The tide turns on vo2max?

I am seeing more and more that reasonable experts are questioning the “higher is better” ideology for vo2max. Since I have been ranting about this for awhile I’ll keep carrying the flag.

This last link is a @ConquerAging video that is very well done and highly recommended for anyone looking to learn about threading the needle on the use of exercise for longevity. This was where the paper on the impact of exercise on mitochondria came up.


Peter Attia always talks about V02 Max correlation to longevity, but then I heard him mention many times when he references cyclists doing Tour de France, that they “are not doing this for their health”.
The risk reduction is pretty similar between top 25% and top 2%. The TdF cyclists are probably top 0.01%. I doubt they gain much at that level and my guess it’s probably a bit of J curve at that point.

I remember reading this review article in JAMA. Going beyond 15 hours of exercise, provides no further heath benefit and going beyond may actually be slightly harmful - atrial fibrillation, osteoporosis (for primarily cycling), etc.

Of course most people are far cry from even doing 10 hours, so they don’t have to worry about the potential J curve. BTW, this 10 hours of pure exercise, not preparing nor driving to and from the gym or trailhead.


Not to mention marathon runners don’t appear to have better longevity. The best of the best have very little muscle mass, which is counterintuitive to longevity.

I tend to think there is a J response curve as well.


The obsession of some in this space on exercise is king - is not consistent with observations of groups of people who actually have a common lifestyle that leads to long life. Those groups would seem to yield at least one approach to long life.
Avoiding sarcopenia is critical - but it is a false situation to think that avoidance of sarcopenia requires absurd physical activity and muscle mass in one’s 50’s.
Exercise and muscle mass is a solid part of a wellness plan - but it isn’t the top item as some would try to push, while trying to avoid nutrition as an pretty important topic.


No, but IMO it requires moderate physical exercise. Couch potatoes die sooner.

"Yes, a sedentary lifestyle can lead to premature death. According to a 2019 Norwegian study, inactive adults have double the risk of early death compared to those who are active. Another study of 8,800 Australians found that each hour of TV viewing is associated with an 11% increased risk of death from any cause, and an 18% increased risk of death from cardiovascular disease. "

“each hour of TV viewing is associated with an 11% increased risk of death from any cause” I think that this is BS or I would be dead. :grin:


My point was that it doesn’t require this (please look at context) - some popular commentators recommend absurd amounts of activity that are well beyond what is required to avoid sarcopenia. It probably only takes 150 min of zone 2 cardio (wt bearing) and 2-3 reasonable weight lifting sessions per week.
Still a lot of work for many … but achievable.
My concern is the commentators who truly think exercise is king in regard to outcomes. This drives recommendations that are going to work for virtually none of the population, and also lack evidence.


I agree. And I am sick of certain health and fitness gurus doing what in essence is bragging about their extensive fitness routines.

So, a little bragging myself. (Of course at my age I could drop dead tomorrow)

Three days a week at ~30 minutes of circuit training has me in what I believe is in the top 10% of physical fitness for people my age. My blood work would probably put me in the top 5% No one at the gym who is near my age is going to kick my a** unless they are trained in martial arts. :laughing:


These claims about VO2 max and 10 year survival need to be investigated and reconciled further. 1) Is much higher VO2 max correlated with extended lifetime or just next 10 years risks? 2) If you already do light, e.g walking and stretching, to moderate intensity exercise for 1 hour every day is attempting to increase your current V02 max whatever it may be, going to result in any 10 year or lifespan benefits? 3) It appears that golf athletes live the longest. Is it due to VO2 max or some other factors that are more important assuming your VO2 max is not in the bottom 25%? 4) It appears that too much of a good thing especially so for men may become detrimental to their longer term health and longevity. For instance, the findings for long-distance runners are: “For male athletes, the vascular age was found to be 15 years older than the average male chronological age. And by this measure, female athletes had a vascular age six years lower than the average for their age.” See Endurance exercise may affect body's largest artery differently in men and women | UCL News - UCL – University College London


This is the study that Attia uses to justify his stand on Vo2 max effect on longevity. It’s a very long study, some subjects followed over 10 years. 122 thousands subjects… it’s hard to argue with the results.


Importance Adverse cardiovascular findings associated with habitual vigorous exercise have raised new questions regarding the benefits of exercise and fitness.

Objective To assess the association of all-cause mortality and cardiorespiratory fitness in patients undergoing exercise treadmill testing.

