Original Article
Brazilian Cardiorespiratory Fitness Classification Based on Maximum 
Oxygen Consumption
Artur Haddad Herdy1,2,3 and Ananda Caixeta1
Instituto de Cardiologia de Santa Catarina1; Clínica Cardiosport2; Universidade do Sul de Santa Catarina3, Florianópolis, SC – Brazil
Mailing Address: Artur Haddad Herdy  •
Instituto de Cardiologia de Santa Catarina. Rua Newton Ramos 91- 601-A, 
Centro. Postal Code 88015-395, Florianópolis, SC – Brazil
E-mail: arherdy@cardiosport.com.br
Manuscript received October 13, 2014; revised manuscript April 30, 2015; 
accepted June 26, 2015.
DOI: 10.5935/abc.20160070
Introduction
Cardiopulmonary exercise test (CPET) is considered 
one of the most complete tools to assess functional aerobic 
capacity, because it provides an integrated assessment of 
response to exercise, involving the cardiovascular, pulmonary, 
hematopoietic, neurophysiological and skeletal muscle 
systems.1 In clinical practice, it has been widely used to 
assess cardiac and pulmonary diseases, to stratify the risk of 
patients with heart failure, and to optimize the prescription 
Abstract
Background: Cardiopulmonary exercise test (CPET) is the most complete tool available to assess functional aerobic 
capacity (FAC). Maximum oxygen consumption (VO2 max), an important biomarker, reflects the real FAC.
Objective: To develop a cardiorespiratory fitness (CRF) classification based on VO2 max in a Brazilian sample of healthy 
and physically active individuals of both sexes.
Methods: We selected 2837 CEPT from 2837 individuals aged 15 to 74 years, distributed as follows: G1 (15 to 24); G2 
(25 to 34); G3 (35 to 44); G4 (45 to 54); G5 (55 to 64) and G6 (65 to 74). Good CRF was the mean VO2 max obtained for 
each group, generating the following subclassification: Very Low (VL): VO2 < 50% of the mean; Low (L): 50% - 80%; Fair 
(F): 80% - 95%; Good (G): 95% -105%; Excellent (E) > 105%.
Results:
Men
VL < 50%
L 50-80%
F 80-95%
G 95-105%
E > 105%
G1
< 25.30
25.30-40.48
40.49-48.07
48.08-53.13
> 53.13
G2
< 23.70
23.70-37.92
37.93-45.03
45.04-49.77
> 49.77
G3
< 22.70
22.70-36.32
36.33-43.13
43.14-47.67
> 47.67
G4
< 20.25
20.25-32.40
32.41-38.47
38.48-42.52
> 42.52
G5
< 17.54
17.65-28.24
28.25-33.53
33.54-37.06
> 37.06
G6
< 15
15.00-24.00
24.01-28.50
28.51-31.50
> 31.50
Women
G1
< 19.45
19.45-31.12
31.13-36.95
36.96-40.84
> 40.85
G2
< 19.05
19.05-30.48
30.49-36.19
36.20-40.00
> 40.01
G3
< 17.45
17.45-27.92
27.93-33.15
33.16-34.08
> 34.09
G4
< 15.55
15.55-24.88
24.89-29.54
29.55-32.65
> 32.66
G5
< 14.30
14.30-22.88
22.89-27.17
27.18-30.03
> 30.04
G6
< 12.55
12.55-20.08
20.09-23.84
23.85-26.35
> 26.36
Conclusions: This chart stratifies VO2 max measured on a treadmill in a robust Brazilian sample and can be used as an 
alternative for the real functional evaluation of physically and healthy individuals stratified by age and sex. (Arq Bras 
Cardiol. 2016; 106(5):389-395)
Keywords: Respiratory Function Tests; Exercise; Exercise Test; Oxygen Consumption.
389
Original Article
Herdy & Caixeta
Cardiorespiratory fitness classification
Arq Bras Cardiol. 2016; 106(5):389-395
of physical exercise.2-5 In Brazil, CPET is preferably performed 
on a treadmill, but, in many countries, a cycle ergometer is 
preferred. Maximum oxygen consumption (VO2 max) reflects 
the individual’s maximum capacity to absorb, transport and 
consume oxygen.2 The major determinants of normal VO2 max 
are: genetic factors, muscle mass amount, age, sex and body 
weight.1,2 In practice, VO2 max is considered to be equivalent 
to the highest VO2 value obtained in peak exertion, which 
is usually used to classify cardiorespiratory fitness (CRF) in a 
population. In this study, for practical purposes, we named 
VO2 peak, which was actually measured, VO2 max.
