VO₂max may be one of the strongest predictors of longevity we have, but no single number tells the whole story. In this piece, we look at where VO₂max falls short – what it can’t measure, who it may not apply to, and why context, not just the number itself, determines what it means for your health.
Despite its strength as a biomarker, VO₂max is not a perfect measure of overall fitness or health. Several important limitations warrant consideration when applying it in clinical or research contexts. Its accuracy and usefulness depend on how it is measured, individual biological factors, and how results are interpreted.
Peak VO₂ is not VO₂max
From a methodological perspective, VO₂max is frequently estimated rather than directly measured, especially in wearable devices or submaximal effort tests. Similarly, when a peak VO₂ is measured during testing, it may not be reflective of VO₂max. If you need a refresher, the distinction between peak VO₂ and VO₂max was discussed in this article.
Briefly, peak VO₂ is the highest oxygen uptake measured during an exercise test. It differs from VO₂max in that VO₂max is the true physiological ceiling of oxygen utilization – i.e., the body can’t use any more oxygen. Period. In other words, at VO₂max, oxygen uptake plateaus even if workload continues to increase.1 Peak VO₂, on the other hand, is the highest oxygen uptake measured regardless of whether a plateau was reached. Peak VO₂ may not be equivalent to VO₂max if the person stopped the test prematurely due to lack of motivation, or symptoms such as fatigue, shortness of breath or chest pain.2
Genetics, Movement, Lactate and Vo₂max
Approximately 50-70% of Vo₂max is determined by genetics, meaning two individuals performing identical training may reach very different ceilings. 3
Two individuals with the same VO₂max may have very different endurance capacities depending on biological and genetic factors.
VO₂max does not reflect lactate threshold (exercise intensity at which lactate builds up in blood faster than it can be removed). An individual who builds up lactate quicker and clears slower, may have a lower exercise endurance, which is not a reflection of their VO₂max.
Another factor is movement economy – how efficiently an individual moves – i.e., the energy required for specific movement.
Muscle power ability and neuromuscular properties also play a role in endurance.4
VO₂max is most meaningful when interpreted within a broader clinical context that includes metabolic markers, functional assessments, body composition, and lifestyle factors. 5
Understanding the limitations of VO₂max doesn’t diminish its value – it sharpens how you use it. A number on its own cannot tell you about your genetics, your movement efficiency, or your lactate threshold, but it can tell you whether you’re moving in the right direction and supporting your healthspan. For most people, that direction starts the same way: more consistent movement, built gradually, week after week.
Seeking Personalized Care
At our practice, we include VO2max as part of our assessment. We encourage our patients to inquire about their VO2max and cardiometabolic fitness and to explore personalized ways to improve it. We are committed to providing the individualized care every person deserves, helping people move forward with confidence and strength. You have the power to take charge of your health. We are here to partner with you to achieve your goals. To learn more about our medical, nutrition, and health coaching services, contact us at 646.627.8000, fill out this form for a complimentary discovery call, or email Bridget@drbojana.com.
Related articles:
- Why Everyone Is Talking About VO2max as the Ultimate Longevity Maker
- Boost Your VO₂max: A Beginner’s Guide to Better Fitness