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The Naturally Aspirated Engine

The Link Between VO2 Max and Lifelong Vitality

May 26, 2024

Abstract:

1. Maximal oxygen uptake or VO2 max is the maximum (max) rate (V) of oxygen (O2)  that your body can absorb and use during exercise 

2. VO2 max is widely regarded as one of, if not the most, important indicators of longevity. In fact, each single unit increase in VO2 max is correlated with a 45-day extension in life expectancy

3. Being in the lowest quartile of VO2 max is comparable or greater than the risk associated with heart disease, smoking or diabetes!

4. If we think of cardiovascular fitness as a pyramid, the height of the pyramid represents VO2 max. If the objective is to build as tall a pyramid as possible, we need to implement a strong, stable foundation

5. Foundational aerobic fitness should focus on Zone 2 cardio - (i.e. cardio where you could hold a conversation but don’t particularly want to). 80% of the cardio exercise we do should focus on Zone 2 cardio - beginners should aim for an hour a week, with more seasoned individuals implementing 3 hours a week

6. In addition to Zone 2, at least one bout a week should be focused on high intensity interval training. One of the most highly regarded methods to improve VO2 max is the Norwegian 4×4 Interval Training Protocol. Here the recommendation is to perform an aerobic exercise (running, rowing, bike, etc.) aiming for the highest intensity you can sustain for a full 4 minutes. Follow this with 3 minutes of very light exercise. Complete this cycle 4 times (25 minutes)

This week in ‘The Espresso’ - why the 10,000 hours rule is misleading and 3 steps to become more decisive.

VO2 max has been hailed as the international ‘gold standard’ of aerobic fitness used to evaluate cardiopulmonary function. In order to get an accurate reading you would need to go to a exercise lab - but there is an easier way known as the Cooper Test. It’s essentially running as far as you can in 12 minutes and inserting the distance you ran into a formula to derive your VO2 max.

Ok - so how does this relate to longevity?

Well a study performed by Mandsager and colleagues in 2018 assessed the all-cause mortality (death by any cause) and cardiorespiratory fitness in patients undergoing treadmill training. Essentially:

  • The experiment tested the VO2 max of 122,000 patients, with an average age of 53 years

  • Patients were then ranked based on their scores as follows:

    • Low - scoring in the bottom 25th percentile

    • Below average - between 25th and 50th percentile

    • Above average - between 50th and 75th percentile

    • High - between 75th and 95th percentile

    • Elite - top 5% of scores

  • Each of the Low to High brackets accounted for c. 30,000 participants with the Elite group holding little over 3,500

THE RESULTS

  1. There is a monotonic relationship between fitness and mortality - this means that although not linear, any improvement in fitness results in a drop in risk for all-cause mortality

  2. Whats most interesting is that the biggest gap lies between those categorised as ‘Low’ fitness and all groups above them

    Risk-Adjusted All-Cause Mortality (Hazard Ratio) by Performance Group

THE KEY STATS:

  • Going only from the Low to Below Average group results in a 50% reduction in mortality over a decade

  • If you go from Low to Above Average - its about a 60 to 70% reduction

  • The lowest improvement is from High to Elite, although it is still statistically significant

The authors of the study put these differences in the context of other things commonly understood as problematic for mortality - things such as smoking, coronary artery disease, diabetes, etc.

Cormobidity and Performance Group Comparison (Adapted)

Lets take a look at the data as here’s where things get REALLY interesting. For example, smoking presents a 41% increase in mortality over a decade, diabetes 40%, high blood pressure 21%, etc.

By comparing these figures to the mortality improvements in fitness levels, you can see just how crucial cardiovascular fitness is towards improving mortality.

If you look at the biggest driver of mortality, which would be end-stage renal disease in this cohort, it’s the same mortality risk (178% vs 175%) as someone in the Low bracket vs. someone in the Above Average group.

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Cardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit.

What this means is that being fitter is REALLY good for your health at every level and there’s ALWAYS room for improvement.

So, how can we max our VO2 max?

Think of your overall cardiovascular fitness as a pyramid - the larger your pyramid the better.

We can think of the height of the pyramid being representative of your VO2 max and the base of the pyramid being general aerobic capacity.

We know then, in order to build a tall pyramid, we need to build a huge stable base first.

THE FOUNDATION

In order to build a solid, stable base - it is suggested that 80% of the work you dedicate to cardiovascular fitness be allocated to so called ‘Zone 2’ cardio. Let’s keep it simple and give you only what you need to know:

  1. Zone 2: Generally classified as ‘light’ cardio, sustainable for long distances with basic exertion of effort

  2. Effort: Aim for between 60-70% of max heart rate - but an even easier measure is a set a pace that you should be able to hold a conversation at, but wouldn’t particularly want to

  3. Frequency: If you are just starting out, 2 bouts of Zone 2 cardio a week, for 30 minutes each would be a good start. The minimum effective dose for more trained individuals is closer to 3 hours of Zone 2 per week

Interestingly, it has been suggested that improvements in cardiorespiratory fitness in response to exercise training varies greatly between individuals with some people responding well or very well and others having only mild improvements (“low-responders") following similar exercise.

In order to ensure we don’t become a ‘low-responder’, we can introduce variance into the exercise regimen. We do this by fluctuating the type of cardio from steady state Zone 2 to high intensity interval training (HIIT) or Zone 5.

HIIT has been shown to significantly improve VO2 max even at shorter durations due to the nature of the exercise recruiting aerobic and anaerobic energy systems, thereby increasing the intensity of the workout and cardiovascular stress and thus generating the adaptations. In general, increasing workout intensity, alongside adjusting frequency or changing modes of exercise aids in overcoming the ‘non-response’.

Association between exercise dose and peak VO2

HIIT is infinitely variable - meaning the intensity, duration, number of intervals, recovery, etc. can come in so many different forms, so here’s a few tips to help shape your protocol:

  • Pick a form of exercise and structure your HIIT in a way that you are able to remain consistent with it - this is really the key, everything else goes out of the window if you can’t stick to it

  • Try to implement longer duration intervals (3 to 8 min.) rather than shorter 20-30 second intervals

  • Periods of rest should be around the same duration as the exercise portion - can be active recovery at VERY low intensity or pausing to rest entirely - the objective being to clear lactate and allow the heart rate to decrease

  • If you are a beginner to cardio or have a significant excess weight, use safer forms of exercise (cycling, rowing, etc.) and start with the foundational protocol to build up some aerobic capacity

THE NORWEGIAN 4X4 PROTOCOL

According to Dr. Rhonda Patrick, the Norwegian 4×4 Protocol is the gold standard method for improving VO2 Max - it follows a fairly simple yet gruelling structure.

  1. Intensity: 4 minutes on for the highest intensity you can SUSTAIN for the full minutes. That means if you’re needing to slow down in between, you’re going too hard. For you heart rate monitoring junkies, this will likely be between 85-95% of your max heart rate

  2. Recovery: 3 minutes of active recovery (very light exercise), reeling the intensity all the way in but remaining active

  3. Repeat: Complete the 4-minute interval followed by the 3-minute recovery a total of 4 times 

Ensuring that you retain regularity with the intensity and recovery (i.e. are not changing the pace) - its a great protocol for making measurable improvements.

Implementing this protocol into your regimen at least once a week, alongside some Zone 2, will ensure you see consistent improvements.

to keep you going

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