VO2 max: the strongest predictor of longevity and how to increase it

VO2 max is the maximum amount of oxygen your body can use in one minute of intense effort, relative to body weight (ml/kg/min), and it is one of the strongest predictors of longevity: in a Cleveland Clinic study of 122,007 adults, those with the lowest cardiorespiratory fitness had a risk of death 5 times higher than those in the elite group. The good news is that VO2 max can be trained at any age. I think of it as the savings account of my longevity, and recovering with a full body red light therapy panel helps me stay consistent with the workouts that raise it. Below you will find what the studies show, how to measure it and what a week that actually works looks like.

What is VO2 max?

VO2 max is maximal oxygen consumption: how much oxygen your body can use, per kilogram and per minute, when you push yourself to the limit. It is a single number that tells you, at the same time, how well your lungs, heart, blood vessels and muscle mitochondria are working.

Think of it as the engine capacity of your body. The lungs bring in the oxygen, the heart pumps it, the blood transports it, and the muscles burn it in the mitochondria to produce energy (ATP). If any link is weak, VO2 max drops. That is why doctors call it "cardiorespiratory fitness" and consider it a snapshot of the whole system, not just the heart.

Why is VO2 max the strongest predictor of longevity?

Because, in studies of hundreds of thousands of people, the level of cardiorespiratory fitness predicts the risk of death better than many of the tests we run every year. And the relationship is dose-dependent: every extra step counts.

Mandsager and colleagues, 2018 (JAMA Network Open). Researchers at Cleveland Clinic followed 122,007 adults who had taken a treadmill exercise test, over a median period of 8.4 years. Compared with the elite group (top 2.3%), those with low fitness had a 5.04 times higher risk of death. Even between the "high" and "elite" groups there was a difference in risk in favour of the elite group. The authors concluded that the risk associated with low fitness is comparable to or greater than that associated with smoking, diabetes or coronary artery disease.

Kodama and colleagues, 2009 (JAMA). A meta-analysis of 33 studies and 102,980 participants showed that every additional MET of maximal aerobic capacity is associated with an approximately 13% lower risk of death from any cause and an approximately 15% lower risk of cardiovascular events.

Lang and colleagues, 2024 (British Journal of Sports Medicine). The most comprehensive synthesis to date, with 26 meta-analyses and over 20.9 million observations, confirms the picture: high versus low fitness means a 53% lower risk of death, and every additional MET is associated with an 11-17% lower risk.

In practice, one MET is just 3.5 ml/kg/min, an increase you can achieve in a few months of well-structured training.

How much does VO2 max decline with age?

VO2 max declines naturally with age, and the pace accelerates: from 3-6% per decade in your 20s and 30s to more than 20% per decade after 70, according to the Fleg (2005) longitudinal study in Circulation.

This is the part I often explain to the women in our community: the decline is not linear. If you reach 70 with a low VO2 max, you can drop below the threshold where climbing stairs, carrying groceries or a longer walk become tiring. If you arrive with a large reserve, you have room to lose some without losing your independence.

An important part of this reserve lies in the muscles, because that is where oxygen is consumed. Muscle mass, mitochondria and the capillaries in the muscles are lost with a sedentary lifestyle. That is why VO2 max and strength go hand in hand, and nutrition matters. I wrote about this in the article how much protein after 40.

How do you find out your VO2 max?

The most accurate method is the cardiopulmonary exercise test (spiroergometry), done in a laboratory or at sports medicine clinics: you run or pedal wearing a mask that measures oxygen and carbon dioxide, up to maximum effort.

Smartwatches and fitness bands offer an estimate based on heart rate and speed. They are not as accurate as the laboratory test, but they are useful for the trend: if the estimate rises month after month, your training is working.

If you are over 40, have cardiovascular disease or high blood pressure, or have not done intense exercise for a long time, talk to your doctor before a maximal test or high-intensity training.

How do you increase VO2 max? What the studies say

The direct answer: VO2 max increases most efficiently through high-intensity intervals, done 1-2 times a week, on a solid base of moderate movement and strength training.

