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and Aging, Department of Kinesiology, University of Colorado, Boulder 80309; 2Center for Research
in Ambulatory Health Care Administration, Medical Group Management Association,
Englewood 80112; and 3Divisions of Cardiology and Geriatric Medicine, Department of Medicine,
University of Colorado Health Sciences Center, Denver, Colorado 80262
Fitzgerald, Margaret D., Hirofumi Tanaka, Zung V. In light of the physiological and clinical significance
Tran, and Douglas R. Seals. Age-related declines in maxi- of maximal aerobic capacity, lifestyle factors that may
mal aerobic capacity in regularly exercising vs. sedentary be associated with a reduced rate of decline in V̇O2 max
women: a meta-analysis. J. Appl. Physiol. 83(1): 160–165, with advancing age are of considerable public health
1997.—Our purpose was to determine the relationship be-
tween habitual aerobic exercise status and the rate of decline
interest. In this context, it has been reported that the
in maximal aerobic capacity across the adult age range in rate of decline in V̇O2 max with age is smaller in endur-
women. A meta-analytic approach was used in which mean ance-trained male athletes than in sedentary men (8,
maximal oxygen consumption (V̇O2 max) values from female 11). Based largely on these data in men, the concept has
subject groups (ages 18–89 yr) were obtained from the been established and widely promoted that the rate of
published literature. A total of 239 subject groups from 109 decline in maximal aerobic capacity with age is attenu-
studies involving 4,884 subjects met the inclusion criteria ated in adults who perform regular aerobic exercise (8,
and were arbitrarily separated into sedentary (groups 5 107; 11, 12).
subjects 5 2,256), active (groups 5 69; subjects 5 1,717), and
In contrast to these findings in men, Wells and
endurance-trained (groups 5 63; subjects 5 911) populations.
V̇O2 max averaged 29.7 6 7.8, 38.7 6 9.2, and 52.0 6 10.5 colleagues (25) and Astrand et al. (1) have reported
ml · kg21 · min21, respectively, and was inversely related to age rates of decline in V̇O2 max with age in physically active
within each population (r 5 20.82 to 20.87, all P , 0.0001). women that are greater than that generally reported
The rate of decline in V̇O2 max with increasing subject group for sedentary women. Recently, we (6) observed a rate
age was lowest in sedentary women (23.5 ml · kg21 · min21 of decline in V̇O2 max with age among highly trained
· decade21 ), greater in active women (24.4 ml · kg21 · min21 female distance runners that was even greater than
· decade21 ), and greatest in endurance-trained women (26.2 that reported in these earlier studies (1, 25). However,
ml · kg21 · min21 · decade21 ) (all P , 0.001 vs. each other). the relatively small sample sizes, limited age ranges,
When expressed as percent decrease from mean levels at age
and lack of sedentary control groups in all of these
,25 yr, the rates of decline in V̇O2 max were similar in the three
populations (210.0 to 210.9%/decade). There was no obvious studies (1, 6, 25) preclude drawing any conclusions
relationship between aerobic exercise status and the rate of concerning this issue.
decline in maximal heart rate with age. The results of this Accordingly, the primary purpose of the present
cross-sectional study support the hypothesis that, in contrast investigation was to determine the relationship be-
to the prevailing view, the rate of decline in maximal aerobic tween habitual aerobic exercise status and the rate of
capacity with age is greater, not smaller, in endurance- decline in V̇O2 max across the adult age range in women.
trained vs. sedentary women. The greater rate of decline in Our secondary aim was to determine the relationship
V̇O2 max in endurance-trained populations may be related to between aerobic exercise status and the rate of decline
their higher values as young adults (baseline effect) and/or to
greater age-related reductions in exercise volume; however, it
in maximal heart rate with age. On the basis of the
does not appear to be related to a greater rate of decline in general prevailing view (8, 11, 12), two specific hypoth-
maximal heart rate with age. eses were tested: 1) women performing regular aerobic
exercise demonstrate a slower age-related rate of de-
aging; exercise; maximal oxygen consumption
cline in V̇O2 max than do sedentary women; and 2) the
slower rate of decline in V̇O2 max in women performing
aerobic exercise is associated with a reduced rate of
MAXIMAL AEROBIC CAPACITY, as measured by maximal decline in maximal heart rate, an important determi-
oxygen consumption (V̇O2 max), decreases with advanc- nant of the age-related reduction in V̇O2 max (5, 10, 16).
