From Olympic labs to modern medicine—how VO₂ Max became the ultimate biomarker.
Most breakthroughs in medicine begin in disease.
VO₂ Max didn’t.
It started with Olympic athletes.
Long before it became a healthspan metric or a clinical vital sign, VO₂ Max was a tool for decoding human performance. For decades, it lived in the shadows of sports labs and exercise physiology departments—respected, yes, but ignored by most of medicine.
Today, that’s changing. Fast.
VO₂ Max is now one of the strongest predictors of mortality we have. But to understand how it earned that title, you have to go back—to the labs, lungs, and legacy of a curious physiologist in the 1920s.
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The Birth of VO₂ Max: A.V. Hill and the 1920s Oxygen Experiments
The story begins with Archibald Vivian Hill, a British physiologist who—oddly enough—won a Nobel Prize in 1922 for heat production in muscle. But it was his post-Nobel experiments that planted the seeds of VO₂ Max.
Hill and his colleague Hartley Lupton studied oxygen uptake during intense exercise. What they discovered was simple but profound: at a certain point, no matter how hard someone tried, their oxygen consumption would plateau. They could run faster or pedal harder—but their oxygen use would stay the same.
Hill called this ceiling “maximum oxygen intake.” We now call it VO₂ Max[1].
For the first time, we had a number that captured the upper limit of the body’s aerobic capacity—a ceiling of cardiorespiratory performance.
It wasn’t about lungs alone. Hill understood it as a systems limit—a capstone determined by lungs, heart, blood, and muscle working together.
VO₂ Max and the Golden Age of Sports Science (1950s–1970s)
After Hill’s initial insight, VO₂ Max became a niche topic. That is, until post-war sports science took off.
By the 1950s, Scandinavian researchers began using VO₂ Max to assess elite skiers, runners, and cyclists. These weren’t casual studies—they were Olympic weapons. Coaches and scientists treated VO₂ Max like a secret edge. And it worked.
The legendary endurance capacity of Nordic athletes wasn’t just folklore—it was measured in milliliters per kilogram per minute.
Erik Hämäläinen, Per-Olof Åstrand, and Bengt Saltin were among the pioneers who refined the measurement protocols and connected VO₂ Max to training, altitude adaptation, and cardiovascular remodeling[2].
By the 1970s, VO₂ Max had become the gold standard for endurance potential. In elite sport, it was gospel. But in clinical medicine? Still ignored.
Why Sports Scientists Got There First
Here’s a strange truth: performance science often sees the future of medicine decades before medicine does.
Athletes push the body to its edges. When you study those edges, you learn how the systems interact under maximum stress. You see failure points before they become disease. You learn to optimize before there’s decline.
Doctors were trained to intervene after dysfunction.
Sports scientists were trained to measure function before it breaks.
That philosophical gap explains why VO₂ Max stayed siloed in athletic circles for so long.
VO₂ Max Enters the Clinic: A Vital Sign for Longevity
It wasn’t until the 1990s and early 2000s that medicine began to catch up.
Researchers studying frailty, aging, and chronic disease began noticing something curious: VO₂ Max predicted outcomes better than traditional labs. It wasn’t just about performance anymore. It was about survival.
By 2009, meta-analyses showed that each 1-MET increase in fitness (equivalent to a ~3.5 ml/kg/min VO₂ Max bump) reduced risk of death by 13%[3].
More recently, large cohort studies like those at the Cleveland Clinic confirmed that cardiorespiratory fitness has a dose-dependent inverse relationship with mortality—and no upper limit to benefit[4].
It became clear: VO₂ Max isn’t just for Olympians. It’s for everyone.
Which is why physicians like Peter Attia now argue it should be treated as a vital sign—as fundamental as blood pressure or resting heart rate[5].
VO₂ Max and the Rise of Bio-Optimization
As preventive medicine, quantified health, and the “optimization” movement took root, VO₂ Max found a new audience.
It was no longer a sterile measurement for endurance nerds. It became a proof point:
Of how you age
Of how well your mitochondria work
Of how much stress you can handle
Of how quickly you’ll recover
Of how likely you are to die in the next decade
In a world flooded with biomarkers—from HRV to glucose to sleep stages—VO₂ Max remained grounded. Simple. Hard to fake. Hard to misunderstand.
And unlike wearables, it had decades of validation across populations.
What This Evolution Tells Us About the Future
The journey of VO₂ Max mirrors a broader shift in medicine—from reactive to proactive, from symptom to system.
We’re moving from treating disease to measuring dysfunction. From waiting until things break to testing how well they work under load.
And VO₂ Max may be the clearest, most integrative lens for seeing that future.
It captures everything modern life erodes: mitochondrial function, circulatory health, aerobic reserve, and resilience.
Which means it’s not just a number from the past.
It’s a signal from the future.
Want to measure the one metric that’s stood the test of time?
Book your VO₂ Max test with DexaFit.
References
Hill AV, Lupton H. Muscular Exercise, Lactic Acid, and the Supply and Utilization of Oxygen. Q J Exp Physiol. 1923;16(1):1–26. doi:10.1113/expphysiol.1923.sp000464
Åstrand PO, Rodahl K. Textbook of Work Physiology: Physiological Bases of Exercise. 3rd ed. McGraw-Hill; 1986.
Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events: a meta-analysis. JAMA. 2009;301(19):2024-2035. doi:10.1001/jama.2009.681
Mandsager K, Harb S, Cremer P, et al. Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing. JAMA Netw Open. 2018;1(6):e183605. doi:10.1001/jamanetworkopen.2018.3605
Attia P. Outlive: The Science and Art of Longevity. New York: Harmony Books; 2023.
