A year traditionally associated with power and bold, forward motion. New Year rituals, whether lunar or calendar-based, give us something deeply human: renewal. Your cells respond to what you demand of them.
It’s the Year of the Fire Horse.
A year traditionally associated with power and bold, forward motion.
New Year rituals, whether lunar or calendar-based, give us something deeply human: renewal. And renewal is more than symbolic. Your body renews itself constantly. Your cells respond to what you demand of them.
Which raises a powerful question.
Do you have the physiological capacity to sustain the life you’re envisioning this year?
One of the strongest markers of that capacity is your VO₂max. The amount of oxygen your body can extract and use when challenged. Let’s dive in.....
Where insight becomes impact
What I’ve been looking at this week…
VO₂ max stands for maximal oxygen uptake. That's the highest amount of oxygen your body can use when you’re working hard.
It’s the size of your engine - the amount of horsepower you have!
And it depends on these 3 things: 1. The ability of your lungs to take in oxygen 2. The ability of the heart to pump oxygen-rich blood around your body, 3. The ability of the mitochondria in your muscles to extract oxygen from the blood and turn it into energy.
And here's why it matters:
Mortality
When researchers looked at tens of thousands of people undergoing treadmill tests, something striking appeared. [PMID: 30646252] Mortality risk didn’t just reduce a bit as fitness improved. It dropped dramatically.
Those in the lowest fitness category had roughly four to five times the risk of dying compared to those in the elite category.
Four to five times. And here’s the part that makes this interesting...
Imagine two 50-year-olds. One has a VO₂ max of 20. One has a VO₂ max of 40. Same birth year. Same candles. Completely different biology.
The person with a V02 max of 40 is not just fitter. They're the one who runs the parents’ race and sees the glee in their son's eyes They're the one who carries the boxes up three flights of stairs when their daughter moves into university. They're the one travelling across time zones for business without feeling dismantled.
Now the uncomfortable truth. Without training, VO₂ max declines around 10 percent per decade after 30. After 60, the drop accelerates.
Ageing isn’t inevitable. It’s a consequence of disuse.
Your body removes capacity you don’t use.
The horse becomes a pony.
Track it to hack it.
What I’ve been monitoring this week…
Here's 3 ways to measure VO2 max properly - it's a number you need to know.
1. Wearables - proxy marker Some wearables like the Apple Watch and Garmin estimate VO2 max using heart rate response, pace and recovery metrics. They are not gold standard, but they are directionally useful for trend tracking. What I look at with my patients
2. Seisomography This is what I use in clinic. A small sensor I put on your chest that measures micro-movements and your heart's pumping capacity. In just 3 minutes I give you your V02max.
3. The Mask Test You wear a mask. Then walk or run on a treadmill, or cycle, and the machine measures the oxygen
you breathe in and the carbon dioxide you breathe out while the intensity gradually increases. This
is the gold standard Cardio-Pulmonary Exercise Test (CPET)
From knowing to doing.
What this means for YOU…
Here are 3 ways to increase your VO₂ max And here’s the encouraging part. You don’t need elite. Even moving from low to below average, or below average to above average, meaningfully reduces mortality risk. You don’t need extraordinary. You need improvement. 1. Zone 2 Training - Build the Engine Exercise at a pace where you can talk in full sentences but wouldn’t sing. That’s your sweet spot. This is where your body builds more mitochondria, the tiny energy factories inside your muscle cells. More mitochondria means more oxygen can be processed efficiently. Think of it as adding more cylinders to your engine. It’s not glamorous. It won’t make you feel heroic. But it expands your capacity with consistency.
2. High Intensity Intervals - Strengthen the Pump Now we raise the ceiling. Short intervals. Easy. Then hard. Then repeat. I like the 2–20. Two minutes easy. Twenty seconds hard. Walk for two minutes. Sprint for twenty seconds. Repeat several times. This challenges stroke volume, which is the amount of blood your heart pumps with each beat. A stronger pump means more oxygen delivered per contraction. More oxygen delivered means a higher VO₂ max. Zone 2 builds the engine. Intervals make the engine more powerful.
3. Oxygen Carrying Capacity - Carry the Fuel Here’s the part many people miss. VO₂ max is not just about how hard your heart pumps. It’s also about how much oxygen your blood can carry. That depends on haemoglobin, iron status and red blood cell mass. If you are iron deficient, even mildly, your aerobic capacity drops. Full stop. This is especially relevant for women, endurance trainers, vegetarians, and anyone with heavy menstrual cycles. You can train perfectly and still plateau if oxygen transport is compromised. So what do you do?
Test. Don’t guess.
Measure ferritin, haemoglobin and transferrin saturation. Check gut health, because iron absorption happens in the small intestine. Ferritin under 30 micrograms per litre can impair performance even if your lab result says normal.
Then correct deficiencies properly.
And sleep. Erythropoiesis, red blood cell production, is hormonally regulated and sleep sensitive. Chronic short sleep blunts erythropoiesis.
So, Zone 2 builds the engine. Intervals strengthen the pump. Iron carries the fuel. Three different levers. One measurable outcome.
And here’s the real question. If this is the Year of the Fire Horse... Are you ready for the momentum?
🎯 If you'd like to make decisions with precision based on your personal data and using devices that are specific for you, then book a private consultation and let's start to decode your health.
Where you’ll find me…
Last week: One of the big topics that's come up in the recent talks and consultations I've had is memory - both the fear of losing it and how to improve it. I'll write about this in next week's memo.
This week: I'm ready for a Launch Lunch at Grand Aesthetics in Brighton and Hove tomorrow! Do come along!
Next week: Lots of consultations, results, revelations and lifestyle changes are on the horizon.
A thought to pause on…
"The Fire Horse is a symbol of power. Your power is oxygen."
Wishing you a wonderful week ahead (that's 168 hours of your Million Hour life!! Dr Alka
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Take the free LQThis article is general education, not medical advice, and reading it does not create a doctor-patient relationship. If something has been going on for a while, please get it properly looked at by your own doctor.