Breath of Fresh Fitness: Improving Mortality and Unlocking Your Potential with VO2 Max Testing

VO2 max testing involves exercising on a treadmill or stationary bike while your oxygen consumption and carbon dioxide production among other biometric data are measured, reflecting your aerobic capacity and cardiovascular fitness. Several studies show higher risk of not only death from heart problems, but also all-cause mortality in people with lower fitness levels as measured by VO2 max testing (Kunutsor et al., 2017, Grazzi et al., 2014, Chiaranda et al., 2019). A study involving chronic heart failure patients indicated that a 6% increase in VO₂ max was associated with a 5% lower risk of all-cause mortality and an 8% lower risk of cardiovascular mortality or heart failure hospitalization (Swank et al., 2012). An analysis of 1491 cardiac patients found that higher percent-predicted VO₂ peak values were associated with better survival rates. Each 1% increase in percent-predicted VO₂ peak resulted in a 3% improvement in survival (Chiaranda et al., 2019).

VO2 MAX TEST PROCEDURE

The test involves exercising on a treadmill or stationary bike while your oxygen consumption and carbon dioxide production are measured, reflecting your aerobic capacity and cardiovascular fitness. The intensity gradually increases until exhaustion (it is hard work!), providing data on your maximum oxygen uptake. The validity and reliability of these measurements are well-supported across various populations, including those with chronic conditions (Langeskov-Christensen et al., 2014). Often, other biometric data is collected in concert including heart rate, rhythm and blood pressure – like a traditional cardiac stress test. 

KEY BENEFITS OF VO2 MAX TESTING

Precise Fitness Assessment and Tracking: VO2 max values offer a benchmark to compare with peers of similar age and gender, providing insights into and motivation for your cardiovascular fitness level and progress over time. Accurate measurements of VO2 max are considered the gold standard for assessing cardiorespiratory fitness (Poole & Jones, 2017). The reproducibility of these tests ensures consistent and reliable tracking of cardiorespiratory fitness (Brown et al., 1985). Again, VO2 max improvement has been shown to improve not only health span but also life span, so this is why we should care even if you aren’t a fitness junky.

Optimize Training Program Design: Understanding your VO2 max helps in tailoring your training zones (e.g., aerobic, anaerobic, recovery). This ensures that you train at the optimal intensity to achieve your fitness goals, such as endurance and speed, enhancing overall performance (Midgley et al., 2006). There are a few different approaches to the numbering of the zones, but for the purposes of this article we will assume 5 zones for heart rate and provide a general guideline for training zones and their corresponding durations to enhance training and, depending on the zone, VO2 max below. Important to note that while certain zones are roughly optimal for training, as Ben Greenfield discusses in his book “Beyond Training,” humans are not machines in that there is some overlap in which types of energy we burn and benefits between zones even if there is a predominant one to a given zone.

ROUGH ESTIMATE OF MAX HEART RATE

The most accurate and personalized way to know your max heart rate and calculate your optimal zones for different kinds of exercise is by performing a VO2 max test. However, if you had an injury for example that prevents you from using a treadmill or bicycle for VO2 max testing or are short on time, you and some smart devices can estimate your zones based on your age, gender etc. 

1. Basic Formula

The most widely used formula for calculating maximum heart rate is MHR=220−age. While the traditional formula 220−age, this is often used regardless of gender, some studies suggest slightly different formulas for men and women:

• For Men: MHR=220−ageMHR=220−age
• For Women: MHR=226−ageMHR=226−age
• Example: For a 30-year-old man, the estimated MHR would be 220−30=190 beats per minute (bpm).

Some researchers have developed gender-specific formulas to account for differences in cardiovascular physiology:

• For Men (Gulati et al. study): MHR=206−(0.88×age)MHR=206−(0.88×age)
• For Women (Gulati et al. study): MHR=206−(0.64×age)MHR=206−(0.64×age)

This formula is simple and gives a general estimate but may not be accurate for everyone, particularly those who are very fit or older.

2. Tanaka Formula

A slightly more accurate formula, especially for older adults, is the Tanaka formula:

MHR=208−(0.7×age)MHR=208−(0.7×age)

• Example: For a 50-year-old, the estimated MHR would be 208−(0.7×50)=173208−(0.7×50)=173 bpm​

3. Gellish Formula

Another method used for better accuracy across different age groups is the Gellish formula:

MHR=206.9−(0.67×age)MHR=206.9−(0.67×age)

• Example: For a 40-year-old, the estimated MHR would be 206.9−(0.67×40)=180.1206.9−(0.67×40)=180.1bpm .