Design, Setting, and Participants This retrospective cohort study enrolled patients at a tertiary care academic medical center from January 1, 1991, to December 31, 2014, with a median follow-up of 8.4 years. Data analysis was performed from April 19 to July 17, 2018. Consecutive adult patients referred for symptom-limited exercise treadmill testing were stratified by age- and sex-matched cardiorespiratory fitness into performance groups: low (<25th percentile), below average (25th-49th percentile), above average (50th-74th percentile), high (75th-97.6th percentile), and elite (≥97.7th percentile).

Exposures Cardiorespiratory fitness, as quantified by peak estimated metabolic equivalents on treadmill testing.

Main Outcomes and Measures All-cause mortality.

Results The study population included 122 007 patients (mean [SD] age, 53.4 [12.6] years; 72 173 [59.2%] male). Death occurred in 13 637 patients during 1.1 million person-years of observation. Risk-adjusted all-cause mortality was inversely proportional to cardiorespiratory fitness and was lowest in elite performers (elite vs low: adjusted hazard ratio [HR], 0.20; 95% CI, 0.16-0.24; P < .001; elite vs high: adjusted HR, 0.77; 95% CI, 0.63-0.95; P = .02). The increase in all-cause mortality associated with reduced cardiorespiratory fitness (low vs elite: adjusted HR, 5.04; 95% CI, 4.10-6.20; P < .001; below average vs above average: adjusted HR, 1.41; 95% CI, 1.34-1.49; P < .001) was comparable to or greater than traditional clinical risk factors (coronary artery disease: adjusted HR, 1.29; 95% CI, 1.24-1.35; P < .001; smoking: adjusted HR, 1.41; 95% CI, 1.36-1.46; P < .001; diabetes: adjusted HR, 1.40; 95% CI, 1.34-1.46; P < .001). In subgroup analysis, the benefit of elite over high performance was present in patients 70 years or older (adjusted HR, 0.71; 95% CI, 0.52-0.98; P = .04) and patients with hypertension (adjusted HR, 0.70; 95% CI, 0.50-0.99; P = .05). Extreme cardiorespiratory fitness (≥2 SDs above the mean for age and sex) was associated with the lowest risk-adjusted all-cause mortality compared with all other performance groups.

Conclusions and Relevance Cardiorespiratory fitness is inversely associated with long-term mortality with no observed upper limit of benefit. Extremely high aerobic fitness was associated with the greatest survival and was associated with benefit in older patients and those with hypertension. Cardiorespiratory fitness is a modifiable indicator of long-term mortality, and health care professionals should encourage patients to achieve and maintain high levels of fitness.



We’ll we’d miss you … so don’t drop dead! It surprisingly seems like there is agreement among many that we don’t need to be rucking for 100 miles while having 10 sticks of jerky? Blasphemy!


I believe that applies mainly to:

“marathons and ultra-marathons, Ironman distance triathlons, and very long distance bicycling can exact a toll on the health and integrity of the heart and blood vessels.”

There are some divergent studies about extreme exercise.

I think we are comparing apples and oranges. Vo2max may be associated with runners in general without requiring them to be marathoners.

From this study, the bottom of the U-shaped curve is about ~7mph which equates to a jogging speed of ~8.5 min per mile. About 2 ½ times average walking speed. This is probably the speed of fit recreational joggers. Recreational joggers in general run less than 5 miles/day and an occasional fun or mini-marathon.

(This article does not mention vo2max)

I believe in “moderation in all things”, something many health and fitness gurus do not

Cardiovascular Damage Resulting from Chronic Excessive Endurance Exercise - PMC

So, pick your camp and be happy.


I agree, but this is probably an “absurd” level for the average person today, at least in many if not most populations.


But who will he sell his jerky to?


It is also about how the exercise is performed, is the recovery proper, diet, alcohol, adequate sleep etc.

Anything above Zone 2 has to me moderated, many amateur athletes run down themselves down by spending to much time in Zone 3-4 (sweet spot), in reality professional athletes spend very little time outside of Zone 1- 2 training and do periodized intervals in Zone 5-6 for maybe 5-10% of their training. They are serious about recovery, they sleep well, they don’t drink alcohol, maintain proper nutrition etc etc etc

What I often see in the mountain bike community is people riding way too fast, all the time, drinking too much, eating like crap (because they earned those greasy fries and burger) sleeping poorly, then going to work, managing family… and few years they burn out. I know few that developed OTS, atrial fibrillation, obesity, CAD, etc.

