Age-related declines in maximal aerobic capacity in
regularly exercising vs. sedentary women: a meta-analysis
MARGARET D. FITZGERALD,1 HIROFUMI TANAKA,1
ZUNG V. TRAN,2 AND DOUGLAS R. SEALS1,3
1Human Cardiovascular Research Laboratory, Center for Physical Activity, Disease Prevention,
and Aging, Department of Kinesiology, University of Colorado, Boulder 80309; 2Center for Research
in Ambulatory Health Care Administration, Medical Group Management Association,
Englewood 80112; and 3Divisions of Cardiology and Geriatric Medicine, Department of Medicine,
University of Colorado Health Sciences Center, Denver, Colorado 80262
aging; exercise; maximal oxygen consumption
MAXIMAL AEROBIC CAPACITY, as measured by maximal
oxygen consumption (V̇O2 max), decreases with advancing age (4, 20). This decrease contributes to the reduction in physiological functional capacity observed with
advancing age, which eventually can result in a loss of
independence in older adults (5, 9, 12). Moreover,
because maximal aerobic capacity is an independent
risk factor for cardiovascular and all-cause mortality
(2, 3), the age-related decrease may also contribute to
premature death in middle-aged and older adults.
160
In light of the physiological and clinical significance
of maximal aerobic capacity, lifestyle factors that may
be associated with a reduced rate of decline in V̇O2 max
with advancing age are of considerable public health
interest. In this context, it has been reported that the
rate of decline in V̇O2 max with age is smaller in endurance-trained male athletes than in sedentary men (8,
11). Based largely on these data in men, the concept has
been established and widely promoted that the rate of
decline in maximal aerobic capacity with age is attenuated in adults who perform regular aerobic exercise (8,
11, 12).
In contrast to these findings in men, Wells and
colleagues (25) and Astrand et al. (1) have reported
rates of decline in V̇O2 max with age in physically active
women that are greater than that generally reported
for sedentary women. Recently, we (6) observed a rate
of decline in V̇O2 max with age among highly trained
female distance runners that was even greater than
that reported in these earlier studies (1, 25). However,
the relatively small sample sizes, limited age ranges,
and lack of sedentary control groups in all of these
studies (1, 6, 25) preclude drawing any conclusions
concerning this issue.
Accordingly, the primary purpose of the present
investigation was to determine the relationship between habitual aerobic exercise status and the rate of
decline in V̇O2 max across the adult age range in women.
Our secondary aim was to determine the relationship
between aerobic exercise status and the rate of decline
in maximal heart rate with age. On the basis of the
general prevailing view (8, 11, 12), two specific hypotheses were tested: 1) women performing regular aerobic
exercise demonstrate a slower age-related rate of decline in V̇O2 max than do sedentary women; and 2) the
slower rate of decline in V̇O2 max in women performing
aerobic exercise is associated with a reduced rate of
decline in maximal heart rate, an important determinant of the age-related reduction in V̇O2 max (5, 10, 16).
To test these hypotheses, we used a meta-analytic
approach in which mean V̇O2 max values of female subject groups across the adult age range were obtained
from the published literature. The subject groups were
classified according to their aerobic exercise status, and
the rate of decline in V̇O2 max with increasing subject
group age was determined for each of these populations. We postulated that new insight into these issues
0161-7567/97 $5.00 Copyright r 1997 the American Physiological Society
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Fitzgerald, Margaret D., Hirofumi Tanaka, Zung V.
Tran, and Douglas R. Seals. Age-related declines in maximal aerobic capacity in regularly exercising vs. sedentary
women: a meta-analysis. J. Appl. Physiol. 83(1): 160–165,
1997.—Our purpose was to determine the relationship between habitual aerobic exercise status and the rate of decline
in maximal aerobic capacity across the adult age range in
women. A meta-analytic approach was used in which mean
maximal oxygen consumption (V̇O2 max) values from female
subject groups (ages 18–89 yr) were obtained from the
published literature. A total of 239 subject groups from 109
studies involving 4,884 subjects met the inclusion criteria
and were arbitrarily separated into sedentary (groups 5 107;
subjects 5 2,256), active (groups 5 69; subjects 5 1,717), and
endurance-trained (groups 5 63; subjects 5 911) populations.