TRAINING ZONE PURPOSES

1. Zone 1: Active Recovery
   • Intensity: 50-60% of Max Heart Rate (MHR)
   • Duration: Typically used for recovery sessions, not specifically for VO2 max improvement.
   • Purpose: Enhance recovery by promoting blood flow without significant stress.
2. Zone 2: Aerobic Endurance 
   • Intensity: 60-70% of MHR
   • Duration: 30-120 minutes per session
   • Purpose: Build aerobic base, improve fat metabolism, and enhance overall endurance (Seiler, 2006)
3. Zone 3: Tempo/Threshold
   • Intensity: 70-80% of MHR
   • Duration: 20-60 minutes per session
   • Purpose: Improve lactate threshold, allowing you to sustain higher intensities for longer periods (Billat, 2001)
4. Zone 4: VO2 Max Intervals
   • Intensity: 80-90% of MHR
   • Duration: 3-8 minutes per interval, with equal rest periods; total session duration 20-40 minutes
   • Purpose: Directly improve VO2 max by pushing the cardiovascular system to its limits. These intervals stress the heart and lungs, promoting greater oxygen utilization efficiency (Midgley, 2006).
5. Zone 5: Anaerobic Capacity
   • Intensity: 90-100% of MHR
   • Duration: 30 seconds to 2 minutes per interval, with longer rest periods; total session duration 10-20 minutes
   • Purpose: Increase anaerobic capacity and power, which indirectly benefits VO2 max by enhancing the ability to sustain high-intensity efforts (Laursen, 2002)

SAMPLE AEROBIC EXERCISE TRAINING PLAN

Important based on your medical history, injuries and training to create a tailored plan. Below is a sample plan: 

• Zone 2 
  • Zone 2 definition – 50-60% of Max Heart Rate calculated using above formula rough estimates, or via VO2 max testing.
  • Purpose is to build aerobic base, improve fat metabolism, and enhance overall endurance.
  • 45 minutes (can be 30 minimum- 60 min) per session for 1.5-2 hours per week. 
  • Examples of this could be a rowing machine, swimming, treadmill, biking etc. 
  • While 10 minutes at a time for example is enough for calorie burning or fat burning, this is not enough time for body to increase mitochondrial reserve generally which is why the longer intervals are recommended. 
• Zone 5 
  • Zone 5 definition – 90-100% of Max Heart Rate – this would be max heart rate sustainable for 3-8 minutes,  calculated using above formula rough estimates, or via VO2 max testing.
  • Purpose is to increase anaerobic capacity and power, which indirectly benefits VO2 max by enhancing the ability to sustain high-intensity efforts.
  • Intervals of 3-8 minutes interspersed with equal intervals of rest / light activity, to add up to a total of 15 minutes of Zone 5 max effort interspersed with 15 minutes interval of very light / restful activity. So the total time spent would be 30 minutes per week, made up of 15 minutes max effort and 15 minutes of light effort. 
  • Can be easier to keep timing of intervals and sustain specific heart rate range on a treadmill or stationary bike, in which case for example the max activity would be running and the light activity would be very light walking.
  • Of note, important to not do your weekly zone 5 on a day when you’re doing intensive strength training such as heavy weighted squats or deadlifts 

Tips for Effective VO2 Max Training

• Progress Gradually: Start with fewer intervals or shorter durations and gradually increase as your fitness improves.
• Monitor Intensity: Use a heart rate monitor to ensure you’re training in the correct zones such as an apple watch or whoop strap connected to your phone.
• Recovery: Ensure adequate recovery between high-intensity sessions to avoid overtraining and injury, especially zone 5 training.
• Consistency: Regular, consistent training is key to improving VO2 max (Bassett, 2000).

OPTIONS FOR LOCAL VO2 MAX TESTING

In the Bay Area, there are several options for focused VO2 max testing. Of course, there are places like Biograph, Human Longevity or Apeiron Life that provide somewhat of “Executive Physicals” that include VO2 max testing as part of a bigger package. Companies that have more focused offerings of VO2 max testing and sometimes other tests such as  Dexascans, Resting Metabolic Rate etc. (for another future article) include:

1. 1. DexaFit
      1. Single VO2 Max test: $129. 
      2. 4 Test Credits: $299 ($75 per test). 
      3. 8 Test Credits: $499 ($62 per test)
      4. DexaFit provides a comprehensive analysis that includes heart rate zones, aerobic/anaerobic thresholds, and metabolic efficiency. They cater to a wide range of clients, from athletes to those managing chronic conditions. 
   2. Custom Fit
      1. VO2 Max + RMR Test: $285
      2. 2 VO2 Max + RMR Tests: $499
      3. Custom Fit provides detailed VO2 max testing reports, which include information on heart rate zones, fitness level comparisons, and metabolic efficiency. Their approach ensures that each client receives personalized feedback to guide their training and nutrition. 
   3. Apeiron life

1. While Apeiron Life does executive / big picture physicals, they also have a select a-la-carte option for combo VO2 Max and DexaFit testing: $999

2. Uniquely, Apeiron Life during VO2 testing includes blood lactate measures. They can also establish personalized training zones using any of their protocols, and cater the testing to various fitness levels. 

CONCLUSION

VO2 max testing provides deep insights into physical capabilities and areas for improvement. The advanced technology and expert guidance ensure a thorough understanding of fitness levels, enabling tailored training regimens effectively. VO2 max testing, in particular, stands out as a crucial tool for anyone serious about optimizing their cardiovascular health and overall fitness.

I have no conflicts of interest to disclose. All information shared is for purposes of sharing education and knowledge. 

If you have feedback on this article or on future topics you’d like Dr. Maia Mossé to write about, or are interested in working with Dr. Mossé, feel free to message the team at [email protected] or via Instagram at @villagedoctor. 

Read Also: Unlocking Longevity and Vitality: The Power of Exercise

Maia Mossé, MD, August, 2024

 Call The Village Doctor at (650) 851-4747 or Contact us to learn more about the practice.