Helgerud and colleagues, 2007 (Medicine & Science in Sports & Exercise). Forty men were divided into four groups for 8 weeks, with 3 workouts a week. The 4-minute intervals at 90-95% of maximum heart rate, with 3 minutes of active rest, increased VO2 max by 7.2%, and the short 15-second intervals by 5.5%. Slow running and threshold running brought significantly smaller gains.

The Generation 100 study, 2020 (BMJ). In Norway, 1,567 people aged between 70 and 77 were followed for 5 years. The group that did 4 × 4 intervals twice a week had the lowest mortality, but the differences from the control group were not statistically significant, partly because the control group also remained very active. The message for me is clear: intervals are safe and feasible even at 70, and regular movement is the foundation.

Day	What you do	Duration	Role for VO2 max
Monday	4 × 4 minute intervals, intense, with 3 minutes of easy walking or pedalling in between	35-40 minutes including warm-up	The main stimulus for the heart and mitochondria
Tuesday	Full body strength training	40-45 minutes	Preserves the muscle, the "engine" that consumes oxygen
Wednesday	Brisk walking, cycling or swimming at a conversational pace	45-60 minutes	Builds the aerobic base and the capillaries
Thursday	Strength and mobility	40 minutes	Balance between effort and recovery
Friday or Saturday	Second interval session or a long, moderate outing	40-75 minutes	Volume and intensity, without overloading
Daily, after exercise	Recovery: sleep, protein, red light therapy on the muscles you worked	10-20 minutes	Supports muscle recovery until the next workout

Indicative example for a healthy, already active person. If you are just starting out, begin with brisk walking and strength for a few weeks, then add a single interval session.

What role does red light therapy play in training for VO2 max?

Red light therapy does not increase VO2 max on its own, and any promise of that kind should be treated with caution. What the studies show is that red light and NIR therapy applied to the muscles supports exercise performance and recovery, and good recovery is what allows you to train consistently, week after week.

The mechanism is the same one that makes VO2 max possible: the mitochondria. Red light (around 660 nm) and near-infrared light (around 850 nm) are absorbed by cytochrome c oxidase, an enzyme in the mitochondrial respiratory chain, and this is associated with more ATP and an anti-inflammatory response, as Michael Hamblin describes in his 2017 review.

Leal-Junior and colleagues, 2015 (Lasers in Medical Science). A meta-analysis of 13 randomised studies showed that laser or LED phototherapy, applied mainly before exercise, increased the number of repetitions and the time to exhaustion compared with placebo. The authors observed the most consistent results with red and infrared wavelengths.

Miranda and colleagues, 2016 (Journal of Athletic Training). Twenty untrained men performed a progressive treadmill test after an active session and after a placebo session. After photobiomodulation, they lasted an average of 780 seconds, compared with 742 seconds with placebo, and covered a greater distance. Oxygen consumption at maximum effort remained practically the same. In other words, red light did not enlarge the "engine", but it helped the muscles hold out longer.

De Paiva and colleagues, 2020 (BMC Sports Science, Medicine and Rehabilitation). In a triple-blind study of 60 men, 12 weeks of treadmill training combined with photobiomodulation and a static magnetic field led to a greater percentage increase in VO2 max than training with placebo. The result is interesting, but it comes from a combination of technologies, not from light alone, so I read it as a promising signal.

For me, the real value shows in the days after intervals. Heavy legs and muscle soreness are the main reason people skip workouts. I wrote in detail about the effect on joints and inflammation in the article on red light therapy for joint pain and inflammation.

When do you use red light therapy: before or after training?

The performance studies applied red light mainly before exercise, while for recovery people usually use it after training or in the evening. Both options are valid. Choose the moment you can repeat.

My ritual looks like this: on interval days, 10 minutes of red light therapy on the thighs and glutes before the warm-up, and on strength days, a session on the back and shoulders in the evening, on the MAT 360 mat, lying down, with the phone far away. For durations and distances for each type of device, see the guide how many minutes of red light therapy per day.

