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Out of Breath, Out of Time: How VO2 Max Shapes Survival

Issue #8 · Read Time: 5 minutes

Simplifying Health, Amplifying Longevity, One Shift at a Time

Your body processes oxygen like an engine processes fuel. But everyone has a maximum horsepower rating—their VO2 max. 🫁

Having a high VO2 max could mean playing with your grandkids and climbing stairs into old age. A low one? It could be deadlier than smoking.

What Needs to Shift?

As I write these words, my cells are quietly consuming 250 mL of oxygen every minute—enough to fill a coffee cup. That's my body at rest, barely breaking a sweat.

Stand up and walk? My oxygen needs triple to 750mL per minute.

Break into a light jog, and my oxygen demand soars to 2,500 mL per minute—ten times what I needed while sitting 🏃. This is the body's power plant scaling up in real-time to meet the increased energy needs.

The fitter I am, the more oxygen my body can process. But everyone has a ceiling—a maximum volume of oxygen their body can utilize during intense activity. This is your VO2 max. Think of it as your body's horsepower rating.

This power rating depends on three systems performing an intricate dance:

  1. Lungs: How much oxygen you can take in 🫁

  2. Heart and Circulation: How well that oxygen is delivered to your muscles ❤️

  3. Muscles: How efficiently your cells use oxygen to produce energy 💪

Your VO2 max is measured in mL of oxygen per kilogram of body weight per minute (ml/kg/min). But don't let the technical details distract you. 📊

Picture three people in their mid-30s:

  • The first scores below 25 ml/kg/min — technically "unfit" for their age — making each flight of stairs feel like climbing Everest. 🤢

  • The second lands between 30-40 ml/kg/min — the "average" range — getting by daily life but struggling with intense activity. 😮‍💨

  • The third scores above 55 ml/kg/min — approaching elite athlete territory — making challenging activities feel effortless. 🏃‍♂️

The difference represents the gap between struggling through life and sailing through it. ⛵

A landmark study following 750,000 individuals revealed something striking: a low VO2 max (bottom 20%) is four times deadlier than being in the top 2% 1.

This isn’t just statistics; it’s a wake-up call written in data. ⚠️

Think about the moments that matter: Your daughter's wedding. A spontaneous game of catch. Your VO2 max today is quietly predicting whether you'll be an active participant or watching these moments from the sidelines. It determines who dances at their grandchild's wedding and who struggles to make it down the aisle.

The Oxygen Oracle

Let's put this into perspective.

Scientists use hazard ratios to measure mortality risk—essentially your odds of checking out of life early. Smoking confers a hazard ratio of 1.40, which means that smokers are 1.4 times (i.e. 40%) more likely to die than non-smokers.1 

Take a look at the graph below. We've spent decades fighting smoking because it increases death risk by 40%. Yet poor cardiorespiratory fitness—a VO2 max in the bottom 20%—is nearly three times deadlier than being the top 20% 1,2.

In other words, improving your VO2 max offers a better risk reduction than a smoker who quits smoking.

Each horizontal bar shows how much different factors increase your risk of death. For diseases like diabetes or behaviours like smoking, the comparison is simple—having it versus not having it. For VO2 max (blue bars), all comparisons are against the fittest 2% of people. This graph is an abstraction of data from Kokkinos et al (2022)1. The data is unchanged—only the format has been adapted for clarity.

The evidence is compelling: A 46-year follow-up study tracking men from age 40 to 60, revealed that those with VO2 max in the top 5% lived five years longer than their less-fit peers 3.

Whether your standard health markers—blood pressure, cholesterol, weight—are normal or in the yellow-zone, they're only snapshots of today. But your VO2 max may signal what's coming. For our most dreaded diseases such as dementia, or many cancers, it might be our best early warning system 4. 🚧 ⚠️

But, unlike genetic risks or past health decisions, your VO2 max is remarkably adaptable. Simply moving from poor to moderate fitness (a change most people can achieve in 3-4 months) cuts your mortality risk in half. 📉🫁

Older adults can improve their VO₂ max by ~13% in just 8–10 weeks.

The top 2.5% isn't some exclusive country club with a velvet rope made of genetics. Most of us can slip past it in a few years of consistent training. 📈

Your Next Move

Find Your Vital Limit 📊

  • Schedule a VO2 max test at a sports clinic or well-equipped gym (widely available in most cities).

  • Set aside 20 minutes.

  • Be warned: it’s intense—you'll finish looking like you just ran from a bear. 🐻 

  • Got heart issues? Chat with your doctor first. This isn't a casual stroll. ⚠️

  • Cost: $125-175 CAD. 💰

💡 A Note on Numbers: Your test will show where you stand for your age, but here’s a rule of thumb—if you’re under 50, your VO2 max shouldn’t be below 50. Ultimately, your target depends on how much life you want to squeeze out of every breath.

No Fancy Sports Clinic? 🤔

  • Your wrist might have a shortcut. ⌚

  • Devices like the Apple Watch estimate VO2 max, but there’s a catch: it only works for outdoor runs (sorry, treadmill warriors), and the accuracy can be off by 10-25% (speaking from experience 😅).

  • Still, even if it’s not spot-on, it can be useful—the trend is what matters.

  • If your VO2 max is climbing, you’re on the right track. If it’s dropping, step up your game.

Upgrade Your Engine 🚀

The secret to boosting your VO2 max lies in two types of training—each vital, each with its purpose.

1. The Steady Gear 🐌

This builds an aerobic engine that makes life feel effortless. It’s low-intensity, longer-duration, and trains your body to use oxygen more efficiently—making both recovery and intense efforts easier.

  • Think: Brisk walking, easy jogging, or cycling at a slow, steady effort.

  • More in Issue #10: The key to Zone 2 training—and why most people do it wrong.

2. The Red Zone: All-Out Effort 🔥 

These high-intensity bursts are where your body learns to process oxygen at maximum capacity and push your upper limit.

  • Think: 4-minute efforts at near-maximum intensity, not just quick sprints.

  • More in Issue #12: How to train at high intensities to maximize your VO2 max gains.

Every breath you take is a transaction with life. Your VO2 max isn't just measuring oxygen—it's measuring the volume of possibilities your body can power. The capacity you build today determines whether you'll be living life or just watching it pass by. And like a high-performance car’s engine, it’s a metric worth tuning up.

Inside A VO2 Max Test

Think ‘longevity’ is about living forever? Last week, we dismantled that tired narrative and broke down why the conversation around aging is completely off track. Read it here: 'Longevity' Is Killing Our Vision of Living Better.

Missed past issues? Catch up here.

P.S. I spent 12 hours writing this, but it takes only 5 seconds for you to share! Make someone’s day (and mine too). 😉 It could be the healthiest thing you do today. 🌟

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I'm a Toronto doctor caring for older adults in hospitals and nursing homes, while spending my spare time digging into longevity science. I'm here to share what I'm learning. No fancy jargon, just practical insights to help you read your body’s early signals. Think of me as your friendly guide, figuring this out alongside you. Medicine has changed, but how we practice it hasn't caught up. That's why I'm here: to help you edit your health story while the early drafts are still open.

Tahsin Khan, MD

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