JONATHAN WAGNER, RAPHAEL KNAIER, DENIS INFANGER, KARSTEN KÖNIGSTEIN,
CHRISTOPHER KLENK, JUSTIN CARRARD, HENNER HANSSEN, TIMO HINRICHS,
DOUGLAS SEALS, and ARNO SCHMIDT-TRUCKSÄSS

Med. Sci. Sports Exerc., Vol. 53, No. 1, pp. 26–37, 2021.

Purpose: Cardiopulmonary exercise testing (CPET) is an importantmeasurement in clinical practice,
and its primary outcome, maximal oxygen uptake (V˙O2peak), is inversely associated with morbidity and mortality. The purposes of this study are to provide CPET reference values for maximal and submaximal parameters across the adult age spectrum of a healthy European cohort, to compare V˙O2peak values with other reference data sets, and to analyze the associations between physical activity (PA) levels and CPET parameters.
Methods: In this cross-sectional study, we prospectively recruited 502 participants (47% female) from 20 to 90 yr old. The subjects a CPET on a cycle ergometer using a ramp protocol. PA was objectively and continuously measured over 14 d using a triaxial accelerometer. Quantile curves were calculated for CPET parameters. To investigate the associations between CPET parameters and PA levels, linear regression analysis was performed. Results: V˙O2peak values observed in the group of 20–29 yr were 46.6 ± 7.9 and  39.3 ± 6.5 mL·kg−1⋅min−1 for males and females, respectively. On average, each age category (10-yr increments) showed a 10% lower V˙O2peak relative to the next younger age category. V˙O2peak values of previous studies were on average 7.5 mL·kg−1⋅min−1 (20%) lower for males and 6.5 mL·kg−1⋅min−1 (21%) lower for females. There was strong evidence supporting a positive association between theV˙O2peak (mL·kg−1⋅min−1) and the level of habitual PA performed at vigorous PA (estimate, 0.26; P < 0.001].
Conclusion: Maximal and submaximal CPET reference values over a large age range are novel, and differences to other studies are clinically highly relevant. Objectively measured vigorous-intensity PA showed a strong positive association with higher V˙O2peak and other performance-related CPET parameters, supporting
the implementation of higher-intensity aerobic exercise in health promotion.