VO2max testing in London, what it measures and why it matters

What a VO2max test is

VO2max is the most oxygen your body can take in and use in a minute, for each kilogram of body weight, at your hardest effort. It reflects how well your heart, lungs, blood and muscles work together, and it is the most direct measure of cardiorespiratory fitness [1].

In a cardiopulmonary exercise test you wear a mask or mouthpiece that analyses each breath while you walk, run or cycle and the effort rises step by step. Fitness is also expressed in METs, where 1 MET is 3.5 mL of oxygen per kilogram per minute, roughly the oxygen you use sitting still [1].

Why it is done and why fitness predicts outcomes

Fitness is one of the strongest single predictors of how long people live. A meta-analysis of 33 studies, with 102,980 people followed for all-cause mortality, found that each 1 MET higher fitness was linked with a 13% lower risk of death and a 15% lower risk of heart disease events [2].

A study of 122,007 adults who had a treadmill test, followed for a median of 8.4 years, found that people in the lowest fitness group had about five times the risk of death of the fittest group. The gap was as large as, or larger than, that linked with smoking or diabetes, and no upper limit of benefit was seen [3].

An American Heart Association scientific statement concluded that fitness may predict death more strongly than smoking, high blood pressure, high cholesterol or type 2 diabetes, and that a gain of 1 to 2 METs is linked with 10% to 30% fewer heart events. It recommended treating fitness as a clinical vital sign [1].

Benefits and limitations

A measured VO2max gives you a number to train against, a training plan based on your own heart rate zones, and a baseline to repeat. It is more exact than an estimate from a watch or from treadmill time alone [1].

The studies show an association, and a higher score on its own does not guarantee a longer life. Results vary with the equipment, and values on a bike can be 10% to 20% lower than on a treadmill in people who are not trained, so repeat tests are best done on the same machine [1].

Who should not do a maximal test

Most people can exercise safely, and screening before a hard test looks at how active you already are, whether you have symptoms or known heart, metabolic or kidney disease, and how hard the planned exercise is [4]. A doctor reviews your history and examines you before the test [5].

The American Heart Association lists conditions in which an exercise test should not be done, including a heart attack within the previous 2 days, unstable angina, an uncontrolled heart rhythm problem, symptomatic severe aortic stenosis, heart failure that is not controlled, a recent blood clot in the lungs or legs, acute inflammation of the heart and aortic dissection [5]. A resting blood pressure above 200/110 mm Hg is a reason for caution [5].

If you have chest pain, sudden breathlessness or fainting, call 999 in the UK, or the local emergency number elsewhere, and do not wait for a planned test.

Risks

An exercise test is generally safe and complications are rare. Blood pressure can drop and make you dizzy, the heart rhythm can be irregular for a short time, and in very rare cases a test can bring on a heart attack [6]. You can stop at any time, and the test is stopped early if you have chest pain, severe breathlessness or dizziness [6].

How you prepare and what to expect on the day

Avoid food for 3 hours before the test, and caffeine on the day [5] [6]. Wear comfortable clothes and trainers, and bring an inhaler if you use one [6].

Sticky patches on your chest record an ECG, a cuff checks your blood pressure, and you breathe through the mask while the pace starts easy and gets harder [6]. The exercise lasts about 15 minutes, and the visit about an hour with preparation and recovery [6].

• Your medicines, especially any for blood pressure or the heart
• Any heart, lung or joint condition, and past test results
• Your usual training, and any race or goal
• Any chest pain, fainting or breathlessness on exertion

Results and what happens next

Your VO2max is compared with people of your age and sex, and the doctor explains where you sit and what would move it. The test also shows the heart rates at which your body changes how it uses fuel, which become your training zones.

• How does my result compare with others my age?
• Which heart rate zones should I train in?
• What change in VO2max is realistic in six months?
• When should I repeat the test?

How The Wellness can help

VO2max testing is part of the Longevity Foundation programme at £6,995, with DEXA, a full body MRI, a metabolic and hormone panel, a physician roadmap and 12 months of a wearable [7]. A GMC registered doctor checks you are safe to test and turns the result into a plan.

If you are deciding where to start, the free longevity consultation is a 45 minute video call with a doctor. Our clinics are on Baker Street in Marylebone and Eccleston Street in Belgravia.