, usually at an activity level of 40-60% of your V02 max, which is generally an easy level of activity.

Do that repeatedly.

Over decades.

And you win the game.

1. Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex. J Am Coll Cardiol. 2022 Aug 9;80(6):598-609.

2. A comparative study of left ventricular structure and function in elite athletes. Br J Sports Med. 1991 Mar;25(1):45-8.

3. Impact of cardiac remodelling on physical fitness measured by VO2 max in preadolescent and adolescent endurance athletes, European Heart Journal, Volume 41, Issue Supplement_2, November 2020, ehaa946.3125,

4. https://www.iat.uni-leipzig.de/datenbanken/iks/ta/Record/4009275

5. VO2max trainability and high intensity interval training in humans: a meta-analysis. PLoS One. 2013 Sep 16;8(9):e73182.

6. A review of the stroke volume response to upright exercise in healthy subjects. Br J Sports Med. 2005 Apr;39(4):190-5.