By Victoria Andarcia, MD | Menopause Certified Practitioner (NAMS) | Reveal Vitality & Longevity Institute
Part 1: VO2 Max — The Longevity Metric Every Menopausal Woman Needs
When women come to the Menopause Renaissance program, they expect to have their hormones tested. They expect comprehensive blood work. They expect a DEXA scan to look at their bones and body composition.
What surprises most of them is the VO2 max test.
“I’m not an athlete,” they tell me. “Why does this matter for me?”
It’s one of my favorite questions to answer — because the response consistently changes how women think about their health, their aging, and what’s actually worth investing in.
VO2 max is not an athletic metric. It is a longevity metric. And for women in perimenopause and menopause, understanding and optimizing it may be one of the most powerful things you can do for your long-term health.
Here’s why.
What Is VO2 Max?
VO2 max — or maximal oxygen uptake — is the maximum rate at which your body can consume oxygen during intense exercise. It is a measure of cardiorespiratory fitness: how efficiently your heart, lungs, blood vessels, and muscles work together to deliver and utilize oxygen during physical demand.
The number is expressed in milliliters of oxygen per kilogram of body weight per minute (mL/kg/min). A sedentary woman in her 50s might score in the low 20s. An elite endurance athlete might score in the 60s or 70s. Most of us sit somewhere in between — and where you sit matters enormously.
But here’s what most people don’t know: VO2 max is not just a measure of fitness. It is one of the strongest independent predictors of all-cause mortality ever identified — more predictive than blood pressure, more predictive than cholesterol, more predictive than smoking status.
Let me say that again more clearly: how fit your cardiovascular system is may predict how long you live more accurately than almost any other single measurement we have.
The Evidence: VO2 Max and Longevity
The research on VO2 max and longevity is not subtle.
A landmark study published in JAMA Network Open in 2018 by Dr. Wael Jaber and colleagues at the Cleveland Clinic followed over 122,000 patients over a decade. The findings were striking enough that Dr. Jaber described cardiorespiratory fitness as “the most powerful marker we have” for predicting mortality.
The study found that individuals with the lowest cardiorespiratory fitness had a mortality risk more than five times higher than those with elite fitness levels. Crucially, the relationship between fitness and survival was linear — there was no threshold at which improvements in fitness stopped reducing mortality risk. Every meaningful increase in VO2 max was associated with a meaningful decrease in risk of death.
Perhaps most provocatively: the mortality risk associated with low cardiorespiratory fitness was comparable to — and in many cases greater than — the risk associated with established risk factors like hypertension, diabetes, smoking, and coronary artery disease.
Dr. Peter Attia, physician and longevity researcher, has been instrumental in bringing VO2 max into broader clinical awareness. In his framework for longevity medicine, VO2 max occupies a central place — not because he is focused on athletic performance, but because the data on its relationship to healthspan and lifespan is among the strongest in all of preventive medicine. Attia has described being in the top quartile of VO2 max for your age and sex as one of the most evidence-based things you can do to extend both the length and quality of your life.
What Happens to VO2 Max During Menopause?
Here is where this becomes specifically relevant to every woman reading this.
VO2 max declines with age — this is well established. The rate of decline is approximately 1% per year beginning in early adulthood, accelerating somewhat after age 50. But for women, menopause adds an additional layer of complexity.
The hormonal changes of menopause — particularly the decline of estrogen — have direct effects on cardiovascular function that can accelerate the decline in VO2 max beyond what age alone would predict.
Estrogen supports cardiovascular health through multiple mechanisms. It promotes vasodilation (the widening of blood vessels), supports healthy endothelial function, improves cardiac output, and has direct effects on mitochondrial function — the cellular machinery responsible for oxygen utilization. When estrogen declines, all of these mechanisms are affected.
Research has shown that postmenopausal women have lower VO2 max values than premenopausal women of the same age and activity level. And some studies suggest that menopausal hormone therapy may attenuate this decline — providing yet another mechanism through which hormonal optimization supports long-term health.
The practical implication is important: the menopausal transition is a period during which a woman’s cardiorespiratory fitness may be declining faster than she realizes — even if her exercise habits haven’t changed. This makes measurement not just useful but essential.
Why We Can’t Know Without Testing
This is the core reason we test VO2 max in the Menopause Renaissance program.
