For those of you who were around in the early 2000s, you may recall Lance Armstrong’s name being mentioned enthusiastically as he mounted his pursuit of seven Tour de France wins.
His name was unmissable, even if you weren’t a fan of bicycle racing. His story of overcoming testicular cancer and ultimately dominating what is arguably one of the world’s most difficult athletic events inspired many. Through his foundation – LiveStrong – he raised millions to help fight cancer. A true American hero.
By now, we know that Lance and many of the top cyclists at the time were taking performance-enhancing drugs to help give them a competitive edge. However, during the peak of his career, Lance was thought to be a “freak of nature” with an anatomically advantaged body that, combined with an intense work ethic and muscular efficiency, gave him the winning advantage.
But there’s a part of his story that relates to cardiovascular wellness, and that is VO2 max. Below, we will explore VO2 max and its connection to heart health.
What is VO2 Max?
One of the metrics often cited when referring to Lance’s physiological gifts was his VO2 max. VO2 max is one’s ability to consume oxygen during intense exercise. Oxygen is like fuel for a body during anaerobically intense activity as your body metabolizes oxygen to create energy. VO2 max is typically measured in milliliters of oxygen per kilogram of body mass per minute (e.g., mL/(kg·min)). Lance’s VO2 max has been reported at 84. Compare that to the following age-grouped norms for men and women, and you can see how gifted he was:
You might ask, I don’t race bicycles, so why does this matter to me? Research, such as this study from the NIH, has correlated VO2 max with longevity – the higher your VO2 max, the longer you will live.
Longevity expert Dr. Peter Attia has gone so far as to say that VO2 max is the single best predictor for longevity, and he notes that “Simply bringing your VO2 max from ‘low’ (bottom 25th percentile) to ‘below average’ (25th to 50th percentile) is associated with a 50% reduction in all-cause mortality. When you go from ‘low’ to ‘above average’ (50th to 75th percentile), the risk reduction is closer to 70%!” He cites more detail here supporting the correlation between VO2 max and longevity.
VO2 max and Heart Health
Beyond increased longevity, VO2 max has been linked to better heart health. One such report concludes that men with higher VO2 max levels had significantly less thickening of their arterial walls, with the low VO2 max group having a 3.56 times higher risk of developing carotid atherosclerosis compared to the high VO2 max group. Atherosclerosis is a key risk factor for heart disease and can cause a heart attack, stroke, aneurysm, or blood clot.
Determining your VO2 Max
Back when Lance was at his peak fitness was around the time that I was at my peak fitness as an amateur “age group” triathlete (note…one of us was not using performance-enhancing drugs!). While I worked with a coach and did blood lactate testing, testing my VO2 max seemed out-of-reach.
Today, gaining insight into your VO2 max is easier than ever.. Many wearable devices, such as the Apple Watch, Garmin, and others, provide an estimate of VO2 max. The readings they provide for VO2 max are estimated based on various inputs (weight, heart rate, etc.), and they are only valid for a VO2 max up to 65 mL/kg/min. So if you are an elite athlete, the Apple Watch may not work for you. For the rest of us, the estimate provides directional insight, which is good enough for most and provides a relative baseline from which to track changes in your VO2 max.
Another approach to estimating your VO2 max is the Cooper Test. Pioneered by Dr. Kenneth Cooper, who literally wrote the book on Aerobics, the Cooper test estimates VO2 max based on the maximum distance one can run in 12 minutes. This is calculated as:
where d(miles)12 is the distance (in miles) covered in 12 minutes. Another variation of the Cooper Test looks at how long it takes you to run 1.5 miles. If mathematical equations like the one above give you a trauma response, you can find online calculators such as this one for the 12-minute run and this one for the 1.5-mile test where you can plug in your age and distance run, and it will output your VO2 max as well as your ranking (Poor to Excellent).
The most scientific way to test for VO2 max is in a lab via a treadmill or bike test. In both cases, you wear a heart rate monitor and a gas mask that measures respiration at increasing intensities up to maximum output. Testing facilities are becoming increasingly common and are likely to be found near you with a Google search. One U.S. nationwide testing facility is Fitnescity, which offers VO2 max, among other wellness testing services.
Increasing your VO2 Max
If you are not a professional or competitive amateur athlete, you may not seek to have an “excellent” or “superior” VO2 max per the table above. However, given the benefits to longevity and heart health, it is worth targeting a “good” VO2 max for your age. As the table above illustrates, our VO2 max naturally declines as we age, so it requires some intentional effort to maintain a good VO2 max.
VO2 max is a measure of cardiovascular fitness, so it makes sense that improving it will require aerobic exercise. Lifting heavy weights will not improve it.
It’s important to understand your heart rate zones, with your max heart rate being 208 – (0.7 x age), so if you are 40 years old, your max heart rate would be 208 – 28, or 180. You may have heard that 220 – your age as the formula to estimate max heart rate, but, per this analysis by the American College of Cardiology, that formula is not accurate in all cases. Alternatively, your wearable device may help you determine your heart rate zones; here’s how Apple Watch determines heart rate zones.
Your Zone 2 is 60-70% of your max heart rate. This is an aerobic heart rate zone, a level of intensity that you should be able to carry a conversation without too much difficulty. 80% of your cardio training should be done in Zone 2. This is where you build your aerobic base and hence increase your VO2 max. It requires discipline to stay in your Zone 2, however through time, your discipline will pay off, and you will likely be able to run longer and faster in your Zone 2 as your VO2 max increases.
As you can see, understanding your VO2 max and improving it as necessary is key for longevity and heart health. Just as Lance Armstrong’s exceptional VO2 max contributed to his legendary performance (as did performance-enhancing drugs!), you can leverage your VO2 max to achieve your healthiest life. Focusing on long, slow cardio workouts might be the key to not only improving your fitness but also ensuring a longer, healthier life.