V̇O2 max averaged 29.7 6 7.8, 38.7 6 9.2, and 52.0 6 10.5
ml · kg21 · min21, respectively, and was inversely related to age
within each population (r 5 20.82 to 20.87, all P , 0.0001).
The rate of decline in V̇O2 max with increasing subject group
age was lowest in sedentary women (23.5 ml · kg21 · min21
· decade21 ), greater in active women (24.4 ml · kg21 · min21
· decade21 ), and greatest in endurance-trained women (26.2
ml · kg21 · min21 · decade21 ) (all P , 0.001 vs. each other).
When expressed as percent decrease from mean levels at age
,25 yr, the rates of decline in V̇O2 max were similar in the three
populations (210.0 to 210.9%/decade). There was no obvious
relationship between aerobic exercise status and the rate of
decline in maximal heart rate with age. The results of this
cross-sectional study support the hypothesis that, in contrast
to the prevailing view, the rate of decline in maximal aerobic
capacity with age is greater, not smaller, in endurancetrained vs. sedentary women. The greater rate of decline in
V̇O2 max in endurance-trained populations may be related to
their higher values as young adults (baseline effect) and/or to
greater age-related reductions in exercise volume; however, it
does not appear to be related to a greater rate of decline in
maximal heart rate with age.
161
DECLINE IN MAXIMAL AEROBIC CAPACITY WITH AGE IN WOMEN
might be gained by using such a large-population
approach.
Table 1. Descriptive data on the three
study populations
METHODS
Population
Variable
Sedentary
Active
EnduranceTrained
No. of groups
No. of subjects
Age, yr
Height, m
Body mass, kg
V̇O2 max , l/min
V̇O2 max ,
ml · kg21 · min21
Maximal heart rate,
beats/min
107
2,256
40.5 6 19.4
1.63 6 0.04
60.8 6 5.5
1.79 6 0.42
69
1,717
34.7 6 17.2
1.64 6 0.03
60.8 6 4.1
2.34 6 0.46
63
911
33.1 6 14.1
1.65 6 0.03
55.9 6 4.3
2.87 6 0.53
29.7 6 7.8
38.7 6 9.2
52.0 6 10.5
177 6 17
182 6 14
180 6 12
Values are means 6 SD. V̇O2 max , maximal oxygen consumption.
tions (sedentary, active, and endurance-trained). When overall significance was indicated, the Tukey’s honestly significant difference method for multiple comparisons was used to
differentiate among the three group means. All data were
reported as pooled means 6 SD. The statistical significance
level was set at P , 0.05 (2-sided tests) for all analyses.
RESULTS
Mean descriptive data for the three subject populations are shown in Table 1. A total of 239 groups (4,884
subjects) and 109 studies met the criteria for inclusion.
There were 63 groups (n 5 911) in the endurancetrained category, 69 groups (n 5 1,717) in the active
category, and 107 groups (n 5 2,256) in the sedentary
category. Mean age was 5–7 yr greater in the sedentary
women compared with the two physically active populations. Body mass was ,4 kg less in the endurancetrained vs. the active and sedentary populations. As
would be expected given our subject selection criteria,
V̇O2 max was lowest in the sedentary women, somewhat
higher in the active women, and highest in the endurance-trained women.
Rate of decline in V̇O2max with age. V̇O2max was strongly
inversely related to age in each of the three populations
(r 5 20.82 to 20.87, all P , 0.0001; Fig. 1). The rate of
decline in V̇O2 max with increasing subject group age was
lowest in the sedentary women (23.5 ml · kg21 · min21 ·
decade21 ), somewhat greater in the active women (24.4
ml · kg21 · min21 · decade21 ), and greatest in the endurance-trained women (26.2 ml · kg21 · min21 · decade21 )
(all P , 0.001 vs. each other, Fig. 2, Fig. 3A, Table 2). In
contrast, the rate of decline in V̇O2 max when expressed
as percent decrease from mean levels at age ,25 yr was
similar among the three subject populations (210.0 to
210.9%/decade; Table 2, Fig. 3B). Relatively few values
for V̇O2 max were available beyond 65 and 70 yr of age,
respectively, for the endurance-trained and active populations (Fig. 1, A and B). To account for this potential
influence, the analysis also was performed by using 60
and 70 yr of mean subject group age as end points.
