Protocols for Increasing VO2 Max (and why zone 2 cardio might not be enough) | Dr. Rhonda Patrick

- VO2 max is a measure of maximal oxygen uptake. It's considered one of the best indicators of cardiorespiratory fitness and it's associated with improved healthspan and longevity. - Speaker A tells the audience the Cooper test should be conducted on a flat surface and the distance covered should be 12 minutes. The distance is then estimated using a formula. The 12-minute run or walk test is a more.

But I want to start by talking about cardiorespiratory fitness, healthspan and longevity. So VO2 max is a measure of maximal oxygen uptake, which reflects an individual's ability to utilize oxygen during exercise. It's considered one of the best indicators of cardiorespiratory fitness and it's associated with improved healthspan increased lifespan. Higher cardiorespiratory levels as measured by VO2max have been consistently leaked to reduced risk of mortality and longer lifespan. So in the podcast when I use the term VO2 max, just keep in mind that it's a measurement of cardiorespiratory fitness. The greatest longevity benefit that comes from improving your VO2 max is from people starting from a below average VO2 max and moving anywhere above average. So even going from a below normal VO2 max for your age group and gender to a low normal is associated with a 2.1 year increase in life expectancy. Bumping that up, going from below normal to high normal. VO2 max is associated with a 2.9 year increase in life expectancy. And going even further to the upper limit of normal is associated with 4.9 years. So almost five year increase in life expectancy on average. Each unit increase in VO2 max, so that's 1 milliliter per kilogram per minute is associated with a 45 day increase in life expectancy. In another study involving only men for every 10 unit increase in VO2 max, so this would be then 10 mils per kilogram per minute, there was a 17% lower risk of death from cancer and a 11% lower all cause mortality. So dying from from many different non accidental causes of death. Another study published in JAMA in 2018 found that there was no apparent upper limit to the benefit of cardiorespiratory fitness on mortality within normal ranges of human life expectancy. Of course, in fact, the study reported that elite performers, these are people that performed in the top 2.3% on the fitness test, had an 80% reduction in mortality risk compared to the lowest performers. So they performed in the bottom 25% on the fitness test. And if you compare the elite performers to the high performers, so these folks did really well, but they were just under the elite. They were, they were between the top 25% and the top 2.3%. The elite performers had a 20% mortality risk decline compared to even those high performers. But going back to what I said earlier about just moving out of that low fitness group will give huge advantages on life expectancy. So people in the low fitness group had a five fold higher risk of death than the elite performers. But what is also so interesting is that the risk of dying due to low fitness was similar or even bigger than risks associated with having heart disease, smoking or diabetes. So being fitter is really good for your health at every level of fitness. And there's always room for improvement. So the question is, well, how can we improve our VO2 max? Lots of different training protocols, zone 2 training, for example high intensity interval training, you know, vigorous intensity exercise, all improve cardiorespiratory fitness and can increase VO2 maximum. HIIT has been shown to significantly improve EO2 max even with shorter training durations. This is because HIIT recruits both aerobic and anaerobic energy systems and increases the intensity of the workout, resulting in greater cardiovascular stress and then adaptations. But this is important. There are individuals who engage in more moderate intensity, you know, steady state zone 2 training that do not experience significant improvements in VO2 max. In fact, research has shown that approximately 40% of people do not see a measurable increase in their VO2 max, even after engaging in guideline based moderate intensity exercise, which is about 2.5 hours of this type of exercise per week for several months. But when these, what are called non responders incorporated more vigorous intensity exercise, such as high intensity interval training, they do start to see improvements in VO2 max. So this suggests that adding higher intensity exercise to an exercise routine can help eliminate that non response and also can lead to greater benefits in cardiorespiratory fitness. The reason for non response to moderate intensity exercise, it's not completely understood, but the addition of vigorous intensity exercise is important for overall improvements in VO2 maximum. And engaging in more vigorous exercise seems to provide a stronger stimulus for physiological adaptations that lead to increased cardiorespiratory fitness. So again, I think these findings do really sort of highlight the importance of incorporating vigorous intensity exercise, particularly incorporating maybe a high intensity interval training into a training routine. And obviously for individuals who are time pressed and can't dedicate several hours per week to doing a more type zone 2 type of training, including shorter sessions of higher intensity exercise can still have significant improvements in VO2 max and overall health. So you might be wondering, you know, how much time do I dedicate to my more vigorous type of exercise versus a more moderate intensity zone 2 type of training? And I really think that answer depends on a lot of factors. Your individual goals, what you enjoy doing most, what you're going to do the most. I mean, all those things are important because at the end of the day, establishing a habit, having an exercise routine that you're going to consistently do is what is most important for endurance athletes. I mean, the answer is easy, right? You're already dedicating several hours a week to doing more zone two training. And about 20% of that training is dedicated to two shorter, higher intensity workouts, more vigorous intensity workouts. And this is commonly known as the 8020 rule. But remember, this is, this is people that are doing extensive amounts of training anywhere between 10 to 30 hours a week. It's, I think it's a common misconception to apply that 8020 rule to, like, any committed exerciser and any