What is VO2max?

The term V02max is equivalent to aerobic capacity and is the maximum amount of oxygen
consumed by the body. Oxygen is used in aerobic processes of energy production within cells.
Your body uses oxygen at a low rate at rest, a faster rate as you begin to exercise, and reaches
its fastest rate of oxygen consumption near your maximum heart rate. The aerobic capacity test
proceeds in a similar manner starting at a very easy intensity progressing up to an individuals
maximum output. The more oxygen that is consumed the higher a person’s VO2max. The
maximum amount of oxygen consumed while an individual is working their hardest produces
an excellent indicator of cardiorespiratory fitness. For endurance athletes, a higher VO2max
indicates a higher potential for endurance performance.
Why would I have a VO2max test?
A VO2max test can be used to:
• Evaluate fitness level
• Make exercise recommendations for training zones based on heart rate, speed, or power
• Measure improvement over time
The best exercise recommendations are based on your unique response to exercise, not
on a generalized formula. These tests are valuable because they are a controlled, scientific
measurement of your own body’s response to exercise at a range of intensities. The information
gained from these tests can help you improve your health, your sports performance or both. In
addition, this will also help you gain a greater understanding of exercise principles, so that you
can apply this knowledge to your workouts.
Who can benefit from VO2max testing?
This test can help anyone who wishes to get the information they need to train smarter to meet
their fitness goals, whether for improving health or for sports performance enhancement. Here
are some examples:
Recreational athlete: someone who trains and competes mainly for the sheer fun of it, but still
wants to improve and have some structure and purpose in their training.
Elite athlete: to fine-tune each training bout, avoid injury and overtraining, monitor changes in
fitness status, gain a competitive edge through application of sport science principles
Former couch potato: someone who’s decided it’s time to get fit, and knows that a proper
exercise regime is crucial to one’s physical and emotional health; wants to be informed and
make the most of exercise time.
Someone who’s not getting results: one who’s been exercising for a while, but isn’t seeing much
improvement anymore; wants to learn how to change their exercise to continue improving.
In short, our doors are open to everyone.
How can I use the results of the test?
The higher a person’s VO2max the more endurance they are likely to have. The results of the
test can be used to more efficiently conduct your training. Training zones can be established
which allow a subject to know much more precisely how hard to train using several indicators
such as heart rate, speed, power, and rating of perceived exertion. In addition, by repeating the
test, a training program can be evaluated to see how successful it was.
How can I raise my VO2max?
Through specific training it is possible for an individual to raise their VO2max value between 10-
20%. There are multiple techniques to raise an individual’s aerobic capacity such as increasing
the training volume or increasing the time spent training at VO2max intensity. In addition,
VO2max is often expressed relative to body weight. Therefore decreasing body mass will result
in an increased value.
Do gender or age affect the measurement?
Yes, gender and age both can affect a person’s VO2max value. Women tend to have a lower
value then men due to higher body fat content, smaller muscle mass, and a lower concentration
of hemoglobin. Also for each decade after the age of 25, healthy but inactive people experience
declines in VO2max of about 9%. Yet, this decrease is not as significant in subjects who remain
active throughout life.

