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Reference values for peak oxygen uptake: cross-sectional analysis of cycle ergometry-based cardiopulmonary exercise tests of 10 090 adult German volunteers from the Prevention First Registry
  1. Daniel Rapp1,
  2. Jürgen Scharhag2,3,
  3. Stefan Wagenpfeil1,
  4. Johannes Scholl4
  1. 1 Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Saarbrücken, Saarland, Germany
  2. 2 Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Saarland, Germany
  3. 3 Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University Munich (TUM), Munich, Germany
  4. 4 Dr. Scholl Prevention First GmbH, Rüdesheim am Rhein, Hessen, Germany
  1. Correspondence to Daniel Rapp; daniel.rapp{at}


Objective This study aims to construct quantile reference values for peak oxygen uptake (V̇O2peak) measured by cycle ergometry-based incremental cardiopulmonary exercise tests.

Design Cross-sectional study using quantile regressions to fit sex-specific and age-specific quantile curves. Exercise tests were conducted using cycle ergometry. Maximal effort in the exercise tests was assumed when respiratory exchange ratio  ≥1.1 or lactate ≥8 mmol/L or maximal heart rate ≥90% of the age-predicted maximal heart rate. This was assessed retrospectively for a random subsample with an a priori calculated sample size of n=252 participants.

Setting A network of private outpatient clinics in three German cities recorded the results of cycle ergometry-based cardiopulmonary exercise tests to a central database (Prevention First Registry) from 2001 to 2015.

Participants 10 090 participants (6462 men, 3628 women) from more than 100 local companies volunteered in workplace health promotion programmes. Participants were aged 21 to 83 years, were free of acute complaints and had primarily sedentary working environments.

Main outcome measure Peak oxygen uptake was measured as absolute V̇O2peak in litres of oxygen per minute and relative V̇O2peak in millilitres of oxygen per kilogram of body mass per minute.

Results The mean age for both men and women was 46 years. Median relative V̇O2peak was 36 and 30 mL/kg/min at 40 to 49 years, as well as 32 and 26 mL/kg/min at 50 to 59 years for men and women, respectively. An estimated proportion of 97% of the participants performed the exercise test until exertion.

Conclusions Reference values and nomograms for V̇O2peak were derived from a large sample of preventive healthcare examinations of healthy white-collar workers. The presented results can be applied to participants of exercise tests using cycle ergometry who are part of a population that is comparable to this study.

  • exercise test
  • physical fitness
  • reference values
  • Vo2peak
  • peak oxygen uptake

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  • Contributors JHS organised the acquisition of the data. JHS, JS and SW originated the idea, designed the study, advised on the analysis of the study and on interpretation of results. DR conducted all statistical analyses, wrote the manuscript draft, and created the web application. All authors interpreted the analyses and critically reviewed and edited the manuscript.

  • Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Anonymised patient level data including only the variables of interest may be requested from the corresponding author. Participants’ informed consent for data sharing was not obtained, but the presented data are anonymised and risk of identification is low.

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