Few studies have provided reference CRF charts for 
populations, and it is yet to be clarified whether the existing 
classifications can be extrapolated to other populations. 
Most published studies have been based on small samples, 
and the profiles of the populations studied have significantly 
differed.6,7 The CRF classification charts most used in Brazil 
are as follows: that of the American Heart Association (AHA), 
published in 1972 (Table 1), and that by Cooper, of 1987. 
Brazil does not have a solid and widely used CRF classification 
for CPET; therefore, this study proposes a classification based 
on Brazilian population data. Such data, resulting from a 
recently published study, were used as reference for CPET 
on a treadmill (ramp protocol) for sedentary and physically 
active men and women.8
Methods
This study’s sample comprised 9,250 CPET performed at a 
large cardiology referral center in southern Brazil.8 Based on 
a questionnaire completed during the test, individuals with 
the following characteristics were excluded from the study: 
any symptom suggesting disease or pathology; amateur or 
professional athletes; smokers; users of any medication; obese 
individuals (body mass index - BMI > 30); and tests with the 
ratio between the amount of carbon dioxide produced and 
of oxygen used (respiratory exchange ratio - RER) < 1.1.  
After applying the exclusion criteria, 3,922 CPET were 
identified, of which, 2,837 CPET, corresponding to healthy 
and active individuals, were selected. Those individuals, aged 
between 15 and 74 years, were of both sexes and different 
ethnicities, and practiced leisure-time aerobic physical activity 
for at least 30 minutes a day, three times a week.8
All exercise tests were conducted by cardiologists 
trained in ergometry and CPET by the Brazilian Society of 
Cardiology Department of Ergometry and Cardiovascular 
Rehabilitation. The tests were performed on a treadmill 
(Inbrasport - ATL™, Brazil, 1999, Software ErgoPC Elite 
Version 3.3.6.2, Micromed Brazil, 1999), using the ramp 
protocol. A mixing chamber gas analyzer (MetaLyzer II, 
CortexTM - Leipzig, Germany, 2004) was used to collect 
the expired gases. For descriptive statistics, central trend 
measures, such as means, were used, in addition to 
dispersion measures (standard deviation). Excel software, 
Microsoft 2008, was used for statistical analyses and charts.
Participants, classified according to sex (female and male), 
were divided into six age groups between 15 and 74 years as 
follows: G1 (15 to 24 years); G2 (25 to 34 years); G3 (35 to 
44 years); G4 (45 to 54 years); G5 (55 to 64 years); and G6 
(65 to 74 years).
The CRF classification proposed in this study was based 
on 2,837 CPET performed in apparently healthy individuals. 
We arbitrarily adopted as “Good” CRF the mean VO2 max 
value expressed in mL.kg-1.min-1 obtained in each group, and, 
taking that value as a reference, we classified CRF as follows: 
“Very Low” (VO2 value < 50% of the mean); “low” (50-80%); 
“fair” (80-95%); “good” (95-105%); and “excellent” (> 105%).
To internally validate our proposed CRF classification, 
sedentary individuals of both sexes from the study population 
sample were assessed, according to previous publication.8
This study was approved by the Ethics Committee in 
Research of the Instituto de Cardiologia de Santa Catarina.
Table 1 – American Heart Association Cardiorespiratory Fitness Chart based on maximum oxygen consumption (VO2 max – mL/kg.min) – 1972
Men
Very Low
Low
Fair
Good
Excellent
Age group
20-29
< 25
25-33
34-42
43-52
≥ 53
30-39
< 23
23-30
31-38
39-48
≥ 49
40-49
< 20
20-26
27-35
36-44
≥ 45
50-59
< 18
18-24
25-33
34-42
≥ 43
60-69
< 16
16-22
23-30
31-40
≥ 41
Women
Very Low
Low
Fair
Good
Excellent
Age group
20-29
< 24
24-30
31-37
38-48
≥ 49
30-39
< 20
20-27
28-33
34-44
≥ 45
40-49
< 17
17-23
24-30
31-41
≥ 42
50-59
< 15
15-20
21-27
28-37
≥ 38
60-69
< 13
13-17
18-23
24-34
≥ 35
390
Original Article
Herdy & Caixeta
Cardiorespiratory fitness classification
Arq Bras Cardiol. 2016; 106(5):389-395
