VO2Max: Exercise To Lower Blood Pressure
- Dmitri Konash
- Jun 28, 2023
- 10 min read
Updated: May 4
Pump Up Your VO2Max and Deflate Your BP
What is VO2Max?
VO2max meaning? VO2max is the maximum rate at which your body can transport and use oxygen during exercise. Think of it as your cardiovascular system's version of a Formula 1 pit crew – the higher your VO2Max, the faster and more efficiently your body can fuel your muscles with oxygen.
VO2max units? Milliliters of oxygen per kilogram of body weight per minute (mL/kg/min). The good news is that you do not need to memorise them. Just know your VO2max number and you can compare it to everyone else.
Now, you might be wondering, "What does this VO2max definition have to do with my blood pressure?" Hold on there, because we're about to uncover the affair between VO2Max and blood pressure that's been the talk of the medical town.
What is so important about VO2Max?
Dr. Peter Attia, the Justin Bieber of longevity medicine has been singing the praises of VO2Max for years [1]. He's been quoted saying, “Peak aerobic cardiorespiratory fitness, measured in terms of VO2max, is perhaps the single most powerful marker for longevity. VO2max represents a maximum rate at which a person can utilise oxygen “
But why is Dr. Attia so obsessed with VO2Max? A higher VO2Max means your heart can pump more blood with each beat, your blood vessels are more elastic, and your muscles are better at extracting oxygen from your blood. It's like upgrading your cardiovascular system from a rusty bicycle to a Tesla – everything just works better.
Here is a quote from the research paper which followed up participants for 46 years [2]. "Cardiorespiratory Fitness (measured by VO2max) was significantly related to longevity over 4 decades in middle-aged, employed men ....the benefits of higher midlife Cardiorespiratory Fitness extend well into the later part of life. "
What is the link between VO2Max and blood pressure?
Now, let's talk about blood pressure. If your blood pressure were a person, it would be that overly enthusiastic party guest who's always pushing against the walls and making everyone uncomfortable. High blood pressure, or hypertension, is when your blood is pushing too hard against your artery walls.
Here's where the magic happens: as you improve your VO2Max, you're essentially teaching your cardiovascular system to chill out. Your heart becomes more efficient, pumping more blood with less effort. Your blood vessels become more flexible, like yoga instructors for your circulatory system. And your overall blood flow improves, reducing the pressure on your artery walls.
Here is the quote from the 5 year prospective study on blood pressure and VO2max [3]. "It is concluded that low VO2max level is related to higher incidence of hypertension. An improved VO2max would therefore be able to prevent hypertension."
Dr. Attia explains it beautifully: "The ability to deliver oxygen to tissues is fundamentally important to health." It's like upgrading your body's delivery service from sluggish snail mail to Amazon Prime – everything gets where it needs to go faster and more efficiently.
What is the most popular VO2max chart by age and gender?
Now, let's talk about the VO2Max age chart that's more popular than a cat video on the internet – the one from the American College of Sports Medicine (ACSM) [4].
It includes VO2max ranges and VO2max for women.
This chart is like the Hogwarts Sorting Hat of the fitness world, placing you into categories based on your age, gender, and VO2Max score.
Why is this chart the Beyoncé of VO2Max references? Well, for starters, it's comprehensive. It breaks down VO2Max scores for men and women across different age groups.
Secondly, the ACSM is to sports medicine what Gordon Ramsay is to cooking – a respected authority that doesn't mince words.
Lastly, this chart gives you a reality check faster than your bank account after a shopping spree. It tells you whether your VO2Max is "Superior," "Excellent," "Good," "Fair," "Poor," or "Very Poor."
Here are the compressed versions of these tables [5].
These VO2max by age charts show that on average we lose 1% of VO2max per year. The picture is approximately the same for women, except that women tend to have on average lower VO2max than men.
