The [almost] unbelievable effects of a high maximal aerobic capacity on all-cause mortality

Everything you need to know about VO2 max

Peter Attia

Read Time 16 minutes

A “Goldilocks principle” applies to many health metrics – going either too low or too high can increase the risk of disease and mortality. For instance, when blood pressure is too high, it is a risk factor for heart attacks and strokes, but when too low, it increases the risks of blood clots and fainting. But the Goldilocks rule certainly has exceptions, and with respect to longevity, one of the most notable of these exceptions is maximal aerobic capacity – known as VO2 max. 

Not only has it been shown that increasing VO2 max is associated with a monotonic risk reduction in cardiovascular mortality, but increasing VO2 max is also associated with a monotonic risk reduction of all-cause mortality (ACM) at any age.

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  1. Been following this line of literature for 2 years. Incorporated 200-300 minutes Z2 and VO2Max training into my already 10 hours a week of resistance training. What a difference. Did a VO2Max test a week ago and scored a 53. Very pleased with that result.

    • I am a long time triathlete using Apple Ultra, Garmin 965, and Oura ring as sensors. I’ve also had multiple vo2 max tests done over the past 35 years, the last ones via a academic sports medicine physician – both bike and run test – which were pretty similar in values although run is usually a little higher than bike. The Apple said it was 42, Garmin 59, and the Vo2 max test was 54. So, not very good accuracy, especially with Apple. I think Garmin has improved their algorithms lately, but the other tests listed above by Dr. Attia like 1.5 mile run, 1 mile walk, etc are probably more accurate than the current smart watches, if less precise. The trends may be of some value, however – that is, going up, steady, or going down.

  2. While I understand that a smart-watch based VO2max measurement cannot be highly accurate is, e.g., the VO2max “estimate” (my word) in the Apple Watch Health app a reasonable indicator of the wearer’s VO2max level?

  3. I was wondering… if my VO2Max is 42 on a running treadmill and 48 on a stationary bike, which one should I use?

  4. Some training devices (rower, assault bike) have wattmeter. For an average Joe like me can I correlate power output with VO2 max? Or zone 2?

  5. I understand the need to develop a fit VO2 max, through zone 4/5 interval training (SIT). your emphasis on zone 2 training and aerobic base makes no sense to me because: i) at my age (70) longer intervals of training at a lower heart beat only exacerbates issues I have with joint and soft tissue pain; and ii) you state that there is a relationship between improving aerobic base and VO2 max but you never define that relationship.

    You refer to a graphic metaphor of a pyramid with a wide base, and more accumulated effort “under the curve.” But training is not an Egyptian engineering problem, or an integration test.

    I understand that form must be efficient during interval training, but I can focus on improving my form during interval training without improving form during zone 2 training.

  6. Similar to above questions.
    How should we interpret the Garmin Connect VO2 max calculations based on power meter and HR data?

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