 When most people think about long-term health, they usually focus on things like cholesterol, blood pressure, blood sugar, or body weight.
And all of those things matter. But one of the strongest predictors of how long and how well you live may actually be how efficiently your body uses oxygen. That is what VO2 max measures. VO2 max is essentially a measurement of how much oxygen your body can take in and use during intense exercise. And while people often associate it with endurance athletes, it is really measuring something much bigger than athletic performance. It is measuring how well your heart, lungs, blood vessels, muscles, and mitochondria are all working together. Can your body bring in oxygen efficiently? Can it deliver that oxygen where it needs to go? And once it gets there, can your cells actually turn it into usable energy? It turns out that tells us a lot about overall health. VO2 Max Has A Huge Relationship With Longevity One of the statistics I mention in this episode is honestly pretty staggering. Some studies show that people in the lowest category for VO2 max have roughly a 500% higher risk of all-cause mortality compared to people with very high cardiorespiratory fitness for their age. That is a massive difference. I use smoking as an example a lot because everyone understands how harmful smoking is long term. The difference in mortality risk between smokers and non-smokers is somewhere around 50%. So when you look at VO2 max statistically, we are talking about something that appears to have an even larger relationship with long-term health outcomes. That is one of the reasons I think this conversation matters so much. VO2 Max Is Really A Measure Of Capacity One of the simplest ways I explain VO2 max to patients is this: It is basically a measure of the size of your engine. The bigger your engine, the easier it is for your body to handle physical and metabolic demands without getting overwhelmed. When cardiorespiratory fitness is low, normal daily life places much more stress on the system. Walking upstairs feels harder. Recovery takes longer. Energy drops faster. The body has to work much harder just to handle everyday demands. But when VO2 max improves, the body becomes much more efficient at producing and utilizing energy. And that tends to improve resilience across multiple systems. I use the example of a vehicle a lot with patients. If you constantly drive a vehicle at the very edge of what the engine can tolerate, eventually it starts wearing down much faster. The human body is not all that different. Higher VO2 Max Usually Means Better Overall Health One of the things that has become increasingly clear in the research is that VO2 max is connected to much more than exercise performance. A large meta-analysis published in 2024 showed strong relationships between cardiorespiratory fitness and multiple longevity markers including inflammation, blood pressure, cellular health, and metabolic function. As VO2 max improves, many other health markers tend to improve alongside it. That is why I think this matters for everyone, not just athletes. This is really about building a body that has enough capacity and resilience to stay healthy long term. Most People Stop Training This System One of the things I notice as people get older is that they gradually stop exposing themselves to higher cardiovascular demands. Once people reach their 50s and 60s, there is often this idea that getting your heart rate too high is dangerous or unhealthy. But for most people, the research really does not support that. In fact, appropriately training those higher heart rate zones appears to be very important for maintaining resilience, energy, and long-term health as we age. The good news is this type of training does not necessarily require hours and hours of cardio. Some of the most effective protocols are actually fairly short. The Norwegian 4x4 One of my favorite methods for improving VO2 max is something called the Norwegian 4x4. The structure is pretty straightforward: warm up for about five to eight minutes perform four minutes at roughly 85-95% effort recover actively for three minutes repeat that cycle four times I usually prefer using a bike for this because it lowers injury risk compared to running, especially for people who are not experienced runners. What makes this protocol so effective is that it forces the body to become more efficient at bringing in oxygen and using it under stress. And over time, the body adapts. I have seen dramatic improvements in VO2 max in patients doing this even once per week consistently over several months. Short Intervals Can Be Extremely Powerful Another protocol I really like is what we call a VO2 max boost. After a proper warm-up, you perform: 30 seconds all out followed by 90 seconds of active recovery And you repeat that six to eight times depending on fitness level. The key here is intensity. For those thirty seconds, you are pushing very hard. Then during recovery you allow your breathing and heart rate to settle before repeating the effort again. Despite how short these intervals are, the adaptations can be pretty remarkable over time. This Matters More As We Age One of the reasons I think VO2 max training becomes more important over time is because cardiorespiratory fitness tends to decline fairly sharply with age. But I do not think that decline is entirely inevitable. I think a large part of it is that most people stop challenging these systems enough as they get older. They stop training oxygen utilization, stop reaching higher heart rates, and gradually lose capacity over time. The body adapts to what we repeatedly ask it to do. And if we stop asking for resilience, we slowly lose it. Building A Bigger Engine Changes A Lot One of the things I love about VO2 max training is that the benefits usually extend far beyond exercise itself. People often notice better energy, better recovery, improved resilience, better physical capacity, and better overall function in daily life. And over time, that adds up to a healthier body with more energy, more resilience, and a much better chance of staying active long term. Derrick Hines, D.P.T., MS O.M.T. Acadiana Pain & Performance Rehab P.S. I break down why VO2 max may be one of the most important predictors of long-term health, resilience, and longevity. Click HERE to watch the video on YouTube
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 About 15 years ago, when I first started using laser therapy clinically, I honestly was not convinced it was going to make much of a difference.
