What is this about in practical terms? Why does a recreational athlete need to know a number that is in constant flux, let alone chase it? As you keep training and your fitness improves, your VO2max, or its utilisation, will improve.
Regarding the frailty threshold, if you can't walk up a flight of stairs, you know it without a number. Just keep moving, improve your fitness. No need to compare yourself to some statistical number. Be the best version of yourself and compare yourself to yourself.
I think this is a futile discussion. No value in daily life, which includes recreational athletes. Race results and faster paces/longer distances at the same RPE tell you all you need to know.
Excellent talk, thank you! I mostly agree with you. I love all the tech and am a data junkie, so more data is always better to me. I am a recreational athlete, and I will continue to do what I do (combination of SS cardio, intervals, and strength) to the highest level I can for as long as I can(I am 56yo), regardless of my VO2max. I hope I am continuing to improve it or at least maintain it as well as possible. Maybe I’ll test it bc I like the data, but maybe not. It won’t influence what I do, bc I’m already doing as much as I can. I think for people who are less active and don’t like to exercise, it may be more instructive to think about what activities they want to do when they are older and (based on known METs or VO2max required to do those activities) to make sure they are doing enough exercise/activity at a younger age to have the ability to do what they want when they are older. So instead of saying “you need at least a VO2max of X now to have a good quality of life when you’re 75 or 80”, maybe say “if you want to play with your grandkids and hike into your 80s, you need to be jogging x miles at this pace this many times/week now.” That may be more tangible to the general public? So everyone doesn’t necessarily need their exact VO2max, but they do need to think about how to achieve/maintain the activity level they want to maintain an know how to achieve that. Just another way to think about it. Sorry for the long-winded comment.
Love it! That's very much the idea that I expressed. No need to know the VO2max (the number), just stay active and fit, and try your best to improve. - I would bet that most people who know their VO2max and compare it to the tables, the moment they come close to the ideal number, they will stop improving, thinking that's all they need, forgetting that this is a statistical average rather than an individual ideal.
I don’t complete disagree Gregor. What you can DO is certainly more important than a number. I guess my argument would be that without knowing the real number, you don’t truly know if your training is actively improving your aerobic fitness (not all training does or will). Compare it do cholesterol or blood pressure. You can do things that “should” improve those metrics but without a test, you’re flying blind!
Sure, to see progress, you need some test: a race, run up a hill, or a flight of stairs, 400 s on the track, whatever. But you can do that without ever knowing your VO2max. And in my opinion, that's enough for most recreational athletes.
Even if you know your number and compare it to the age-related tables, it's still an individual matter. You may be above average and still die from cancer. You are below average and live into your 90s (unlikely if you are far below average).
The message to the general population should be that high cardiovascular/aerobic fitness is a good thing, as it is something they can relate to. How many people can tell you what VO2max really is?
1) compared to peak output at maximal effort on a ramp test, what is the value of isolating maximal oxygen uptake? as you say, the peak output at the end of a ramp test is largely driven by VO2max, but the other factors influencing peak output (anaerobic capacity, economy, lactate threshold insofar as it preserves anaerobic capacity through the lower ramp stages) all probably influence longevity in varying ways. should we consider the cumulative effect of those variables to be noise or valuable info?
2) many of the longevity studies use submaximal tests, and they find a relationship with mortality risk that's just as large as the studies that use maximal tests. Apple Watch, Garmin, and other wearables tend to use submaximal data (how heart rate moves with output) for their "VO2Max" measurements, which leads to more error than the estimates would if they required users to do a maximal effort for a measurement. But if submaximal tests are just as good at predicting longevity, the fact that the Apple Watch test is misestimating your VO2max is not particularly relevant. In fact, we're back to the question of whether the error is actual valuable information, if the submaximal test implicitly incorporating LT1/LT2 tells you more about the users mitochondrial function (if that's what we care more about with regards to health)
Fair points Nick. What I would love to see is a study using a composite of submax thresholds + maximal, and their low-high combinations, in relation to mortality. Because obviously maximal output is only part of the story and may not reflect other nuances in lactate clearing capacity or mito function like sub max tests do!
absolutely, and that would give more insight into the distinction people really care about here - how to design training! any competitive endurance athlete knows you can focus on one or the other, and while most people aren't going to be designing their training entirely around longevity benefits, it's at least worth understanding
I think the issue is that researchers are more concerned about the general population, where the variance between subjects in general fitness level is so big that trying to figure out which element of fitness is most importance is missing the forest for the trees
Hi Brady. Thanks for the thoughtful video. Not sure where i stand on the value of VO2max as a predictor of health/longevity but appreciate the civil back and forth. Two questions you didnt address. First, although wearables are not accurate measures of VO2max, most maximal treadmill protocols will calculate VO2max/METS the same way most of the people studied were assessed….wouldn’t that mean that these kinds of tests are just as valuable as a true gas exchange test? Also, since we don’t know if these people actually reached their true max, all the non-gas tests really measure is how long people are willing to continue to suffer. Is it not possible that the ability to sustain uncomfortable activities might be just as directly associated with health/longevity as aerobic power is?
Thanks for the post! I read Dr. Topol’s article yesterday and had the same thoughts as you. I left a polite comment as I am a huge fan of his. Now, I have purchased your book so I am probably biased, but as an endurance athlete, I do get a VO2 lab test every year or two :)
What is this about in practical terms? Why does a recreational athlete need to know a number that is in constant flux, let alone chase it? As you keep training and your fitness improves, your VO2max, or its utilisation, will improve.
