The strongest predictor of how long you'll live

You don’t need a VO2 max test to estimate your cardiorespiratory fitness.

All you need is four flights of stairs and a stopwatch.

Want to know the single strongest predictor of how long you'll live? It's not your blood pressure. It's not your cholesterol. It's not even your weight.

It's how fit your heart and lungs are. Cardiorespiratory fitness. In the largest studies we have, this metric outperforms all those other things. 

Here’s the good news

Unlike your age or your genes, this one is trainable. At any age.

So naturally, the longevity world went looking for the perfect way to measure it. Enter VO2 max, the gold-standard test where you run on a treadmill in a face mask, breathing like Darth Vader, until you'd very much like to lie down. Peter Attia put it on the map, and to his credit, he's right that fitness matters more than almost anything else you can track.

But (plot twist!) those landmark studies, the ones linking fitness to a longer life? Most of them never actually measured VO2 max. You can't strap a metabolic mask onto 750,000 people. What they used instead was METs, a fitness score estimated from how fast and how steep you can go on a treadmill before you tap out. 

Translation: the MET version predicts mortality just as well as the fancy masked version. For most of us, the misery mask is optional.

So, what’s the number?

For women, the target is about 10 METs or higher.  On a treadmill test, that's roughly 10 minutes of progressively harder walking, finishing at near 3.4 mph on a steep 14% incline. Hit that and you're in the "fit" zone, with roughly half the mortality risk of the least-fit women.  

No treadmill? No problem. There's a beautifully simple field test: four flights of stairs, in <45 seconds. Hustling up roughly 60 steps at that clip puts most people around 10 METs, right in that fit zone we just talked about.  

If a single flight leaves you gripping the railing, that is not a character flaw. That's just your starting line. And a starting line is a wonderful thing to have, because it only goes up from here.

Do you actually need the VO2 max test?

Maybe. If you're a competitive athlete chasing marginal gains, or you simply love data for its own sake, the lab test gives you a precise number to train against. It's an excellent (albeit uncomfortable) test.

But if you're a regular human who just wants to know if you’re fit enough to add years to your life, you don't need the mask, the lab, or the bill. Your stairs, or a treadmill at incline, will tell you most of what you need to know.

Here’s how to HOP to it

The best news of the whole newsletter? Fitness responds to training at every age. You are never too old, too late, or too out of shape to move the needle. Here’s where to start:

Find your spicy minutes. A couple of times a week, push hard enough that talking gets difficult. That's the zone that grows your fitness.

Always take the stairs (ATTS). This acronym was coined by my friend, OB/GYN Dr. Jaime Seeman (@doctorfitandfabulous). I love it!

Keep the easy movement flowing. Long, easy walks build the aerobic base that makes the hard stuff possible.

Where HOP Box fits in

HOP Box isn’t a shortcut, because a shortcut doesn’t exist. The workout does the work. 

But HOP Box does support the machine you're driving. NR helps fuel the cellular energy your muscles lean on, while astaxanthin and tetrahydrocurcumin help your body handle the oxidative stress that comes with pushing yourself. Support the engine, then go use it.

The bottom line

VO2 max is a great test. But it made fitness sound like something you need a lab and a budget to care about. You don't. The science says the same thing your stairs do: get fitter, live longer, and start from exactly where you are today.

Now, HOP to it!

Dr. Amy Killen & the HOP Team

One note: if you have heart disease, chest pain, or you've been sedentary for a long stretch, check with your doctor before you go sprinting up four flights or maxing out a treadmill. A quick conversation first is always the smart move.

References

1. Mandsager K, et al. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Network Open, 2018.
   
   
2. Ross R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: fitness as a clinical vital sign. Circulation, 2016.
   
   
3. Kokkinos P, et al. Cardiorespiratory fitness and mortality risk across the spectra of age, race, and sex. JACC, 2022.
   
   
4. Fletcher GF, et al. Exercise standards for testing and training. Circulation, 2013.
   
5. Farrell SW, et al. Cooper Center Longitudinal Study work on cardiorespiratory fitness and mortality in women.
   
   
6. Teh KC, Aziz AR. Heart rate, oxygen uptake, and energy cost of ascending and descending stairs. Med Sci Sports Exerc, 2002.
   
   
7. Bassett DR Jr, et al. Energy cost of stair climbing. Med Sci Sports Exerc, 1997.