VO₂max and Longevity: What Does the Research Actually Show?

By. Dr. Sean Delanghe BSc (Hons), DC

If you run, cycle, swim, or do pretty much any type of endurance exercise, you’ve probably heard of VO₂max. It’s often described as one of the best measures of cardiovascular fitness, and you’ll now find it reported on many Garmin, Apple and other fitness watches. But does having a higher VO₂max actually have anything to do with how long we live?

A recent systematic review and meta-analysis provides some pretty compelling evidence that it does.

First, what exactly is VO₂max?

VO₂max is essentially a measure of how much oxygen your body can use when you’re exercising as hard as you can. It reflects the combined ability of your lungs to bring in oxygen, your heart and blood vessels to deliver it, and your muscles to use it. It is usually expressed as millilitres of oxygen per kilogram of body weight per minute (mL/kg/min).

A true VO₂max is traditionally measured in a laboratory while exercising to exhaustion, usually running or cycling. However, fitness can also be estimated using exercise tests and mathematical equations. This distinction becomes important in the study.

What did the researchers actually do?

The researchers performed a systematic review and meta-analysis, meaning they combined the results of many previous studies rather than looking at one group of people. They found 42 studies representing 35 different cohorts and more than 3.8 million observations, including more than 362,000 deaths from any cause and 56,000 cardiovascular deaths.

The studies measured fitness in several different ways. Some directly measured VO₂max in a laboratory, while others estimated fitness using maximal or submaximal exercise tests, or even equations that did not require an exercise test. The researchers wanted to determine whether these different measures of cardiorespiratory fitness were associated with mortality in a similar way.

What did they find?

The results were remarkably consistent. For every 1 MET higher level of fitness, which is approximately 3.5 mL/kg/min of VO₂max, there was an association with approximately a 14% lower risk of death from any cause and a 16% lower risk of death from cardiovascular disease.

Put another way, people with higher cardiorespiratory fitness tended to live longer. And this wasn’t a small study — we’retalking about millions of observations across dozens of studies. The relationship was also broadly similar whether fitness was directly measured or estimated.

That doesn’t mean, however, that increasing your VO₂max by 1 MET will automatically reduce your personal risk of death by exactly 14%. This is an important distinction when interpreting health research.

Does higher VO₂max actually cause people to live longer?

Ready for the most obvious statement of the day? Correlation does not equal causation! We don’t know for certain if this relationship is CAUSAL.

Most of the evidence in this review came from observational studies. These can tell us that two things are strongly associated, but they cannot completely prove that one causes the other. People with higher fitness may also exercise more, smoke less, eat differently, have healthier body weights or have fewer underlying health problems.

The researchers adjusted for many potential confounding factors, but statistical adjustment can never eliminate every possible influence. So the safest interpretation is that higher fitness is strongly and consistently associated with lower mortality risk. That’s different from saying that deliberately increasing your VO₂max by a specific amount will produce a predictable reduction in your risk of death.

What about people who aren’t endurance athletes?

This may actually be one of the most useful parts of the research. You don’t need to be a marathon runner to benefit from being fit.

Previous research suggests that some of the largest health differences occur when people move from very low fitness to moderate fitness. In other words, going from very unfit to reasonably fit may be considerably more important for health than taking an already-fit person and making them extremely fit.

So while a VO₂max of 55 might be impressive, someone increasing their fitness from 25 to 35 may be making a much more meaningful change to their health than an already-fit person going from 50 to 55. The goal isn’t necessarily to become an elite endurance athlete. Getting out of the very-low-fitness category appears to be particularly important.

Do you need a laboratory VO₂max test?

Long story short- NO! The researchers found broadly similar associations between mortality and both directly measured and estimated cardiorespiratory fitness.

That doesn’t mean every smartwatch gives you an accurate VO₂max. Wearable devices use algorithms and estimates, and their accuracy can vary. What the research suggests is that estimated fitness can still contain useful information about health at a population level, even when it isn’t measured in a laboratory.

What does this mean for you?

The practical takeaway is pretty simple: you don’t need to obsess over your VO₂max number. Instead, think about cardiorespiratory fitness as something you can develop and maintain throughout your life.

