What is VO2 max? The metric that could give you better workouts
In short, you can think of this metric as the maximum amount of oxygen your body uses during exercise – V stands for volume, and O2 stands for oxygen, per Harvard Health. But what do you gain from trying to increase it? For some people, improving VO2 max could help you attain longer, sustained workouts, and offer potential cardiovascular benefits, experts say.
So, whether you're an athlete, or simply trying to improve your performance during exercise, here's why it might be worth taking a closer look at your VO2 max.
As the heart pumps oxygen-rich blood throughout the body, it delivers oxygen to your muscles. Our muscles then utilize oxygen to produce adenosine triphosphate (ATP), which provides energy, says Heather Milton, a board-certified clinical exercise physiologist, and certified strength and conditioning specialist with NYU Langone.
'(VO2 max is) a function of your cardiorespiratory system to (be) able to transmit oxygen from the air around you into your lungs and into your circulatory system,' says Dr. Christopher Tanayan, a sports cardiologist and Director of Sports Cardiology at Lenox Hill Hospital at Northwell Health.
The most accurate way to calculate your VO2 max is in a clinical setting, says Tanayan. 'A CPET (cardiopulmonary exercise test) is the gold standard of estimating someone's VO2 max,' he says. In the setting of a performance center, this test might also be referred to as an aerobic capacity test, or a VO2 max test, says Milton.
During a CPET, you'll wear a mask that records the amount of oxygen you inhale, the amount of carbon dioxide you exhale and your number of respirations per minute. 'Essentially, the mask is measuring the volume of air that we're taking in,' says Milton.
You'll complete a series of exercises (typically using treadmills or bikes) that become increasingly strenuous over time. The test continues until you reach a point where you're no longer able to consume and deliver oxygen to your muscles – that number is your VO2 max, Tanayan says. Your VO2 max is measured in mL/kg/min (milliliters of oxygen consumed per kilogram of body weight per minute of exercise), according to Harvard Health.
Another way to find your VO2 max is using a wearable (such as a Fitbit, Garmin or Apple Watch) to track your performance during exercise. With a bit of math and extrapolation, wearables can approximate the amount of energy you're using during your workout by measuring your heart rate response to submaximal efforts, ideally taking into account your age, weight and sex, says Milton.
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Ultimately, 'there is no perfect VO2 max score – it varies from individual to individual,' says Tanayan.
There are lots of variables that go into calculating your VO2 max, including your genetics, age, sex, fitness level and altitude that you're exercising at, says Dr. Amadeus Mason, an assistant professor in the othopaedics and family medicine department at Emory University School of Medicine, and the chief medical officer for Atlanta United FC and medical director for Team USA Track & Field.
A higher VO2 max could indicate better cardiovascular fitness and endurance – this means you'll be able to move and sustain more activity for longer periods of time, says Mason. Research shows there may be a potential correlation between having a higher VO2 max, and decreased risk for cardiovascular diseases, per Harvard Health. However, the metric alone should not be interpreted as an indicator of overall health, Mason underscores.
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From a training standpoint, once you know your VO2 max, there are steps you can take to improve this number, which could increase your endurance during a workout. Still, not everyone needs to train to improve their VO2 max; it really depends on your exercise goals. For example, if you're an anaerobic athlete (i.e. a weightlifter or sprinter) who needs short bursts of power to get through a workout, training to increase your VO2 max might not be necessary, says Milton.
On the other hand, if you perform a mix of aerobic (a.k.a. cardio) and anaerobic exercise, there are benefits to improving your VO2 max. Having a solid aerobic base promotes 'fast recovery in between bouts of high intensity (or anaerobic) exercise,' Milton says. For the general population, improving your VO2 max could also help with enhanced longevity and potential cardiovascular benefits, she says.
To increase your VO2 max, try out these types of exercise, experts say:
HIIT. Incorporate high intensity interval training (HIIT) into your workout routine, recommends Mason. There's a misconception that HIIT only consists of high impact exercises like jumping jacks, burpees and squat jumps, says Milton. However, because the ultimate goal of HIIT is to elicit a heart rate response, low-impact HIIT exercises could include incline treadmill walking, using an elliptical or working out with a stationary bike, she says.
Cardio. For the non-professional athlete, one of the best ways to improve your VO2 max is by performing consistent aerobic exercise, says Mason. To get your heart rate and oxygen intake up, try steady-state cardio exercises like running, jogging, cycling or swimming.