Link between Vo2Max, stress and longevity
Here are the results of the research by Swedish scientists [7] on 792 men started in 1963. They split participants into three groups based on their VO2Max numbers and followed them over the years. The research has found that each tertile increase (move from lower to high VO2max group) in predicted VO2 max was associated with a 21% lower risk of death over 45 years of follow up. Or rephrasing statistics data: 10% increase in VO2Max can reduce all-cause mortality risk by 15%.
Another research shows that people who are more physically active experience less anxiety and stress and are more resilient to the impacts of stress when it does arise.
Vo2Max test. How do you measure VO2Max at home?
How do we measure this mystical VO2Max? The golden standard is a lab test which requires you to run on a treadmill or cycle on a stationary bike at your maximum effort.
However there is a simple way to estimate VO2Max quite accurately. Enter the Cooper formula. Named after Dr. Kenneth Cooper, the godfather of aerobics, this formula has been helping people estimate their VO2Max since the 1960s.
The Cooper formula is like the Swiss Army knife of VO2Max estimation – it's not the fanciest tool in the shed, but it gets the job done. Here's how it works.
It requires you to run at your maximum speed for 12 minutes and note the distance covered. Note this number and plug into the Cooper formula. Surprisingly enough, the formula will produce a reasonable estimate of your VO2Max just on this single parameter.
Why is the Cooper formula still so popular? It's like the karaoke version of VO2Max testing – it might not be perfect, but it's accessible, fun, and gives you a pretty good idea of where you stand. Unlike laboratory VO2Max tests that require more equipment than a space shuttle launch, the Cooper test can be done with nothing more than a track and a stopwatch. Check free Cooper vo2max calculator here
Read below about the more precise free VO2max test which can be completed at home in 5 minutes.
VO2max Apple Watch: Does this VO2max test work?
Yes, the Apple Watch does provide an estimation of VO2max. From my experience this estimation is not as good as the one provided by Garmin smartwatch or the 5 minute Cambridge home step test described below. However it is Ok for most people who want to track progress with their VO2max training.
How do you improve VO2Max?
Now, let's circle back to our dynamic duo: VO2Max and blood pressure. Improving your VO2Max is like sending your cardiovascular system to a spa retreat. It comes back refreshed, rejuvenated, and better equipped to handle the stress of daily life – including managing your blood pressure.
When you exercise regularly and improve your VO2Max, you're essentially giving your heart and blood vessels a makeover. Your heart becomes stronger and more efficient, pumping more blood with each beat. This means it doesn't have to work as hard to circulate blood throughout your body, which can lead to lower resting heart rate and blood pressure.
Your blood vessels also get in on the action. Regular exercise makes them more elastic and less resistant to blood flow. It's like replacing rigid pipes with flexible hoses – the blood flows more smoothly, reducing the pressure on the vessel walls [8,9,10].
Dr. Attia puts it succinctly: "Exercise is the most potent 'drug' we have to prevent chronic disease and extend lifespan." And improving your VO2Max through exercise is like getting a bonus with every workout – you're not just burning calories, you're investing in your long-term health.
Not all exercises produce equal VO2Max improvement. Start with whatever exercise you enjoy – walking, swimming, cycling, or even dancing like nobody's watching. The key is to gradually increase the intensity of your workouts.
It's like dating your cardiovascular system – you start slow, build trust, and before you know it, you're in a committed relationship with better health.
Remember, every step you take, every lap you swim, and every hill you cycle up is a step towards a higher VO2Max and potentially lower blood pressure. It's like you're secretly training to become a superhero, except instead of fighting crime, you're fighting against cardiovascular disease. Your superpower? The ability to climb a flight of stairs without sounding like Darth Vader.
What are typical VO2max training protocols?
The simplest protocol for HIIT VO2max training is performing intervals of running or cycling at close to maximum heart rate for 30 seconds, then slowing down to a comfortable jog for 30 seconds and then repeating this interval 3-5 times. As you progress with your HIIT workouts, you may consider increasing the duration of intervals to running at a maximum speed for 1 minute, then resting for 1 minute and repeating this interval 3 times.