Normative data for VO2max

Female (values in ml/kg/min)
Age Very Poor Poor Fair Good Excellent Superior
13-19 <25.0 25.0 - 30.9 31.0 - 34.9 35.0 - 38.9 39.0 - 41.9 >41.9
20-29 <23.6 23.6 - 28.9 29.0 - 32.9 33.0 - 36.9 37.0 - 41.0 >41.0
30-39 <22.8 22.8 - 26.9 27.0 - 31.4 31.5 - 35.6 35.7 - 40.0 >40.0
40-49 <21.0 21.0 - 24.4 24.5 - 28.9 29.0 - 32.8 32.9 - 36.9 >36.9
50-59 <20.2 20.2 - 22.7 22.8 - 26.9 27.0 - 31.4 31.5 - 35.7 >35.7
60+ <17.5 17.5 - 20.1 20.2 - 24.4 24.5 - 30.2 30.3 - 31.4 >31.4
Male (values in ml/kg/min)
Age Very Poor Poor Fair Good Excellent Superior
13-19 <35.0 35.0 - 38.3 38.4 - 45.1 45.2 - 50.9 51.0 - 55.9 >55.9
20-29 <33.0 33.0 - 36.4 36.5 - 42.4 42.5 - 46.4 46.5 - 52.4 >52.4
30-39 <31.5 31.5 - 35.4 35.5 - 40.9 41.0 - 44.9 45.0 - 49.4 >49.4
40-49 <30.2 30.2 - 33.5 33.6 - 38.9 39.0 - 43.7 43.8 - 48.0 >48.0
50-59 <26.1 26.1 - 30.9 31.0 - 35.7 35.8 - 40.9 41.0 - 45.3 >45.3
60+ <20.5 20.5 - 26.0 26.1 - 32.2 32.3 - 36.4 36.5 - 44.2 >44.2
Table Reference: The Physical Fitness Specialist Certification Manual, The Cooper Institute for
Aerobics Research, Dallas TX, revised 1997 printed in Advance Fitness Assessment & Exercise
Prescription, 3rd Edition, Vivian H. Heyward, 1998.p48
“Most professional cyclists produce power outputs between 325 and 450 watts while time
trialing distances ranging from 5 to 75 km, and between 100 watts while drafting in the peleton
and up to 300 watts for long periods of time while riding alone or in small groups in flat stages.
The typical laboratory data for these cyclists is a VO2max of greater than 5.5 Liters/minute
and 450 watts, corresponding to a power to weight ratio of greater than 6.5 watts per kilogram.
Laboratory lactate threshold data show power outputs at threshold of about 350 watts, with
higher wattage outputs well over 400 watts produced while time trialing from the Tour winners.”
Ed Burke, PhD
Athlete Event VO2Max (ml/kg/min)
Greg Lemond Cyclist (winner of Tour de France) 92.5
Bjorn Daehlie Cross country skier 90.0
Miguel Indurain Cyclist (winner of Tour de France) 88.0
Benard Hinault Cyclist (winner of Tour de France) 87
John Ngugi 5 times world cross country champ 85.0
Dave Bedford 10km World Record holder 85.0
Steve Prefontaine 1 mile in 3:54.6 84.4
Lance Armstrong Cyclist (winner of Tour de France) 84.0
Joan Benoit Marathon runner (2:24:52) 78.6
Bill Rodgers Marathon runner (2:09:27) 78.5
Eddy Merckx Cyclist (winner of Tour de France) 77
Sebastian Coe Middle distance (1 mile WR) 77.0
Grete Waitz Marathon runner (WR 1980) 73.0
Frank Shorter Marathon runner 71.0
Derek Clayton Marathon runner (WR 1969) 69.7
George W. Bush U.S. President 52.5
Sir Edmund Hilary (First man to climb Mt. Everest) 48.8

ulmonary Function Testing (PFTs)

At the start of exercise an individual begins to breathe more rapidly and take larger breaths as
the body demands more oxygen and the removal of carbon dioxide. The pulmonary system
composed of the conducting zone such as the trachea and mouth, and the respiratory zone
composed of the bronchioles and alveoli are where these gases are exchanged.
The performance of the pulmonary system can be measured using pulmonary function
tests also referred to by its acronym PFT’s. The major types of pulmonary function tests
(PFT’s) include the measurement of lung volumes, maximal respiratory pressures and forced
inspiratory flow rates. Additional tests can also be performed.
For competitive endurance athletes speculation on whether years of training (running/cycling)
leads to changes in pulmonary function or volumes along with changes in performance have
often occurred. Yet two studies, one done on elite male runners and the other done on elite
female runners tested on standard pulmonary function tests show no adaptive response
when their values were compared to sedentary and intermediate runner controls. These
results have indicated that endurance training at sea level does not change various PFT
measurements and nor result in changes in performance. On the other hand it is speculated
that specific training of the ventilatory muscles through inspiratory resistive training devices
and ventilatory capacity training devices may show training effects.
Although PFT measurements are not associated with performance an athlete may be
interested in spirometry for several reasons. The first and most simple reason is a curiosity of
their pulmonary function. Although the size of the lungs do not appear to have any significant
effect on performance it is an interesting for a person to know how big or small are their lungs
The second more important reason is to assess for an obstructive disease such as asthma
which could inhibit training and therefore performance.
Asthma is a lung disease that can be defined with airway obstruction, airway inflammation
and increased airway responsiveness to a variety of stimuli. Some people will have
mild obstruction only evident with pulmonary function testing, whereas others will suffer
from “asthma experiences” such as coughing and wheezing, but it is estimated that
approximately 10 million individuals in the United States have asthma.
Exercise can also increase the irritability of pulmonary system leading to constriction referred
to as exercise induced asthma. In exercise induced asthma irritation from pollutants, changes
in moisture and or temperature can cause the bronchial network to become irritable and
contract. In exercise induced asthma there is not the characteristic inflammation as in regular
asthma. The constriction peaks approximately 5-10 minutes after exercise and is usually
resolved after 30 minutes of recovery.
Tests
Spirometry — Spirometry, which includes measurement of forced expiratory volume in one
second (FEV1) and forced vital capacity (FVC), is the most readily available and most useful
pulmonary function test. It takes ten to 15 minutes, uses an expensive instrument, and carries
no risk. PFT's are done prior to and after tests of aerobic capacity or efficiency/economy tests.
Costs
Pulmonary Function Tests (SVC, FVC, MVV pre and post exercise): $40

