How High-Intensity Exercise Improves VO2 Max and Heart Function
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VO2 max measures the body's ability to take in, transport, and use oxygen during maximal exercise. In a retrospective cohort of 122,007 adults who completed treadmill testing, higher cardiorespiratory fitness was associated with progressively lower all-cause mortality over a median 8.4 years. Because this was observational, fitness is best understood as a powerful risk marker and modifiable capacity rather than a guarantee of longevity. [1]
Longer high-intensity intervals can raise VO2 max efficiently. In a randomized study of 40 healthy, moderately trained men, eight weeks of four four-minute intervals at 90 to 95 percent of maximum heart rate increased VO2 max by 7.2 percent. A shorter 15-second interval format increased it by 5.5 percent, and both interval groups improved more than the work-matched moderate-intensity groups. [2]
The cardiac-remodeling study Dr. Rhonda Patrick describes tested a progressive two-year program, not a single workout. Sixty-one healthy but sedentary middle-aged adults were randomized, and 53 completed the study. The program increased VO2 max by 18 percent and reduced measured left-ventricular stiffness, supporting sustained vigorous aerobic training as one part of a broader, gradually progressed exercise plan. [3]
This clip is excerpted, with permission, from Dr. Rhonda Patrick's appearance on Modern Wisdom. Thank you to Modern Wisdom for allowing us to share it.
- ^ 10.1001/jamanetworkopen.2018.3605
- ^ Helgerud J; Høydal K; Wang E; Karlsen T; Berg P; Bjerkaas M, et al. (2007). Aerobic high-intensity intervals improve VO2max more than moderate training. Med Sci Sports Exerc 39, 4.
- ^ 10.1161/circulationaha.117.030617
Chris Williamson: Peter Attia told me that VO2 max is the single most important metric when looking at someone's longevity. How much truth do you think is in that?
Dr. Rhonda Patrick: I think he is absolutely right. VO2 max is one of the most important things, and the thing I love about it is that it is something you can measure. It is a biomarker. There is evidence that vigorous exercise is important, but it has to be a longer interval type of exercise. At least one minute would be the minimum, but it is better if you can get to four minutes.
There is something called the Norwegian 4x4 protocol. That is four minutes at the highest intensity you can maintain for the entire four minutes, followed by three minutes of light exercise for recovery. You want your heart rate to come down so that you can do it again four times.
Chris Williamson: Miserable. Absolutely miserable.
Dr. Rhonda Patrick: The Norwegian 4x4. There was a study that inspired me out of UT Southwestern in Dallas. The study took healthy 50-year-olds who were not physically active. They did not have type 2 diabetes and all that, but they were not active.
Chris Williamson: They were also detrained.
Dr. Rhonda Patrick: Exactly. They were detrained, and the researchers put them on a pretty intensive training protocol for two years. It was a progressive protocol. Obviously, when you have an untrained person, you do not start with the Norwegian 4x4 on day one. It took them six months to work up their training and endurance.
By the six-month mark, they were doing about four hours a week of what is called maximal-intensity exercise. This is vigorous exercise.
Chris Williamson: Four hours a week of maximum intensity?
Dr. Rhonda Patrick: Yeah.
Chris Williamson: Wow.
Dr. Rhonda Patrick: They were basically doing 30-minute workouts at the highest vigorous intensity they could maintain. They were doing about 75 to 80 percent of maximum heart rate for 30 minutes.
Chris Williamson: Okay, so they were doing that eight times a week.
Dr. Rhonda Patrick: No. They were also doing other things. When I say four hours a week, I mean that they were exercising four hours a week.
Chris Williamson: I thought you meant they were doing four hours of the Norwegian 4x4.
Dr. Rhonda Patrick: No, no, no. They were exercising four hours a week. A lot of it was 30-minute sessions of maximal-intensity exercise. I think they were probably doing one and a half to two hours of that. They were also doing some strength training and the Norwegian 4x4. It was nicely balanced.
The control group was doing a type of body-weight training, but it was not high intensity like CrossFit can be. It was more like lower-intensity stretching, maybe something like yoga.
After two years, the 50-year-olds had reversed the aging of their cardiac structure by 20 years. As we age, the heart gets smaller and stiffer. That is part of aging. It increases cardiovascular disease risk, and exercise performance and capacity go down. After two years of this vigorous-intensity exercise protocol, their hearts looked more like 30-year-old hearts than 50-year-old hearts.
That was so motivating to me. These were untrained people who did not usually work out, and by the end of two years they were really getting at it. I have stepped up my game a little bit. I have a coach coming two days a week. I am doing resistance training that also works like intervals, so I get a high heart rate and interval training.