Table 2 – Distribution of the physically active and sedentary male population according to mean VO2 max (mL/kg.min) and age groups
Active men
Age (years)
15 – 24
25 – 34
35 – 44
45 – 54
55 – 64
65 – 74
n = 1818
343
597
427
285
134
32
Mean VO2 max (mL/kg.min)
50.6 ± 7.3
47.4 ± 7.4
45.4 ± 6.8
40.5 ± 6.5
35.3 ± 6.2
30 ± 6.1
Sedentary men
Age (years)
15 – 24
25 – 34
35 – 44
45 – 54
55 – 64
65 – 74
n = 570
85
188
157
100
30
10
Mean VO2 max (mL/kg.min)
47.4 ± 7.9
41.9 ± 7.2
39.9 ± 6.8
35.6 ± 7.7
30 ± 6.3
23.1 ± 6.3
Table 3 – Distribution of the physically active and sedentary female population according to mean VO2 max (mL/kg.min) and age groups
Active women
Age (years)
15 – 24
25 – 34
35 – 44
45 – 54
55 – 64
65 – 74
n = 1019
177
300
229
206
81
26
Mean VO2 max (mL/kg.min)
38.9 ± 5.7
38.1 ± 6.6
34.9 ± 5.9
31.1 ± 5.4
28.6 ± 6.1
25.1 ± 4.4
Sedentary women
Age (years)
15 – 24
25 – 34
35 – 44
45 – 54
55 – 64
65 – 74
n = 515
85
149
108
108
40
25
Mean VO2 max (mL/kg.min)
35.6 ± 5.7
34.0 ± 4.8
30.0 ± 5.4
27.2 ± 5.0
23.9 ± 4.2
21.3 ± 3.4
Results
Tables 2 and 3 show the mean VO2 max values of the 
original population and the number of CPET performed, 
stratified by sex and age groups, of physically active and 
sedentary individuals. The VO2 max levels were higher in the 
active groups as compared to the sedentary ones, and men 
had greater VO2 max levels than women did. Tables 4 and 5 
show our proposed CRF classification, with five different 
categories, stratified by sex and age group, of apparently 
healthy individuals. Table 6 shows the classification of the 
sedentary population (men and women) from the original 
sample, considering the new CRF chart proposed in this 
study. It is worth noting that the CRF of sedentary individuals 
is always classified as either fair or low.
As expected, VO2 max levels dropped throughout the age 
groups for both sexes (Figures 1 and 2).
Discussion
We elaborated a CRF classification chart based on VO2 
max levels measured during CPET (ramp protocol) performed 
on an ergometric treadmill, to more accurately classify a solid 
Brazilian sample of healthy and physically active individuals of 
both sexes. We chose to base our analysis on data of physically 
active individuals, who would provide CRF in the “good” 
category, corresponding to mean CRF values. Not using data 
of sedentary individuals allowed us to validate our proposed 
CRF classification chart, observing in which category sedentary 
individuals would fit.
According to our CRF classification chart, we confirmed 
that the CRF of active men is higher than that of active 
women of the same age group, and, for both sexes, active 
individuals had a better CRF as compared to sedentary 
ones. According to Nunes et al.,7 mean VO2 max values of 
women are lower than those of men, the mean VO2 max 
values of the former corresponding to only 70% of those of 
the latter. The present study showed a mean VO2 max of 
women corresponding to 76% to 83% of the mean VO2 max 
of men of the same age group.
Sedentary individuals not only had a lower VO2 max as 
compared to physically active ones, but also a twice higher 
decrease in VO2 max as age advanced.9,10 Regular exercise 
practice reduces the VO2 max rate of decrease as compared 
to a sedentary lifestyle,11 and, the greater the VO2, the greater 
the protection against cardiovascular events. An increase in 
aerobic capacity is associated with an increase in survival, 
as reported by Myers et al.,12 who have demonstrated a 
significant increase in the relative risk of death from any 
cause as functional capacity decreased, regardless of the risk 
factors involved. In addition, those authors have reported 
a 12%-increase in survival for each 1-MET increase in the 
CRF level.12
Most CRF classification charts used in clinical practice 
have been elaborated in other countries and have not been 
validated for the Brazilian population. Extrapolating those 
classifications to the Brazilian population can lead to relevant 
discrepancies. Belli et al.13 have shown significant discrepancies 
when comparing international charts with Brazilian data. 