Resting Metabolic Rate (RMR)

The Resting Metabolic Rate (RMR) test measures the major component of daily caloric
expenditure for those wishing to gain or lose weight, or for those who simply want to eat right to
fuel their exercise. This test is performed in the morning, and involves having you breathe into a
device which measures the amount of energy that your body consumes at rest.

The RMR test can be helpful for those interested in weight loss. Resting metabolic rate (RMR)
accounts for the majority of energy expended during the day. Measuring your RMR will enable
the dietitian to adjust your intake goals to meet the needs of your body, without putting you at
risk of taking in too few calories.
Resting metabolic rate ~60-75% of total daily energy expenditure
Patient Instructions:
● Participants fast overnight for at least 12 h and attended the clinic on wakening.
● Before commencement of the measurements, subjects rest quietly for 30 min,
● Subjects sit quietly in a comfortable chair for the duration of the measurement.
● Subjects are asked to remain awake and motionless
Costs
Resting Metabolic Rate: $75

ports Nutrition
Nutrition Analysis:
Using a computerized program your eating habits over a three-day period are analyzed. The
results of the analysis are presented to you with further recommendations for health and
performance. This includes fueling during a competitive event, eating for recovery,. and making
sure your dietary habits are helping and not hurting your performance.
Nutrition Consultation:
This involves a 45 minute one-on-one consultation (without 3-day food record evaluation) to
help you eat better and fuel your activities more effectively.
Nutrition Follow-up:
Many clients who come in for nutrition appointments benefit from meeting several times after
their initial visit. The follow-up appointments help answer additional questions, and are used to
evaluate your progress toward your nutrition and health goals.
Sports Nutrition Appointments
● Nutrition Evaluation with Resting Metabolic Rate (RMR) $150
● Nutrition Evaluation $100
● Nutrition Consultation $80
 ● Nutrition Follow-up $45

Anaerobic Power - Cycling (Wingate Test)

Anaerobic power is assessed during a 30-second test on a cycle ergometer. During the 30
seconds the subject pedals all out giving a peak effort and allowing a measurement of peak
anaerobic sprinting performance.
During the test the following variables are measured:
● Peak power – highest mechanical power generated during any 3 to 5 second period of
the test
● Average power output – the arithmetic average of the total power generated during the
30 second test period
● Rate of fatigue – the rate of decline in power relative to the peak value
Patient Instructions:
● Do not perform hard or long workouts two days prior to testing, easy recovery rides/runs
are fine.
● Maintain normal nutrition patterns
● Test should not be preformed if injured or sick.
● The test involves cycling as hard as possible for 30 seconds (feels much longer) and
takes approximately 20minutes for set-up, the test and consultation.
Costs
Wingate Test: $55

Resources

Performance Newsletter
Summer 2006- Sports Science and the Tour de France (PDF)
Human Performance Lab Definitions
Economy – The concept pertaining to the oxygen consumption required to perform a given task
Electrocardiogram (EKG or ECG) - a graphic produced by an electrocardiograph, which records
the electrical voltage in the heart in the form of a continuous strip graph.
Heart Rate (HR) – Usually measured as the number of heart beats per minute and an indication
or exercise intensity.
Lactate threshold – The term used to denote the intensity of exercise when there is an abrupt
increase in lactate accumulation in blood or muscle
Pulmonary Function Testing (PFT) -A broad range of tests that measure how well the lungs take
in and exhale air and how efficiently they transfer oxygen into the blood.
Rating of Perceived Exertion (RPE) – A subjective measure of how hard a bout of exercise
feels. It is based on the physical sensations a person experiences during physical activity,
including increased heart rate, increased respiration or breathing rate, increased sweating, and
muscle fatigue.
Resting Metabolic Rate - the minimum number of calories your body needs to support its
basic physiological functions, including breathing, circulating blood and all of the numerous
biochemical reactions required to keep you alive. Your RMR is generally 60-75% of your total
daily caloric expenditure.
Ventilaotry threshold – The metabolic intensity associated with an increase in the ventilatory
equivalent for oxygen (VE/VO2)
VO2max – Maximum volume of oxygen consumed by the body during exercise
Watts - A unit of power or the amount of energy per unit time, measurement is often used in
assessing cycling performance and designing training programs.

