Sports Medicine

Maximal VO₂: a guide to understanding your health and performance

8 min read

What is VO₂max and why should it matter to you?

This number speaks indirectly about our capacity to breathe, and about how our muscles, heart and lungs work together to transport and use the oxygen needed during physical activity.

In short, VO₂max is a comprehensive indicator of our cardiac health, lung capacity, muscular strength and metabolism.

A few facts about VO₂max:

• In general, the higher your VO₂max, the better your health. Values above 35 mL/Kg/min allow us to maintain an active life without difficulty.
• VO₂max reaches its highest point in young adulthood and from age 30 declines progressively — around 10 % per decade in people who do not train. In master athletes who maintain their training volume, that decline is 5 to 6.5 % per decade: close to half. In fact, how much is lost depends more on training than on age: 54 % of that difference in men and 39 % in women is explained by how much their training volume changed.
• Exercise can readily improve the VO₂max of an untrained person. Raising it by as little as 3.5 mL/Kg/min can substantially reduce the risk of metabolic disease, heart disease, cancer and death.
• Regular physical exercise, particularly cardiovascular exercise, can increase VO₂max by 10% in just three months. Although trained people have a stable VO₂max, they can improve other aspects of their respiratory capacity.
• High-performance athletes in disciplines such as cycling, athletics or triathlon often have a VO₂max above 60 mL/Kg/min.
• Having a high VO₂max is not enough on its own. Although it is a crucial indicator, a high aerobic capacity does not immediately guarantee sporting results. Exercise is essential.
• Not training, or leading a sedentary lifestyle, can cause your VO₂max to decline gradually. This has a negative effect on your physical capacity and your health.

How is VO₂max measured?

A person is usually put through a controlled, progressive effort while the amount of oxygen inhaled and carbon dioxide exhaled is measured.

There are two main approaches to measuring this capacity to consume oxygen:

• Direct methods: they use masks that assess gas exchange while high-intensity exercise is performed progressively.

• Indirect methods: they estimate VO₂max through formulas based on factors such as age, gender, exercise level and other variables.

Direct methods are the most precise for measuring VO₂max. For a long time, however, access to them was restricted to high-performance athletes in a sports laboratory or clinical setting, because of the high cost of the equipment, the technology it requires and the need for experts.

Fortunately that situation has now changed. It is increasingly easy to find services offering high-quality, precise direct measurements to a wider public.

Indirect methods have been used as an option in the face of the complexity of direct methods. Their precision is limited, however, because the equations they use are valid only for populations similar to those of the original study. This makes it hard to apply those equations reliably to most people.

Smart sports watches, for example, often use equations to estimate athletes' VO₂max. The problem is that their margin of error can be 10% to 20%, which makes the data less than fully reliable for proper assessment and follow-up.

In tests using direct methods, the athlete performs whichever exercise best suits their capacity, such as running or cycling, and does so progressively up to maximal effort. This guarantees a precise, reliable measurement of VO₂max, which can be fundamental for understanding and improving physical endurance and health in general.

Who should have a VO₂max test?

Today, measuring VO₂max is regarded as a vital indicator for men and women of any age and physical condition.

Although it is thought of as a test for high-performance athletes, in reality everyone who is regularly physically active should consider having this measurement.

How often the test is repeated will depend on each person's goals, their exercise plan and the advice of their coach or sports physician.

How is the VO₂max test performed?

Taking a VO₂max test involves cycling or running. Behind that simple process there are preliminary steps to establish the person's state of health and set the conditions for the test.

Here we explain it step by step:

• Initial health assessment: before starting, the athlete completes a questionnaire, and a resting electrocardiogram is performed to ensure they are in optimal condition for the test.
• Preparation: the athlete is fitted with the necessary devices, such as the mask for analysing oxygen uptake and a heart-rate sensor. These are synchronized with the cycling equipment or the treadmill to be used during the test.
• Warm-up: it begins with a gentle 3 to 5 minute warm-up, and the details of the test are explained to the athlete.
• Measurements during the test: various parameters are measured continuously. These include heart rate, perceived exertion, oxygen uptake (VO₂), ventilation and biomechanical aspects. Depending on the test, power in cycling or speed and pace in running is also included.
• Progressive increase in effort: the effort starts gently and is increased progressively until maximal effort is reached.
• Ending: the test concludes when the athlete reaches maximal effort, or when the assessor decides to stop it for medical or technical reasons.
• Cool-down: a 5-minute cool-down is performed, and initial results are given.

What do VO₂max results mean?

The results obtained in the test are reviewed by a sports physician, who provides valuable data, including:

• Physical capacity, or VO₂max: that is, the level of maximal oxygen uptake reached during the test.

• Respiratory thresholds (VT1 and VT2): critical points for planning your training and competitions, and for assessing the impact of your physical preparation.

• Specific heart-rate zones: defined according to your actual response during the test, not in theory.

• Estimated power zones or paces: key markers for your training.

• Recommendations: advice unique to you, to help you reach your goals and improve your athletic performance.

What are the restrictions on a direct VO₂max test?

Measuring VO₂max is a valuable tool for anyone who is physically active. It provides a comprehensive assessment of health, of the cardiac response to exercise and of the training plan. Even so, it is important to bear in mind some restrictions before undergoing the test:

• Serious cardiac problems: those with a history of serious, uncontrolled cardiac problems may not be suitable for maximal-effort tests such as VO₂max measurement.
• Respiratory problems: people with severe chronic respiratory disease may experience difficulty during the test.
• Uncontrolled hypertension: uncontrolled high blood pressure can increase the risk of complications during a physical capacity test.
• Recent injuries: in the case of a recent injury or surgery that prevents vigorous exercise, it is advisable to wait until recovery before taking the test.
• Pregnancy: VO₂max tests can be too intense during pregnancy, especially in the later stages.
• Advanced age: above all in older people who do not usually take vigorous exercise.
• Other medical conditions that may increase risk during exercise.

Before performing a VO₂max test it is essential that the sports physician assesses all of these conditions in order to weigh the risks and benefits. Making sure everything is under control is essential before undergoing this assessment.

At Biuman, our physician specialized in sports medicine accompanies you through every stage of the test — from the assessment you need beforehand, through support during the test, to calculating your VO₂ max and interpreting your results. We also have state-of-the-art technology to measure your VO₂max on a bicycle or treadmill. Our aim is to optimize your training and to have you understand your physical capacity thoroughly.

Book your appointment on WhatsApp at +57 3125382342 and discover with us everything your body can achieve!

Sources:

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Blair, S. N., Kohl, H. W., 3rd, Barlow, C. E., Paffenbarger, R. S., Jr, Gibbons, L. W., & Macera, C. A. (1995). Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA, 273(14), 1093–1098.

Gallo-Villegas, J. A., & Calderón, J. C. (2023). Epidemiological, mechanistic, and practical bases for assessment of cardiorespiratory fitness and muscle status in adults in healthcare settings. European journal of applied physiology, 123(5), 945–964. https://doi.org/10.1007/s00421-022-05114-y

Burtscher, J., Strasser, B., Burtscher, M., & Millet, G. P. (2022). The Impact of Training on the Loss of Cardiorespiratory Fitness in Aging Masters Endurance Athletes. International Journal of Environmental Research and Public Health, 19(17), 11050. https://doi.org/10.3390/ijerph191711050