What is VO2 max? It is a measurement of how much oxygen can your body consume, usually measured per kilogram of body weight in certain period, usually 1 min. VO2 max is the maximum capacity of an individuals body to transport and use oxygen during incremental exercise. Also called maximum oxygen consumption. It reflects aerobic physical fitness of individual.

VO2 max is expressed either in absolute rate in liters consumed per minute (l/min) or as relative rate in milliliters of oxygen per kilogram of body weight per minute (ml/kg/min).

I remember being obsessed with VO2 max when I was competitively racing in rowing. I would go to our sport medicine department and ask my doctor: How can I reach maximum VO2 max levels? How can I increase it? Is it important? Do genes play a role?

Why? A simple answer to that question is that, whoever had higher VO2 max on race track was a winner. Of course in reality, it is not that simple.

Yes, having high levels of VO2 max is a huge advantage, but being able to cross the finish line first takes more than that, like certain technique, pain tolerance, outdoors conditions, nutrition and others.

Interesting thing is, that when I talk to people about VO2 max, and it is the first time they hear about it, they think that having high VO2 max is a bad thing. It is quite understandable. If you really think about it. Having high VO2 max means you consume more oxygen to do certain work than other person. Needing more of something to do something sounds like a bad thing.

But, the opposite is true. Every movement we make is happening by contracting muscles. For a muscle to contract, it needs energy. That energy supply for our muscles is mainly glycogen, which is human kind of carbohydrate, than fat and protein. And our body is constantly using combination of these nutrients for energy.

But nature made this process a little bit more complicated than that. To use that energy we also need oxygen. We actually can do certain movements without oxygen at the moment, but eventually we will have to supply it later.

VO2 max perfect example is 100 yard sprint. In real life it would be  you catching a bus or train that’s already on the go. If you sprint 100 yards, it will be fast intensive activity, but it will not seem like a big deal to you. You sprint, you finish, you catch your buss and you breath heavily after that.

What you just did is a very intensive activity for about 15 seconds. And this activity was done, burning mainly carbohydrates, some fat and some protein too. But you burned exponentially more energy and used very little oxygen to cover that energy. That’s why, when you stopped, you were still breathing heavily.

Your body just experienced very intensive burning energy without supplying enough oxygen. And now you are covering that deficit. Maybe for another 3 minutes, maybe shorter or a little bit longer.

If you could supply that oxygen during this intensive sprint in full, you would have incredible ability to do endurance exercises and probably become Olympic champion in several insurance sports.

But there are very few people in this world who’s bodies can do it.

Basically what happened was, instead of burning energy with a presence of oxygen and exhaling the waste (CO2), you were burning it without it and keeping the waste in your body, in your muscles.

This waste is called lactic acid and eventually, if you continue doing this intensive activity for longer period of time, you will have to stop. The lactic acid will not let you go any further. You will have to decrease that intensity and start running a little bit slower, or start walking until that oxygen deficit is supplied.

What is VO2 max in practice?

Many of us will never really experience the true VO2 max in practice. But if you engage in any kind of recreational and competitive intensive endurance activities like swimming, kayaking, bicycling, running or others you will.

In 1998 when I raced at the international regatta in Vienna – Austria, I placed second, behind Croatian rower. This was a singles race, which used to be my specialty. I still clearly remember the race progressing.

We started and immediately I and my competitor from Croatia separated from the the pack and were leading the entire time.

The race is 2000 meters, which takes about 7 – 8 minutes to complete, depending on wind, currents and other conditions. It is a clearly VO2 max dominating activity. That simply means that, who ewers body can consume more oxygen wins.

People often thing, that rowing is about strength. While strength in definitely a part of it, endurance (VO2 max), the ability to consume more oxygen is 90% of a success.

500 meters to the finish line, we were about 11 seconds ahead of the pack and my co racer from Croatia started increasing the intensity and getting slightly ahead of me. I tried to keep up. The gold medal was in stake and I really wanted to win it. But my body said no.

My muscles were already full of lactic acid – the waste, that was accumulating in my muscles. Instead of me exhaling it as CO2. Remember? You can do this only if your body can consume more oxygen and cover that intensity without lactic acid accumulation.

At this point I was overcooked, as we used to call this state. My muscles were full of lactic acid, I was hurting, and it was impossible for me to increase intensity to keep up.

At this point my body wasn’t consuming more oxygen. I reached my VO2 max and the waste (Lactic acid) was deposited and was still depositing in my muscles, instead of me exhaling it by breathing out (CO2).

My counterpart from Croatia still had some reserves left, and I can clearly tell that his VO2 max – maximum oxygen consumption was higher than mine. It probably wasn’t by much but it made a big difference.

