6 Reasons Women Should Care About VO2 Max & How To Improve Yours

VO₂ max used to be a metric that only elite athletes or endurance runners were familiar with—which makes sense. It's the gold standard to evaluate stamina as it measures how efficiently the body consumes and uses oxygen during exercise (a higher number equals a higher level of fitness). 

But the relevance of knowing your VO₂ max and working to improve (or increase) it extends beyond those training for marathons—especially for women. 

"Women should care about VO₂ max because it is a key indicator of cardiovascular fitness and overall aerobic capacity, both of which are crucial for health and longevity," says Gabrielle Lyon, D.O., author of NYT best-seller Forever Strong. "As women age, maintaining a good VO₂ max can help mitigate the natural decline in aerobic capacity, support healthy aging, and enhance the ability to perform daily activities, which is especially important during the 'Marginal Decade'—the last decade of life when maintaining physical independence is most critical."

Generally, a higher VO₂ max means a healthier body composition1. 

We know that a higher body fat percentage2 negatively impacts VO₂ max scores, while activities that improve our VO₂ max scores can reduce body fat and increase fat-burning lean muscle mass—a win-win, with plenty of room for continuous improvement.

It may seem like women start at a bit of a disadvantage here—as they require a higher percentage of body fat for optimal health (it's just a fact of life). Muscles use oxygen and fat does not, so higher amounts of fat reduce oxygen demand. 

There are more metabolism-boosting benefits to be had from VO₂ max training too. Research has shown that higher VO₂ max and cardiorespiratory fitness levels improve resting metabolic rate1, making the body more efficient at burning calories even when not exercising. 

And Lyon adds, "VO₂ max, aerobic training, and resistance training can improve metabolic flexibility." Metabolic flexibility refers to the body's ability to easily switch between burning fat and glucose, which equals more energy and endurance.

Collectively, working on your VO₂ max improves body composition and metabolism, with a lower body fat percentage and more lean muscle mass to keep you strong and able.

Longevity expert Peter Attia, M.D., advocates for strength training and increasing VO₂ max as equally important parts of a fitness routine and previously said on the mindbodygreen podcast, "If you look at all of the metrics that are associated with longevity, there are none that even come within the same ZIP code as having a very high cardiorespiratory fitness measured by VO₂ max and having high muscle mass and having high strength." 

Every time we take a breath of oxygen, our lungs absorb it and get to work creating adenosine triphosphate3 (ATP). This is our cells' energy currency, and the more oxygen we can effectively utilize, the more energy we can create and spend. 

It's a positive cycle of reinforcement—with more energy, we're likely to work out more often and push ourselves harder; pushing harder means increasing VO₂ max, and round and round we go. 

Lyon also pointed out, "A strong VO₂ max is linked to better mitochondrial function, which is vital for energy production and metabolic health. This is important for women, who often experience changes in metabolic health due to hormonal shifts." (For example, perimenopause and menopause4 are known to affect metabolic health.)

Luckily, we don't just feel benefits during exercise. When we improve VO₂ max, activities like carrying groceries into the house, walking up flights of stairs, running after a loose toddler, and all our other random daily physical feats feel easier. This extra ATP benefits every cell of the body. 

Let’s start with a PSA: Heart disease is the leading cause of death for women in the U.S., with 44% of U.S. women5 living with some form of it. 

After that news settles, consider this—increasing VO₂ max reduces the risk of heart disease, and improving VO₂ max by just 6% (considered a modest goal) over the course of three months was found to reduce the risk of cardiovascular mortality and heart failure6 hospitalization by 8%.

What's more, boosting VO₂ max helps lower blood pressure7 and reduces the chances of stroke8, two risk factors that increase for women after menopause9 when estrogen drops. 

As Galpin mentioned on the podcast, improving VO₂ max can significantly improve your lung health. 

When we increase our VO₂ max and the amount of oxygen supplied to our lungs, they get a workout by keeping up with that extra input and sending oxygenated blood to our muscles. This creates more respiratory endurance, which equals less likelihood of getting that winded feeling during a cardio workout (or walking to the coffee shop). 

It's long been recognized that exercise is good for mental health. It can release feel-good endorphins like serotonin11 and endogenous opioids while fighting neurodegeneration and supporting brain function with increased brain-derived neurotrophic factor. Exercise is also linked to lowering the stress-inducing hormone cortisol12, which supports better sleep and a more positive outlook.

So it may be unsurprising that VO₂ max is linked to better mood and mental health outcomes, such as reductions in depressive symptoms13 and improved mental well-being. 

Good VO₂ max also comes with the benefit of maintaining total brain volume and gray matter volume. Gray matter is a layer of the brain that helps us process information, learn new things, control movement, and remember (among other responsibilities). 

This may be the VO₂ max pièce de résistance, and for good reason. This cardiovascular metric is now being touted as one of the most reliable longevity indicators14. The higher your score, the longer your estimated lifespan.

Nutrition and fitness expert JJ Virgin previously shared on the mindbodygreen podcast, "Let's look at aging. What do we need to have? We need to have a great VO₂ max, the single most important thing that we know overall for all predictors of all-cause mortality, for how well you're going to live, how long you're alive."

VO₂ max naturally declines with age for both men and women, but we've also learned that women may be at an unfair disadvantage15, due to the fact that women naturally have higher levels of intramuscular fat (which increases with age in both men and women), and this can affect muscular oxygen consumption.

Women's hormones create a unique environment in how they respond to activity. It's been shown that during the premenstrual phase16 (days 20-25 of the cycle) women experience a significant decrease in cardiorespiratory efficiency, leading to lower VO₂ max scores—possibly making you feel out of breath more easily. This is why some women may opt for lower-impact workouts during this time and ramp up cardio training post-period. 

And if you're new to cardiovascular workouts altogether? Lyon suggests focusing on lower-intensity cardio to acclimate before ramping your training up. "Zone 2 training is sustained moderate-intensity exercise, such as brisk walking, jogging, cycling, or rowing, at an intensity where conversation is uncomfortable but possible," says Lyon. "It helps increase aerobic base and mitochondrial efficiency. This may not push our VO₂ max, but it builds a solid foundation upon which we can continue to push our VO₂ max."

With the ever-evolving world of health tech, we're seeing more wearable trackers that can assess VO₂ max anywhere—a much more accessible method than being confined within the walls of an exercise lab.

And while the latter may be the most accurate way to measure VO₂ max and worthwhile for professional athletes, most of us can certainly still benefit from wearable trackers if we're just trying to gauge our own progress.

Here's a guide for different ways to measure your VO₂ max and some of our favorite trackers.