VO₂max and longevity: what the evidence shows

Mandsager et al., 2018 (JAMA Network Open)

Researchers at the Cleveland Clinic followed 122,007 adults who had a treadmill test between 1991 and 2014, for a median of 8.4 years.¹ They grouped people by fitness for their age and sex. Risk-adjusted mortality fell as fitness rose. Compared with the lowest-fitness group, the "elite" group (top 2.3%) had an adjusted hazard ratio of 0.20. The extra risk linked to low fitness was comparable to or greater than that of coronary artery disease, smoking or diabetes.¹

Two caveats. Fitness was estimated from treadmill time and speed (peak estimated METs), not measured from breath gases. And the patients were referred for testing, so they are not a random sample of the population.¹

Kodama et al., 2009 (JAMA)

This meta-analysis pooled 33 cohort studies of healthy adults, including 102,980 participants for all-cause mortality.² Each 1-MET higher fitness level (roughly a 1 km/h faster running speed, in the authors' words) was associated with a 13% lower risk of death (risk ratio 0.87) and a 15% lower risk of coronary and cardiovascular events (risk ratio 0.85). People with low fitness had a risk ratio for death of 1.70 compared with people with high fitness.²

In 2016 the American Heart Association reviewed this body of work and argued that fitness should be assessed in clinical practice as a "vital sign".³

Three things to keep in mind. Values differ between countries.⁵ A 2022 update, drawing on 22,379 treadmill and cycle tests, set US treadmill standards 1.5 to 4.6 mL/kg/min lower than the 2015 figures.⁶ And cycle tests give lower values than treadmill tests.⁶ Use the full percentile tables in the papers for any individual comparison.

Age

Across six decades, the 2022 FRIEND update found median treadmill VO₂max fell by an average of 13.5% (4.0 mL/kg/min) per decade.⁶ That is a cross-sectional comparison of different people. Following the same people tells a sharper story. In the Baltimore Longitudinal Study of Aging, peak VO₂ fell about 3–6% per decade in people in their 20s and 30s, and more than 20% per decade in their 70s and beyond. The decline sped up regardless of self-reported physical activity.⁷

Training

VO₂max responds to training, on average. A meta-analysis of interval training in healthy, sedentary or recreationally active adults under 45 found a mean increase of 0.51 L/min after 6 to 13 weeks.⁸ But the average hides a wide spread. In the HERITAGE Family Study, 481 sedentary adults trained for 20 weeks. The mean gain was about 0.4 L/min, yet some people gained little or nothing and others gained more than 1.0 L/min.⁹

Estimates from wearables can be useful across a group but are less reliable for one person. A 2022 meta-analysis found that watches using exercise data had almost no average bias, but limits of agreement of about −9.9 to +9.7 mL/kg/min against lab tests. Algorithms based on resting data overestimated VO₂max and had wider limits still. The authors concluded the error at the individual level is large.¹⁰

Measured tests vary too. In a 2026 study of repeated human testing, day-to-day VO₂ variability ranged from 3% to 12% across systems, after excluding one outlier. Roughly 60–70% of that came from the person, not the equipment.¹¹ So a small change between two tests may be noise. Use the same device, protocol, time of day and test mode each time.

• Give training time to work. The studies above measured change after 6 to 20 weeks of structured training.^8,9
• Expect real change to be larger than day-to-day noise before acting on it.¹¹
• Keep conditions the same between tests, including the device.
• Get medical clearance before maximal testing, especially if you have symptoms or known heart disease.

VenTracer is a wireless VO₂max mask in development, designed to measure breath flow, oxygen and carbon dioxide on every breath. It is not a medical device, and we will publish validation against a lab cart before making any accuracy claim. If you run a lab or clinic, see how we work with labs or apply to be a pilot partner.

1. Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Netw Open, 2018.
2. Kodama S et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA, 2009;301:2024–2035.
3. Ross R et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign. A scientific statement from the American Heart Association. Circulation, 2016.
4. Kaminsky LA, Arena R, Myers J. Reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing: data from the Fitness Registry and the Importance of Exercise National Database. Mayo Clin Proc, 2015.
5. Peterman JE et al. Development of global reference standards for directly measured cardiorespiratory fitness: a report from FRIEND. Mayo Clin Proc, 2020.
6. Kaminsky LA et al. Updated reference standards for cardiorespiratory fitness measured with cardiopulmonary exercise testing: data from FRIEND. Mayo Clin Proc, 2022.
7. Fleg JL et al. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation, 2005.
8. Bacon AP, Carter RE, Ogle EA, Joyner MJ. VO₂max trainability and high intensity interval training in humans: a meta-analysis. PLoS One, 2013.
9. Bouchard C et al. Familial aggregation of VO₂max response to exercise training: results from the HERITAGE Family Study. J Appl Physiol, 1999.
10. Molina-Garcia P et al. Validity of estimating the maximal oxygen consumption by consumer wearables: a systematic review with meta-analysis and expert statement of the INTERLIVE network. Sports Med, 2022.
11. Van Hooren B, Souren T, Miqueu F, Bongers BC. Technological and biological reliability, and validity of five different CPET systems during simulated and human exercise. Scand J Med Sci Sports, 2026.