Measurement of the maximum oxygen uptake V̇ o 2max : V̇ o 2peak is no longer acceptable
Abstract
The maximum rate of O 2 uptake (i.e., V̇o 2max ), as measured during large muscle mass exercise such as cycling or running, is widely considered to be the gold standard measurement of integrated cardiopulmonary-muscle oxidative function. The development of rapid-response gas analyzers, enabling measurement of breath-by-breath pulmonary gas exchange, has facilitated replacement of the discontinuous progressive maximal exercise test (that produced an unambiguous V̇o 2 -work rate plateau definitive for V̇o 2max ) with the rapidly incremented or ramp testing protocol. Although this is more suitable for clinical and experimental investigations and enables measurement of the gas exchange threshold, exercise efficiency, and V̇o 2 kinetics, a V̇o 2 -work rate plateau is not an obligatory outcome. This shortcoming has led to investigators resorting to so-called secondary criteria such as respiratory exchange ratio, maximal heart rate, and/or maximal blood lactate concentration, the acceptable values of which may be selected arbitrarily and result in grossly inaccurate V̇o 2max estimation. Whereas this may not be an overriding concern in young, healthy subjects with experience of performing exercise to volitional exhaustion, exercise test naïve subjects, patient populations, and less motivated subjects may stop exercising before their V̇o 2max is reached. When V̇o 2max is a or the criterion outcome of the investigation, this represents a major experimental design issue. This CORP presents the rationale for incorporation of a second, constant work rate test performed at ~110% of the work rate achieved on the initial ramp test to resolve the classic V̇o 2 -work rate plateau that is the unambiguous validation of V̇o 2max . The broad utility of this procedure has been established for children, adults of varying fitness, obese individuals, and patient populations.
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All included participants fulfilled the maximal effort criteria: heart rate ≤10 beats/min or ≤5% of age-predicted maximum, blood lactate ≥8 mmol/L, and respiratory exchange ratio >1.10.
“All the included participants fulfilled the maximal effort criteria: (1) HR ≤ 10 beats/min or ≤5% of the age-predicted (220 - age) maximum, (2) bLa ≥ 8 mmol/L, and (3) respiratory exchange ratio > 1.10 [27].”
From Transferability of Exercise Intensity Based on Muscle Oxygenation from Normoxia to Hypoxia in Ski-Mountaineering Athletes—Exploratory Study (2024) · cites this paper as [27]
VO2max was considered valid when a plateau in VO2 occurred despite increasing speed or incline, supported by a respiratory exchange ratio ≥ 1.10, RPE > 16, exercise duration > 6 min, and a maximal HR within ±10-15 bpm of the age-predicted maximum.
“VO₂max was considered valid when a plateau in VO₂ occurred despite increasing speed or incline (Howley et al. 1995), supported by a respiratory exchange ratio ≥ 1.10, RPE > 16, exercise duration > 6 min, and a maximal HR within ± 10–15 beats per minute (bpm) of the age-predicted maximum (Poole and Jones 2017).”
From Effects of caffeine and acute exercise on the validity of a submaximal cycle ergometer test: a randomised, placebo-controlled crossover study (2026) · cites this paper as Poole and Jones 2017
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- Authors
- Poole, D. C., & Jones, A. M.
- Affiliations
- Kansas State University (US)
- University of Exeter (GB)
- Corresponding author
- Poole, David C.
- Venue
- Journal of Applied Physiology
- Publisher
- American Physiological Society
- Published
- 2017-04-01
- Volume
- 122
- Issue
- 4
- Pages
- 997-1002
- ISSN
- 0161-7567 (ISSN-L)
- 8750-7587
- 1522-1601
- OpenAlex
- W2585625244
- Cited by
- 533
- References
- 58
- Citations by year
- 2026: 58 · 2025: 70 · 2024: 43 · 2023: 53 · 2022: 54 · 2021: 60 · 2020: 61 · 2019: 54 · 2018: 55 · 2017: 25
- FWCI
- 11.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Applied Physiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports Performance and Training
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- VO2max, respiratory exchange ratio, maximal heart rate, cardiopulmonary exercise testing, exercise efficiency, gas exchange threshold
- MeSH terms
- Exercise Test, Heart Rate, Humans, Kinetics, Oxygen, Oxygen Consumption, Pulmonary Gas Exchange, Exercise, Muscle, Skeletal
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