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Anyone Know Their VO2Max?

pemone

Senior Member
Messages
448
Hi all,

I have had my VO2max, Anaerobic Threshold etc tested by Dr.Betsy Keller at Ithaca. She follows the protocol developed by the Pacific Fatigue Lab(?) that was the original 2 day CPET test protocol for ME/CFS patients and has written a/some papers regarding ME/CFS and PEM. She is now becoming one of our best ME/CFS research docs.

From what I understand, it is all very complicated and complex to calculate the VO2max and other things and requires quite a bit of data, a lot of equipment that is set up in a precise way. I did the 2 days of testing but Dr Keller could not just look at the data immediately and say what was wrong. It all had to be analyzed in a certain way ( don't ask me how or what).

It's actually very simple to read these tests, very easy to interpret them. I think they are blowing smoke at you. Ask them for your raw VO2Max data and copy and paste that here and we'll help you understand it.

The points of interest in these tests:

* At what workload and pulse rates are you aerobic, and specifically where are you burning fat? VCO2/VO2 (named RER on the test column) will be around 0.70 when this is happening.

* When do you reach aerobic threshold, which is typically when RER ~= 0.95

* When do you go into full on glycolysis, which is your VO2Max, when RER ~=1.05

* When do you exhaust exercise capacity, which is the point where additional work does not increase VCO2. They may not test that given your condition as it will increase your exhaustion.

VO2Max is not calculated. VO2Max is simply the VO2 level on the report that corresponds to your reaching glycolysis.
 

pemone

Senior Member
Messages
448
May I point out to anyone who is continuing to exercise during the early years of ME, that this may worsen the condition and make it permanent.

The best way to improve your mitochondrial function is exercise, but the critical thing is to discover the exact level of exertion at which your body can function aerobically instead of anaerobically. VO2Max tests let you discover this.

Some people are so sick that there is no level of exertion that can benefit them much but even the person who tests VO2Max of 15 is likely going to get phenomenal benefits from exercise at a sufficiently low level.

The problem is almost no one understands their own physiology well enough to seek the appropriate pulse rates during exercise. People tend to push themselves into the aerobic threshold (which is very little exertion for someone with CFS). My own aerobic range is between 92 and 98 beats per minute, which feels to me like NOTHING. I would never have guessed at this range on my own. It requires very deliberate slowing down of my movement. But I can exercise at those levels for one full hour and not get post exertional malaise!!

VO2Max tests are just great, both as a helpful diagnostic of the extent of your mitochondrial dysfunction, as well as a guide to the patient about what levels of exertion can be tolerated.
 

Mij

Messages
2,353
@pemone I think there are other factors that come into play when addressing PEM.

I would be interested to know my VOMax when I'm feeling baseline and when my immune system is affected with a viral infection. Do you think this contributes to the outcome?
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
The best way to improve your mitochondrial function is exercise, but the critical thing is to discover the exact level of exertion at which your body can function aerobically instead of anaerobically. VO2Max tests let you discover this.

Some people are so sick that there is no level of exertion that can benefit them much but even the person who tests VO2Max of 15 is likely going to get phenomenal benefits from exercise at a sufficiently low level.

The problem is almost no one understands their own physiology well enough to seek the appropriate pulse rates during exercise. People tend to push themselves into the aerobic threshold (which is very little exertion for someone with CFS). My own aerobic range is between 92 and 98 beats per minute, which feels to me like NOTHING. I would never have guessed at this range on my own. It requires very deliberate slowing down of my movement. But I can exercise at those levels for one full hour and not get post exertional malaise!!

VO2Max tests are just great, both as a helpful diagnostic of the extent of your mitochondrial dysfunction, as well as a guide to the patient about what levels of exertion can be tolerated.

I agree - the VO2 max tests may be very useful for some people, but they can be very dangerous for others, who may suffer long-term damage and worsening of their illness.