Chris Williamson: It is funny to see Peter Attia and you converge on this. It is not new, but it is definitely something I was not hearing people talk about four years ago. Everything was zone 2, like “go slow to go fast,” or whatever the tagline is. One problem with zone 2 is that you need a fairly long duration by design, such as 45 minutes or an hour multiple times per week, and that is difficult.
There are many benefits from improving VO2 max. Take us through the Norwegian 4x4 again and what else belongs in a program that someone could take into the gym today to improve VO2 max.
Dr. Rhonda Patrick: I would say the Norwegian 4x4 is by far the best. For people who are really determined and committed, that would be it. It is four minutes at the hardest exercise intensity you can maintain for that entire time.
Chris Williamson: Dig into that. What does “as hard as you can go and maintain it” mean?
Dr. Rhonda Patrick: You do not want to go all out at 95 percent of your maximum heart rate, because then you can only last for about a minute and you will slow down. For some people, it might be 75 percent of maximum heart rate. For others, it might be 80 percent. You want to go as hard as you can for four minutes without really slowing down. You have to pace yourself a little, but you do not want to go too slowly. You definitely should not be able to talk while doing it. It is hard, but it is not all out.
Chris Williamson: Four minutes.
Dr. Rhonda Patrick: Four minutes, followed by three minutes of totally light activity. You are all the way back to something like zone 1 so your heart rate can come down.
Chris Williamson: If your heart can come down.
Dr. Rhonda Patrick: If your heart can come down, yes. You do that for three minutes because you want to recover enough to do it again. You complete the work interval four times, meaning the first interval plus three repeats. I think that is probably one of the best protocols to improve VO2 max.
Dr. Martin Gibala has been on my podcast. He is a real expert on high-intensity interval training at McMaster University in Ontario, Canada. He says there is also evidence for one-minute intervals. Doing a one-minute interval a few times can improve VO2 max. That is a little easier. I do one-minute intervals, and I am now trying to incorporate the 4x4 into my routine. A coach helps with that.
Chris Williamson: I imagine it is a motivation issue, which is probably one of the biggest hurdles. If you have any program in front of you that is not the Norwegian 4x4 for the day, you might choose back and biceps or a little jog instead. It is mañana, mañana, mañana.
Dr. Rhonda Patrick: Yeah, it is. But as I said, you do have to try to make it consistent.
Chris Williamson: What frequency per week?
Dr. Rhonda Patrick: The Norwegian 4x4 would be about one time a week.
Chris Williamson: Okay. That is the hard day.
Dr. Rhonda Patrick: That is the less miserable day.
Chris Williamson: It is. Is there any benefit to going twice per week?
Dr. Rhonda Patrick: Probably, yeah.
Chris Williamson: It would have been so much better if you had not said that.
Dr. Rhonda Patrick: These 50-year-olds did it one time a week for two years, and they reversed their cardiac-structure aging by 20 years. Of course, they were also doing other vigorous-intensity exercise. It was not all the torturous Norwegian 4x4.
Chris Williamson: If the Norwegian 4x4 is the gold standard at the moment for improving VO2 max, what are some examples of other vigorous exercise workouts? What else is in that bucket?
Dr. Rhonda Patrick: People can do what they enjoy. You can go for a run. I often run at 75 to 80 percent of my maximum heart rate for about 20 minutes. You want to go at the highest intensity you can maintain for 20 minutes and get a feeling for that. Running also gets you out in nature. Some people like to cycle. You can get on a bike and do 20 to 30 minutes at 75 to 80 percent of maximum heart rate.
Chris Williamson: We are aiming for 75 to 80 percent of maximum heart rate for about 20 minutes.
Dr. Rhonda Patrick: You can do that, or you can do high-intensity interval training. For high-intensity intervals, you will go above 80 to 85 percent. You might do submaximal or even maximal intervals, reaching 90 to 95 percent of maximum heart rate. Obviously, you can only maintain that for so long. Some people might do 30-second pushes.
I do many Tabatas as well. I like to do something most days of the week. I adopted this routine when I was trying something a little like Joe Rogan's Sober October, but mine was “every day October.” I was trying to work out every day. I noticed that I could do it for a month. I was not going as hard as the guys doing Sober October, where it was a competition. The goal was simply to do something every day.
Sometimes I do a 10-minute Tabata and go hard for 10 minutes. Most of the time I do 45 seconds on and 15 seconds off, a three-to-one ratio. I really like that one. Sometimes I do 20 seconds on and 10 seconds off. Even for just 10 minutes, I time it around when I am going to work. I want to feel motivated, better, more focused, and on my game. I get on the bike for 10 minutes and do...
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