VO2 Max: the Next Vital Sign
Optimising physiological and neurological performance through maximal aerobic function.
Neuro Athletes,
TWO things you need to know this week.
Why you should be testing your VO2 max even if you aren’t an athlete.
How CRF (measured as VO2 max) can predict cognitive function/ capacity, longevity outcomes and determine cancer risk.
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Lately, one thing that's been top of mind for me is, what is the future of VO2 max testing? For the purpose of this email I’ll introduce the topic of VO2 max, its importance and how it should be a standard measurement taken once or twice a year to predict health outcomes.
This topic is one that should be discussed more openly because I think we’re sitting at the brink of a major misunderstanding when it comes to VO2 max.
This rant comes from a long string of baseline testing in month two of the Neuro Athletics program. All athletes undergo a VO2 max test and it was surprising to me that 90% of the athletes that come to us have not had a VO2 max test done before.
So last week after completing four tests and I tweeted my thoughts on the topic as it relates to more than just physical fitness, but cognitive performance, longevity and disease states as well. Moreover, one of the biggest reasons that we include VO2 max testing at Neuro Athletics is simply because;
We love baseline measurements and we love identifying how well the Neuro Athletics program is working. We also do a follow up test 6 months after the program to reassess.
Working at a high intensity means training the anaerobic system. When you train in this system you increase capillary beds and increase the ability of neurons to access more energy.
Lastly, reduced mitochondrial function is an important cause of ageing and age-related diseases. We know that relatively higher levels of mitochondrial DNA (mtDNA) content has been identified in centenarians, so more mitochondria = factor contributing to long-term health. Well, it turns out that the mitochondria is consuming the oxygen when we are measuring VO2 max. This suggests that the total quantity of mitochondrial respiratory enzymes in cells determines the oxidative capacity of muscles.
It’s really a no brainer..
In my opinion, VO2 max is no different from other major risk factors of disease like insulin levels, blood pressure, and cholesterol. But, we’re not getting tested, we’re not educated on the importance and historically we’ve been made to believe that about half of the VO2 max differences between people are the result of genetic factors. That is a fallacy.
Mounting evidence has firmly established that low levels of cardiorespiratory fitness (CRF) are associated with a high risk of cardiovascular disease, all-cause mortality, and mortality rates attributable to various cancers. A growing body of clinical evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes.
If we know the importance and the evidence is there, then why isn’t this being measured routinely? and also, why is the education on VO2 max solely focused on traditional forms of measurements for athletes to increase their CRF?
It all starts with education...
Recap on VO2 max and it’s Important.
VO2 max, or cardiorespiratory fitness (CRF), as it’s referred to clinically, is the maximum amount of oxygen the body can utilize during exercise. It’s a combination of how much oxygen-rich blood your heart can pump and the heart’s efficiency in extracting and utilizing oxygen.
A typical test for this would be a ramp test (increasing power/speed every few minutes) while wearing a mask that collects the exhaled air. This determines the maximal or near-maximal oxygen uptake.
A lot of people inaccurately underestimate the test and think this is a test of the heart and lungs, but it’s really a test of what your muscles can do in terms of utilizing that oxygen.
Different organs have different amounts of mitochondria and different rates of oxygen consumption.
Figure 1: an example of how different organs in our body utilise oxygen
Ageing and CRF/ VO2 max
Structural and functional changes in the respiratory system with age, e.g., loss of elastic recoil, increasing rigidity of the chest wall, and decreasing respiratory muscle strength, declining alveolar surface area and capillaries perfusing the lung might all affect sufficient ventilation and pulmonary gas exchange, resulting in VO2max limitation.
Your longevity depends on numerous factors, including gender, blood pressure, cholesterol, age, and lifestyle choices. A recent study in the journal Mayo Clinic Proceedings suggests there may be another one for that list: CRF level, which is determined by your VO2 max.
The study found that each increase in predicted VO2 max levels was linked with a 21% lower risk of death over 45 years of follow-up, even after adjusting for other risk factors such as smoking, blood pressure, and cholesterol levels.
They also found that survival improved significantly when unfit individuals became fit at least 6 months after the initial CRF test.
Although the VO2max is affected by the aging process, it can improve significantly at any age with regular endurance training by approximately 15–20% or 0.5.l/min, depending on exercise intensity, in healthy sedentary/recreationally active humans.
Accordingly, it is possible that a trained 70-year-old can exhibit the biological age of an untrained 50-year-old based on the VO2max, which declines at about 7% (women) to 10% (men) per decade from the age of around 25 years, but in an endurance-trained person starting from a higher level.
Figure 3: Hypothesis of physical fitness (cardiorespiratory fitness and muscle strength) on Healthy Life Years (disability-free life expectancy) in trained versus sedentary subjects. The dotted line represents the prognostic exercise capacity generally necessary for an independent lifestyle and associated with an increased risk for mortality. The cut-off values are: 17.5. ml/kg/min (5 METs) for aerobic capacity; 30 kg and 18 kg for grip strength in men and women aged over 65 years, respectively.
Cognitive Performance and CRF/ VO2 max
This as we all know is my favourite category. Being able to work on your mind and brain via the aerobic and anaerobic system is such a beautiful concept. But how does our brain and nervous system change in response to oxygen and CRF?
The literature indicates that CRF is associated with brain volume and white matter integrity in healthy older adults. Regions showing the strongest relationship appear to be anterior cingulate cortex, lateral prefrontal cortex, and lateral parietal regions.
One study showed that CRF was associated with faster response times in the incongruent condition, in which there was a mismatch between the word and the colour in which the word is printed. Taken together, these studies show a consistent impact of CRF on activity in fronto-parietal regions that mediate enhanced cognitive control when there is processing conflict.
For all my portfolio managers, this is the paragraph to really take note of!
The Bottom Line
Do I believe VO2 max testing should be mandatory across the lifespan? Yes. It’s more than just a tool to measure fitness, it’s an assessment to measure metabolic health, efficiency, CRF and long-term health.
Although physicians don’t routinely check this health marker, I believe a VO2 max assessment shouldn’t be reserved only for those experiencing cardiovascular issues or for elite athletes. The difficulty though is that many physicians don’t have easy access to such testing, nor do they have the personnel to administer and monitor the tests. That can make it tricky to request a VO2 max test unless there are other risk factors that warrant the assessment.
As yet, it is not possible to extend the genetically fixed lifespan with regular exercise training, but the chance to reach the later end of natural lifespan increases with higher physical fitness in midlife, where targeted preventative efforts may be launched. CRF (VO2max) is the strongest independent predictor of future life expectancy in both healthy and cardiorespiratory-diseased individuals. In addition, muscle stimulation is essential in order to prevent muscle wasting, disability, and increased hospitalization in old age, all crucial ways to avoid long-term care, thereby promoting quality of life in ageing humans. Thus, extending life is not as important as giving those years more life. This is where physical fitness plays an important role.
Hopefully we see changes in this tool for assessments in the coming years along with wearing a CGM and other precision medicine tools to increase healthspan and lifespan.
If you’re a paid subscriber you will get a separate email detailing the following:
A chart that I use with my Neuro Athletes to gauge where you are with your VO2 max
Protocol for improving VO2 max with specific measurements
How to measure VO2 max without going into a testing lab
BONUS: you will get my new sleep stack that I have been experimenting with!
That's all for this week!
Thanks for reading this through. I hope you're able to use this email and take some action items to add to your performance routine.
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Have a great week!
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