Journal of Exercise Physiologyonline
Volume 22 Number 1
Tommy Boone, PhD, MBA
Todd Astorino, PhD
Julien Baker, PhD
Steve Brock, PhD
Lance Dalleck, PhD
Eric Goulet, PhD
Robert Gotshall, PhD
Alexander Hutchison, PhD
M. Knight-Maloney, PhD
Len Kravitz, PhD
James Laskin, PhD
Yit Aun Lim, PhD
Lonnie Lowery, PhD
Derek Marks, PhD
Cristine Mermier, PhD
Robert Robergs, PhD
Chantal Vella, PhD
Dale Wagner, PhD
Frank Wyatt, PhD
Ben Zhou, PhD
Official Research Journal
of the American Society of
Official Research Journal of
the American Society of
Changes in the Cardiorespiratory Fitness of Men and
Women in Various Age Groups
Crystina L. B. P. Bara, Danilo L. Alves, Maria A. Ruy-Barbosa, Diogo
de P. Palumbo, Bruna B. Sotomaior, Leandro da Silva, Marcelo B.
Leitão, Raul Osiecki
Physical Performance Studies Center, Federal University of Paraná,
Bara CLBP, Alves, DL, Ruy-Barbosa MA, Palumbo DP,
Sotomaior BB, da Silva L, Leitão MB, Osiecki R. Changes in the
Cardiorespiratory Fitness of Men and Women in Various Age
Groups. JEPonline 2019;22(1):1-10. The purpose of this study was
to compare the VO2 max between the sexes and in different age
groups in the Brazilian population. A total of 6,590 cardiopulmonary
tests were performed of healthy individuals, regardless of physical
activity level, of both sexes between 11 and 45 yrs of age (3,482
women and 3,108 men, respectively). The tests were performed
between January 2012 and December 2017, and the oxygen
consumption was measured directly with a gas analyzer. The
subjects of both sexes were divided into 7 age groups: G1 (11 to 15
yrs old); G2 (16 to 20 yrs old); G3 (21 to 25 yrs old); G4 (26 to 30 yrs
old); G5 (31 to 35 yrs old); G6 (36 to 40 yrs old); and G7 (41 to 45
yrs old). The results showed a main effect of sex (F(1) = 16665.5,
P<0.001; ES = 0.157), age group (F(6) = 75.4, P<0.001; age (F(4) =
4.7, P = 0.003, ES = 0.003). Significant reductions were found in
males between groups G2 and G3, G4 and G5, and G5 and G6
(P<0.01). Comparing the sexes, men showed higher values of VO2
max in all age groups (P<0.001). In summary, although VO2 max
values are higher in males, the decline in this group was more
pronounced over time. We recommend that physical activity should
be promoted in the Brazilian population, especially among males.
Key Words: Cardiopulmonary Test, Physical Activity, VO2 max
Cardiorespiratory fitness is usually expressed as maximal oxygen uptake (VO2 max) or
metabolic equivalent (MET), which can be estimated through a variety of maximum or
submaximal running tests performed in the field or in the laboratory (21). Cardiorespiratory
fitness is also an important marker of cardiovascular health (16,30), in addition to being
classified as the fourth risk factor for cardiovascular disease (14). It is more strongly
associated with all-cause mortality than risk factors such as obesity, smoking, hypertension,
dyslipidemia and diabetes (5). Consequently, there is considerable interest in studying factors
that lead to differences in cardiorespiratory fitness.
Several studies describe changes in VO2 max through aging in men and women (6,17,33). It
is suggested that VO2 max may decline approximately 10% per decade from the age of 25 to
30 in active and sedentary adults of both sexes (6,12,13,18,27). On average, men have a
higher VO2 max than women, which is primarily due to their higher ventricular ejection
volume, hemoglobin concentration, muscle mass, and lower body fat (9).