These analyses provided the same results as did the
original analysis.
Rate of decline in maximal heart rate with age.
Maximal heart rate was strongly inversely related to
subject group age in each of the three populations (r 5
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Meta-analysis is a quantitative approach by which mean
results from different experimental studies are sorted, classified, and summarized as parametric data (7). It is also the
application of research methodology to the characteristics
and findings of studies. Meta-analysis in the present study
was conducted as described previously (24). Briefly, as an
initial step, an extensive literature search was conducted to
identify as many English-language studies (1960–1996) as
possible in which V̇O2 max was measured in women. This was
done by using computer searches (via Sport Discus and
Medline) using the key words aerobic fitness, maximal oxygen consumption, and women. In addition, extensive hand
searching and cross-referencing were done by using bibliographies of already located studies. All mean values from previous studies meeting the following criteria for inclusion were
analyzed: 1) data on women reported separately; 2) age
groups separated; 3) at least five subjects per group; 4) only
the most recently published results used on a particular
population; 5) subject groups consisted of adult women, i.e.,
18–89 yr of age; 6)V̇O2 max values obtained by using objective
criteria (23); 7) maximal exercise protocols performed either
on treadmills or cycle ergometers; and 8) only healthy subject
populations. A list of papers included in the meta-analysis can
be obtained from the authors on request.
Group assignment. Because the studies included in the
meta-analysis used different terms to describe the aerobic
exercise status of their subject groups, we have separated and
analyzed the groups in three arbitrarily defined categories: 1)
endurance trained, referring to regular performance ($3
sessions/wk) of vigorous endurance exercise (e.g., running,
cycling, swimming, rowing, cross-country skiing) for $1 yr; 2)
active, referring to occasional or irregular performance (#2
sessions/wk) of aerobic exercise (walking, basketball, dancing, stairmaster exercise, etc.); and 3) sedentary, referring to
no performance of aerobic exercise.
Coding variables. Subsequently, the important characteristics of all of the relevant studies located in the literature
search were classified and coded. To integrate the differing
methodologies (subjects, results, and so on), a coding sheet
was constructed. Primary variables coded included the following: 1) study characteristics, 2) physical characteristics of
subjects, 3) exercise program characteristics, and 4) V̇O2 max
and maximal heart rate values.
Statistical analysis. Data from treadmill and cycle ergometry exercise were evaluated together and separately. There
were no differences in results between the two analyses.
Therefore, data from both exercise modes were pooled and are
presented together. Because we have previously shown that
weighted results (by sample size) were not significantly
different from unweighted results (24), no weighting scheme
was used in the present meta-analysis.
Of the key dependent variables, complete data were available for V̇O2 max , age, and body weight on all groups. Maximal
heart rate values were missing in 10–15% of the subject
groups; therefore, for this variable, analyses were performed
on the available database only.
Linear regression analyses were performed to determine
the association among variables. In all cases, age was used as
the predictor variable. Pearson’s product-moment correlation
coefficients were used to indicate the magnitude and direction
of relations among variables. One-way analysis of variance
was used to determine differences in the dependent variables
(e.g., percent and absolute decline in V̇O2 max) among popula-
162
DECLINE IN MAXIMAL AEROBIC CAPACITY WITH AGE IN WOMEN
Fig. 3. Mean rates of decline in V̇ O2 max given in ml · kg21 ·
min21 · decade21 (A) and %/decade (B) in the 3 study populations. The
ml · kg21 · min21 · decade21 rates of decline are increasingly greater
from sedentary to active to endurance trained (all P , 0.001 vs. each
other). In contrast, %/decade decreases from mean values at age ,25
yr were not different among the 3 populations.
20.89 to 20.91, all P , 0.001; Fig. 4). In contrast to the
absolute declines in V̇O2 max, however, the corresponding
declines in maximal heart rate were not different in the
three populations (27.0 to 27.9 beats · min21 · decade21 ).
Maximal heart rate was correlated with V̇O2 max in the
each of the three populations (r 5 0.75–0.85, all P ,
0.0001), explaining 73, 56, and 71% of the variance in
the sedentary, active, and endurance-trained subjects,
respectively.
