VO₂ Max: The Breath of Longevity. What one number can tell us about how we live—and what it can’t.

By: Siobhan Gray, MD

A Conversation with Your Breath

Take a moment and notice your breath. Inhale slowly through your nose, then exhale. It’s such an ordinary act that we rarely pause to consider its power. Each breath is a quiet conversation between your body and the world—an exchange that fuels every thought, every step, every heartbeat.Hidden within that exchange is a number called VO₂ max. It might sound like a metric meant for endurance athletes, yet it is one of the strongest predictors of how long and how well we live. At PEAKMD, I often call it the breath of longevity because it reflects how gracefully your body still remembers how to move through life.

What VO₂ Max Really Measures

VO₂ max stands for maximal oxygen uptake. It measures how much oxygen your body can take in and use during intense exertion. In essence, it’s a portrait of how well your heart, lungs, and muscles work together when you challenge them. Scientific formula: VO₂ max = Cardiac Output × Arteriovenous Oxygen DifferenceTranslated more simply, it represents how much oxygen-rich blood your heart can pump and how effectively your muscles can extract and use that oxygen. Genetics set the baseline, but training and lifestyle determine where it can go.

Why It Matters for Longevity

Among all the biomarkers we can measure, VO₂ max stands out as one of the most powerful predictors of both lifespan and healthspan.

Every 3.5 ml/kg/min increase in VO₂ max (roughly one “metabolic equivalent”) reduces the risk of death from any cause by about 13 percent.

Moving from one fitness category to the next—for example, from “average” to “above average”—can cut mortality risk by nearly 50 percent.

Those in the top 25 percent of cardiorespiratory fitness have an 80 percent lower all-cause mortality risk than those in the lowest quartile. (Cleveland Clinic data summarized by Peter Attia, MD.)

Even modest improvements carry meaningful benefit. Every bit of conditioning you build is an investment in longevity and vitality.

But It Is Not the Whole Story

There are many things we cannot measure in a lab. We cannot test for connection, joy, or purpose. We cannot chart the way awe floods the body when sunlight moves through a forest, or how the heart softens in the presence of someone we love. And yet, these immeasurable qualities shape health just as powerfully as oxygen uptake. Most of the world’s longest-lived people have probably never heard the term VO₂ max. They aren’t wearing fitness trackers or chasing metrics. They are simply living in ways that keep their aerobic engines quietly strong—walking to a neighbor’s house, tending gardens, climbing hills to church, carrying groceries home instead of ordering delivery.Their lives are built around movement that matters, effort connected to purpose. Science would call it sustained aerobic activity; they simply call it living.So yes, VO₂ max is worth knowing. It offers a tangible glimpse of vitality. But longevity is not built on oxygen alone. It depends just as much on relationships, belonging, rest, and the willingness to stay curious about life itself.

Estimating VO₂ Max at Home

You can approximate your VO₂ max using practical, validated tools:

• Rockport 1-Mile Walk Test — Walk one mile briskly, record your time and heart rate, then use an online calculator.

• Cooper 12-Minute Run — Run or walk as far as possible in 12 minutes; distance correlates closely with VO₂ max.

• Wearables — Devices from Garmin, Apple, WHOOP, and Oura estimate VO₂ max trends from pace and heart-rate data.

• Talk Test — If you can talk in full sentences but not sing, you’re likely in Zone 2, the intensity range that builds aerobic capacity most effectively.

How We Measure It at PEAKMD

At PEAKMD, we use the PNOĒ metabolic analyzer, a lab-grade system that measures real-time oxygen and carbon-dioxide exchange as you complete a tailored ramp protocol. Your results integrate directly into your personalized health and longevity plan, aligning your training, recovery, and nutrition strategies with your physiology and purpose.

Testing is not about competition. It is about clarity—a snapshot of where you are today and the roadmap to where you can go.

The Deeper Meaning

Breath is more than biology. It is the rhythm that ties every moment of your life together. Measuring VO₂ max is simply another way of listening—to your effort, to your energy, to the partnership between your body and the life moving through it.

But numbers will never tell the whole story. The rest is written in the spaces we cannot quantify: laughter, stillness, belonging, and awe.

Train your heart and lungs. Move often and with purpose. But remember to notice what gives your breath meaning in the first place.

That is the true measure of longevity.

Ready to see your own numbers?

Book your VO₂ Max Assessment at PEAKMD and discover how your physiology can guide a longer, stronger, more intentional life.

Typical VO₂ Max Ranges (ml/kg/min)

Men

Age	20–29	30–39	40–49	50–59	60+
Excellent	≥ 60	≥ 56	≥ 52	≥ 48	≥ 45
Good	52–59	49–55	46–51	42–47	39–44
Above Average	47–51	44–48	41–45	38–41	35–38
Average	42–46	40–43	38–40	34–37	31–34
Below Average	37–41	35–39	33–37	30–33	27–30
Poor	< 37	< 35	< 33	< 30	< 27

Women

Age	20–29	30–39	40–49	50–59	60+
Excellent	≥ 56	≥ 52	≥ 48	≥ 45	≥ 42
Good	47–55	44–51	41–47	38–44	36–41
Above Average	42–46	39–43	37–40	34–37	32–35
Average	38–41	35–38	33–36	31–33	28–31
Below Average	33–37	31–34	29–32	27–30	24–27
Poor	< 33	< 31	< 29	< 27	< 24

(Adapted from the American College of Sports Medicine, 2020.)

How to Train for a Higher VO₂ Max

Method	Goal	Example Practice
Zone 2 Training	Builds mitochondrial density and metabolic flexibility	30–45 min brisk walking, cycling, or hiking where you can speak but not sing, 3–4× per week
HIIT Intervals	Improves cardiac output and oxygen utilization	4 × 4-min high-effort intervals with equal recovery, 1–2× per week
Strength Training	Increases muscle efficiency and protects lean mass	Full-body resistance training 2–3× per week
Sleep & Recovery	Enables adaptation and repair	Prioritize 7–9 hr of quality sleep plus recovery days
Body Composition	Enhances oxygen use relative to body weight	Maintain healthy lean mass through nutrition and movement

References

1. Kodama S et al. “Cardiorespiratory Fitness as a Quantitative Predictor of All-Cause Mortality and Cardiovascular Events in Healthy Men and Women.” JAMA 301 (19), 2009: 2024-2035.

2. American College of Sports Medicine. Health-Related Physical Fitness Assessment Manual, 5th ed. Wolters Kluwer, 2020.

3. Levine BD. “VO₂ max: What Do We Know, and What Do We Still Need to Know?” J Physiol 586 (1), 2008: 25-34.

4. Tsekouras YE et al. “Validity and Reliability of the Portable Metabolic Analyzer PNOĒ.” Front Sports Act Living 1 (2019): 24.

5. Mandsager K et al. “Association of Cardiorespiratory Fitness With Long-Term Mortality Among Adults.” JAMA Network Open 1 (6), 2018: e183605.

6. Attia P. Outlive: The Science and Art of Longevity. Harmony Books, 2023.