Exercise, VO2 max, and longevity | Mike Joyner, M.D

I’m a moderate exerciser - 2 to 4 times a week for 1.5 hours or so each time, moderately strenuous (perhaps 40 or 50 METs as they describe it in the podcast. I’ve been thinking that was enough. But - I see the reductions of all-cause mortality as you continue to increase your fitness, and I think that I need to do much more. After listening to this podcast a few times, I figure I need to up my game… and work towards 100 METs per week.

Fitness reduces all-cause mortality and CVD

Peter Attia mentioned a paper in JAMA that he describes as by far the most compelling description of this phenomenon.

The figure below shows hazard ratios (HRs) for all-cause mortality of varying fitness compared to low performers

All-cause mortality was inversely proportional to cardiorespiratory fitness

Peter said that this paper is one he would consider one of the 10 most influential papers he’s read in terms of changing how he thinks about healthspan and lifespan

  • There are very few things in physiology where more is better
    • Usually physiology behaves in J curves, plateaus, sigmoid curves, and things like that
  • In this study people are grouped by fitness (see the figure below)
    • Bottom 25th %
    • 25-50%
    • 50-75%
    • 75-97.5%
    • The elite fitness group was the top 2.5%

Full Paper:

Hazard ratios (HRs) for all-cause mortality compared with low performers. Image credit: JAMA Network Open 2018

As these people fitness increased, all-cause mortality just went lower and lower

Peter Attia notes:

“We often think about hazard ratios in risk reduction, but if you think about the risk increase. Compare people in the top 2.5% VO2 max to the bottom 25%, the hazard ratio moving in that direction is 5.04. See group comparison in the table above for Low vs. Elite”

This means there is a 5 fold increase in all-cause mortality between the fittest 2.5% and the least fit 25%

I also really liked the example of the Nordic cross-country skiers who were very active and fit into their 80s (doing 90km cross country ski trips). They were as fit and physically capable as many people 30 or 40 years younger. That is the type of fitness I’d like to have.

Examples where exercise preserves fitness in old age

  • Studies of some Swedish cross-country skiers, men who were world and Olympic champions in the 40s and 50s
  • They remained very active and were studied in their 80s, and their fitness levels were similar to what you would see in people in very early middle age

Mortality and cardiovascular morbidity among long-term endurance male cross country skiers followed for 28-30 years

Full Paper:

Mortality and cardiovascular morbidity among long-term endurance male cross country skiers followed for 28-30 years


Being unfit is an incredible risk factor ”‒ Mike Joyner

Jill Barnes and Mike wrote an editorial for the Mayo Clinic Proceedings 5-10 years ago where they said if people have 12-14 MET peak exercise capacity (with the exception of cancer screening), you could probably ignore everything else

It is no coincidence that the increase in chronic disease in people corresponds with the rapid decline in physical activity. The dramatic shift in lifestyle and behavior during the past 50 years is creating substantial challenges for the medical community to keep patients healthy. This issue of Mayo Clinic Proceedings includes a collection of articles that address declining physical activity in the general population and the resulting cardiovascular risk and mortality. Collectively, these articles highlight the importance of accurately quantifying physical activity in populations, 2, 3 determining the threshold metric for cardiovascular risk, 4, 5 and systematically delivering preventive recommendations to patients. 6 Three major points from these articles deserve emphasis: (1) fitness, and not just fatness, is important for stratifying cardiovascular risk; (2) simple physiologic measures, such as resting heart rate (RHR) and routine exercise testing, can be highly predictive of risk; and (3) physical activity should be recommended by all physicians, regardless of whether an institutional protocol for exercise prescription is yet in place.

How to figure out the MET equivalent for your workouts:


What I coincidence, I was just listening this podcast as I started my new season of structured indoor cycling training program to motivate me for the horrible vo2max and threshold workouts that will follow in the program…


Excellent information! Tried to calculate my METs per day. Not sure if did it correctly. I swim (moderately) for 15 min - it’s 8met *15 = 120. I also walk on treadmill with speed 3.5 ml/h for 20 min. It’s 3met * 20 = 60. So the sum is 180 MET. Looks like a lot! Is it a correct calculation? Is it enough for my age? Also, there’s a problem calculating vo2 max if on beta blockers. Mine is 31-34 (high for my age per Apple Health app) - does it take into consideration that I’m on a beta-blocker?

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Those are per hour so swimming 15 minutes is 2 MET
Walking on the treadmill is 3x30/60=1 MET

Total 3 METs


Thank you! 3 met sounds much more realistic! Is it enough or not for my age (67)? Do I need more per day?

I haven’t finished listening but iirc ideally you’d want around 50 METs per week


This means that I’ll have to at least double my activity. Not easy but doable.

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Tip: If you want to climb stairs in your 80s, follow or exceed the VO2 max green line!![:running_man:]

A student summarized this graph today by saying, “VO2max, critical power and the lactate threshold become increasingly more relevant to everyday life as we age, with tasks of daily living eliciting greater percentages of VO2max as we age.”


Build it up gradually, like 10% more every week


This is excellent and useful information! Looks like I have some VO2 boosting to do

Though I have to admit, somewhat depressing seeing the sharp decline even in the highly trained.


Is weight training synonymous to resistance training exercises?

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Weights or body weight, e.g. Planks…

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Not so very surprising as maintaining a high intensity requires a lot of focus and attention to delivering that output as well as focus to not feel the pain and exhaustion

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I suspect increased blood flow is also a factor… but you are right, I’ve seen research that people that dance regularly later in life also have better brain health and cognitive health, perhaps due to focus and attention.


Another perspective / Review paper:

Effect Of Exercise on Muscle Mass, Fat Mass, Bone Mass, Muscular Strength and Physical Performance in Community Dwelling Older Adults: Systematic Review and Meta-Analysis



Benefits of sustained physical activity from middle age to early old age on quality of life in early old age


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“We know that exercise works, but we don’t know which variables of exercise make the exercise more effective,” said Marc Roig, a physical and occupational therapy professor at McGill University who studies the effect of exercise on cognition and was not involved with the study. “We believe intensity is one of those factors.” …

Participants who regularly exercised more intensely — such as going for a run or doing a HIIT workout — were more likely to perform better on spatial memory tasks. Spatial memory is the ability to remember physical relationships between objects or locations in space, like where you put your keys. This mirrors a number of other studies that show high-intensity exercise improves memory, but goes further, suggesting it might be more helpful for this type of memory over another.

Related Paper:

Fitness tracking reveals task-specific associations between memory, mental health, and physical activity


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