Links
Running
Track and Field News
Lets Run
US Track & Field Association
Team XO
Bicycling
Bike Forums
Northern California and Nevada Cycling Association
Velo News
USA Cycling
Triathlons
USA Triathlon

Intervention should begin early. The risk of persistent obesity

increases with the age of the child. Furthermore, change in
adolescents is much more difficult to facilitate and maintain as habits
become ingrained.
American Academy of Pediatrics
Prevention of Pediatric Overweight and Obesity
Summary and Conclusions
● Prevalence of overweight and its significant comorbidities in
pediatric populations has rapidly increased and reached epidemic
proportions
● Genetic, environmental or combinations of risk factors
predisposing children to obesity can and should be identified.
● Early recognition of excessive weight gain relative to linear
growth should become routine in pediatric care settings. BMI
should be calculated and plotted periodically.
● Families should be educated and empowered through
anticipatory guidance to recognize the impact they have on their
children's development of lifelong habits of physical activity and
nutritious eating.
● Dietary practices should be fostered that encourage moderation
rather than overconsumption, emphasizing healthful choices
 rather than restrictive eating patterns.
● Regular physical activity should be consciously promoted,
prioritized, and protected within families, schools, and
communities.
● Optimal approaches to prevention need to combine dietary and
physical activity interventions.
● Advocacy is needed in the areas of physical activity and food
policy for children; research into pathophysiology, risk factors,
and early recognition and management of overweight and
obesity; and improved insurance coverage and third-party
reimbursement for obesity care.
Kids in Action is not a diet. Instead the program focuses on making
healthy eating a way of life. Participants develop an awareness of their
current eating habits and identify unhealthy behaviors. They are then
taught how to modify current behaviors by starting with small, doable
and gradual changes and then adding further plans when previous
changes are in place.
The nutrition treatment goals are listed below:
• Develop awareness of current eating habits, and parenting behavior.
• Identify problem behaviors such as consumption of high-calorie
foods, eating patterns.
• Reduce calorie intake by emphasizing a well balanced healthy food
plan with gradual reduction or elimination of specific high calorie foods.
• Modify current behaviors and situations by starting with a few small,
doable and gradual changes and then adding further plans when
previous changes are in place.
• Monitor eating and associated problems over time by patient and
family.
• Increase in patient’s responsibility a for healthy diet.
• Healthier eating pattern.

Activity is an important ingredient to a healthy growing body.

Participants in the Kids in Action program will become aware of
their current physical activity, and identify barriers to participating
in physical activity. The program aims for the child to develop a
more physically active lifestyle that emphasizes personal choice and
enjoyment.
The plan of action for activity follows the nutrition plan. Below are the
goals of the intervention:
• Develop awareness of current physical activity, and parenting
behavior.
• Identify problem behaviors such as barriers to participating in
physical activity.
• Modify current behaviors and situations by starting with a few small,
doable and gradual changes and then add further plans when previous
changes are in place.
• Increase activity level and decrease sedentary time.
• Monitor physical activity and associated problems over time by
patient and family.
• More physically active lifestyle that emphasizes personal choice and
enjoyment.
• Increase in patient’s responsibility for physical activity choices.
In addition, the Kids in Action program is proud to announce a
partnership with RClub the only fitness club for kids ages 6-17 in the
Tri-Valley Area