DISCUSSION
Fig. 2. Rates of decline in V̇O2 max with increasing subject group age in
the 3 study populations. Rate of decline was smallest in sedentary
women and greatest in endurance-trained women.
At least two important new findings were generated
by the present investigation concerning the relationship between habitual aerobic exercise status and the
rate of decline in maximal aerobic capacity with adult
aging. First, in marked contrast to current theory
based primarily on data in men (8, 11, 12), our results
indicate that the rate of decline in V̇O2 max with increas-
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Fig. 1. Relationship between maximal oxygen consumption (V̇O2 max)
and subject group age. A: endurance trained. B: active. C: sedentary.
V̇O2 max was strongly inversely correlated with age in each of the 3
study populations.
DECLINE IN MAXIMAL AEROBIC CAPACITY WITH AGE IN WOMEN
Table 2. Cumulative rates of decline in V̇O2 max
per decade for the three study populations
Population
Sedentary
Active
Endurance-Trained
Age,
yr
%
ml · kg21 · min21
%
ml · kg21 · min21
%
ml · kg21 · min21
,35
,45
,55
,65
,75
12
23
31
40
59
4.4
8.3
11.1
14.5
21.2
10
17
35
37
66
4.4
7.4
15.5
16.2
29.2
8
19
27
46
59
4.4
12.1
16.8
27.6
34.9
Percent decline is expressed relative to baseline V̇O2 max value at
,25 yr of age.
Fig. 4. Relationship between maximal heart rate and increasing
subject group age in the 3 study populations. bpm, Beats/min.
Maximal heart rate was strongly inversely correlated with age in
each population (all P , 0.001). However, rates of decline were not
different among populations.
in V̇O2 max with age in highly active vs. sedentary
women. In a previous cross-sectional study, Wells and
colleagues (25) reported a rate of decline in V̇O2 max with
age in female distance runners (aged 35–70 yr) of 24.7
ml · kg21 · min21 · decade21, which is much greater than
that generally reported for sedentary women (see next
paragraph). This is approximately the same high rate
of decline that Astrand et al. (1) reported in a longitudinal investigation of active female physical education
teachers who were studied ,20 yr apart. Moreover, in
our recent cross-sectional study (6) of highly trained
female distance runners (aged 23–56 yr) who were
matched for age-adjusted performance, V̇O2 max was 12.3
ml · kg21 · min21 lower in runners with a mean age of 52
yr vs. those with a mean age of 30 yr, corresponding to a
decline of 25.6 ml · kg21 · min21 · decade21. Finally, a
chapter by Smith and Gilligan in a larger government
publication (22) contained a cross-sectional analysis of
data on V̇O2 max women aged ,18–80 yr taken from
published studies up to the year 1987. No methods,
results, or specific conclusions were presented. The
scatterplot of their data and the accompanying legend
(their Fig. 3, p. 297) describe the slopes of the declines
in V̇O2 max with age in ‘‘active’’ vs. ‘‘sedentary’’ women as
not significantly different. However, the slope of the
regression line for their active women was ,22%
greater than that for the sedentary women, which is
similar to the difference observed in the active vs.
sedentary populations in the present study.
During the development of the present manuscript,
the results of a cross-sectional analysis of 409 healthy
women aged 20–64 yr by Jackson and colleagues (13)
were published. The analysis concerned the relationship between self-report physical activity levels, body
fatness, and their interaction on the rate of decline in
V̇O2 max with age. Although the rates of decline in V̇O2 max
across age groups for each of their four self-report
physical activity classifications were not presented,
calculations based on their mean data (their Table 4, p.
887) indicate similar rates of decline among the four
groups at any particular level of body fatness. One
explanation for the apparent difference in these results
and those of the present study is the high rate of decline
in V̇O2 max with age reported for their sedentary subjects
(25.4 ml · kg21 · min21 · decade21 ). This is much greater
than the respective rates for sedentary women reported
by Buskirk and Hodgson (4) (range 22.8 to 23.5
ml · kg21 · min21 · decade21 ), by Smith and Gilligan (22)
(23.0 ml · kg21 · min21 · decade21 ), and in the present
study (23.5 ml · kg21 · min21 · decade21 ) (Figs. 1–3) and
would effectively preclude the ability to show differences from highly active women.
