All you need to know about Peter Attia’s VO2 max training

VO2 max is more than a number you see in your lab report or fitness app; it represents the maximum amount of oxygen your body can use during an intense workout. VO2 max directly reflects how efficiently your heart, lungs, and muscles work together, influencing endurance, cardiovascular health, and overall physical performance.

According to Peter Attia, longevity expert and author of Outlive, VO2 max is a critical indicator of your healthspan and lifespan —  in fact, he refers to it as the greatest predictor of lifespan. 

In this article, we review Peter Attia’s VO2 max protocol, exercises, and strategies for enhancing this key metric for health and longevity.

A detailed breakdown of VO2 max 

Source: Li Sun

To fully grasp VO2 max, it's important to understand some of the key terms associated with it. Here’s a breakdown of each to clarify how VO2 max functions as an indicator of cardiovascular efficiency and overall fitness:

• Oxygen uptake: During exercise, your muscles require oxygen to produce more energy. VO2 max measures how efficiently your body takes in, transports, and uses oxygen during increasingly intense exercises or activities. 

• Cardiorespiratory fitness: A higher VO2 max indicates better heart and lung fitness. This means your cardiovascular system is effective at delivering oxygen to muscles, and your muscles are efficient at using that oxygen for energy. 

• Maximal exertion: VO2 max is only measured when your body reaches maximal exertion — the point at which you can no longer continue due to fatigue. This is typically determined through a graded exercise test, where intensity gradually increases until you reach this limit.

• Units of measurement: VO2 max is expressed in milliliters of oxygen per kilogram of body weight per minute (mL/kg/min). For example, a VO2 max of 50 mL/kg/min indicates that at peak exertion, your body uses up to 50 milliliters of oxygen per kilogram of body weight each minute. 

Why you need a high VO2 max — the science behind it  

Source: Julia Larson

In discussions with longevity and health experts, Attia often cites research that shows a strong correlation between VO2 max and reducing the risk of all-cause mortality. Higher VO2 max values are consistently linked to longer life expectancy, and here’s why improving and maintaining a high VO2 max is so important:

• Reduces the risk of early death: If you can raise your VO2 max from the bottom 25th percentile to the 25th–50th percentile, you could lower your risk of early death by 50%. If you continue improving into the 50th–75th percentile, it can drop your risk by up to 70%. Research shows that even a small increase — just 1 mL/kg/min — can lower your risk of death by 9%.

• Slows the aging process: VO2 max naturally declines by about 10% each decade after age 30. But with the right training, you can slow this decline and even reduce its effects, helping you live a longer, healthier life.

• Maintains physical function and independence: To maintain a healthy, independent lifestyle, you need a VO2 max of at least 17.5 mL/kg/min (5 metabolic equivalents, or METs). If it drops too low (below 3 METs), your body can struggle to meet basic energy needs, leading to exhaustion and even death.

[Youtube](https://www.youtube.com/watch?v=KpCkJs6DKCw)

The science behind VO2 max

When you breathe, oxygen enters your lungs, travels into your blood, and then reaches your muscles. Your muscles use this oxygen to produce energy. But during high-intensity exercise, like sprinting or weightlifting, your muscles need more oxygen than your body can provide. That’s when your body turns to a backup system called anaerobic glycolysis to produce energy without relying on oxygen.

Think of it like this: when you’re running a marathon, your body is using slow-twitch muscle fibers, which rely on oxygen to work efficiently. These muscles help you keep going at a steady pace. But when you suddenly sprint or lift something heavy, your body needs a quick burst of energy. That’s when fast-twitch muscle fibers take over. They don't need oxygen and give you the power to push hard for a short time. The process of anaerobic glycolysis kicks in here, producing energy without oxygen for those fast, intense movements.

This shift between using oxygen (aerobic) and switching to anaerobic energy systems is what makes VO2 max so important. It’s not just about how much oxygen your body can take in — it’s about how efficiently your body switches between these two systems. The better your body is at this switch, the longer and harder you can push yourself during your workouts. 

What is Peter Attia’s VO2 max protocol?

Source: Chris Peeters

Peter Attia advocates a balanced approach to improving VO2 max that combines two key training methods: Zone 2 training and High-Intensity Interval Training (HIIT). As a general rule, he recommends dedicating 80% of your training time to Zone 2, with the remaining 20% focused on HIIT. 

Here’s what each exercise category entails:

Zone 2 training

Attia refers to Zone 2 training as exercises performed at a moderate intensity — typically around 60–70% of your maximum heart rate. In this zone, your body primarily burns fat for fuel, and your lactate levels stay low (below two millimoles per liter), allowing you to sustain exercise for longer periods. 

Zone 2 training boosts your body’s ability to burn fat for fuel and improves mitochondrial efficiency, laying a solid foundation for higher-intensity training. Exercises in this category typically include:

• Walking

• Jogging

• Cycling

• Swimming

• Rowing

• Hiking

HIIT

HIIT involves short bursts of maximum-effort exercises followed by brief recovery periods. These intense intervals push your body to its limits and target improvements in your VO2 max by simulating the demands of high-intensity physical exertion. 

Attia incorporates HIIT in his workout routine to target VO2 max improvements. To get the most out of these sessions, he emphasizes that the intensity of each interval should be as close to your maximal effort as possible. HIIT exercises include:

• Sprinting

• Burpees

• Jump squats

• Kettlebell swings

Attia also highlights the importance of selecting exercises you enjoy. When you're engaged and consistent, you're more likely to achieve sustained improvements in your VO2 max.