If you’re currently inactive, you don’t need to start training like an Olympian. Walking regularly, cycling, swimming, jogging or other activities that challenge your cardiovascular system can improve fitness. If you’re already active, adding some higher-intensity exercise can help push your fitness further. And if you’re an endurance athlete, VO₂max can be an interesting performance metric, but it certainly isn’t the only measure that matters.

The bigger picture is that cardiorespiratory fitness appears to be one of the strongest measurable markers we have for long-term health.

And the beauty is you don’t need an elite VO₂max to be healthy, and you don’t need a laboratory test to start improving your fitness. The important thing is to keep moving, challenge your cardiovascular system consistently, and strive to find FUN ways maintain your fitness throughout your life.

If you have any questions about improving your overall health, feel free to reach out to our Waterloo based chiropratros, physiotherapists and registred massage therapists HERE.

Price increases- August 2026

Our chiropractic and physiotherpy fees will be increasing effective August 1st 2026.

In general, regular chiro visits will be going up $1, extended chiro and regular physio visits will be going up $3.

Here is a complete list of upcoming fees. If you have an inability to pay and require care, please let us know.

Chiropractic fees effectice August 2026:

Regular chiro- $54

Regular chiro student/ senior- $51

Chiro extended/ Reassessment- $81

New Patient (45mins)- $115

New Patient (1 hour) – $135

Fees specific to Dr. Rebecca:

Chiro Plus – $68

Chiro Plus Student/Senior- $65

Chiro extended Student/Senior- $78

Chiro 1 hour visit- $189

Chiro 45′ visit- $135

Physotherapy fees effective August 2026:

Regular physio visit- $81

Student/senior physio visit- $76

Physio extended visit- $108

Physio initial visit- $135

Does exercise improve bone density?

The answer may seem obvious, but there definitely are some caveats! Can we improve our bone density with exercise?

A recent systematic review and meta-analysis published in Frontiers in Physiology examined this, and here is what they found:

Bone Mineral Density (BMD)

• Exercise significantly increased lumbar spine BMD in women under 30
• Exercise significantly increased femoral neck BMD in women under 30
• Effect sizes were moderate
  • Lumbar spine: SMD ~0.46
  • Femoral neck: SMD ~0.42

Beyond these primary findings, the review showed that the type of exercise performed plays an important role in determining outcomes.

• Programs that combined resistance training with weight-bearing or impact activities consistently produced the largest improvements in bone density.
• These combined approaches appear to create a stronger mechanical stimulus by loading bone in multiple ways, which enhances adaptation.

In contrast, single-mode exercise such as endurance or aerobic training alone resulted in smaller or less consistent changes in BMD. This reinforces the idea that bone responds best to varied and progressively challenging loading rather than repetitive, low-variation activity.

Bone Turnover Markers

The study also examined changes in bone turnover markers, which provide insight into how bone is actively remodeling. Exercise increased markers of bone formation, including osteocalcin and bone-specific alkaline phosphatase, indicating that bone-building processes were being stimulated. Shorter training programs, particularly those under four months, were associated with early increases in markers like osteocalcin and P1NP, suggesting that biological changes in bone can occur relatively quickly, even before large changes in density are measurable. Bone-specific alkaline phosphatase increased with both short- and longer-term training, supporting the idea that continued exercise helps maintain this positive remodeling environment.

Start Young!

One of the more notable findings relates to age.

The review found significant improvements in bone density in women under 30, but not in those over 30.

At first glance, this may suggest that exercise becomes ineffective for bone health after early adulthood, but that interpretation would be misleading. Bone tissue is most responsive during the years leading up to peak bone mass, which typically occurs in the late twenties. After this point, the body becomes less sensitive to mechanical loading, meaning it is harder to produce measurable increases in bone density over shorter study periods.

However, this does not mean exercise is no longer beneficial for women over 30. In this group, exercise still plays a critical role in maintaining existing bone mass and slowing age-related decline. Without regular loading, bone density tends to decrease gradually over time, increasing the risk of osteoporosis later in life. Exercise, particularly resistance and impact training, helps preserve bone structure, improve strength, and reduce fracture risk even if large increases in BMD are not seen.