Personally, I have significantly reduced my mountain bicycle races per year as I started nearing 50. It’s much harder to recover now than in my 40’s when I could podium 10-15 races per year.
I run about 1-2 hours a week, spend 3-4 hours in the gym doing weight lifting, 1 hour yoga and steam/hot tub and ride about 4-5 hours a week. I still race 3-4 times a year, but it’s definitely harder to podium with less training. My Vo2 (estimated) dropped from low 60s in my 40s to now 54 at age 50, but this is a more sustainable life style.

I also make sure I recover properly, sleep well, I reduced my drinking to 1-2/month and I’m nuts about my nutrition.


Good approach. And yes VO2 max data looks strong. However, my key concern (seems to be shared) with trying to maximize VO2 max for all the people is the potential for injury either direct through exercise or indirect due to e.g. poor or even just average nutrition. If your intake of magnesium is low (average situation in America) and then you sweat a lot during exercise, you are going to eventually sustain DNA damage. (And let’s not forget other nutrient intake like Omega-3, where low levels of are nearly as bad as smoking.) Also If you sustain a physical injury during your exercise, you may require surgery e.g. knee or heap replacement or intervention to treat a frozen shoulder (Matt K.). As a result you won’t be exercising so much if at all and your VO2 max will go down. So in summary, moderation is a king and queen. Not all of us have bodies and or/ exercise knowledge to be top performers Instead improving our fitness, just a bit, will be already very beneficial.


Seems like an interesting study in key ways. My big intuition is that while the results may* be internally consistent, we should perhaps not extrapolate them too much to other contexts either. 10 year mortality for a group that is an average of 53 years does not necessity say a lot about what maximizes probability to live healthily into one’s 90s and 100s.

It seems to me from what we know from optimal nutrition calorie restriction (CRON) vs larger food intake (even if healthy food), large protein loads (especially methionine and BCAAs), levels of Growth Hormone, IGF-1 and testosterone/free testosterone is a picture of those things helping with a lot of healthspan metrics up to a certain age and also avoiding certain very specific risks risks at older age (osteoporosis, sarcopenia).

But - and this is a massive but - at the same time if the goal is to maximize health and longevity at later ages it does not seems to have had those things at high levels maximizes the odds of success.

The picture of course more complex, but my intuition is that the optimal max longevity amount of VO2max and muscle building is smaller than the paper and Attia seems to suggest.

  • Note a separate thought is how can a paper like this adequately control for things like the lowest and even average exercise behaviors also likely correlated with a whole host of other “worse” health behaviors than those that exercise more - like diet quality, sleep hygiene, how often one goes to the doctor, etc?

Similarly without looking at twins or at least large sets of siblings or running a controlled trial, how does one control for that people who are more sick genetically or even random reasons become sick will all else equal exercise less?


Folks should really watch that video to the end. You can’t argue with data but you can nitpick it. It was as I had guessed — yes higher vo2 max confers advantages at every tier but there’s convergence to low deltas with age so it makes a difference of maybe 5 years. Won’t help anyone break past the statistical hard ceilings of lifespan. Also some great tips in the video for maximal yields on minimal efforts in increasing VO2 max. I think it was quoting a paper @Joseph_Lavelle recently posted on the adaptation response of mitochondria to various volumes and intensities of exercise.


I’m saying that much of what we know about longevity in animals suggest that it will HURT people’s max longevity - not neutral.

Do you disagree with that knowledge around

optimal nutrition calorie restriction (CRON) vs larger food intake (even if healthy food), large protein loads (especially methionine and BCAAs), levels of Growth Hormone, IGF-1 and testosterone/free testosterone

suggests that that at least is a strong hypothesis we should consider?


I think we build castles in the sky. All I know is my grandma passed at 99 with ZERO exercise throughout her life, and pretty ridiculous sugar consumption. To anyone who tells me she’d have made it to 115 with these hyper optimized exercise programs and with chia seed nutty puddings and whatnot instead of her chocolate and cookie diet, I’d laugh in his face.

We’re programmed to stick around for a certain while, and no longer. Period. We should eat well and exercise to feel good and be healthy, not with the self delusional notion that if will enable us to live forever. Something quite extrinsic would need to change to significantly move the needle — hopefully rapamycin is one such lever. My intuition whispers to me that for women it might do even more than for men, depending on when one starts taking it, because of how it seems to affect menopause onset, which is our genetic expiration alarm. Mice don’t even get menopause. Anyway I could be wrong, maybe it doesn’t do diddly at all for humans. But Attia is selling pie in the sky with his vo2max obsession.