Cardiorespiratory fitness cannot be accurately estimated from how someone looks, how much they exercise, or how they feel. A woman who walks 10,000 steps a day and takes fitness classes three times a week may have a VO2 max that is adequate, excellent, or deeply suboptimal — and there is no way to know without measuring it.
Many of the women I see in my practice are active. They work out regularly. They consider themselves healthy. And yet when we test their VO2 max, some of them are in a fitness category that, according to the evidence, significantly elevates their risk of cardiovascular disease, cognitive decline, and premature mortality.
That information changes everything. It changes how we train, how hard we push, what interventions we prioritize, and how urgently we act.
Equally important: testing gives us a baseline from which to measure progress. If we retest at the end of 12 months and your VO2 max has improved — even by a few points — that is a measurable, meaningful improvement in your longevity trajectory. It’s not a subjective feeling. It’s data.
VO2 Max Is Trainable — At Any Age
The most empowering thing about VO2 max is that, unlike some biomarkers, it responds robustly to training at virtually any age.
The most effective method for improving VO2 max is high-intensity interval training (HIIT) — alternating periods of near-maximal effort with recovery. Studies consistently show that even older adults, including women well into their 60s and 70s, can achieve meaningful improvements in VO2 max through structured training programs.
The doses required are actually smaller than most people expect. Research suggests that as little as two sessions per week of interval training — 10–20 minutes of actual high-intensity work, embedded within a longer session — can produce significant VO2 max improvements over 8–12 weeks.
This is accessible. It is not a requirement to become a marathon runner or spend hours on a treadmill. It requires intentionality, appropriate intensity, and consistency. And within the Menopause Renaissance program, we use the baseline VO2 max measurement to guide exactly that — a training strategy calibrated to where you actually are, not where you think you are.
VO2 Max and the Bigger Picture: Longevity Is Not Just About Living Longer
I want to be clear about something that matters to me personally in how I talk about longevity with my patients.
The goal of optimizing VO2 max — and of the Menopause Renaissance program more broadly — is not simply to extend the number of years you live. It is to extend the number of years you live well. With strength. With independence. With mental clarity. With the ability to do the things that make your life meaningful.
The evidence on VO2 max speaks to both. Higher cardiorespiratory fitness is associated not just with lower all-cause mortality, but with lower risk of dementia and cognitive decline, lower risk of cardiovascular events, better metabolic health, and better physical function and independence in later life.
A woman who enters her 60s and 70s with strong cardiorespiratory fitness is a woman who is more likely to travel, to play with grandchildren, to maintain her social connections, to remain independent in her home, and to experience her later decades as a continuation of a vibrant life rather than a slow withdrawal from it.
That is what we are building toward. Not just years — but years worth living.
What to Expect From the VO2 Max Test
For women who are unfamiliar with VO2 max testing, a brief description may help reduce any apprehension.
The test we use in the Menopause Renaissance program involves graded exercise — typically on a treadmill or stationary bike — during which the intensity is progressively increased while your oxygen consumption and carbon dioxide production are measured through a mask or mouthpiece. The test typically takes 10–15 minutes of actual exercise time, preceded by a brief familiarization period.
It is vigorous. The final stages of a maximal VO2 test are genuinely demanding — the point is to take you to the edge of your capacity so we can measure it accurately. But it is safe, it is supervised, and the discomfort is brief. Most women describe it as one of the most informative experiences they’ve ever had related to their health.
At the end, you have a number. And that number, set against age- and sex-specific norms, tells you exactly where you stand in the landscape of longevity medicine — and gives us a precise target to work toward together.
Why This Matters Now More Than Ever
Perimenopause and menopause represent a critical inflection point in a woman’s long-term health trajectory. The hormonal changes happening during this transition are not just about symptoms. They are reshaping cardiovascular risk, metabolic function, bone density, cognitive health, and — as we have explored here — cardiorespiratory fitness.
The decisions made during this window — about hormonal health, about nutrition, about strength training, about cardiovascular fitness — have consequences that extend for decades. They are among the most consequential health decisions a woman will ever make, even though our medical system rarely treats them that way.
VO2 max testing is part of how we take those decisions seriously. It gives us data where most people have only guesses. And in longevity medicine, data is everything.
About the Author
Dr. Victoria Andarcia
Internal Medicine & Functional Medicine Physician