In other words, while younger individuals may be building bone, older individuals are protecting what they have, which is just as important!

Practical Applications

Exercise can improve bone density in young adult women, but not all exercise is equally effective.

• Programs that combine resistance training with weight-bearing or impact activities produce the best results.
• The largest gains are seen before the age of 30- put as much bone density in the bone bank as possible during your younger years!
• Exercise remains highly valuable afterward by helping maintain bone mass and reduce long-term risk. If you’re over 30, don’t stress about what you may or may not have done in your younger years- work to maintain what you have with resistance training mixed with some impact -oriented cardiovascular exercise!

If you have any questions about how to structure a program to maintain bone density- feel free to contact our Waterloo based chiropractors, physiotherapists or book online HERE.

Does glucosamine help with arthritic pain?

Glucosamine is a naturally occurring amino sugar that is found in the human body and is involved in the formation and repair of cartilage, particularly within joints. As a supplement, it is most commonly used by individuals with osteoarthritis in the hope that it can slow cartilage breakdown, improve joint function, and reduce pain. It is often sold as glucosamine sulfate or glucosamine hydrochloride, sometimes combined with chondroitin sulfate, another compound found in cartilage.

How is glucosamine thought to work (theoretical mechanism)?

The proposed mechanisms (mostly based on laboratory and animal studies, not strong human evidence) include:

• Serving as a building block for glycosaminoglycans, which are components of cartilage
• Potentially stimulating cartilage repair or slowing breakdown
• Possible anti-inflammatory effects within the joint
• Reducing activity of enzymes that degrade cartilage (e.g., matrix metalloproteinases)

However, it is important to note that these mechanisms are largely theoretical in humans, and the clinical effect in real-world trials has been uncertain.

Study

The GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial) was a large, high-quality clinical trial funded by the U.S. National Institutes of Health (NIH). It was designed to rigorously test whether glucosamine, chondroitin sulfate, or their combination could reduce pain and improve function in patients with knee osteoarthritis. It is considered the gold standard study on this topic!

What it included:

• Randomized, double-blind, placebo-controlled trial
• Total participants: 1,583 patients with knee osteoarthritis
• Duration: 24 weeks
• Treatment groups:
  • Glucosamine hydrochloride (1500 mg/day)
  • Chondroitin sulfate (1200 mg/day)
  • Combination of both
  • Celecoxib (NSAID active control)
  • Placebo
• Primary outcome: ≥20% reduction in knee pain

The inclusion of celecoxib was important because it acted as a benchmark to confirm the trial could detect real treatment effects if they existed.

Results:

Primary outcomes

• No statistically significant difference between placebo and:
  • Glucosamine alone
  • Chondroitin alone
  • Glucosamine + chondroitin

Active control

• Celecoxib showed a clear and statistically significant reduction in pain compared to placebo
• This confirmed the study design was sensitive enough to detect true analgesic effects
• In other words- it glucosamine + chondroitin was going to work, the study would have shown it!

Subgroup analysis

• In patients with moderate-to-severe baseline pain:
  • Combination glucosamine + chondroitin showed a higher response rate than placebo
• This effect was:
  • Not consistent across all analyses
  • Considered hypothesis worth studying more, but definitely not definitive

Secondary outcomes

• No meaningful or consistent improvement in:
  • Physical function
  • Joint stiffness
  • Overall osteoarthritis symptom scores

Safety outcomes

• Glucosamine and chondroitin were generally:
  • Well tolerated
  • Similar adverse event rates compared to placebo
• No major safety concerns identified

Practical Applications 

In the end, this study showed that despite biologically plausible mechanisms, glucosamine (with or without chondroitin) did not provide meaningful clinical benefit for most patients with knee osteoarthritis.

While there was a possible signal of benefit in a subgroup with more severe pain, this was not strong or consistent enough to change overall conclusions. Celecoxib’s positive results supported the validity of the trial design, strengthening confidence in the negative findings for glucosamine.

In the end it’s safe to try glucosamine, but go in knowing that you will likely not see any change, and if you do notice a change, it’s very likely identical to what a placebo would provide.

Stress fractures 101!