ing age (4, 20). This decrease contributes to the reduc- To test these hypotheses, we used a meta-analytic
tion in physiological functional capacity observed with approach in which mean V̇O2 max values of female sub-
advancing age, which eventually can result in a loss of ject groups across the adult age range were obtained
independence in older adults (5, 9, 12). Moreover, from the published literature. The subject groups were
because maximal aerobic capacity is an independent classified according to their aerobic exercise status, and
risk factor for cardiovascular and all-cause mortality the rate of decline in V̇O2 max with increasing subject
(2, 3), the age-related decrease may also contribute to group age was determined for each of these popula-
premature death in middle-aged and older adults. tions. We postulated that new insight into these issues
160 0161-7567/97 $5.00 Copyright r 1997 the American Physiological Society http://www.jap.org
DECLINE IN MAXIMAL AEROBIC CAPACITY WITH AGE IN WOMEN 161
might be gained by using such a large-population Table 1. Descriptive data on the three
approach. study populations
METHODS Population
Table 2. Cumulative rates of decline in V̇O2 max in V̇O2 max with age in highly active vs. sedentary
per decade for the three study populations women. In a previous cross-sectional study, Wells and
colleagues (25) reported a rate of decline in V̇O2 max with
Population age in female distance runners (aged 35–70 yr) of 24.7
Sedentary Active Endurance-Trained ml · kg21 · min21 · decade21, which is much greater than
Age,
yr % ml · kg21 · min21 % ml · kg21 · min21 % ml · kg21 · min21
that generally reported for sedentary women (see next
paragraph). This is approximately the same high rate
,35 12 4.4 10 4.4 8 4.4 of decline that Astrand et al. (1) reported in a longitudi-
,45 23 8.3 17 7.4 19 12.1
,55 31 11.1 35 15.5 27 16.8
nal investigation of active female physical education
,65 40 14.5 37 16.2 46 27.6 teachers who were studied ,20 yr apart. Moreover, in
,75 59 21.2 66 29.2 59 34.9 our recent cross-sectional study (6) of highly trained
Percent decline is expressed relative to baseline V̇O2 max value at
female distance runners (aged 23–56 yr) who were
,25 yr of age. matched for age-adjusted performance, V̇O2 max was 12.3
ml · kg21 · min21 lower in runners with a mean age of 52
yr vs. those with a mean age of 30 yr, corresponding to a
ing age is greater in endurance-trained women than in decline of 25.6 ml · kg21 · min21 · decade21. Finally, a
sedentary women. Specifically, we observed a direct, chapter by Smith and Gilligan in a larger government
not inverse, relationship between habitual aerobic exer- publication (22) contained a cross-sectional analysis of
cise levels and the rate of decline in V̇O2 max with age data on V̇O2 max women aged ,18–80 yr taken from
across our three subject populations. Second, the pres- published studies up to the year 1987. No methods,
ent data indicate that there is no discernible relation results, or specific conclusions were presented. The
between the rate of decline in maximal heart rate with scatterplot of their data and the accompanying legend
advancing age in healthy women and their aerobic (their Fig. 3, p. 297) describe the slopes of the declines
exercise status. Thus both of our working hypotheses in V̇O2 max with age in ‘‘active’’ vs. ‘‘sedentary’’ women as
were refuted by the present findings. not significantly different. However, the slope of the
Rate of decline in V̇O2 max with age. Only a modest
regression line for their active women was ,22%
amount of data exists in women concerning the relation-
greater than that for the sedentary women, which is
ship between aerobic exercise levels and the rate of
similar to the difference observed in the active vs.
decline in V̇O2 max with age. In their classic 1987 review
sedentary populations in the present study.
on V̇O2 max and aging, Buskirk and Hodgson (4) summa-
During the development of the present manuscript,
rized the results of several studies in women (their
the results of a cross-sectional analysis of 409 healthy
Table 3, p. 1826). No consistent relationship was demon-
women aged 20–64 yr by Jackson and colleagues (13)
strated between the habitual exercise status of the
were published. The analysis concerned the relation-
population and the associated rate of decline in V̇O2 max
ship between self-report physical activity levels, body
with age.
fatness, and their interaction on the rate of decline in
However, at least four independent lines of evidence
support the present findings of a greater rate of decline V̇O2 max with age. Although the rates of decline in V̇O2 max
across age groups for each of their four self-report
physical activity classifications were not presented,
calculations based on their mean data (their Table 4, p.