Regarding the frailty threshold, if you can't walk up a flight of stairs, you know it without a number. Just keep moving, improve your fitness. No need to compare yourself to some statistical number. Be the best version of yourself and compare yourself to yourself.
I think this is a futile discussion. No value in daily life, which includes recreational athletes. Race results and faster paces/longer distances at the same RPE tell you all you need to know.
Excellent talk, thank you! I mostly agree with you. I love all the tech and am a data junkie, so more data is always better to me. I am a recreational athlete, and I will continue to do what I do (combination of SS cardio, intervals, and strength) to the highest level I can for as long as I can(I am 56yo), regardless of my VO2max. I hope I am continuing to improve it or at least maintain it as well as possible. Maybe I’ll test it bc I like the data, but maybe not. It won’t influence what I do, bc I’m already doing as much as I can. I think for people who are less active and don’t like to exercise, it may be more instructive to think about what activities they want to do when they are older and (based on known METs or VO2max required to do those activities) to make sure they are doing enough exercise/activity at a younger age to have the ability to do what they want when they are older. So instead of saying “you need at least a VO2max of X now to have a good quality of life when you’re 75 or 80”, maybe say “if you want to play with your grandkids and hike into your 80s, you need to be jogging x miles at this pace this many times/week now.” That may be more tangible to the general public? So everyone doesn’t necessarily need their exact VO2max, but they do need to think about how to achieve/maintain the activity level they want to maintain an know how to achieve that. Just another way to think about it. Sorry for the long-winded comment.
I appreciate long-winded comments, Monique! Thanks for the stimulating discussion.
Love it! That's very much the idea that I expressed. No need to know the VO2max (the number), just stay active and fit, and try your best to improve. - I would bet that most people who know their VO2max and compare it to the tables, the moment they come close to the ideal number, they will stop improving, thinking that's all they need, forgetting that this is a statistical average rather than an individual ideal.
I don’t complete disagree Gregor. What you can DO is certainly more important than a number. I guess my argument would be that without knowing the real number, you don’t truly know if your training is actively improving your aerobic fitness (not all training does or will). Compare it do cholesterol or blood pressure. You can do things that “should” improve those metrics but without a test, you’re flying blind!
Sure, to see progress, you need some test: a race, run up a hill, or a flight of stairs, 400 s on the track, whatever. But you can do that without ever knowing your VO2max. And in my opinion, that's enough for most recreational athletes.
Even if you know your number and compare it to the age-related tables, it's still an individual matter. You may be above average and still die from cancer. You are below average and live into your 90s (unlikely if you are far below average).
The message to the general population should be that high cardiovascular/aerobic fitness is a good thing, as it is something they can relate to. How many people can tell you what VO2max really is?
Thanks anyway, keep the good stuff coming!
1) compared to peak output at maximal effort on a ramp test, what is the value of isolating maximal oxygen uptake? as you say, the peak output at the end of a ramp test is largely driven by VO2max, but the other factors influencing peak output (anaerobic capacity, economy, lactate threshold insofar as it preserves anaerobic capacity through the lower ramp stages) all probably influence longevity in varying ways. should we consider the cumulative effect of those variables to be noise or valuable info?
2) many of the longevity studies use submaximal tests, and they find a relationship with mortality risk that's just as large as the studies that use maximal tests. Apple Watch, Garmin, and other wearables tend to use submaximal data (how heart rate moves with output) for their "VO2Max" measurements, which leads to more error than the estimates would if they required users to do a maximal effort for a measurement. But if submaximal tests are just as good at predicting longevity, the fact that the Apple Watch test is misestimating your VO2max is not particularly relevant. In fact, we're back to the question of whether the error is actual valuable information, if the submaximal test implicitly incorporating LT1/LT2 tells you more about the users mitochondrial function (if that's what we care more about with regards to health)
Fair points Nick. What I would love to see is a study using a composite of submax thresholds + maximal, and their low-high combinations, in relation to mortality. Because obviously maximal output is only part of the story and may not reflect other nuances in lactate clearing capacity or mito function like sub max tests do!
absolutely, and that would give more insight into the distinction people really care about here - how to design training! any competitive endurance athlete knows you can focus on one or the other, and while most people aren't going to be designing their training entirely around longevity benefits, it's at least worth understanding
I think the issue is that researchers are more concerned about the general population, where the variance between subjects in general fitness level is so big that trying to figure out which element of fitness is most importance is missing the forest for the trees
Hi Brady. Thanks for the thoughtful video. Not sure where i stand on the value of VO2max as a predictor of health/longevity but appreciate the civil back and forth. Two questions you didnt address. First, although wearables are not accurate measures of VO2max, most maximal treadmill protocols will calculate VO2max/METS the same way most of the people studied were assessed….wouldn’t that mean that these kinds of tests are just as valuable as a true gas exchange test? Also, since we don’t know if these people actually reached their true max, all the non-gas tests really measure is how long people are willing to continue to suffer. Is it not possible that the ability to sustain uncomfortable activities might be just as directly associated with health/longevity as aerobic power is?
Thanks for the post! I read Dr. Topol’s article yesterday and had the same thoughts as you. I left a polite comment as I am a huge fan of his. Now, I have purchased your book so I am probably biased, but as an endurance athlete, I do get a VO2 lab test every year or two :)