By. Dr Sean Delanghe BSc (Hons), DC

There’s nothing worse than hearing you have a stress fracture as a runner (maybe)! This 2024 review of systematic review will help to arm you with the information you need to avoid them and catch them early!

What This Study Is About
Stress fractures are overuse injuries that develop when repeated mechanical loading exceeds the bone’s ability to recover. The paper explores how frequently these injuries occur, where they are most likely to happen, what contributes to their development, and how they are best diagnosed and treated.

How the Research Was Done
The authors reviewed evidence from major databases – primarily systematic reviews. Around 90 studies were initially identified, with approximately 57 included in the final analysis. This is the best of the best!

Where Stress Fractures Happen Most
Stress fractures occur predominantly in the lower extremities due to repetitive loading during running. In long-distance runners, the tibia is the most commonly affected bone, followed by the metatarsals. In contrast, sprinters tend to experience more stress fractures in the toe bones, likely due to the higher forces and forefoot loading associated with sprinting mechanics.

Why Stress Fractures Develop
Stress fractures are multifactorial and typically result from a combination of biological, nutritional, mechanical, and psychological factors.

Key factors include:

• female sex
• reduced bone density
• nutritional factors such as low energy availability and deficiencies in calcium or vitamin
• Training-related issues, particularly rapid increases in workload
• In addition, psychological factors like high stress levels, perfectionism, and fear of failure may indirectly increase injury risk by influencing training behaviours and recovery.

How They Are Diagnosed
Diagnosis begins with a detailed clinical history and physical examination, but imaging is often required for confirmation.

• MRI is considered the most sensitive and preferred method for detecting stress fractures, especially in the early stages.
• X-rays are commonly used but may not detect early bone stress injuries, which can delay diagnosis if relied upon alone.
• Bone scans are the fastest and most sensitive option for most of us in Canada.

What Treatment Looks Like
Treatment primarily involves reducing or temporarily stopping the activity that caused the injury, allowing the bone time to heal. A gradual return to running is introduced once symptoms improve. Importantly, treatment should also address the underlying factors that contributed to the injury- see above!

How to Reduce Your Risk
Preventing stress fractures requires a proactive approach that includes maintaining adequate nutrition and energy availability, progressing training loads gradually, and addressing any biomechanical inefficiencies. Screening for conditions such as RED-S or the Female Athlete Triad may also be important in certain populations. Psychological stress should not be overlooked, as it can influence both training habits and recovery- are you doing the right thing for your training, or are you responding to anxiety that is telling you to illogically ramp up?

Practical applications:

• Most stress fractures occur in the lower extremities
• Tibia is the most common site in long-distance runners
• Metatarsals are the second most common
• Sprinters more commonly experience stress fractures in the toes
• Risk factors include biological, nutritional, mechanical, and psychological components
• MRI is the most sensitive diagnostic tool, bone scan is probably our best choice in Canada
• Treatment focuses on rest, gradual return, and addressing underlying causes
• Prevention requires proper training progression, nutrition, and overall load management
• Managing anxiety related to training and racing is a huge factor for most competitive runners!

If you have any questions about any of your injures for our Waterloo based chiropractors, physios or RMTs- feel free to contact us or book online HERE.

Does Dry Needling help with Plantar Fasciitis?

This article examined whether dry needling (DN) is effective for treating plantar fasciitis (PF), a common cause of heel pain. Dry needling involves inserting thin needles into muscle trigger points wth a goal reduce pain and improve movement.

This is not meant to replace more important strategies like load management, strengthening/ rehab etc. But is it actually a useful adjunct to these better supported potions?

Methods

The authors conducted a systematic review and meta-analysis of previously published research.

Major research databases were searched (PubMed, Embase, Web of Science, etc.), and only randomized controlled trials (RCTs) were included.

Study sample

• 12 RCTs
• 781 total participants
• Comparisons included:
  • Dry needling plus routine care (stretching, massage, exercise)
  • Dry needling alone
  • Other conservative treatments without dry needling

Key Findings

Pain Reduction

Dry needling combined with routine treatment resulted in significantly lower heel pain compared to routine treatment alone. Pain was measured using standard tools such as the Visual Analog Scale (VAS) and Numeric Pain Rating Scale (NPRS).