Resistance training. It's easy to slip into a pattern of only doing cardio as your sole mode of exercise, but resistance training is equally important, says Milton. Resistance training helps maintain muscle mass, and enhances the quality of the muscle you already have. It also lends itself to a few other benefits, including enhanced longevity, balance and agility and fall prevention, she says.
This article originally appeared on USA TODAY: What is VO2 max? And how to increase it
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She acknowledged that this self-investigation requires 'courage,' adding, 'every day, I'm still working on it.' Tips for Physicians The experts offered tips to help physicians avoid medical gaslighting. Don't be afraid to admit you don't know the answer. 'Most patients aren't expecting perfection,' Geraghty said. 'They're looking for someone to walk alongside them. Saying, 'I may not know yet, but I'm committed to figuring it out with you' is far more supportive than minimizing symptoms or blaming the patient.' You don't have to do everything the patient wants. Patients, often armed with articles from the internet, may ask for a medication, procedure, or test that's not warranted for their condition or symptoms. If this happens, 'take a moment to explain why that's the case, which can reduce the patient's feeling of being dismissed,' Hayburn advised. Some patients have developed their own hypotheses about what's causing their symptoms, which may not be 'based in empirical evidence,' Fuss added. 'The willingness to listen to their perspective regarding causation is important for establishing trust.' But this doesn't mean physicians are 'required to defer to patients' perceptions about the etiology of their symptoms.' Be careful about 'diagnostic overshadowing.' 'Be mindful not to over-engage in diagnostic overshadowing,' Fuss warned — a process by which healthcare professionals wrongly attribute a person's physical symptoms to other causes, such as disability or mental illness. She encouraged physicians to engage in 'thoughtful communication' when discussing potential psychological interventions. For example, patients with irritable bowel syndrome 'often describe unhelpful messages they've heard in the past, such as 'it's all in your head' or 'it's just stress.' So it's important to communicate the role of the gut-brain axis and discuss how psychological support is a valid treatment option recommended as part of comprehensive healthcare, as psychological factors can influence physical symptoms. Providers should emphasize that they'll continue to work on addressing [physical] symptoms as well.' Empathetic demeanor and validation build trust. Demeanor is an important component of helping people feel valued and taken seriously. Fuss advises clinicians to build trust by 'bolstering perceptions of competence and warmth.' Competence includes intelligence, skill, and assertiveness, while warmth includes qualities such as empathy, kindness, and honesty. Demonstrating both qualities also builds trust. An empathetic demeanor also includes validating the patient's statements, which 'doesn't take a lot of time but just takes intention,' according to Geraghty, whose private practice includes a specialty in medical gaslighting. 'You can say something like, 'I believe you' or 'that sounds really difficult,' which only takes a few seconds. That kind of acknowledgment can completely change the tone of the appointment.' Allow patients to ask questions. 'Asking if the patient has any questions means patients are more likely to feel heard and listened to,' said Fuss. Despite the compressed nature of medical appointments, time can be reserved for questions at the end of the visit. If patients require additional time for the discussion, a follow-up appointment can be scheduled. Validation isn't the same as reassurance. Bontempo recommends that physicians 'do not reassure patients that their symptoms are 'normal,' especially if they've been living with them for a long time and have distress about them. Patients know when something is wrong with them, especially the longer they live with their symptoms.' Research suggests that reassurance isn't helpful to patients with high distress about their symptoms and may be perceived as dismissive. So instead of reassurance, Bontempo recommends validation. 'Many patients who struggle to receive a diagnosis actually have reported wanting to have their symptoms validated independent of whether a diagnosis can be identified. At the very least, this validation reassures patients that they are not crazy and offsets the self-doubt that ensues from being undiagnosed, which is only exacerbated when physicians normalize their symptoms.' A Call for Action Although the term 'medical gaslighting' has 'exploded,' it has garnered relatively little formal research, Zha pointed out. Furthermore, 'some are even arguing that we need to abandon the term because it's cynical and not good for our business.' But that itself is a form of gaslighting — acting as though a real problem doesn't exist. 'The popularity of the term is a message to us. Rather than putting our energies into eliminating this term, let's put our energies into providing patient care that is affirming and takes symptoms seriously.' Geraghty emphasized that her statements reflect her own views and not those of the US Department of Defense, and Zha emphasized that her statements reflect her own views and not those of the Yakima Valley Farm Workers Clinic. Hayburn, Fuss, Geraghty, Zha, and Shapiro reported having no relevant financial relationships.