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Peter Attia’s VO2 max workout routine

Source: Leandro Boogalu

Peter Attia follows a daily workout routine based on his comprehensive exercise framework, which targets four key pillars of fitness: stability, strength, aerobic (Zone 2), and anaerobic (Zone 5). Within this framework, Attia focuses specifically on two categories for VO2 max training:

1. Aerobic (Zone 2)

2. Anaerobic (Zone 5) 

Here’s what his VO2 max training routine looks like:

| Exercise type | Weekday                              | Duration        |
| ------------- | ----------------------------------- | --------------- |
| Zone 2        | Tuesday, Thursday, Saturday, Sunday | 60 minutes each |
| Zone 5 (HIIT) | Saturday                            | 30 minutes

Attia recommends a comprehensive approach to exercise — combining proper nutrition and sufficient sleep, to maximize the benefits of VO2 max training.

While Attia has a specific workout routine that aligns with his needs, he often suggests the 4x4 protocol for many of his patients looking to train VO2 max. Here’s what it looks like:

1. Do four minutes of high-intensity exercise

2. Rest for four minutes

3. Repeat 4–6 times

4. Add a warm-up and cool-down at the beginning and the end

Here’s a tabularized version of the 4x4 routine to help with your workouts:

| Phase          | Activity        | Duration                |
| -------------- | --------------- | ----------------------- |
| Warm-up        | Light cardio    | 10–15 minutes           |
| Intervals      | High-intensity  | 4 minutes (repeat 4–6x) |
| Recoveries     | Active recovery | 4 minutes (repeat 4–6x) |
| Cool-down      | Stretches       | 5–10 minutes            |
| <b>Total Time</b> | <b>60 minutes</b>  | <b>60 minutes</b>

This 4x4 protocol fits within the 80/20% approach to VO2 max training — 80% of the time in lower intensity (Zone 2) and 20% in high-intensity intervals (Zone 5). 

How to test for VO2 max

[Instagram](https://www.instagram.com/peterattiamd/reel/DEs0mrPuos9/)

VO2 max testing helps you understand your current VO2 max level, providing a baseline for progress. It’s typically done through a graded exercise test in a lab, though portable devices are now available for home testing. 

Here’s how it works:

1. The calorimeter measures the exchange of gases (oxygen and carbon dioxide) during exercise.

2. You wear a mask or mouthpiece connected to the device, which measures how much volume and oxygen concentration is inhaled and how much carbon dioxide is released.

3. You gradually increase the intensity of the workout by raising the speed or resistance of the treadmill or bike until you reach maximal exertion.

4. The device measures the difference between the amount of oxygen inhaled and the amount of carbon dioxide exhaled. This provides a flow rate known as VO2 and VCO2.

5. Using the Fick principle, which calculates energy usage by measuring oxygen intake and carbon dioxide output, you can determine your total energy consumption. The principle uses a formula where energy consumption is approximately 3.94 times your VO2 and 1.11 times your VCO2, which helps estimate how much energy you use.

6. It reaches a point where the oxygen you consume hits a plateau, even when the exercise intensity increases — this is where your VO2 max value is determined.

For the most accurate results, Attia recommends that anyone testing their VO2 max should use the right equipment and work with trained professionals.

How to increase VO2 max with Peter Attia’s strategies

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To effectively boost your VO2 max using Peter Attia’s strategies, follow these four steps:

1. Progressively increase workout intensity, duration, and frequency: As your fitness level improves, gradually raise these factors to keep challenging your body. This will help push your VO2 max higher.

2. Be consistent: Stick to your training routine and focus on consistency — a sustainable, long-term approach yields better results than short, intense bursts of exercise.

3. Use a heart rate monitor: Tracking your heart rate helps keep you in the correct zones for each exercise. It enables you to push hard enough during HIIT sessions to maximize VO2 max improvements.

4. Adopt a personalized approach to VO2 max training: What works for Attia might not work for you. To get the most out of your training, tailor it to your specific needs, goals, and your overall health. Understanding your body’s unique physiology can help guide these adjustments, and genetic testing offers one way to gain deeper insight into factors that influence your VO2 max potential.

The role of genetics in VO2 max potential

While consistent exercise is the primary driver of VO2 max improvement, genetics can also significantly influence your baseline aerobic capacity and responsiveness to training. Attia believes everyone can improve their VO2 max through dedicated training, but genetic factors largely influence the extent of those improvements. 

Although genetic tests don’t directly measure VO2 max, they can offer valuable insight into your genes’ role in energy production, muscle composition, and cardiovascular function. Research has identified up to 97 genes linked to VO2 max adaptation, with more discoveries emerging.

If you’re ready to explore your genetic makeup and gain a deeper understanding of your VO2 max potential, take a test with Nucleus. The platform provides in-depth genetic insights that help personalize your training for peak performance.

Nucleus: The key to effective VO2 max training personalization

Nucleus is a cutting-edge, clinical-grade DNA testing platform that analyzes nearly 100% of your genome. It provides key insights into your genetic predispositions, including crucial factors for VO2 max performance. 

After a comprehensive analysis of your DNA using advanced whole-genome sequencing, Nucleus delivers detailed reports offering valuable insights into key areas related to VO2 max, such as:

• Cardiovascular health 

• Metabolic health

• Mitochondrial function

• Muscle strength

• BMI

• Longevity traits 

The reports break down your genetic and lifestyle insights in simple terms, and you’ll also receive actionable AI-powered health tips. If you require expert interpretation or further guidance, you can speak with genetic counselors, thanks to Nucleus' partnership with SteadyMD.

How to get started with Nucleus Premium

Getting started with Nucleus Premium is easy:

1. Sign up for Nucleus Premium

2. Fill out your personal information

3. Order your test kit

When your test kit arrives, swab your cheeks to collect your samples and send the kit to the lab for analysis. You will receive your results within 6–8 weeks.

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Featured image source: VO2 Master