391
Original Article
Herdy & Caixeta
Cardiorespiratory fitness classification
Arq Bras Cardiol. 2016; 106(5):389-395
Table 4 – Classification of cardiorespiratory fitness based on maximum oxygen consumption (VO2 max – mL/kg.min) for the male sex
Age group (years)
Very Low
Low
Fair
 Good
Excellent
15 – 24
< 25.30
25.30 – 40.48
40.49 – 48.07
48.08 – 53.13
> 53.13
25 – 34
< 23.70
23.70 – 37.92
37.93 – 45.03
45.04 – 49.77
> 49.77
35 – 44
< 22.70
22.70 – 36.32
36.33 – 43.13
43.14 – 47.67
> 47.67
45 – 54
< 20.25
20.25 – 32.40
32.41 – 38.47
38.48 – 42.52
> 42.52
55 – 64
< 17.54
17.65 – 28.24
28.25 – 33.53
33.54 – 37.06
> 37.06
65 – 74
< 15
15.00 – 24.00
24.01 – 28.50
28.51 – 31.50
> 31.50
Table 5 – Classification of cardiorespiratory fitness based on maximum oxygen consumption (VO2 max – mL/kg.min) for the female sex
Age group (years)
Very Low
Low
Fair
Good
Excellent
15 – 24
< 19.45
19.45 – 31.12
31.13 – 36.95
36.96 – 40.84
> 40.85
25 – 34
< 19.05
19.05 – 30.48
30.49 – 36.19
36.20 – 40.00
> 40.01
35 – 44
< 17.45
17.45 – 27.92
27.93 – 33.15
33.16 – 34.08
> 34.09
45 – 54
< 15.55
15.55 – 24.88
24.89 – 29.54
29.55 – 32.65
> 32.66
55 – 64
< 14.30
14.30 -  22.88
22.89 – 27.17
27.18 – 30.03
> 30.04
65 – 74
< 12.55
12.55 – 20.08
20.09 – 23.84
23.85 – 26.35
> 26.36
Table 6 – Classification of cardiorespiratory fitness based on maximum oxygen consumption (VO2 max – mL/kg.min) of the male and female 
sedentary population from the original study and according to the new cardiorespiratory fitness chart proposed in this study
Men
Age group (years)
Very Low
Low
Fair
Good
Excellent
15 – 24
VO2 = 47.4
25 – 34
VO2 = 41.9 
35 – 44
VO2 = 39.9 
45 – 54
VO2 = 35.6 
55 – 64
VO2 = 30.0 
65 – 74
VO2 = 23.2
Women
15 – 24
VO2 = 35.6
25 – 34
VO2 = 34.0
35 – 44
VO2 = 30.0
45 – 54
VO2 = 27.2
55 – 64
VO2 = 23.9
65 – 74
VO2 = 21.2
Nunes et al.7 have classified CRF into percentiles, similarly to 
Cooper et al., and have observed a difference in VO2 max 
when comparing the two charts.
VO2 max depends on a frequent and constant physical 
activity and can be enhanced with treinos.14 However, despite 
the volume or intensity of the workout raise VO2 max by 10 
to 30%, there is also an important genetic influence. Research 
has shown that genetic inheritance is the main responsible 
for max VO2 each individual and may be responsible for up 
to 25% to 50% of the variation in the values of VO2 max, ie, 
alone accounts for almost half of ACR.15
VO2 max can be measured directly by analyzing the gases 
expired during CPET, or indirectly, by using calculations. 
Although some prediction equations provide an acceptable 
392
Original Article
Herdy & Caixeta
Cardiorespiratory fitness classification
Arq Bras Cardiol. 2016; 106(5):389-395
Figure 1 – Behavior of maximum oxygen consumption (VO2 max – mL/kg.min) throughout the years in men.
Figure 2 – Behavior of maximum oxygen consumption (VO2 max – mL/kg.min) throughout the years in women.
association with values obtained via direct measurements, 
the difference varies, depending on the population studied. 
The error for one certain individual can be extremely high, 
ranging from 15% to 20% in some studies, and can even reach 
or exceed 30%, a high margin of error, considering other 
measurements in the biological area16.
According to data obtained in this study, VO2 max 
drops with age. That drop in women varies less from 
one age group to the other as compared to that in men.  
We observed a higher drop in VO2 max among active women 
from group 3 to group 4, with a mean of 0.38 mL.kg-1.min-1 
per year. Among sedentary women, that drop was sharper 
393
Original Article
Herdy & Caixeta
Cardiorespiratory fitness classification
Arq Bras Cardiol. 2016; 106(5):389-395
from group 2 to group 3, with a mean of 0.4 mL.kg-1.min-1 
per year. Among both active and sedentary men, however, 
the VO2 max drop was more marked from group 5 to 
group 6, with a mean of 0.53 mL.kg-1.min-1 per year among 
active men, and of 0.69 mL.kg-1.min-1 per year among 
sedentary men. Nunes et al.7 have shown a VO2 max drop of  
0.4 mL.kg-1.min-1 per year among men aged 20 to 60 years. 
