Given a choice, virtually all of us would like to live long, healthy lives. The question is, how do we manage that? Well, it’s like the old joke about how do you get to Carnegie Hall -- “Practice, practice, practice!” In other words, you need to work at it, consistently engaging in the behaviors that will help you achieve the goal. We’re talking about the things I stress all the time, like healthy whole foods, restorative rest, stress reduction, and plenty of movement. But when it comes to the last one, it’s about more than just doing a little yoga or getting up from the desk frequently during the day. Great practices both but you also need cardiovascular fitness and that will take a little more effort. 

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Why does cardio fitness matter so much to longevity? Cardiovascular fitness, best measured by assessing your VO₂ (oxygen consumption), is one of the most powerful indicators we have to measure your overall health and longevity potential. Your ‘VO₂ max’ reflects how efficiently heart, lungs, and muscles function together to keep the body moving when it’s working hard. Research indicates that higher VO₂ max levels are associated with a lower risk of mortality and a longer lifespan, which is the main reason I encourage everyone to work on improving their VO₂ max. Here’s my in-a-nutshell look at your VO₂ max and how to harness it so you can do life well and long:

What’s my ‘VO₂ max’ about anyway?

In short, VO₂ max is the maximum rate at which your body can consume and then use oxygen during exercise. It’s widely regarded as the most important measure of aerobic fitness and cardiovascular capacity. Typically measured in a lab setting, VO₂ max is tracked as a person undergoes an exercise-to-exhaustion test on a treadmill or stationary bike (aka a ‘cycle ergometer’) while their oxygen consumption is monitored throughout. With this test, we get the most accurate assessment of your body's ability to deliver and use oxygen during sustained, high-intensity physical activity. Essentially, the results come down to this: the higher VO₂ max score, the greater your aerobic capacity and endurance. The score also helps show us how efficiently (or not) your cardiovascular system is delivering oxygenated blood to your muscles, in fact, to all your tissues. 

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Not quite up for a full Tour de France-style lab test? In that case, you can get a rough read on your VO₂ max using a Cooper 12-minute run test (time yourself on a track and see how much ground you can cover in 12 minutes) or by using a higher-end fitness tracker/device that uses algorithms to estimate VO2 max based on heart rate and physical activity data.

A high VO₂ max is the ticket to a happier, longer-wearing heart.

Not surprisingly, there are a couple of big links between a VO₂ max and your healthspan, starting with your heart.  A higher VO₂ max score means your heart pumps more blood per beat, while your lungs send oxygen to the blood more efficiently. All to the good. Individuals with higher VO₂ max levels have lower blood pressure, better lipid profiles and, generally speaking, enjoy better metabolic health. All of that adds up to reducing the risk of cardiovascular disease which, as you probably know, is the leading cause of death, not only in the U.S., but worldwide. Put it this way: a high VO₂ level means a healthier heart that’s in better shape to go the longevity distance.

Higher VO₂ max may mean lower life-shorteners.

Research points to a strong correlation between high VO₂ and lower risk of developing other chronic, often life-shortening conditions, like diabetes, hypertension, and metabolic syndrome. In fact, a study published in JAMA Network Open in 2018 found that individuals with higher cardiorespiratory fitness (as indicated by VO₂ max) had a significantly lower risk of mortality, even after adjusting for factors such as age, gender, and body mass index (BMI). Better metabolic function and enhanced insulin sensitivity help tame the life-shortening scourge of inflammation which drives most, if not all, the most common age-related diseases.

VO₂ max amps up your energy – and your mitochondrial game.

VO₂ max is linked to mitochondrial efficiency. The energy that runs the human system is generated inside the mitochondria, often referred to as the 'powerhouses' of our cells. The more oxygen the body can deliver to the mitochondria inside the muscle cells, the more energy (in the form of ATP molecules) those cells can produce. And when we engage in aerobic exercise, like running or cycling, it not only improves our VO₂ max but also stimulates the production of new mitochondria – yet more energy on tap. The bigger and more numerous these mitochondria are, the better they are at slowing down the aging process at a cellular level, giving us all a considerably better shot at extending our lifespan and keeping our brains and muscles in fighting form as we age.

VO₂ max as a biomarker for your biological age.

Having a high VO₂ max may also mean that you have a lower “biological age,” indicating how fast you're aging at a cellular level rather than just how many years you've been around. It's been found that older folks with impressive VO₂ max levels tend to have better physical and mental capabilities, basically making them ‘younger' than their less fit counterparts. So, imagine being in your 60s but with a VO₂ max that makes your body feel like 40 or 50 - that's some serious aging magic.

More VO₂ max, equals more living.

A higher VO₂ max level is kind of like having a longevity-oriented superpower. In 2018, a meta-analysis published in Circulation looked at a whopping 100,000 participants and discovered that folks with high VO₂ max had a whopping 45-60% lower risk of kicking the bucket compared to those with low levels. And here's the real kicker: even a tiny bump up in your VO₂ max can do wonders for your chances of sticking around, especially if you're starting from the couch potato level of fitness (though I hope you’re a good bit north of there).

Bust a move – and don’t hold back.

Few of us want to die before our time, so the time to start working on your upgrading your VO₂ max game is now, no matter where you are in the fitness journey. But if you are starting from zero or getting back into your fitness groove after long hiatus, do not overdo it, get your doc’s OK and consider working with a trainer to help you manage the ramp up safely, effectively and (save for maybe some muscle soreness) injury-free. A trainer can also help monitor your progress and adjust the training variables as needed to help you continue nudging your VO2 max gently upwards over time. Also remember to be patient with yourself as building up your VO₂ max (or rebuilding it) is a marathon, not a sprint, so resist the urge to go pedal to the metal right out of the gate. Ultimately, improving your VO₂ max game will involve plenty of consistent aerobic exercise, so lace up your sneakers and consider these options:

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1. Cardiovascular Activities: Think running, cycling, swimming, rowing, and brisk walking, any of which will elevate the heart rate and challenge your cardiovascular system.
2. Interval Training: High-intensity interval training (HIIT) sessions alternate between short periods of intense effort and longer periods of recovery.
3. Long, Continuous Workouts: Endurance workouts at a moderate intensity for extended durations can also improve aerobic capacity.
4. Muscle Efficiency: Strength training exercises improve muscular efficiency, allowing muscles to use oxygen more effectively during exercise.
5. Full-Body Workouts: Incorporate compound exercises that target multiple muscle groups, such as squats, deadlifts, lunges, and push-ups.

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And, you may be wondering, how much time are we talking? As a general guideline: aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week, along with muscle-strengthening activities on two or more days per week. And trainer or not, increase exercise intensity, duration, or frequency gradually over time to avoid injury and continually improve fitness levels. 

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Stay hydrated, eat well and give yourself time to rest and recover, and before you know it, you’ll be well on your way to giving your longevity potential the leg up it needs.