887) indicate similar rates of decline among the four
groups at any particular level of body fatness. One
explanation for the apparent difference in these results
and those of the present study is the high rate of decline
in V̇O2 max with age reported for their sedentary subjects
(25.4 ml · kg21 · min21 · decade21 ). This is much greater
than the respective rates for sedentary women reported
by Buskirk and Hodgson (4) (range 22.8 to 23.5
ml · kg21 · min21 · decade21 ), by Smith and Gilligan (22)
(23.0 ml · kg21 · min21 · decade21 ), and in the present
study (23.5 ml · kg21 · min21 · decade21 ) (Figs. 1–3) and
would effectively preclude the ability to show differ-
ences from highly active women.
The prevailing concept of a smaller rate of decline in
maximal aerobic capacity with age in regularly exercis-
ing/endurance-trained compared with sedentary indi-
viduals (8, 11, 12) is logical based on our understanding
of the physiological adaptations to regular exercise and
Fig. 4. Relationship between maximal heart rate and increasing is certainly attractive from a ‘‘preventive gerontology’’
subject group age in the 3 study populations. bpm, Beats/min.
Maximal heart rate was strongly inversely correlated with age in
standpoint. However, an argument also can be made for
each population (all P , 0.001). However, rates of decline were not hypothesizing greater rates of decline in V̇O2 max with
different among populations. age in endurance exercise-trained adults.
164 DECLINE IN MAXIMAL AEROBIC CAPACITY WITH AGE IN WOMEN
The first argument involves a baseline effect, i.e., the markedly with age in endurance-trained adults. Be-
law of initial baseline applied to V̇O2 max. Stated simply, cause sedentary young adults, by definition, are not
according to this concept those individuals with the performing regular aerobic exercise, it follows that the
highest levels of V̇O2 max as young adults should demon- magnitude of decline in the intensity, duration, and
strate the greatest rates of decline with advancing age. frequency of aerobic exercise with age, which collec-
Support for this idea is provided by our data on the tively have a strong influence on V̇O2 max (17), is much
‘‘relative’’ rates of decline in V̇O2 max. Specifically, when greater in regularly exercising individuals. Thus this
this baseline effect is removed by expressing the data as greater decrease in the overall exercise stimulus for
percent change from mean levels at age ,25 yr, the maintaining maximal aerobic capacity could contribute
rates of decline in V̇O2 max with age in the endurance- to a greater rate of decline in V̇O2 max with age in
trained, active, and sedentary women are similar. It is exercise-trained vs. sedentary adults.
interesting (and possibly instructive) that a similar Finally, because V̇O2 max is traditionally expressed in
relationship exists in the age-related rates of decline in units corrected for differences in body weight, it is
V̇O2 max in men vs. women. Men have higher levels of possible that greater increases in body weight with age
V̇O2 max as young adults compared with women but in the exercising groups contributed to their greater
demonstrate a greater absolute rate of decline in V̇O2 max rates of decline in maximal aerobic capacity in the present
with age compared with women based on cross- study. This would appear to be a reasonable possibility in
sectional data (4, 22). When expressed as percent
that young adults who perform aerobic exercise on a
change, however, gender-related differences are no
regular basis demonstrate lower levels of body weight due
longer evident.
to lower body fatness compared with their sedentary peers
The second argument involves declines in habitual
and, therefore, might tend to gain more weight with age
aerobic exercise levels with advancing age. Studies of
male endurance athletes indicate that training vol- as they undergo a greater decline in exercise-related
umes of older athletes often are up to 50% lower than energy expenditure. This does not appear, however, to
those of their young adult colleagues (5, 15, 19). In our have played a role in the results of the present study.