The prevailing concept of a smaller rate of decline in
maximal aerobic capacity with age in regularly exercising/endurance-trained compared with sedentary individuals (8, 11, 12) is logical based on our understanding
of the physiological adaptations to regular exercise and
is certainly attractive from a ‘‘preventive gerontology’’
standpoint. However, an argument also can be made for
hypothesizing greater rates of decline in V̇O2 max with
age in endurance exercise-trained adults.
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ing age is greater in endurance-trained women than in
sedentary women. Specifically, we observed a direct,
not inverse, relationship between habitual aerobic exercise levels and the rate of decline in V̇O2 max with age
across our three subject populations. Second, the present data indicate that there is no discernible relation
between the rate of decline in maximal heart rate with
advancing age in healthy women and their aerobic
exercise status. Thus both of our working hypotheses
were refuted by the present findings.
Rate of decline in V̇O2 max with age. Only a modest
amount of data exists in women concerning the relationship between aerobic exercise levels and the rate of
decline in V̇O2 max with age. In their classic 1987 review
on V̇O2 max and aging, Buskirk and Hodgson (4) summarized the results of several studies in women (their
Table 3, p. 1826). No consistent relationship was demonstrated between the habitual exercise status of the
population and the associated rate of decline in V̇O2 max
with age.
However, at least four independent lines of evidence
support the present findings of a greater rate of decline
163
164
DECLINE IN MAXIMAL AEROBIC CAPACITY WITH AGE IN WOMEN
Fig. 5. Weekly running mileage with increasing subject group age in
subset of endurance-trained women on whom such data were reported. There was a progressive reduction in running mileage with
increasing group age.
markedly with age in endurance-trained adults. Because sedentary young adults, by definition, are not
performing regular aerobic exercise, it follows that the
magnitude of decline in the intensity, duration, and
frequency of aerobic exercise with age, which collectively have a strong influence on V̇O2 max (17), is much
greater in regularly exercising individuals. Thus this
greater decrease in the overall exercise stimulus for
maintaining maximal aerobic capacity could contribute
to a greater rate of decline in V̇O2 max with age in
exercise-trained vs. sedentary adults.
Finally, because V̇O2 max is traditionally expressed in
units corrected for differences in body weight, it is
possible that greater increases in body weight with age
in the exercising groups contributed to their greater
rates of decline in maximal aerobic capacity in the present
study. This would appear to be a reasonable possibility in
that young adults who perform aerobic exercise on a
regular basis demonstrate lower levels of body weight due
to lower body fatness compared with their sedentary peers
and, therefore, might tend to gain more weight with age
as they undergo a greater decline in exercise-related
energy expenditure. This does not appear, however, to
have played a role in the results of the present study.
Body weight increased with age within each of our
populations (all P , 0.01), but the slopes of regression
lines representing the respective rates of increases
were not different from each other.
Age-related rate of decline in maximal heart rate.
Because maximal heart rate is considered to be an
important determinant of age-related decline in V̇O2 max
(10, 16, 19), the question has been raised as to whether
the greatest declines in V̇O2 max with age are associated
with the largest reductions in maximal heart rate (8,
10, 11). The present findings indicate that there is no
obvious relationship between age-related declines in
V̇O2 max and maximal heart rate in women differing
widely in habitual aerobic exercise status. The data
from the aforementioned analysis of Smith and Gilligan (22), as well as the earlier findings of Astrand et al.
(1), support this observation. Taken together, these
findings suggest that other factors (e.g., declines in
maximal stroke volume or skeletal muscle oxidative
capacity) were responsible for differences in the absolute rates of decline in V̇O2 max observed in the exercising
vs. sedentary populations in the present study.
Physiological significance and study limitations. The
present finding that the absolute rate of decline in
V̇O2 max with advancing age is directly related to aerobic
exercise status suggests that the rate of loss of physiological functional capacity with age, at least that
which depends on maximal aerobic power, would be
greater in endurance-trained vs. sedentary women.
Thus, from their high levels of functional capacity as
young adults, exercise-trained women may experience
greater absolute reductions over the normal life span.