Hopefully a safer method of estimating our anaerobic threshold can be devised. In the meantime, a rough estimate can be made. I invited suggestions for this in this thread.
 

pemone

Senior Member
Messages
448
@pemone I think there are other factors that come into play when addressing PEM.

I would be interested to know my VOMax when I'm feeling baseline and when my immune system is affected with a viral infection. Do you think this contributes to the outcome?

I don't think anyone should be exercising during an infection.

When you do not have an infection, my understanding of post exertional malaise is that the activity sent your body well above your aerobic threshold for a period of time and creates a lot of glycolysis. Tissue repair from that kind of stressful exercise can leave you highly glycolytic for days. What people in this condition perceive as "brain fog" is not actually very complex: it's literally tissue starvation because the body just cannot create enough energy to satisfy its energy needs. The brain is short on energy and simply does not function. A similar kind of effect happens when you are at high altitude and hypoxic, but that is oxygen starvation. I think many with CFS have other parts of their electron transport chains broken and have no problem supplying oxygen to mitochondria. The bottom line is you cannot produce much ATP aerobically.

If you can determine the workload at which you burn fat aerobically and stay within the narrow pulse ranges that requires, you never go into glycolysis. You avoid the aerobic threshold. For me, anyway, that avoids the post extertional malaise. None of that means I am particularly well, but I can handle what my body does after that kind of low intensity exercise. After exercise that leaves me above aerobic threshold for an extended period of time, I really crash, and the PEM is truly unbearable.
 

pemone

Senior Member
Messages
448
I agree - the VO2 max tests may be very useful for some people, but they can be very dangerous for others, who may suffer long-term damage and worsening of their illness.

Hopefully a safer method of estimating our anaerobic threshold can be devised. In the meantime, a rough estimate can be made. I invited suggestions for this in this thread.

I think that the sickest patients could be tested right up until they reach aerobic threshold, before they get near VO2Max. I think it gives sufficient information to determine the person is compromised aerobically, and equally important it would expose the range in which you burn fat aerobically, so you can target that pulse rate for future exercise.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
I don't think anyone should be exercising during an infection.

When you do not have an infection, my understanding of post exertional malaise is that the activity sent your body well above your aerobic threshold for a period of time and creates a lot of glycolysis. Tissue repair from that kind of stressful exercise can leave you highly glycolytic for days. What people in this condition perceive as "brain fog" is not actually very complex: it's literally tissue starvation because the body just cannot create enough energy to satisfy its energy needs. The brain is short on energy and simply does not function. A similar kind of effect happens when you are at high altitude and hypoxic, but that is oxygen starvation. I think many with CFS have other parts of their electron transport chains broken and have no problem supplying oxygen to mitochondria. The bottom line is you cannot produce much ATP aerobically.

If you can determine the workload at which you burn fat aerobically and stay within the narrow pulse ranges that requires, you never go into glycolysis. You avoid the aerobic threshold. For me, anyway, that avoids the post extertional malaise. None of that means I am particularly well, but I can handle what my body does after that kind of low intensity exercise. After exercise that leaves me above aerobic threshold for an extended period of time, I really crash, and the PEM is truly unbearable.

I agree that it is probably unwise to exercise during an infection, or anything that feels like an infection (e.g. PEM).

I think that what happens is that we take time to clear the lactic acid that builds up due to the excessive glycolysis. If that keeps our blood acidic, it will presumably make it hard to get enough oxygen to the mitochondria. I've discussed it briefly here and given other details, including links to scientific papers, in the blogpost linked from that one.

I like the idea of an exercise test just up to anaerobic threshold, but can VO2 max be determined from that?
 
Messages
21
I like the idea of an exercise test just up to anaerobic threshold, but can VO2 max be determined from that?

I took the Aerolution test and with that test you don't need to go further than anaerobic threshold. Here is a video of the test:

 

Gamboa

Senior Member
Messages
261
Location
Canada
It's actually very simple to read these tests, very easy to interpret them. I think they are blowing smoke at you. Ask them for your raw VO2Max data and copy and paste that here and we'll help you understand it.