recent study (6), female distance runners matched for Body weight increased with age within each of our
age-adjusted performance, weekly training mileage populations (all P , 0.01), but the slopes of regression
was 45% lower in women runners with a mean age of 52 lines representing the respective rates of increases
yr vs. that for runners with a mean age of 30 yr; weekly were not different from each other.
training frequency and running velocity also were Age-related rate of decline in maximal heart rate.
lower in the older runners. In the present meta- Because maximal heart rate is considered to be an
analysis, weekly running mileage was reported for 25 important determinant of age-related decline in V̇O2 max
subject groups in 14 studies. The data are plotted in (10, 16, 19), the question has been raised as to whether
Fig. 5 and reveal a progressive, significant age-related the greatest declines in V̇O2 max with age are associated
decline. Based on the regression line from this sample, with the largest reductions in maximal heart rate (8,
running mileage would be expected to decline from ,90 10, 11). The present findings indicate that there is no
km/wk at age 20 yr to ,30 km/wk at age 70 yr, a obvious relationship between age-related declines in
decrease in excess of 65%. These observations support V̇O2 max and maximal heart rate in women differing
the view that overall aerobic exercise levels decline widely in habitual aerobic exercise status. The data
from the aforementioned analysis of Smith and Gilli-
gan (22), as well as the earlier findings of Astrand et al.
(1), support this observation. Taken together, these
findings suggest that other factors (e.g., declines in
maximal stroke volume or skeletal muscle oxidative
capacity) were responsible for differences in the abso-
lute rates of decline in V̇O2 max observed in the exercising
vs. sedentary populations in the present study.
Physiological significance and study limitations. The
present finding that the absolute rate of decline in
V̇O2 max with advancing age is directly related to aerobic
exercise status suggests that the rate of loss of physi-
ological functional capacity with age, at least that
which depends on maximal aerobic power, would be
greater in endurance-trained vs. sedentary women.
Thus, from their high levels of functional capacity as
young adults, exercise-trained women may experience
greater absolute reductions over the normal life span.
We wish to emphasize, however, that despite their
apparent greater rate of decline in V̇O2 max at any age,
Fig. 5. Weekly running mileage with increasing subject group age in
subset of endurance-trained women on whom such data were re-
women who regularly engage in aerobic exercise demon-
ported. There was a progressive reduction in running mileage with strate significantly higher absolute levels of maximal
increasing group age. aerobic capacity than do their sedentary peers. There-
DECLINE IN MAXIMAL AEROBIC CAPACITY WITH AGE IN WOMEN 165
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support the hypothesis that on average the absolute 13. Jackson, A., L. Wier, G. Ayers, E. Beard, J. Stuteville, and S.
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decline in maximal aerobic capacity with age in healthy 16. Ogawa, T., R. J. Spina, W. H. Martin, W. M. Kohrt, K. B.
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least in sedentary women, contrary to the currently aging, sex, and physical training on cardiovascular responses to
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This study was supported by National Institutes of Health (NIH) ated with the lower maximal oxygen consumption of master
RO1 Awards AG-06537, AG-13038, and HL-39966. H. Tanaka was runners. J. Appl. Physiol. 66: 949–954, 1989.
supported by NIH Individual National Research Service Award 20. Robinson, S. Experimental studies of physical fitness in rela-
AG-05717. tion to age. Arbeitsphysiologie 10: 162–323, 1938.
Address for reprint requests: D. R. Seals, Univ. of Colorado, Dept. 21. Saltin, B. The aging endurance athlete. In: Sports Medicine for
of Kinesiology, Campus Box 354, Boulder, CO 80309 (E-mail: the Mature Athlete, edited by J. R. Sutton and R. M. Brock.
Seals@spot.Colorado.edu). Indianapolis, IN: Benchmark, 1986, p. 59–80.
Received 16 September 1996; accepted in final form 12 March 1997. 22. Smith, E., and C. Gilligan. Health-related fitness of the older
adult. In: Assessing Physical Fitness and Physical Activity in
Population-Based Surveys. Hyattsville, MD: US Dept. of Health
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