Kids in Action is not a diet. Instead the program focuses on making

healthy eating a way of life. Participants develop an awareness of their
current eating habits and identify unhealthy behaviors. They are then
taught how to modify current behaviors by starting with small, doable
and gradual changes and then adding further plans when previous
changes are in place.
The nutrition treatment goals are listed below:
• Develop awareness of current eating habits, and parenting behavior.
• Identify problem behaviors such as consumption of high-calorie
foods, eating patterns.
• Reduce calorie intake by emphasizing a well balanced healthy food
plan with gradual reduction or elimination of specific high calorie foods.
• Modify current behaviors and situations by starting with a few small,
doable and gradual changes and then adding further plans when
previous changes are in place.
• Monitor eating and associated problems over time by patient and
family.
• Increase in patient’s responsibility a for healthy diet.
• Healthier eating pattern.
Overweight in children and adolescents can cause complications in
many organ systems. For more information click on the links below.
Cardiovascular Comorbidities
● Hypertension
○ Quiz: Test your knowledge of high blood pressure.
● Hyperlipidemia
○ Quiz: Test your knowledge of cholesterol.
Orthopedic Comorbidities
● Slipped capital femoral epiphysis
● Blount's disease
Respiratory Comorbidities-
● Sleep apnea, Obesity Hypoventilation Syndrome
Endocrine Comorbidities
● Type 2 Diabetes
● Polycystic Ovarian Syndrome
Neurologic Comorbidities
● Pseudotumor Cerebri
Gastrointestinal Comorbidities
● Gallbladder disease
● Non-alcoholic Steatohepatitis
Psychologic and Social Complications
● Eating Disorders
○ Anorexia Nervosa
○ Bulimia
○ Binge Eating
● Depression
● Low Self-esteem, Teasing and Bullying
RClub Interactive Fitness
RClub Interactive Fitness in Pleasanton, the Tri-Valley’s first kids-only fitness club, opened in
April 2006 as a complete cardio, strength, and fitness training center for children ages 6-17
years. RClub is a fitness club that encourages children and teens to workout doing what they
love – dancing and playing video games. RClub features state-of-the art equipment, including
GameBike™Connected to PlayStation2®, Arcade-Style Dance Dance Revolution stations,
resistance training equipment for children 6-11 and a traditional weight training room for
adolescents 12-17. In addition, members can attend kid-focused cardio and fitness classes and
have access to certified personal trainers for more specialized fitness needs. www.rclubif.com.
American Academy of Pediatrics (AAP)
Advocates on behalf of children and youth, educates the public and professionals, conducts
research, and advocates for the interests of pediatricians. The site contains AAP policy
statements related to the topics of obesity and overweight. http://aappolicy.aappublications.org/
American Diabetes Association
Visit Youth Zone, a fun, interactive page for kids with information on "Diabetes Basics", a
question and answer section, hyper and hypoglycemia checklists, games, suggestions for "living
it up" and more. http://www.diabetes.org
CANFit - California Adolescent Nutrition and Fitness Program
The program seeks to engage communities, and build their capacity to improve the nutritional
status and physical fitness of California´s low-income, African American, Latino, Asian/Pacific
Islander, and American Indian youth between the ages of 10 and 14. http://www.canfit.org
Center for Science in the Public Interest (CSPI)
A nonprofit education and advocacy organization that focuses on improving the safety and
nutritional quality of our food supply. This website offers education and advocacy materials, and
news updates and special reports.http://www.cspinet.org
The Children's Nutrition Research Center (CNRC)
Operated by Baylor College of Medicine in cooperation with Texas Children's Hospital and
the Agricultural Research Service of the U.S. Department of Agriculture (USDA/ARS), The
Children's Nutrition Research Center (CNRC) is one of six federally funded human nutrition
research centers in the nation and the first to conduct scientific investigations into the role
of maternal, infant and child nutrition in optimal health, development, and growth.http://
www.bcm.tmc.edu/cnrc/
NUTRITION.GOV
A new federal resource that provides easy access to all online federal government information
on nutrition, including specialized nutrition information for infants and children, adult women
and men, and seniors. Includes extensive interactive scientific reference section. http://
www.nutrition.gov/
US Department of Health and Human Services
An online encyclopedia of health information, dietary guidelines, and links to pages for children.
This site links to several multi-agency health initiatives and activities of federal departments and
agencies.
http://www.health.gov/
American Obesity Association
A nonprofit organization dedicated to promoting education, research and community action that
can improve the quality of life for people with obesity.http://www.obesity.org
CDC's Nutrition and Physical Activity Program
Website contains Pediatric Growth Charts, surveillance data on obesity and diabetes,
descriptions of CDC sponsored nutrition and physical activity promotion programs, including
Kids Walk-to-School: A Guide to Promote Walking to School, http://www.cdc.gov/nccdphp/
dnpa/, and Physical Activity Evaluation Handbookhttp://www.cdc.gov/nccdphp/dnpa/physical/
handbook/index.htm
National Heart, Lung, and Blood Institute (NHLBI)
Website allows easy access to information contained in The Clinical Guidelines on the
Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence
Report, produced by the NHLBI in cooperation with the NIDDKD. Topics addressed in the
Clinical Guidelines include the health risks associated with overweight and obesity, as
well as the assessment, treatment, and management of overweight and obese patients.
www.nhlbi.nih.gov/