The more demanding but also more effective training is the so-called “Norwegian 4×4 protocol”. It involves running or cycling at the highest intensity you can maintain for four minutes, followed by three minutes of recovery through very light exercise. This interval process is repeated four times.
This kind of training is intended to stress your cardiovascular system a LOT! Hence I strongly encourage everyone to discuss their potential health limitations with your doctor. Especially if you have a chronic medical condition or have not exercised for a while.
Important comments:
1. Perform this protocol well rested. You should refrain from any intensive workouts and alcohol for at least 24 hours before VO2max training.
2. Warm up for at least 15 minutes before doing VO2max High Intensity Interval Training (HIIT). You know that you are ready for your interval when you are able to bring your heart rate to the max heart rate minus 10 beats/minute for at least a few seconds.
3. You will benefit from a heart rate monitor (HRM) or a smartwatch with embedded HRM to perform these intervals. Otherwise the level of accuracy may not be sufficient.
How do you know if you are sufficiently recovered and ready for VO2max intervals?
Use an app which reliably measures Heart Rate Variability (HRV) by analysing your heart rate. Make sure that your stress level (as measured by inverted HRV) is within your normal range. More details about this below.
Is there an easier way to try VO2max training without pushing yourself to the limit?
Definitely! The first thing is still to talk to your doctor and secure their agreement. Then you may start by locating a hill in a nearby park which you can walk up with an effort in 30 seconds. Walk up the hill for 30 seconds, recover heart rate as you walk down, and repeat this workout 2-3 times.
As you feel more confident, you will be able to walk up hills with higher gradients and this exercise will improve your VO2max gradually.
Personal example of reducing blood pressure with VO2max training.
Consider my personal example. I started performing High Intensity Interval Training (HIIT) at 48 when I was diagnosed with high blood pressure and my doctor suggested that I should try these workouts. I started from slow breathing and brisk walking as I have never exercised much. Over the next few months I realised that I am making some positive progress with my blood pressure and I started my first HIIT workouts which target VO2max. This strategy worked beautifully for me and my hypertension was gone in less than a year.
As I celebrated my 60th birthday and was preparing for a half marathon, I increased my VO2max to 49. It was very nice to see an encouraging comment from my Garmin smartwatch about my fitness age of 20 :) Also my blood pressure stays in the normal range for the last 12 years.
Can you recover VO2Max after COVID?
Covid hits your VO2Max (and your longevity) like a train. See the graph below.
It has taken me more than a year to bring VO2max to my original level. The good news: it definitely can be done [11]. Though it takes time and effort.
I am interested. What’s next?
Let’s assume you are ready for action and would like to get your VO2Max estimate. You may start from performing the 12 minute Cooper test described above and plug your results in the VO2max calculator here. You can then go back to the compressed ACSM VO2max charts by age in gender above and see how your numbers compare to average.
Alternatively, if you are not in the mood of running at your full speed for 12 minutes, you can take an easier VO2Max test which was developed by the scientists from the University of Cambridge (UK) [12]. It can be done at home and requires you just step up and down for 5 minutes.
This test is included in the free version of our blood pressure app BreathNow. It also produces more accurate results than a Cooper formula. When done regularly this test will help you to see clearly the progress which you are making with your VO2Max training.
BreathNow also includes instructional videos for VO2max training for users with different fitness levels. Including hill walks described above for anyone who is just starting their VO2max journey.
The app includes a number of relaxation techniques, i.e. breathing exercises and meditations, which lower blood pressure immediately (but for a relatively short time). Unlike long term improvements which come with improvement of VO2max. These relaxation exercises will stimulate your recovery and prepare for more demanding HIIT sessions.
As we explained earlier, blood pressure, stress and cardio fitness (VO2max) are closely linked. The 3in1 program in the BreathNow app includes calming exercises to lower stress, easy aerobic exercises (i.e. walking in nature) and short HIIT exercises to improve VO2max. The 3 elements of the program logically follow each other. The app BreathNow is designed to help perform these exercises and monitor progress objectively. Please try the app and let me know how it worked for you.
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