You obviously understand more about this than most people. I'm not so good with this so was happy to leave it up to the experts.

I know that there is more to the testing such as proving that the test was done with maximal effort, converting it to METS etc. I got a six page report from Dr. Keller after my test that no insurance company or doctor could argue with. My long term disability as well as Canada Disability was approved with no problem.

Just curious but are you aware of who Dr. Betsy Keller is? Or The Pacific Fatigue Lab who now have a new name which I forget. They are highly respected in the ME/CFS and working extremely hard to prove to everyone that we have a real disease. They wouldn't be "blowing smoke" at me or us.

FYI: Christopher Snell, Stacy Stevens and the Workwell Group are the ones first responsible for figuring out how to measure and document PEM in CFS/ME patients by doing the 2 day CPET test. They used to be called The Pacific Fatigue Lab. Stacy Stevens developed "The Stevens Protocol". It is this that finally showed that we aren't lazy or deconditioned but are actually working at top capacity but still achieve abnormal results. Also, the key thing, is that they showed that it is on the second day of testing that things go haywire.

www.cortjohnson.org/blog/2013/05/08/university-dumps-pacific-fatigue-lab-pacific-fatigue-lab-workwell-moves-on/

Dr. Betsy Keller, of Ithaca College, has adopted and continued on this work and has a ( maybe a few now) paper (s) out about this and has and is now one of our best ME/FCS researchers. It is due to her work and that of The Pacific Fatigue Lab, and a few others, that the IOM could see that we have PEM and say that yes, we have a real disease.

I
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
You obviously understand more about this than most people. I'm not so good with this so was happy to leave it up to the experts.

I know that there is more to the testing such as proving that the test was done with maximal effort, converting it to METS etc. I got a six page report from Dr. Keller after my test that no insurance company or doctor could argue with. My long term disability as well as Canada Disability was approved with no problem.

Just curious but are you aware of who Dr. Betsy Keller is? Or The Pacific Fatigue Lab who now have a new name which I forget. They are highly respected in the ME/CFS and working extremely hard to prove to everyone that we have a real disease. They wouldn't be "blowing smoke" at me or us.

FYI: Christopher Snell, Stacy Stevens and the Workwell Group are the ones first responsible for figuring out how to measure and document PEM in CFS/ME patients by doing the 2 day CPET test. They used to be called The Pacific Fatigue Lab. Stacy Stevens developed "The Stevens Protocol". It is this that finally showed that we aren't lazy or deconditioned but are actually working at top capacity but still achieve abnormal results. Also, the key thing, is that they showed that it is on the second day of testing that things go haywire.

www.cortjohnson.org/blog/2013/05/08/university-dumps-pacific-fatigue-lab-pacific-fatigue-lab-workwell-moves-on/

Dr. Betsy Keller, of Ithaca College, has adopted and continued on this work and has a ( maybe a few now) paper (s) out about this and has and is now one of our best ME/FCS researchers. It is due to her work and that of The Pacific Fatigue Lab, and a few others, that the IOM could see that we have PEM and say that yes, we have a real disease.

There's a very good Phoenix Rising article about 2-day CPET here.
 

pemone

Senior Member
Messages
448
I agree that it is probably unwise to exercise during an infection, or anything that feels like an infection (e.g. PEM).

I think that what happens is that we take time to clear the lactic acid that builds up due to the excessive glycolysis. If that keeps our blood acidic, it will presumably make it hard to get enough oxygen to the mitochondria. I've discussed it briefly here and given other details, including links to scientific papers, in the blogpost linked from that one.

I like the idea of an exercise test just up to anaerobic threshold, but can VO2 max be determined from that?

No, VO2Max can be inferred, but you won't get a precise number until you push to the point where VCO2 is greater than VO2. But if your aerobic threshold is very low, anyone will understand that the VO2Max was also going to be very low, and you will have the critical ranges where your exercise is aerobic. When things are really broken, I doubt that having exact precision is all that important.
 
