VO2 max is the maximum rate at which your body can take in, transport, and use oxygen during exercise. Because it depends on the lungs, heart, blood, and muscle working together under sustained load, it is used as a single summary number for aerobic capacity, and it is treated as a healthspan proxy because higher values track with lower modelled mortality risk.
The size of that relationship is worth stating precisely. A 2026 Scientific Reports study of 340 multi-marathon runners modelled mortality risk using published meta-analytic data indicating a 3.7% reduction in all-cause mortality per 1 mL/kg/min increase in VO2max.1 That is a modelled figure carried in from a prior meta-analysis, not an outcome measured in that cohort, so the honest way to use your own number is as a trend you can influence rather than a verdict.
Key takeaways
- VO2 max summarizes whole-body aerobic capacity in one number, which is its strength and its limitation.
- The mortality relationship most often quoted is a modelled dose-response, not a measured outcome.
- Measured laboratory values differ substantially by sex and by training status.
- Wearable estimates are trend tools; they are not interchangeable across devices.
- When joint pain is what limits training, the joint is the problem to solve first. See the conditions we evaluate.
What the published cohorts actually show
Sustained endurance training and age
The Scientific Reports cohort was a global cross-sectional online survey of 340 multi-marathoners with a mean age of 52.2 years, 54.1% men, across 24 countries, with an average of 121 lifetime marathon completions.1 Their estimated VO2max values were substantially higher than population norms across all age groups when compared against FRIEND registry normative data, with multiple age bands exceeding the 95th percentile.1
Compared with those normative trajectories, the multi-marathoners showed a more gradual age-associated pattern in VO2max, particularly among older adults.1 The authors are explicit that this is cross-sectional and that cohort effects may explain part of it, so it is not proof that running marathons slows the decline.
Men and women measure differently
Sex differences show up clearly in directly measured data. In a laboratory study of 30 athletes and 120 age- and sex-matched controls aged 17 to 25 at an Indian medical college, treadmill VO2 max averaged 52.37 ± 8.78 mL/kg/min in male athletes and 40.96 ± 4.06 in female athletes; among controls it was 33.35 ± 3.77 in men and 25.09 ± 7.07 in women.2
Two things follow. Training status moved the number more than sex did in that sample, and a raw value means little without knowing the age, sex, and conditioning of the people you are comparing yourself to.
A note on the numbers you will see elsewhere
Widely repeated figures for the age at which VO2 max peaks, the percentage it falls per decade, and the gain achievable in your sixties circulate mostly through commercial health blogs. We removed them from this page because we could not trace them to a primary source we had actually read. If you see one quoted at you, ask which study it came from.
How VO2 max is estimated in practice
Wearable estimates are trend tools
Research does use wearable-derived VO2max, as the multi-marathoner study did.1 But an estimate produced by a device algorithm from heart rate and pace is not the same measurement as a graded laboratory test, and estimates are sensitive to training load and to how the data was captured.
The practical consequence is that your device number is most useful compared against your own earlier numbers on the same device. Switching watches resets the baseline.
When joint pain is what limits training
The joint is the constraint, not the motivation
Aerobic capacity responds to sustained conditioning, and sustained conditioning requires a knee, hip, or back that tolerates repeated loading. When knee osteoarthritis is what ends the walk or the ride, no amount of programming fixes the number.
Where orthobiologics fit, and where they do not
Regen.MD offers intra-articular and tendon platelet-rich plasma, intraosseous and subchondral PRP, bone marrow aspirate concentrate, Lipogems, and intradiscal orthobiologics. For advanced knee osteoarthritis, PRP is framed as , a safe bridge therapy prior to joint replacement. None of it regrows cartilage and none of it raises VO2 max directly; the aim is tolerance for the training that does. The full scope is under orthobiologics.
Where conservative measures have been exhausted, surgery is discussed on its merits. Dr. Gurpreet Singh Padda, MD, MBA, MHP is a surgeon; surgery is simply not the first step.
Measure, correct, re-measure
Metabolic work sits underneath all of this. The Biological Baseline Program runs fasting insulin, HbA1c, hs-CRP, lipid fractionation, and a hormone profile alongside coronary artery calcium scoring and vascular-age imaging, and it is the mandatory first phase before any joint, spine, or nerve procedure is scheduled. What we measure and why is set out under metabolic optimization.
Find out what is limiting your capacity, not just what your watch says
Regen.MD begins with a physician-led Clinical Evaluation — a review of your history, imaging, and metabolic data, and a written terrain roadmap. Evaluation is contingent upon review of your data.
Questions? Call (314) 295-3000 or text (314) 886-5902.
Frequently Asked Questions
What actually is VO2 max?
It is the maximum rate at which your body can take in, transport, and use oxygen during exercise, expressed in millilitres of oxygen per kilogram of body weight per minute. Because it depends on the lungs, heart, blood, and muscle all working together, it is used as a single summary number for aerobic capacity. How we use measurements like this inside a plan is described in our approach.
Is the VO2 max on my watch accurate?
Treat it as an estimate. Published research does use wearable-derived VO2max, including a 2026 Scientific Reports study of 340 multi-marathon runners, but the value depends on the device’s algorithm, your training load, and how the data was captured. It is useful for watching your own trend, not for comparing yourself against someone on a different device, and more on how we read measurements sits in the Regen.MD library.
Do men and women get different numbers?
Yes, and the gap is well documented in measured laboratory data. In a study of 30 athletes and 120 age- and sex-matched controls aged 17 to 25, treadmill VO2 max averaged 52.37 mL/kg/min in male athletes against 40.96 in female athletes, and 33.35 in male controls against 25.09 in female controls. Read your number against people like you, not against a universal cutoff; we see patients at 4477 Woodson Rd, Suite 103, St. Louis, MO 63134, listed on our locations page.
Can peptides raise my VO2 max instead of training?
No, and we would not present them that way. Peptides are discussed at Regen.MD as a clinical and educational subject and are not sold as a product, as set out under peptide therapy. Aerobic capacity responds to sustained conditioning; nothing here substitutes for that.
Sources
- Lundy L, Reilly RB, Fleming N. “VO2max ageing and all cause mortality in a global cohort of multi marathoners.” Scientific Reports, published May 12, 2026. https://www.nature.com/articles/s41598-026-52475-x
- Srivastava S, Tamrakar S, Nallathambi N, Vrindavanam SA, Prasad R, Kothari R. “Assessment of Maximal Oxygen Uptake (VO2 Max) in Athletes and Nonathletes Assessed in Sports Physiology Laboratory.” Cureus, 2024 May 26;16(5):e61124. https://pmc.ncbi.nlm.nih.gov/articles/PMC11197041/