In a recent systematic review, Lamoureux et al. (21) estimated temporal trends in
cardiorespiratory fitness of more than 2.5 million apparently healthy adults between 1967 and
2016 and the associations with health, socioeconomic, and environmental indicators. The
study found a significant decline in adult VO2 max since 1980 that suggested a decline in
population health. Declines were higher for men than for women, and for young adults (<40
yrs old) than for middle-aged adults (≥40 yrs old). However, the data were obtained in the
population of eight high- and upper-middle-income countries, indicating the inexistence of
these analyzes in low- and middle-income countries. In another study, Ekblom-Bak et al. (11)
described trends in the estimated VO2 max (from 1995 to 2017) of a submaximal cycle
ergometer test of Swedish workers, aged between 18 and 74 yrs old and variations between
women and men of different age groups. The authors found a steady and pronounced decline
in mean cardiorespiratory fitness in Swedish adults with greater reductions in males and
Considering the importance of the contribution of studies with outcome variables directly
related to cardiovascular health, the purpose of this study was to compare VO2 max between
the sexes and in different age groups to provide a better understanding of the differences in
cardiorespiratory fitness in the Brazilian population.
This study was conducted using data from 6,590 cardiopulmonary tests of 3,108 healthy male
subjects and 3,482 female subjects (regardless of their level of physical activity) between 11
and 45 yrs of age. The tests were performed between January 2012 and December 2017 in a
private clinic in the city of Curitiba-PR. All the tests were supervision of a medical specialist in
sports medicine and cardiology in a temperature-controlled room. This study was carried out
in accordance with the ethical standards established by the Declaration of Helsinki (3).
The subjects underwent a cardiopulmonary exercise test in an Inbrasport - ATL® treadmill
exercise treadmill. Oxygen consumption (VO2) was directly measured with a Metalyzer II gas
analyzer. The data were analyzed using data from the software Metasoft (Cortex Leipzig,
Germany) and ergo PC Elite (Micromed Brasilia, Brazil).
The tests were interrupted when the individual reached maximum heart rate (220-age),
voluntary exhaustion, or any other abnormalities that were observed during the test. All the
test were carried out in accordance with the method established in the Guideline of the
Brazilian Society of Cardiology (15). The subjects of both sexes were divided into 7 age
groups: G1 (11 to 15 yrs old); G2 (16 to 20 yrs old); G3 (21 to 25 yrs old); G4 (26 to 30 yrs
old); G5 (31 to 35 yrs old); G6 (36 to 40 yrs old); and G7 (41 to 45 yrs old).
Descriptive data were reported as mean, standard deviation (±SD), and confidence interval
(95% CI). The normality of the data was verified through the Komogorov-Sminorv test. The
analysis of variance (ANOVA) was used to verify the difference in VO2 max (dependent
variable) between sexes and age groups (independent variables). When a significant
difference was found, the Tukey post hoc test was used for multiple comparisons. All
analyzes were performed using Statistica® software (version 7.0). Statistical significance was
set at an alpha level of P<0.05.
Table 1 shows the descriptive values of VO2 max (mean ± SD, 95% CI) in females and males
in different age groups.
The ANOVA showed interaction between sex and age group (F(4) = 4.7, P = 0.003, ES =
0.003). In females, post hoc tests showed a tendency to significant reductions in VO2 max
between G1 and G2 (P = 0.052) and G6 and G7 (P = 0.053). In the male sex, significant
reductions were found between G2 and G3 (P<0.001), G4 and G5 (P = 0.003), G5 and G6 (P
= 0.002), and a significant reduction between G6 and G7 (P = 0.051). Comparing the sexes,
men showed higher values of VO2 max in all age groups (P<0.001).
The main effect of sex was found (F(1) = 16665.5, P<0.001; ES = 0.157), in which men
presented higher VO2 max values when compared to women (P<0.001). In addition, the main
effect of the age group (F(6) = 75.4, P<0.001; ES = 0.048) was found with significant
reductions in VO2 max between groups G2 and G3 (P<0.001), G4 and G5 (P=0.008), G5 and
G6 (P<0.001), and G6 and G7 (P<0.001).
Table 1. Descriptive Values of VO2 max in Females and Males in Different Age Groups.
