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Mayo Clin Proc. 2015 Nov;90(11):1515-23. doi: 10.1016/j.mayocp.2015.07.026. Epub 2015 Oct 5.

Reference Standards for Cardiorespiratory Fitness Measured With Cardiopulmonary Exercise Testing: Data From the Fitness Registry and the Importance of Exercise National Database.

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Fisher Institute for Wellness and Gerontology and Clinical Exercise Physiology Laboratory, Ball State University, Muncie, IN. Electronic address:
Department of Physical Therapy and Integrative Physiology Laboratory, College of Applied Science, University of Illinois, Chicago, IL.
Division of Cardiology, Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA.



To develop standards for cardiorespiratory fitness by establishing reference values derived from cardiopulmonary exercise testing (CPX) in the United States.


Eight laboratories in the US experienced in CPX administration with established quality control procedures contributed data from January 1, 2014, through February 1, 2015, from 7783 maximal (respiratory exchange ratio, ≥ 1.0) treadmill tests from men and women (aged 20-79 years) without cardiovascular disease (CVD) to the Fitness Registry and the Importance of Exercise: A National Data Base (FRIEND). Percentiles of maximal oxygen consumption (VO 2max) for men and women were determined for each decade from 20 years of age through 79 years of age. Comparisons of VO 2max were made to reference data established with CPX data from Norway and to US reference data established without CPX measurements.


There were significant differences between sex and age groups for VO 2max. In FRIEND, the 50th percentile VO 2max of men and women aged 20 to 29 years decreased from 48.0 and 37.6 mLO2 · kg(-1) · min(-1) to 24.4 and 18.3 mLO2 · kg(-1) · min(-1) for ages 70 to 79 years, respectively. The rate of decline in this cohort during a 5-decade period was approximately 10% per decade.


These are the first cardiorespiratory fitness reference data using measures obtained from CPX in the United States. FRIEND can be used to provide a more accurate interpretation of measured VO 2max from maximal exercise tests for the US population compared with previous standards on the basis of workload-derived estimations.

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