A few simple rules: do not use the panel on an acute injury without your doctor's approval, protect your eyes with powerful panels and do not extend the duration beyond the recommendations. The optimal dose matters more than "as much as possible".

Frequently asked questions

What is VO2 max?

VO2 max is the maximum amount of oxygen the body can use per minute during maximal effort, expressed in ml/kg/min. It reflects the combined capacity of the lungs, heart, blood vessels and muscles and is one of the best indicators of cardiorespiratory health.

Why is VO2 max important for longevity?

Because high cardiorespiratory fitness is associated with a 53% lower risk of death from any cause compared with low fitness, according to a 2024 synthesis with over 20.9 million observations. Every additional MET, that is 3.5 ml/kg/min, is associated with an 11-17% lower risk.

How do I increase my VO2 max after 40?

Through 1-2 workouts a week with intense intervals, for example 4 × 4 minutes at 90-95% of maximum heart rate, combined with moderate movement and strength training. In the Helgerud study, this type of interval increased VO2 max by 7.2% in 8 weeks. Talk to your doctor before intense exercise if you have cardiovascular problems.

How quickly does VO2 max increase?

In interval studies, increases of 5-7% in VO2 max appeared after 8 weeks, with 3 workouts a week. Long-term consistency matters more than the intensity of a single week.

Does red light therapy help VO2 max?

Red light therapy does not increase VO2 max on its own, but studies show that red light and NIR therapy applied to the muscles supports exercise performance and recovery. In a meta-analysis of 13 randomised studies, it increased time to exhaustion and the number of repetitions, which helps you train consistently.

Read also

• The complete guide to red light therapy
• How much protein after 40: muscle, the organ of longevity
• Red light therapy: benefits and what the studies show
• How many minutes of red light therapy per day

Sources

• Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open. 2018;1(6):e183605. PubMed
• Kodama S, Saito K, Tanaka S et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024-2035. PubMed
• Lang JJ, Prince SA, Merucci K et al. Cardiorespiratory fitness is a strong and consistent predictor of morbidity and mortality among adults: an overview of meta-analyses representing over 20.9 million observations from 199 unique cohort studies. Br J Sports Med. 2024;58(10):556-566. PubMed
• Fleg JL, Morrell CH, Bos AG et al. Accelerated longitudinal decline of aerobic capacity in healthy older adults. Circulation. 2005;112(5):674-682. PubMed
• Helgerud J, Høydal K, Wang E et al. Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc. 2007;39(4):665-671. PubMed
• Stensvold D, Viken H, Steinshamn SL et al. Effect of exercise training for five years on all cause mortality in older adults: the Generation 100 study: randomised controlled trial. BMJ. 2020;371:m3485. PubMed
• Leal-Junior ECP, Vanin AA, Miranda EF et al. Effect of phototherapy (low-level laser therapy and light-emitting diode therapy) on exercise performance and markers of exercise recovery: a systematic review with meta-analysis. Lasers Med Sci. 2015;30:925-939. PubMed
• Miranda EF, Vanin AA, Tomazoni SS et al. Using Pre-Exercise Photobiomodulation Therapy Combining Super-Pulsed Lasers and Light-Emitting Diodes to Improve Performance in Progressive Cardiopulmonary Exercise Tests. J Athl Train. 2016;51(2):129-135. DOI
• de Paiva PRV, Casalechi HL, Tomazoni SS et al. Does the combination of photobiomodulation therapy (PBMT) and static magnetic fields (sMF) potentiate the effects of aerobic endurance training and decrease the loss of performance during detraining? A randomised, triple-blinded, placebo-controlled trial. BMC Sports Sci Med Rehabil. 2020;12. DOI
• Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys. 2017;4(3):337-361. PubMed

This information is for educational purposes and does not replace medical advice. NeuroGenesis DNA red light therapy devices are intended for wellbeing and are not intended to diagnose or treat any disease. Before starting high-intensity training, talk to your doctor, especially if you have cardiovascular problems.