I ended up finishing second, 5 seconds after my opponent. I collected my silver medal with a thought in my mind, that I have to keep working on my VO2 max.

For competitive endurance athlete, working on VO2 max never ends. A lot of experimentation is involved in the process. Reaching maximum VO2 max is the name of the game if you want to be a successful endurance athlete.

VO2 max in medicine

VO2 max is also tested in older people and people with serious lung conditions.

If you really think about it, oxygen is the most important thing we need to live. We can live without food and water for several days, but we will not survive without oxygen for longer than 5 minutes.

When people get older, or they have some serious lung condition, their VO2 max substantially decreases. To survive and maintain their quality of life, it is critical for these people to keep their VO2 max the highest possible.

For an older person whose VO2 max is very small, climbing a flight of stairs can feel like racing Olympic final in crew.

Older people will strongly benefit from endurance training, to increase or maintain theirs VO2 max. Walking, swimming and other endurance activities are recommended for older people to do by doctors. To help them to maintain and increase their VO2 max.

Now, that you know what is VO2 max, the question is what to do to make it higher?

VO2 max changes in all of us constantly. It really depends on how much, how often and what kind of cardiovascular activity you do. But generally, for people who are not athletes and don’t care about competing in Olympic Games some day, 30 minutes of vigorous exercise everyday will keep their VO2 max on healthy levels.

If you are a competitive athlete do, that’s a different story. To bring your VO2 max to the maximum levels, you need to do a lot of endurance training. And a different kinds of it. Since we are all different, we also respond to various kinds of training differently. But generally 5-7 endurance sessions of various intensity will bring your VO2 max to your maximum potential.

After my own experimentation with my VO2 max levels, I came up with the training that worked best for me. And generally it could work very well for you too. It was a well thought combination of interval training and a long distance endurance training. I will write about it in my next article.

VO2 max and genetics

When you see athletes like Lance Armstrong or Ethiopian marathon runners constantly winning theirs gruesome long endurance events, their great VO2 max genetics are at play. Yes, some people are more gifted by nature by higher levels of VO2 max than others.

The common rule that hard work beats talent, when talent doesn’t work hard still applies at VO2 max levels. If your friend in your running team is more gifted and has naturally higher VO2 max levels than you, you can still be a faster and better runner if you work harder and smarter than him.

Lance Armstrong is a special case. He is a guy hugely gifted by natural with high natural levels of VO2 max. But he also works incredibly hard. In his case, drive, work ethic and talent creates one, if not the most successful endurance athlete in a history of sport. He won 7 Tour de France titles and I don’t think that, we will see anybody beating his record very soon.

VO2 max and health

High, above average levels of VO2 max are also associated with healthy cardiovascular system, and generally with great health.

I think everybody should strive to improve theirs VO2 max levels. To do that, you have to do cardiovascular exercises regularly. 

What is your VO2 max?

You can get your VO2 max levels tested in any sports medicine facility. And they will tell you your exact levels. However, if you are not an athlete and you feel physically fit and exercise regularly, you don’t have to worry about knowing your VO2 max levels. They are most likely fine and healthy numbers you can be proud of.  

The majority of over the counter pain relievers sold in U.S. contain one of the following ingredients: acetaminophen, ibuprofen, or aspirin. At recommended doses, all three have about same effect on reducing pain.

For reducing pain and inflammation, only ibuprofen and aspirin are effective.

Aspirin (brand names: Anacin, Ascriptin, Bayer, Bufferin, Ecotrin, Excedrin)

• is most commonly used anti-inflammatory medication

• sport doctors recommend aspirin to reduce the pain and inflammation seen in the initial stages of most injuries

• aspirin is strong enough to reduce mild to moderate pain caused by inflammation like tendon inflammation, nerve inflammation

• first effects of aspirin are felt in 30 min, although its maximum benefits are experienced two hours after the dosage is taken

Aspirin has well known side effects like tendency to irritate the stomach lining; prolonged use may cause permanent kidney damage; some people are allergic to aspirin and others.

Ibuprofen (brand names: Advil, BayerSelect Ibuprofen, Midol IB, Motrin IB, Nuprin)

• is less irritating to stomach than aspirin

• is effective in controlling the pain and inflammation of sports injuries

• ibuprofen is a powerful drug, and only the amount necessary to reduce symptoms should be used

You should always ask your doctor before you use aspirin and ibuprofen!

Related articles:

• Inflammation – how to recognize it and what to do

Here are the symptoms of inflammation:

• increased temperature at the injury site, due to dilation of blood vessels and increase of blood flow

• redness, due to increased blood flow

• swelling, due to movement of a fluid into a injured area

• pain, caused by swelling that has put pressure on the free nerve endings (pain=protective mechanism of the body and should not be ignored)

• loss of function, which results from the first four symptoms

What to do:

Immediately apply RICE – rest, ice, compression, elevation.