Mean pain score reduction ranged from −1.76 to −2.12 points, which represents a moderate to large clinically meaningful improvement.

Dry needling alone was not consistently superior to other conservative treatments for pain relief- so you still have to do the other stuff!

Functional Improvement

Dry needling combined with routine care led to significant improvements in foot function (measured with the Foot Function Index), and dry needling alone also showed better functional outcomes than other conservative treatments. This suggests dry needling may improve a patient’s ability to walk, stand, and perform daily activities, even when pain reduction is limited.

Timing of Benefits

Improvements were more consistent after one month. Short-term results (less than one month) were mixed, suggesting dry needling is more effective as a medium-term intervention rather than an immediate solution.

Safety and Side Effects

About 50% of the included studies reported minor side effects, most commonly temporary soreness, mild bruising, or minor bleeding at the needle site. No serious adverse events were reported.

Overall Conclusion

Dry needling appears to be a safe and effective treatment option for plantar fasciitis, particularly when combined with routine conservative care, used for at least one month, and aimed at improving both pain and foot function. However, the authors note that study quality varied, sample sizes were relatively small, and more high-quality randomized controlled trials are needed before strong clinical recommendations can be made.

If you have more questions about this therapy, or would like to try it, please contact us or book online HERE!

Manipulation for acute neck pain- does it work?

Does spinal manipulation actually help with acute neck pain? A recent systematic review and meta-analysis took a look HERE.

Acute neck pain , meaning neck pain that lasts less than three months, is very common and can lead to disability or persistent problems. The authors wanted to investigate how effective and safe SMT is specifically for acute neck pain, since previous reviews often mixed acute, sub-acute, and chronic cases, which makes interpretation difficult.

Methods
The researchers searched several major databases (PubMed, Embase, Web of Science, PEDro, Cochrane) up to March 20, 2023, for randomized controlled trials (RCTs) involving SMT versus control in adults with acute neck pain lasting less than 3 months. Outcomes of interest were pain intensity, cervical range of motion, and disability. They included 8 RCTs, with a total of 965 patients.

Key Findings

• Pain: SMT significantly reduced pain compared to controls (mean difference 1.53 points lower on the pain scale, 95% CI 0.83 to 2.22)
• Cervical range of motion: SMT improved neck movement in all directions (flexion, extension, rotation, lateral flexion). Flexion improved by a mean of 11 degrees (95% CI 9.10 to 12.93)
• Disability: Patients receiving SMT had lower disability scores than controls (mean difference 6.20, 95% CI 2.59 to 9.81)
• Safety: No serious adverse events were reported. One patient had a mild, transient arm sensation episode after SMT

Clinical Implications
Despite limitations (small sample sizes in some cases, dose/response not established), the review suggests SMT can be an effective and safe option for acute neck pain: it reduces pain, improves neck movement, and lowers disability in the short term. SMT is best considered alongside other treatments, such as exercise and education.

This study is a good start, but more research is required to determine which patients benefit most, how much and how often it should be performed, and which SMT techniques work best.

If you suffer from neck pain, or have more questions about this study, feel free to contact us HERE.

WANTED: PHYSIOTHERAPIST

Our awesome physio, Sayaka, is expecting her second child and needs help keeping her patients strong and healthy!

Sayaka works with a diversity of patients ranging from Parkinson’s rehab, surgical rehab all the way to strength training for athletes. We are looking for somebody who works with a strong emphasis on strength work/ rehab- we want to put that gym space to use!

Some general facts about the job:

• Flexible hours
• Expected duration: 1 year
• Part-time or full time- we will take what we can get if the practitioner is a good fit!
• Your own treatment room and access to gym space
• Jane practice software
• Patient- focused, evidence-based work environment
• Plenty of parking with store front entrance into the clinic
• Reception coverage for 40 hours/week with the option to work outside of those hours

There’s always the option to work beyond the locum if it makes sense for all, but for now the focus would be on maintaining Sayaka’s patients and other new physio patients that come into the clinic.

E-mail seandelanghe@gmail.com if you want to learn more!