Does VO2 max predict how long you live?
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Strongly. In 122,007 people who took a treadmill test, the least fit quarter for their age and sex had about 5 times the death rate of the fittest 2% over the next 8 years. Being unfit carried as much risk as smoking or diabetes, or more. And fitness is a number you can test and raise.
What we’d do
Treat fitness like a vital sign. Get a VO2 max estimate from your watch or a test, note your group for your age, and train to move up one group. Most of the gain comes from leaving the bottom, so if you’re there, brisk walking most days and some uphill or harder efforts each week will move you.
Why people underrate it
Doctors check blood pressure, cholesterol and blood sugar at every physical. Almost nobody gets their fitness measured, so people think of fitness as a nice extra for athletes rather than one of the strongest signals of how long they’ll live.
What VO2 max is
VO2 max is the most oxygen your body can use in a minute, per kilogram of body weight, when you’re working as hard as you can. To score high, your heart has to pump a lot of blood, your lungs have to load it with oxygen and your muscles have to use it. So one number sums up the heart, lungs, blood vessels and muscles together. Doctors often give fitness in METs instead, and one MET is 3.5 ml of oxygen per kg per minute.
The simple version
VO2 max is the size of your engine. It’s how much fuel your body can burn at full throttle, and a bigger engine has more left over on every hill.
The treadmill study
Researchers at one large US hospital looked at 122,007 adults who had a treadmill test between 1991 and 2014, average age 53, and followed them for a median of 8.4 years. They sorted everyone by fitness for their age and sex, from low (the bottom quarter) to elite (the top 2.3%).
| Comparison | Risk of dying |
|---|---|
| Low fitness against elite | 5.04 times |
| Below average against above average | 1.41 times |
| Smoking against not smoking | 1.41 times |
| Diabetes against none | 1.40 times |
| Elite against high | 23% lower |
Two findings stand out. Being just below average for fitness, against just above, carried the same extra risk as smoking. And there was no ceiling. The elite group did better than the high group, including people over 70. These were patients referred for a treadmill test, so they were probably a bit less healthy than average.
A 2009 review of 33 studies in 102,980 healthy people found the same pattern from another angle. Each 1 MET more fitness went with 13% lower risk of dying.
How big is this for you?
The study odds tool puts the low-against-elite result on the 2024 US life table. Our calculator takes a watch VO2 max, divides it by 3.5 to get METs and shows your group from the study, beside your estimate and never added into it. Watch numbers are estimates, so use them to track your own trend.
For training, see vo2max.guide, and for the weekly dose, how much exercise do you need to live longer.
2 sources
- Mandsager K and others, Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing, JAMA Network Open, 2018jamanetwork.com
- Kodama S and others, Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis, JAMA, 2009pubmed.ncbi.nlm.nih.gov