Sex Age Group N Mean ± SD CI (95%)
Females G1 (11-15) 125 38.79 ± 0.73 37.35 40.22
G2 (16-20) 165 35.55 ± 0.64 34.30 36.80
G3 (21-25) 300 34.92 ± 0.47 34.00 35.85
G4 (26-30) 601 35.48 ± 0.33 34.82 36.13
G5 (31-35) 782 34.66 ± 0.29 34.09 35.24
G6 (36-40) 797 33.29 ± 0.29 32.72 33.86
G7 (41-45) 712 31.93 ± 0.31 31.33 32.53
Males G1 (11-15) 302 48.26 ± 0.47 47.34 49.18
G2 (16-20) 431 47.28 ± 0.39 46.51 48.06
G3 (21-25) 451 43.78 ± 0.39 43.02 44.53
G4 (26-30) 779 44.04 ± 0.29 43.47 44.61
G5 (31-35) 1145 42.48 ± 0.24 42.00 42.95
G6 (36-40) 1260 41.06 ± 0.23 40.61 41.52
G7 (41-45) 1127 39.94 ± 0.24 39.46 40.42
Figure 1. VO2 max (mL·kg-1·min-1) in Female and Male in Different Age Groups. *Significant
difference for the previous age group (P<0.01); t Significant difference for the previous age group; §
Significant difference for males (P<0.01); aMain effect of age group; bMain effect of sex
The purpose of the study was to compare the cardiorespiratory fitness in both sexes and in
different age groups. The main findings demonstrate that VO2 max in men is higher than in
women in all age groups. We also found that VO2 max decreased over time, which was more
pronounced in the male subjects at 30 yrs of age.
The results demonstrate a significant difference between the sexes, where men presented
higher values of VO2 max than the women in all age groups. These findings corroborate
previous findings, as in the study by Herdy and Uhlendorf (19) that analyzed Brazilian men
and women and found significant differences in VO2 max between the sexes in all age
groups. Another study performed with the Brazilian sedentary population also found a
significant difference between the VO2 max values between men and women for all age
groups analyzed (20 to 80 yrs of age) (P<0.01) (25). The pattern seems to be repeated also
in trained individuals (19-23).
The differences in VO2 max between genders are attributed to the higher percentage of fat
and lower level of hemoglobin found in the female subjects (7,31). In fact, a previous study
with Hockey players identified that variation in VO2 max values between the sexes was
caused by body fat percentage (27.6%) and body mass index (31.91%) (32). Also, in relation
to the morphological and body composition aspects, studies indicate that other factors can
also be responsible for the VO2 max differences between the sexes, such as a greater
amount of lean mass and lower blood volume (2,20). In addition, a study conducted with
marathon runners in a 1-hr run test on treadmill identified that 25% of the difference in VO2
max results were caused by the lower percentage of lean mass found in the female subjects
Another morphological factor that seems to influence VO2 max is related to the females’ heart
size, which is smaller than in the males. The females’ smaller heart size is responsible for the
lower maximum systolic volume and, consequently, a lower cardiac output (20). One study
reported that heart size (i.e., left ventricular mass) was responsible for 68.3% of the
difference in VO2 max levels between males and females with the same training level. Thus, it
is evident how morphological aspects and body composition are important determinants of
Another factor related to the VO2 max difference between genders is the hemoglobin levels.
In fact, a study conducted with elite cross-country skiers demonstrated that hemoglobin level
was 10% lower in female athletes, which resulted in lower VO2 max values when compared to
the male athletes (31). In agreement, Sharma and Kailashiya (32) also demonstrated that
approximately 10% of the difference in VO2 max between the sexes was related to a lower
concentration of hemoglobin in females.
Studies suggest that after 30 yrs of age, VO2 max values decline progressively as individuals
age (1,6). Arena et al. (1) and Bortz et al. (6) indicate significant differences were found in the
VO2 max values between the age groups in both sexes. They also reported a sharp fall at 30
yrs of age. Likewise, in a meta-analysis performed with 13,828 individuals divided into 6 age
groups (from 20 to <70 yrs old) and 3 levels of physical activity (sedentary, active, and
athletes), reductions in VO2 max values were also observed with the increase in the subjects’
The physiological mechanisms underlying the decrease in VO2 max appear to be central
(e.g., cardiovascular) and peripheral (e.g., oxygen extraction) (34). Studies have reported a
reduction in maximal cardiac output in healthy individuals and athletes with advancing age
(4), resulting in declines in maximal heart rate and maximal ejection volume (34). Carrick-
Ranson et al. (8) demonstrated that healthy subjects had a lower maximum cardiac output
and a lower maximum heart rate with an increase in age, thus reducing VO2 max.
