And how I fixed high blood pressure along the way
In this post I will explain what VO2max is, why this number is an important indicator of both our capacity to manage blood pressure and our biological age and how to increase VO2max. Also share my own experience with increasing VO2max.
What is VO2max and why is it important for both longevity and blood pressure?
“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 “ Peter Attia, MD, a host of the popular podcast The Drive [1].
Here is a quote from the research paper which followed up patients for 46 years [2]. "Cardio Respiratory Fitness (measured by VO2max) was significantly related to longevity over 4 decades in middle-aged, employed men ....the benefits of higher midlife Cardio Respiratory Fitness extend well into the later part of life. "
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."
How does VO2max change with age?
The VO2max by age chart shows 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.
These VO2max charts correlate well with the results of the above-mentioned scientific papers and our own observations: as we age, we generally see the speed of our aerobic activities (like running or cycling) decreasing and many of us start experiencing challenges with blood pressure. That is if we do nothing about it. How to slow aging? Increase your VO2max.
Can you increase VO2max with training?
Definitely! Though VO2max is strongly linked to someone’s genetics, scientists say that it is never too late to work on improving your VO2max.
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.
I did a standard VO2max test for the 1st time in my life when I was 50 years old. My test result was 34, which is an average number for men of my age. At the same time the VO2Max estimate produced by my Garmin smartwatch was 35 which was certainly close enough for my needs. I integrated the VO2max protocol into my training and it peaked at 54 in January 2021. I was 57 at that time. As you can see in the chart above this is considered by the medical community as ‘Excellent’ for men of my age.
For a number of reasons I have not trained much in 2021 and first half of 2022. My VO2max gradually reduced to 48 by September 2022. Then I had a nasty COVID infection and my VO2max dropped to 45 within a few weeks. This COVID infection did knock me out of my usual training routine for the rest of 2022. I returned back to systematic VO2max training in January 2023 and was able to recover it to the 50 level in 6 months. The table above shows that this level is average for 20-24 old men.
What is a typical VO2max training protocol?
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.
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.
If you get a green light from your doctor, they will also help you to determine your maximum heart rate. A very approximate value of the maximum heart rate can be calculated with this formula: 220-age=max heart rate. For example, for an average 50 year-old-person the maximum heart rate is 170 beats per minute.
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 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 to measure VO2max?
A standard procedure involves running on a treadmill or riding a stationary bike at your maximum speed in a lab while special equipment analyzes the mix of O2 and CO2 which you exhale.
Many current smartwatches provide a reasonable estimation of VO2max without forcing the user to perform at a maximum speed. This is done by comparing the data of a user to the database of previously collected data. Similar approach is used by some mobile apps (see below). The accuracy in most cases is 90%+, which is sufficient for most people. After all, what is really important is a trend of VO2max change.
How do you know if you are sufficiently recovered and ready for VO2max intervals?
Use one of the apps which reliably measures Heart Rate Variability (HRV) by analysing your heart rate. Our BreathNow app produces this simple chart. If the line becomes orange or red after a routine morning measurement - it is a good idea to postpone your VO2max intervals until the line reverses into the green territory again.
Is there an easier way to try HIIT 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. Our blood pressure app BreathNow includes guiding videos which will help you to time your hill walks with audio prompts. The app also includes a simple 5 min VO2max step test from the University of Cambridge which everyone could easily perform without leaving their house. When done regularly this test will help you to see clearly the progress which you are making with your VO2Max.
Why are so few people trying to increase their VO2max?
It is a great question given that 1.3B people globally have hypertension and this number just keeps growing. The answer to this question is that VO2max HIIT is hard. Really hard.
Those with hypertension, who are given green light from their doctors to perform VO2max training have two choices. Either to address this health challenge with medication, which reduces symptoms, but doesn’t fix the underlying issue. And often have negative side effects. Or try VO2max HIIT training which helps to address this issue long term AND also have an additional benefit of slowing aging.
What makes me hopeful is that the number of seniors participating in endurance races increases significantly year over year. The USA Triathlon reported that the number of triathletes aged 50 and older increased by 150% between 2000 and 2020.
I am not suggesting that everyone should participate in endurance races. If, however, your doctor is Ok for you to try a HIIT exercise, our app BreathNow will help you to get started and will objectively measure the progress you make. Stay healthy!
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