Belli et al.,13 using indirect VO2 max measurement, have 
evidenced a drop of 20% to 25% per decade in mean VO2 
max from the age of 50 years onward, that drop being sharper 
after the age of 60 years. An approximate drop in VO2 max 
of 0.4 mL.kg-1.min-1 per year is estimated to occur from the 
age of 25 years onward, and that VO2 max decline is twice 
greater in sedentary individuals as compared to physically 
active ones.8,9
We used the new CRF classification chart to classify 
sedentary individuals undergoing CPET under the same 
conditions of the physically active ones from the original 
population. This would allow us to validate our proposed 
classification, considering how the VO2 max values of those 
individuals would fit. Differently from the studies estimating 
VO2 max indirectly, the direct measurement of VO2 max shows 
that CRF in sedentary individuals is classified, at the most, as 
fair, regardless of age and sex (Table 6). From the practical 
viewpoint, sedentary individuals have decreased tolerance 
to exertion, and, thus, physical exercise prescription to active 
and sedentary individuals should differ.17
The CRF chart by Cooper18 and that of the AHA19 
(Table 1) are the most commonly used tools to classify CRF 
in CPET programs in Brazil. However, the literature lacks 
data concerning sampling methods and sample types used 
to elaborate the AHA chart. Therefore, the comparison of 
data obtained in this study with the AHA chart is limited. Our 
classification comprises a wider age range, from 15 to 74 years, 
as compared to that of the AHA (20 to 69 years). The VO2 max 
analysis in both charts evidences, in younger age groups, very 
similar VO2 max values. However, in the other age groups, a 
greater difference is observed between our data and the VO2 
max values of the AHA chart. 
Most CRF charts published so far have been elaborated 
with CPET performed on a cycle ergometer. The VO2 max 
obtained in tests performed on a treadmill, as opposed to those 
performed on a bicycle, is approximately 5% to 17% higher 
(mean of 8%).20,21 The difference is attributed to the amount 
of active muscle mass involved in the test, which is greater 
for the inclined treadmill. Another important factor relates to 
the pedaling effect, which causes localized muscle fatigue by 
using the large muscle groups of the thigh, and that fatigue can 
occur before maximum exertion is imposed to the circulatory 
and respiratory systems, generating a lower VO2 max.2
In our study sample, the age range was wide, including 
adolescents older than 15 years. We believe that from that 
age on, individuals already have muscle maturation and 
performance close to those of young adults under the age 
of 25 years.22,23 The classification chart proposed should be 
assessed as an instrument to predict risk for morbidity and 
mortality, according to each individual’s functional profile. 
Further studies are required.
This study has limitations, such as the lack of standardization 
of ramp protocols. Individuals classified as physically active 
practiced different types of activities and sports, making the 
comparison of the results in different populations difficult. 
Further studies are required, using the same intensities 
and inclinations in the protocol ramp and with individuals 
practicing the same type of aerobic exercise, because that 
would improve the analysis and comparison of the results. 
Individuals with hypertension, diabetes or dyslipidemia, those 
on any type of medication, and those with a BMI greater 
than 30 (obese) were excluded, making the applicability of 
that classification in those subgroups uncertain. The Brazilian 
population is known to be diversified, and, in southern Brazil, 
the European colonization predominates (smaller percentage 
of Afrodescendant and Native individuals, as compared to 
other Brazilian regions). New studies should be developed, 
including different ethnicities and individuals from other 
Brazilian regions, aiming at comparing with the classification 
proposed to verify whether the values differ.
Conclusion
This is one of the few Brazilian studies to propose a CRF 
chart with data extracted from a robust population sample, 
and based on VO2 max measured via CPET on a treadmill. 
These data can be used for functional capacity classification 
according to sex and age group and considering different 
risk profiles.
Author contributions
Conception and design of the research: Herdy AH e Caixeta 
A. Acquisition of data: Herdy AH. Analysis and interpretation 
of the data: Herdy AH e Caixeta A. Statistical analysis: Herdy 
AH e Caixeta A. Obtaining financing: Herdy AH. Writing of 
the manuscript: Herdy AH e Caixeta A. Critical revision of the 
manuscript for intellectual content: Herdy AH e Caixeta A.
Potential Conflict of Interest
No potential conflict of interest relevant to this article 
was reported.
Sources of Funding
There were no external funding sources for this study.
Study Association
This study is not associated with any thesis or dissertation work.
394
Original Article
Herdy & Caixeta
Cardiorespiratory fitness classification
Arq Bras Cardiol. 2016; 106(5):389-395
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Brazilian Cardiorespiratory Fitness Classification Based on Maximum Oxygen Consumption.
Herdy, Artur Haddad,Caixeta, Ananda