In addition, a restriction in blood circulation to the active muscles contributes to a lower VO2
max (28,29). Lawrenson et al. (22) evaluated the effect of age on the blood circulation of the
quadriceps muscle during incremental knee extension exercise. The results demonstrated a
decrease in blood circulation (by approximately 500 mL·min-1) in the older subjects compared
to the younger subjects (22). The arteriovenous oxygen difference (a-vO2 diff), characterized
as the ability of the skeletal and respiratory muscles to extract and consume oxygen (O2)
from the blood to produce energy during maximal exercises (34), can also contribute to the
decline of VO2 with advancing age. In a study of 110 sedentary and trained subjects aged 18
to 72 yrs of age, a lower a-vO2 diff was reported in the older subjects regardless of gender
and level of physical activity. When the data were normalized by body mass, Ogawa (26)
found that differences in VO2 max were related to the increase in age and also to the
decrease in oxygen extractions (72% and 28%, respectively). In another study, healthy
subjects also had lower a-vO2 diff values with advancing age (8).
Based on the findings of this study, we suggest that differences between sexes and ages
should be considered during the cardiorespiratory fitness assessment. In addition, we
recommend the promotion of physical activity in males to avoid a marked decrease in VO2
max after 30 yrs of age.
Although VO2 max values are higher in males, the decrease in this group is more pronounced
over time. We recommend that regular physical activity should be promoted in the Brazilian
population, especially among males.
Address for correspondence: Crystina Linhares Batista Pinheiro Bara, Department of
Physical Education, University of Paraná, Curitiba, Paraná, Brazil, Email: crysepaulo@
1. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of
functional capacity in clinical and research settings: A scientific statement from the
American Heart Association Committee on Exercise, Rehabilitation, and Prevention of
the Council on Clinical Cardiology and the Council on Cardiovascular N. Circu. 2007;
2. Armstrong N, Welsman JR. Assessment and interpretation of aerobic fitness in
children and adolescents. Exerc Sport Sci Rev. 1994;22:435-476.
3. Association, WM. World Medical Association Declaration of Helsinki: Ethical principles
for medical research involving human subjects. JAMA. 2013;310:2191.
4. Betik AC, Hepple RT. Determinants of VO2 max decline with aging: An integrated
perspective. Appl Physiol Nutr Metab. 2008;33:130-140.
5. Blair SN. Physical inactivity: The biggest public health problem of the 21st century. Br
J Sports Med. 2009;43:1-2.
6. Bortz WM, Bortz WM. How fast do we age? Exercise performance over time as a
biomarker. Journals Gerontol Ser A Biol Sci Med Sci. 1996;51:M223-M225.
7. Calbet JAL, Joyner MJ. Disparity in regional and systemic circulatory capacities: Do
they affect the regulation of the circulation? Acta Physiol. 2010;199:393-406.
8. Carrick-Ranson G, Hastings JL, Bhella PS, Shibata S, Fujimoto N, Palmer D, et al.
The effect of age-related differences in body size and composition on cardiovascular
determinants of VO2max. J Gerontol Ser A Biomed Sci Med Sci. 2012;68: 608-616.
9. Cheuvront SN, Carter R, DeRuisseau KC, Moffatt RJ. Running performance
differences between men and women. Sport Med. 2005;35:1017-1024.
10. Coast JR, Blevins JS, Wilson BA. Do gender differences in running performance
disappear with distance? Can J Appl Physiol. 2004;29:139-145.
11. Ekblom-Bak E, Ekblom Ö, Andersson G, Wallin P, Söderling J, Hemmingsson E, et al.
Decline in cardiorespiratory fitness in the Swedish working force between 1995 and
2017. Scand J Med Sci Sports. 2018.
12. Eskurza I, Donato AJ, Moreau KL, Seals DR, Tanaka H. Changes in maximal aerobic
capacity with age in endurance-trained women: 7-yr follow-up. J Appl Physiol. 2002;
13. Fitzgerald MD, Tanaka H Tran ZV, Seals DR. Age-related declines in maximal aerobic
capacity in regularly exercising vs. sedentary women: A meta-analysis. J Appl
14. Fletcher GF, Balady G, Blair SN, Blumenthal J, Caspersen C, Chaitman B, et al.
Statement on exercise: Benefits and recommendations for physical activity programs
for all Americans: A statement for health professionals by the Committee on Exercise
and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart
Association. Circu. 1996;94:857-862.
