VO2 max is the top rate at which your body can take in, carry, and use oxygen during exercise. It depends on the lungs, heart, blood, and muscle working together under steady load. So it is used as one summary number for aerobic fitness. It is treated as a stand-in for healthspan because higher values go with lower modeled risk of death.
The size of that link is worth stating exactly. A 2026 Scientific Reports study of 340 runners who had run many marathons modeled their risk of death. It used published data showing a 3.7% drop in death from any cause per 1 mL/kg/min increase in VO2max.1 That is a modeled figure taken from an earlier meta-analysis. It was not measured in that group. So the honest way to use your own number is as a trend you can change, not a verdict.
Key takeaways
- VO2 max sums up whole-body aerobic fitness in one number. That is both its strength and its limit.
- The link to death risk that is most often quoted is a modeled estimate, not a measured result.
- Lab-measured values differ a lot by sex and by training level.
- Wearable estimates are tools for tracking trends. They do not match from one device to another.
- 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 group came from a world-wide online survey at one point in time. It covered 340 multi-marathoners with a mean age of 52.2 years, 54.1% men, across 24 countries. They averaged 121 marathons finished in their lives.1 Their estimated VO2max values were much higher than normal for every age group. That was compared against FRIEND registry norms, and several age groups were above the 95th percentile.1
Compared with the norms, the multi-marathoners showed a slower decline in VO2max with age, especially among older adults.1 The authors are clear that this was a snapshot study, and that group effects may explain part of it. So it is not proof that running marathons slows the decline.
Is VO2 max different for men and women?
Sex differences show up clearly in directly measured data. One lab study at an Indian medical college tested 30 athletes and 120 controls matched for age and sex, all aged 17 to 25. 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 moved the number more than sex did in that group. And a raw value means little unless you know the age, sex, and fitness of the people you compare yourself to.
A note on the numbers you will see elsewhere
Some figures get repeated a lot: the age when VO2 max peaks, how much it falls each decade, and how much you can gain in your sixties. They spread mostly through commercial health blogs. We took them off this page because we could not trace them to a primary source we had really read. If someone quotes one at you, ask which study it came from.
How is VO2 max measured?
Is the VO2 max on a smartwatch accurate?
Research does use VO2max from wearables, as the multi-marathoner study did.1 But a device estimate built from heart rate and pace is not the same as a step-by-step lab test. Estimates also shift with training load and with how the data was captured.
So your device number is most useful when compared with your own earlier numbers on the same device. Switching watches resets the baseline.
What if joint pain is what limits your training?
The joint is the constraint, not the motivation
Aerobic fitness responds to steady training. And steady training needs a knee, hip, or back that can handle repeated load. When knee osteoarthritis is what ends the walk or the ride, no training plan fixes the number.
Where orthobiologics fit, and where they do not
Regen.MD offers platelet-rich plasma into the joint and into tendons. We also offer intraosseous and subchondral PRP, bone marrow aspirate concentrate, Lipogems, and orthobiologics into the disc. For advanced knee osteoarthritis, PRP is framed as a safe bridge therapy before joint replacement. None of it regrows cartilage, and none of it raises VO2 max directly. The aim is to let you handle the training that does. The full scope is under orthobiologics.
When conservative care has run its course, 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 under all of this. The Biological Baseline Program checks fasting insulin, HbA1c, hs-CRP, a detailed lipid panel, and hormones. It adds coronary artery calcium scoring and blood vessel age scans. It is the required first phase before any joint, spine, or nerve procedure is booked. What we measure and why is laid out under metabolic optimization.
For more information, get our free guide to knee pain and treatment options.
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 or text us.
Frequently Asked Questions
What actually is VO2 max?
It is the top rate at which your body can take in, carry, and use oxygen during exercise. It is written as milliliters of oxygen per kilogram of body weight per minute. It depends on the lungs, heart, blood, and muscle all working together. So it is used as one summary number for aerobic fitness. How we use numbers 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 VO2max from wearables, including a 2026 Scientific Reports study of 340 multi-marathon runners. But the value depends on the device’s formula, your training load, and how the data was captured. It is useful for watching your own trend. It is not useful for comparing yourself with someone on a different device. More on how we read numbers is in the Regen.MD library.
Do men and women get different numbers?
Yes, and the gap is well documented in lab-measured data. One study tested 30 athletes and 120 controls matched for age and sex, aged 17 to 25. Treadmill VO2 max averaged 52.37 mL/kg/min in male athletes against 40.96 in female athletes. It was 33.35 in male controls against 25.09 in female controls. Read your number against people like you, not against one cutoff for all. 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 covered at Regen.MD as a medical and teaching topic. They are not sold as a product, as set out under peptide therapy. Aerobic fitness responds to steady training. Nothing here takes the place of that.
Why does VO2 max matter for health and longevity?
VO2 max sums up how well your lungs, heart, blood, and muscle work together under steady load. That is why it is treated as a healthspan marker. Higher values go with lower risk of death. A 2026 Scientific Reports study modeled a 3.7% drop in death from any cause for each 1 mL/kg/min increase. It used data from an earlier meta-analysis. That figure is modeled, not measured. So use your own number as a trend you can move, not a verdict.
How do I check my VO2 max at home?
A smartwatch or fitness tracker gives you an estimate. The device’s formula works it out from your heart rate and pace. That is a different measure from a step-by-step lab test. It shifts with your training load and with how the data was captured. Compare each reading with your own earlier readings on the same device. Switching watches resets your baseline.
How can I improve my VO2 max?
Aerobic fitness responds to steady training, and nothing replaces that work. The catch is that steady training needs a knee, hip, or back that can handle repeated load. If knee osteoarthritis or another joint problem ends the walk or the ride, fix the joint first. No training plan can raise the number while pain keeps stopping the training.
Sources
- Lundy L, Reilly RB, Fleming N. “VO2max aging 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/