REST. Rest is necessary to allow the damaged tissue to heal without further injury. Use “relative” rest, which means avoiding activities that stress the injured area, but continuing with activities for healthy parts of the body. For example – when you develop inflammation in your shoulder-tendinitis, you can still work out your leg muscles and the opposite shoulder.

ICE. Ice may be applied in variety forms, crushed ice in the plastic bag mixed with water is common. This pack should be applied for approximately 20 minutes, 3 to 8 times per day for at least 3 days immediately following the injury. Ice reduces inflammation, stops swelling and promotes healing.

COMPRESSION. Compression, usually with an elastic wrap or cloth, aids in reducing swelling, forcing the fluid into the drainage system of the body. Compression is often used when applying ice.

ELEVATION. With the ice pack wrapped in place, elevate the injured area above the level of the heart. Elevation allows gravity to assist in the movement of fluid toward and into the drainage systems of the body.

• Insomnia

• Irritability

• Elevated morning pulse (10beats per minute higher than normal for several days in a row)

• Consistently elevated blood pressure

• Body aches

• Fatigue

• Loss of appetite

• Depression

• Decreased or lost motivation to exercise

• Increased frequency of colds and influenzas

• Increased frequency of injuries

While some people don’t want to work very hard in the gym, others drive their bodies too hard in effort to achieve their goals more quickly, or just very ambitiously push their bodies to the limit every day. They believe the “no pain, no gain” approach and find themselves plagued with injuries or symptoms of overtraining.

The role of proper rest and exercise program intensity, duration, and frequency is important.

If you don’t train with fitness professional, then your approach to exercise should be “train, don’t strain.” That is certainly the most enjoyable approach to exercise.

• Pain when bending the wrist upward against a force or when stretching muscles by straightening or bending the elbow or bending the wrist downward

• Pain felt over the bony part on the outside of the elbow

• Swelling of the elbow area

Who is at risk?

• Anyone who overuses his or her forearm muscle

• It is not limited to tennis players – less than 5 percent of all tennis elbow diagnoses are related to playing tennis

• It occurs among people who do a lot of heavy lifting, typists, construction workers, baggage handlers and others

• Tennis elbow gets its name from the fact, that up to half of all frequent players develop it at some time during their careers. It is especially common among players who swing improperly, or players that overuse their forearm muscle by playing too frequently or too long.

How it develops?

Tennis elbow is a form of tendinitis caused by continued stress on the forearm muscles used in grasping and extending motions that originate in elbow.

Pain first occurs in the tendons involved in extending the wrist, such as when tennis player hits the a backhand shot. With continued stress, the muscles and tendons begin to hurt when bent or extended, or even at rest due to tiny tears that become inflamed and do not have a chance to heal.

What can you do when tennis elbow pain appears?

• Rest from the activities that cause elbow pain is the most important treatment for tennis elbow

• Apply ice to the area – for two days – 20 minutes every two hours through the day

• Place an elastic bandage around the forearm just below the elbow

• After two days of ice treatment – alternate warm compresses with ice packs to promote healing

• See the doctor if the pain persist for more than two weeks

How can you prevent tennis elbow?

• If playing tennis, use the right backhand movement

• Weight train and stretch your arms to make them stronger and more flexible - Chin ups are great exercise to strengthen your arms and upper body. Do them 3 times maximum repetitions – 3 times a week.

• Learn to pace yourself; for example, if playing tennis every day provokes the symptoms, cut back to every other day

For women, it’s hard to escape wearing high heels. Are they really that bad for the feet?

When you raise your heels more than two inches off the ground, the biomechanics of the whole body dramatically change. You force more weight on the balls of your feet, which adds more pressure onto joints and nerves and than changes the pull of the tendons and muscles. Wearing high heels continually over a matter of years can actually cause the calf muscle to shorten and tighten, which can cause arch cramps, achilles tendinitis and knee and hip joint pain. The back can become tired and sore because your muscles will try to keep you in balance.

So you would say don’t wear them?

Not higher than two inches. They look nice, but they aren’t very functional. They’re made purely for for cosmetic reasons – not long walks.

You know high-impact exercise builds bone mass, but how much does it take for results?A recent study found that women who did an average of just one 60-minute high-intensity exercise session a week (running at a 7.5-minute-mile pace, jumping and aerobic stepping), as well as two 10-minute workouts (again high intensity), gained small but significant increase in thighbone density.Do your bones good and add sprints, jumping jacks, rope jumping, jumping with weights to your exercise plan two or three times a week for 10 – 15 minutes.