casual exerciser who are doing well under less than 10 hours a week. As you think about someone who is a committed exerciser, maybe you work out three to five days a week, how much of that time should be spent doing vigorous intensity exercise? I would say for VO2 Max and other adaptations, we're going to discuss including the brain, about half of that exercise training time, I think, should be spent in vigorous doing a vigorous exercise. So again, you want to be at least 80% of your max heart rate or more. Obviously, there's resistance training to incorporate as well into any training program. There's casual exercisers. So people that work out maybe two to three times a week, they should probably spend more than half of their time doing more vigorous intensity exercise. I think this ensures you're pushing your limits and making sure that you're getting adaptations, fitness gains in a shorter period of time. There are a variety of VO2 max training protocols. So for people that are looking for that more vigorous exercise using, you know, using high intensity interval training to improve their VO2 max. The key here is longer intervals. So incorporating longer intervals, such as two, three, four, maybe even five minutes at the highest workload you can sustain for that time, and then performing four intervals with rest and recovery in between each of those. So this protocol may require maybe a 20 minute time commitment, but it can lead to significant improvements in VO2 max. There's a few examples of VO2 max training. Dr. Martin Gabala, who was a recent podcast guest, gave a variety of examples of this. So there's three to five minute repeats at the highest sustainable intensity. We talked about you doing those three to five minute intervals that you can maintain, and then you rest and recover and repeat those intervals for a total of 20 minutes. I think a popular variation of this is called the Norwegian 4 by 4 interval training protocol. So the intervals are four minutes long and you're aiming for about 85 to 95% of your max heart rate, or the maximum level of intensity you can maintain for the entire four minutes. These interval, these intervals can be brutal. So the recovery period is three minutes long and the intensity is significantly lower. Like light, light exercise, more like a zone one training exercise. You want to allow yourself recovery time, the clearance of lactate. You want your heart rate to come down significantly so that you can prepare for the next four minute interval. So these four minute intervals are repeated four times and again in between each interval is a three minute recovery. So that's the Norwegian 4x4 interval training. There's another type of VO2 max training protocol. It's the one minute on, one minute off protocol. This is where you perform one minute of intervals at the highest intensity you can do for one minute and then it's followed by a one minute recovery period. And then you repeat this interval pattern 10 or maybe five times for about 25 minutes or so. And this protocol also is effective at improving VO2 max and it does provide a lot of flexibility in terms of time commitment. It's also not, as you know, grueling in terms of like doing a four minute interval versus a one minute interval. One minute intervals are a little bit, you know, less intense and less painful. Obviously, it's important that, you know these protocols are sort of templates. They vary a lot based on individual fitness goals. You know, there's other protocols out there that can improve VO2 max. The key is like a longer interval, longer than like a tabata, like a 20 second interval. And so, you know, probably about at least one minute at the highest sustainable intensity that you can do. I think the Norwegian 4x4 protocol is probably one of the best out there, one of the best hit protocols out there for improving VO2 max. How do you measure VO2 max without equipment found in an exercise physiology lab? It's obviously challenging. There are several tests that have been developed and verified for getting an estimate of your VO2 max. They don't directly measure maximum oxygen uptake, but they predict your VO2 max based on the relationship between your exercise intensity and your oxygen consumption. They're sort of useful in determining whether or not you're improving VO2 max if you're testing a type of training protocol. So there's a couple of really, like I said, validated tests that have been validated in scientific literature that can sort of be done. Probably one of the best ones is the 12 minute run, or sometimes called walk test, depending on your level of fitness. It's often also referred to as the Cooper test, and it involves having the participant run or jog as far as possible in 12 minutes. So you're supposed to pace yourself evenly. You don't want to start too fast. And the test should be conducted on a flat surface. So, like a track field is the best. You don't want to have hills and stuff because it's. It's about, you know, the maximum amount of distance you can cover in 12 minutes. And if you have hills and stuff, that's going to lesson that it's going to be more challenging. And you know, the distance won't be quite as far. So you'll need a fitness device, something that can record your distance, an Apple watch or, you know, Fitbit or something. And depending on your fitness level, you can walk or you can run or a combination. So the distance covered within that 12 minute period serves as the primary metric for evaluating VO2 maximum, which is then estimated using a formula. So it's distance in meters -504.9 and then divided by 44.73. And you can look this formula up, just look up the Cooper test to find the formulas online. Again, there's some other validated tests, but I think that's probably one of the best, better ones out there. You'll need a device like an Apple watch or some sort of other device that can measure your distance. But there's also some of these devices and wearables do estimate VO2 max during exercise using heart rate and your motion data. You know, for best results, you have to make sure all your personal information's in there, like your age and your weight and gender and all that stuff. But that's another possibility. I would say the 12 minute run or walk test is a more. It's a better way to do it, particularly if you're trying to do something like the 4 by 4 Norwegian HIIT protocol to measure VO2 max improvements. You want to see if what you're doing is improving your estimated VO2 max.