We wish to emphasize, however, that despite their
apparent greater rate of decline in V̇O2 max at any age,
women who regularly engage in aerobic exercise demonstrate significantly higher absolute levels of maximal
aerobic capacity than do their sedentary peers. There-
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The first argument involves a baseline effect, i.e., the
law of initial baseline applied to V̇O2 max. Stated simply,
according to this concept those individuals with the
highest levels of V̇O2 max as young adults should demonstrate the greatest rates of decline with advancing age.
Support for this idea is provided by our data on the
‘‘relative’’ rates of decline in V̇O2 max. Specifically, when
this baseline effect is removed by expressing the data as
percent change from mean levels at age ,25 yr, the
rates of decline in V̇O2 max with age in the endurancetrained, active, and sedentary women are similar. It is
interesting (and possibly instructive) that a similar
relationship exists in the age-related rates of decline in
V̇O2 max in men vs. women. Men have higher levels of
V̇O2 max as young adults compared with women but
demonstrate a greater absolute rate of decline in V̇O2 max
with age compared with women based on crosssectional data (4, 22). When expressed as percent
change, however, gender-related differences are no
longer evident.
The second argument involves declines in habitual
aerobic exercise levels with advancing age. Studies of
male endurance athletes indicate that training volumes of older athletes often are up to 50% lower than
those of their young adult colleagues (5, 15, 19). In our
recent study (6), female distance runners matched for
age-adjusted performance, weekly training mileage
was 45% lower in women runners with a mean age of 52
yr vs. that for runners with a mean age of 30 yr; weekly
training frequency and running velocity also were
lower in the older runners. In the present metaanalysis, weekly running mileage was reported for 25
subject groups in 14 studies. The data are plotted in
Fig. 5 and reveal a progressive, significant age-related
decline. Based on the regression line from this sample,
running mileage would be expected to decline from ,90
km/wk at age 20 yr to ,30 km/wk at age 70 yr, a
decrease in excess of 65%. These observations support
the view that overall aerobic exercise levels decline
DECLINE IN MAXIMAL AEROBIC CAPACITY WITH AGE IN WOMEN
This study was supported by National Institutes of Health (NIH)
RO1 Awards AG-06537, AG-13038, and HL-39966. H. Tanaka was
supported by NIH Individual National Research Service Award
AG-05717.
Address for reprint requests: D. R. Seals, Univ. of Colorado, Dept.
of Kinesiology, Campus Box 354, Boulder, CO 80309 (E-mail:
[email protected]).
Received 16 September 1996; accepted in final form 12 March 1997.
4.
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22.
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fore, on average, exercise-trained women enjoy a higher
level of physiological functional capacity throughout
adult aging compared with sedentary women. This
means that endurance-trained females are able to
perform physical tasks that cannot be performed by
their sedentary peers (or would require a much greater
effort and percentage of their physiological reserve).
The major limitation of the present investigation is
its cross-sectional design. A longitudinal approach in which
the same subjects are studied over their entire adult life
span, theoretically, would provide more definitive insight
into this issue. Saltin (21) has demonstrated that the
average rate of decline in V̇O2max with advancing age in
endurance athletes is similar whether they are studied
cross-sectionally or longitudinally. Despite this finding,
however, it is important to appreciate that the crosssectional nature of the present study could have produced
results that are different from those that would have been
obtained from a longitudinal approach.
Finally, we recognize that it has been demonstrated
that maximal aerobic capacity can be maintained over
10- to 20-yr periods in middle-aged men who are able to
sustain their levels of aerobic exercise training (14, 18).
The present findings are not in conflict with these
previous observations in any way. Rather, our results
support the hypothesis that on average the absolute
rate of decline in V̇O2 max in endurance-trained women
as a whole is greater than that observed in less active
women when viewed over the normal adult life span. As
discussed previously, this may be due in part to a
progressive and, ultimately, substantial reduction in
their exercise habits with advancing age.
Conclusions. The results of the present study provide
experimental support for the idea that the rate of
decline in maximal aerobic capacity with age in healthy
women is greatest in endurance-trained women and
least in sedentary women, contrary to the currently
accepted view. The greater rate of decline in V̇O2 max in
highly active women may be due to their high baseline
levels as young adults and/or to greater reductions in
their exercise levels with advancing age compared with
sedentary women. Our findings also fail to provide evidence that the level of habitual aerobic exercise is related
to the rate of decline in maximal heart rate with age.
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