VO2 Max and Longevity

VO2 Max is the single strongest predictor of all-cause mortality, outperforming smoking, diabetes, and hypertension as a risk factor. Moving from the bottom 25% to even the 25th-50th percentile of cardio fitness cuts mortality risk substantially. This is not speculation. It is the conclusion of multiple large-scale studies spanning decades and hundreds of thousands of patients.

The Evidence

The landmark 2018 Cleveland Clinic study (Mandsager et al., published in JAMA Network Open) followed over 122,000 patients who underwent treadmill testing between 1991 and 2014. The key finding: extremely high cardio fitness was associated with the lowest mortality risk across all subgroups, and there was no observed upper limit to the benefit. Being in the most fit group carried a lower risk than every other group, including those who were merely “above average.”

Perhaps more striking was the magnitude of risk at the bottom. Patients with low cardio fitness had a mortality risk comparable to, or greater than, those with coronary artery disease, diabetes, or a history of smoking. The benefit of moving from “low” to “below average” fitness was larger than the benefit of quitting smoking.

Peter Attia, a physician focused on longevity, has framed this in practical terms: being in the bottom 25% of VO2 Max for your age carries a mortality risk roughly equivalent to being a smoker. Getting to the 50th percentile essentially removes that excess risk.

What This Means Practically

You do not need elite fitness. The biggest return on investment comes from getting out of the bottom quartile. For a 50-year-old male, that means getting above roughly 35 ml/kg/min. For a 50-year-old female, above roughly 27 ml/kg/min. These are achievable numbers for nearly anyone willing to exercise consistently. See the VO2 Max by age and gender chart for specific percentile ranges.

Beyond the 25th percentile, every additional improvement continues to provide benefit. The relationship is linear and dose-dependent. Higher is always better. But the steepest part of the curve, where the most mortality risk is removed per unit of fitness gained, is at the bottom.

The Decline Is Not Inevitable

VO2 Max declines approximately 10% per decade after age 30 in sedentary individuals. But active individuals slow this to roughly 5% per decade or less. Training at 60 can raise your VO2 Max above where it was at 50 if you were previously sedentary. The decline is not a law of nature. It is largely a consequence of reduced activity.

This means a 60-year-old who trains consistently can have better cardio fitness than the average 40-year-old who does not exercise. The strategies for improving VO2 Max are the same at every age: consistent aerobic exercise combining Zone 2 base training with some higher-intensity efforts.

Tracking It

Apple Watch gives you a continuous estimate of your VO2 Max based on outdoor walks, runs, and hikes. Luen helps you see what daily habits, exercise frequency, sleep quality, daylight exposure, and stress, are actually associated with changes in your VO2 Max over time. The data is already on your wrist. The question is whether you are looking at it in the right context.