Last edited:

pemone

Senior Member
Messages
448
I took the Aerolution test and with that test you don't need to go further than anaerobic threshold. Here is a video of the test:

Do you have a way to publish the report that device gives you? Do you see columns in the report VO2, VCO2, and RER? RER should be the fraction created by VCO2 / VO2.
 

pemone

Senior Member
Messages
448
Just curious but are you aware of who Dr. Betsy Keller is? Or The Pacific Fatigue Lab who now have a new name which I forget. They are highly respected in the ME/CFS and working extremely hard to prove to everyone that we have a real disease. They wouldn't be "blowing smoke" at me or us.

Pacific Fatigue Lab is the group that charges $1600 for a VO2max test that your gym will sell you for $150. :) They are good scientists but a VO2Max test is a commodity and it is not hard to read it. The reason people overpay for these tests is because they are filing insurance claims for disability. Insurance companies would never accept data collected by someone who is not a doctor or specialty lab. What Pacific Fatigue is giving you is their reputation and a report that makes an argument to the insurance company about why this test result means you have a specific disease condition.

If you have a six page report and it includes the raw VO2Max data, scan that and show it and we can guide you through how to read it. On the other hand, if the six page report does NOT include the raw VO2Max data, ask your doctor who gave that test to provide you the raw data. Here is what that report looks like:
http://aravaiparunning.com/images/jamilvo2max1.bmp?width=644
I had to make a special request to get my raw data, so that happens.


FYI: Christopher Snell, Stacy Stevens and the Workwell Group are the ones first responsible for figuring out how to measure and document PEM in CFS/ME patients by doing the 2 day CPET test. They used to be called The Pacific Fatigue Lab. Stacy Stevens developed "The Stevens Protocol". It is this that finally showed that we aren't lazy or deconditioned but are actually working at top capacity but still achieve abnormal results. Also, the key thing, is that they showed that it is on the second day of testing that things go haywire.

I heard a lecture by Pacific Fatigue Lab, and this is all great work.

Some of us you will have no problems identifying serious aerobic problems after just one test. All you need to do is take your VO2Max number and graph it against a large population study, and it's interesting to see where your aerobic metabolism is on day one. If you are the single worst data point in a study that includes 200 data points from a variety of sedentary and active patients, you don't need a lot of science to understand that something is horribly broken.
 
Last edited:
Messages
15,786
I just wanted to add that @pemone is correct - the test can be quite cheap (mine was in Belgium), and the VO2max is very easy to compute if you have the raw values.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
Pacific Fatigue Lab is the group that charges $1600 for a VO2max test that your gym will sell you for $150. :) They are good scientists but a VO2Max test is a commodity and it is not hard to read it. The reason people overpay for these tests is because they are filing insurance claims for disability. Insurance companies would never accept data collected by someone who is not a doctor or specialty lab. What Pacific Fatigue is giving you is their reputation and a report that makes an argument to the insurance company about why this test result means you have a specific disease condition.

If you have a six page report and it includes the raw VO2Max data, scan that and show it and we can guide you through how to read it. On the other hand, if the six page report does NOT include the raw VO2Max data, ask your doctor who gave that test to provide you the raw data. Here is what that report looks like:
http://aravaiparunning.com/images/jamilvo2max1.bmp?width=644
I had to make a special request to get my raw data, so that happens.

I heard a lecture by Pacific Fatigue Lab, and this is all great work.

Some of us you will have no problems identifying serious aerobic problems after just one test. All you need to do is take your VO2Max number and graph it against a large population study, and it's interesting to see where your aerobic metabolism is on day one. If you are the single worst data point in a study that includes 200 data points from a variety of sedentary and active patients, you don't need a lot of science to understand that something is horribly broken.

Can you tell anything from my 1995 step-exercise test results that can be downloaded from this page?