VO2 max in underwriting: What you need to know

Assessing VO2 max levels

It is important to identify and recognize the difference between clinical and wearable VO2 max assessments where accuracy matter. While wearable devices (e.g., smartwatches, fitness trackers) offer estimated VO2 scores based on heart rate and activity data, these are often inaccurate and lack clinical rigor. For underwriting purposes, only clinically administered VO2 max tests typically conducted via treadmill or cycle ergometer with gas exchange analysis should be considered. Clinical VO2 max testing is increasingly included in executive physicals, providing underwriters with reliable data that can supplement traditional medical records. These tests are standardized, reproducible, and interpreted against age- and sex-specific norms.

Traditional ECGs have been used for years by the life insurance industry. VO2 max and stress ECGs are considered complementary tools in risk evaluation. Both VO2 max and stress ECG tests involve graded exercise protocols and measure physiological response to exertion. However, their focus and diagnostic value differ. A stress ECG evaluates cardiac electrical activity, detecting arrhythmias, ischemia and coronary artery disease. It is primarily diagnostic. VO2 max on the other hand assesses systemic aerobic capacity, predicting physical decline, endurance, and long-term health outcomes. It is primarily predictive.

Together, these tests offer a comprehensive view of cardiovascular health, with VO2 max providing broader insight into systemic resilience and aging.

Underwriting considerations

It is important to note that there can be a strategic use of VO2 max in underwriting. VO2 max can be integrated into underwriting models in several strategic ways:

1. Positive risk modifier: Applicants with high VO2 max scores may qualify for preferred rates, especially when other risk factors (e.g., BMI, cholesterol) are borderline. VO2 max can serve as a compensatory factor, indicating overall physiological resilience.
2. Clarifying ambiguous profiles: In cases where traditional metrics are inconclusive or conflicting, VO2 max provides objective clarity. For example, an applicant with elevated BMI but high VO2 max may present lower actual risk than BMI alone suggests.
3. Risk stability assessment: VO2 max can help assess the stability of cardiovascular risk over time, particularly in applicants with fluctuating blood pressure or metabolic markers. It offers a longitudinal view of health trajectory.
4. Predictive modeling: Advanced underwriting platforms may incorporate VO2 max into predictive algorithms, enhancing accuracy in mortality and morbidity projections. This aligns with the industry’s shift toward data-driven, personalized underwriting.

Demographic considerations and interpretation are also important to understand. VO2 max values vary significantly based on:

• Age: VO2 max naturally declines with age (~1% per year after age 25). ^{footnote 22}
• Sex: Males typically have higher VO2 max due to greater muscle mass and hemoglobin levels. ^{footnote 22}
• Genetics: Heritability accounts for ~25–50% of VO2 max variability. ^{footnote 22}
• Training status: Regular aerobic exercise significantly improves VO2 max.

Underwriters must interpret VO2 max scores in context, comparing results against age- and sex-specific norms and considering co-morbidities. A high VO2 max in a 60-year-old applicant may carry more weight than the same score in a 30-year-old.

Improving VO2 max can be a preventive health strategy. VO2 max is not static – it can be improved through targeted lifestyle interventions. This makes it a modifiable risk factor and a potential focus for applicants seeking to enhance their insurability. Aerobic training such as running, cycling, swimming and high-intensity interval training (HIIT) are particularly effective.

• Weight management: Reducing excess body fat improves oxygen efficiency.
• Smoking cessation: Smoking impairs lung function and oxygen transport.
• Hormonal balance: Thyroid and adrenal health influence energy metabolism.
• Stress reduction: Chronic stress affects cardiovascular and respiratory function.

In the end, applicants who demonstrate improved VO2 max over time may warrant re-evaluation for better risk classification, especially in policies with renewal or re-underwriting provisions.

In conclusion, VO2 max can be seen as a forward-looking metric. It represents a paradigm shift in life insurance underwriting from reactive to proactive. It offers a scientifically grounded, clinically validated, and highly predictive measure of health and longevity. As the industry embraces data-driven underwriting and personalized risk assessment, VO2 max should be considered a strategic asset in evaluating and managing long-term risk.

^{Footnote 1 details1} Importance of Assessing Cardiorespiratory Fitness in Clinical Practice. American Heart Association. (2021). 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. Circulation, 144(5), e1–e21.

^{Footnote 2 details2} Biological and Methodological Factors Affecting Response. Meyler, J., et al. (2021). Biological and methodological factors affecting response variability to endurance training and the influence of exercise intensity prescription. Experimental Physiology, 106(11), 2321–2334.

Disclaimer:

This article is for information purposes only and is not intended to provide insurance, financial, legal or health advice, and should not be relied upon in that regard. BMO Life Assurance Company does not provide any such advice to the policyholder or to the insurance advisor. Facts or information provided in this article are believed to be reliable and accurate, but we cannot guarantee that it is reliable and accurate at all times.

Insurer: BMO Life Assurance Company                                        

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