15. Guimarães JI, Stein R, Vilas-Boas F. Normatização de técnicas e equipamentos para
realização de exames em ergometria e ergoespirometria. Arq Bras Cardiol. 2003;80:
16. Harber MP, Kaminsky LA, Arena R, Blair SN, Franklin BA, Myers J, et al. Impact of
cardiorespiratory fitness on all-cause and disease-specific mortality: Advances since
2009. Prog Cardiovasc Dis. 2017;60:11-20.
17. Hawkins SA, Wiswell RA. Rate and mechanism of maximal oxygen consumption
decline with aging. Sport Med. 2003;33:877-888.
18. Heath GW, Hagberg JM, Ehsani AA, Holloszy, JO. A physiological comparison of
young and older endurance athletes. J Appl Physiol. 1981;51:634-640.
19. Herdy AH, Uhlendorf D. Valores de referência para o teste cardiopulmonar para
homens e mulheres sedentários e ativos. Arq Bras Cardiol. 2011;96:54-59.
20. Kenney WL, Wilmore J, Costill D. Physiology of Sport and Exercise. (6th Edition).
Champaign, IL: Human Kinetics, 2015.
21. Lamoureux NR, Fitzgerald JS, Norton KI, Sabato T, Tremblay MS, Tomkinson, GR.
Temporal trends in the cardiorespiratory fitness of 2,525,827 adults between 1967 and
2016: A systematic review. Sport Med. 2018;1-15.
22. Lawrenson L, Poole JG, Kim J, Brown CF, Patel PM, Richardson RS. Vascular and
metabolic response to isolated small muscle mass exercise: The effect of age. Am J
Physiol Circ Physiol. 2003;285:H1023-H1031.
23. Loftin M, Sothern M, Tuuri G, Tompkins C, Koss C, Bonis M. Gender comparison of
physiologic and perceptual responses in recreational marathon runners. Int J Sports
Physiol Perform. 2009;4:307-316.
24. Maldonado-Martin S, Mujika I, Padilla S. Physiological variables to use in the gender
comparison in highly trained runners. J Sports Med Phys Fit. 2004;44:8-14.
25. Neder JA, Nery LE, Peres C, Whipp BJ. Reference values for dynamic responses to
incremental cycle ergometry in males and females aged 20 to 80. Am J Respir Crit
Care Med. 2001;164:1481-1486.
26. Ogawa T, Spina RJ, Martin WH 3rd, Kohrt WM, Schechtman KB, Holloszy JO, et al.
Effects of aging, sex, and physical training on cardiovascular responses to exercise.
27. Pimentel AE, Gentile CL, Tanaka H, Seals DR, Gates PE. Greater rate of decline in
maximal aerobic capacity with age in endurance-trained than in sedentary men. J
Appl Physiol. 2003;94:2406-2413.
28. Poole JG, Lawrenson L, Kim J, Brown C, Richardson RS. Vascular and metabolic
response to cycle exercise in sedentary humans: The effect of age. Am J Physiol
Circ Physiol. 2003;284(4):H1251-H1259.
29. Proctor DN, Shen PH, Dietz NM, Eickhoff TJ, Lawler LA, Ebersold EJ, et al. Reduced
leg blood flow during dynamic exercise in older endurance-trained men. J Appl
30. Ross R, Blair SN, Arena R, Church TS, Després J-P, Franklin BA, et al. Importance of
assessing cardiorespiratory fitness in clinical practice: A case for fitness as a clinical
vital sign: A scientific statement from the American Heart Association. Circu.
31. Sandbakk Ø, Ettema G, Leirdal S, Holmberg H-C. Gender differences in the
physiological responses and kinematic behaviour of elite sprint cross-country skiers.
Eur J Appl Physiol. 2012;112:1087-1094.
32. Sharma HB, Kailashiya J. Gender difference in aerobic capacity and the contribution
by body composition and haemoglobin concentration: A study in Young Indian
National Hockey Players. J Clin Diagnostic Res. 2016;10(11):CC09-CC13.
33. Shephard RJ, Allen C, Benade AJS, Davies CTM, Di Prampero PE, Hedman R, et al.
The maximum oxygen intake: An international reference standard of cardio-respiratory
fitness. Bull World Health Organ. 1968;38:757.
34. Tanaka H, Seals DR. Endurance exercise performance in masters athletes: Age-
associated changes and underlying physiological mechanisms. J Physiol. 2008;586:
The opinions expressed in JEPonline are those of the authors and are not attributable to
JEPonline, the editorial staff or the ASEP organization.