At the time, the technology was much more limited than what we have available now, and I remember feeling somewhat skeptical about how impactful it could really be. After using it a handful of times, I eventually stopped pulling it out very often. Then I had a patient come in who kept specifically asking for laser treatment during his visits. I remember asking him one day if he actually felt like it was helping, and he immediately started showing me the changes in his knee. His swelling had improved, his motion had improved, and he had gone several weeks without another meniscus flare-up. That was one of the first moments where I realized there was probably much more happening physiologically than I initially understood. A lot has changed since then. The technology has improved dramatically over the last decade. Treatment depth has improved. The research has improved. And our understanding of how light interacts with human physiology has changed significantly as well. That is one of the reasons I wanted to sit down with Dr. Rob Hanopole for this conversation. You can CLICK HERE to watch the conversation Laser Therapy Is Very Different Than Most People Think One of the biggest misconceptions around laser therapy is that people tend to lump everything into the same category. Red light therapy, infrared therapy, LED panels, and medical laser systems all get grouped together online, but they are not all operating at the same therapeutic level. Some lower-powered devices can absolutely still provide benefits. People often notice improvements in circulation, skin health, inflammation, and recovery with them. But high-powered medical laser systems are designed to deliver energy much deeper into tissue, which creates a very different therapeutic effect when you are talking about healing injured tissue, improving recovery, or supporting regeneration. That distinction matters because healing is an energy-dependent process. Healing Starts At The Cellular Level One of the things we discussed heavily in this episode is mitochondria. Mitochondria are the energy-producing structures inside our cells. They help generate ATP, which is essentially the fuel cells use to do their jobs properly. When tissue becomes injured, inflamed, or chronically dysfunctional, energy production inside those cells often becomes impaired as well. That is part of what makes chronic injuries so frustrating. The tissue is trying to heal, but the environment surrounding that tissue is often working against recovery at the same time. Photobiomodulation, or laser therapy, appears to stimulate receptors inside cells that improve energy production. And when cells produce energy more efficiently, they tend to function more efficiently too. If cells are involved in tissue repair, they repair tissue more effectively. If they are regulating inflammation, they regulate inflammation more effectively. If they are helping build tendon, muscle, or connective tissue, those processes improve as well. That is one of the reasons laser therapy has become so interesting clinically over the last several years. Chronic Pain Often Involves Poor Recovery Capacity One of the things I think healthcare is beginning to understand more clearly is that chronic pain is not always simply a structural problem. Sometimes tissue never fully heals. Sometimes inflammation stays elevated longer than it should. Sometimes circulation is poor. Sometimes the nervous system stays locked into a protective response long after the initial injury occurred. And sometimes the body simply does not have enough cellular energy available to recover efficiently. This is where therapies that support healing at the cellular level become very interesting. Because instead of only asking how we reduce pain temporarily, the conversation starts shifting toward improving the environment that allows healing to happen in the first place. That is a very different approach to healthcare. The Conversation Around Disc Injuries Is Changing We also spent time talking about chronic spine and disc injuries because this is one of the areas where regenerative therapies and laser therapy are generating a lot of interest right now. Disc injuries can be incredibly frustrating for patients. Discs have relatively poor blood supply compared to many other tissues, which limits healing capacity. Once inflammation and nerve irritation become chronic, people often end up cycling through medications, injections, and sometimes surgery without ever feeling like the underlying issue fully resolved. That does not mean surgery is never appropriate because there are certainly situations where it is necessary. But more patients are beginning to ask whether there are ways to support healing before immediately moving toward more invasive interventions. That is one of the reasons regenerative medicine, photobiomodulation, biologics, peptides, and recovery-based therapies are growing so rapidly right now. People are becoming much more interested in helping the body repair itself more effectively instead of simply masking symptoms. Medicine Is Starting To Think About Healing Differently For a long time, healthcare focused heavily on chemistry and structure: medications, surgery, biomechanics, structural damage. And all of those things still matter tremendously. But we are also beginning to better understand the electrical and energetic side of human physiology. Cells communicate electrically. The nervous system functions electrically. Healing itself requires enormous amounts of energy. That is opening the door to therapies designed to support recovery and healing through cellular signaling and energy transfer instead of only chemical intervention. I think we are still very early in understanding where this field is ultimately going. Recovery Affects Much More Than Pain One of the reasons I find these conversations so interesting is because recovery affects nearly every aspect of long-term health. Recovery affects inflammation. It affects movement quality. It affects energy production. It affects nervous system regulation. It affects resilience and aging. The better the body recovers, the better it tends to function overall. That is why therapies focused on improving circulation, mitochondrial function, tissue healing, and recovery capacity are becoming increasingly important not only for injuries, but also for longevity, performance, and healthy aging. And I suspect we are only scratching the surface of what these therapies may eventually become capable of doing. Derrick Hines, D.P.T., MS O.M.T. Acadiana Pain & Performance Rehab P.S. You can watch a wonderful conversation I had with Rob Hanopole about Laser Therapy. Click HERE  One of the biggest mistakes people make with their health is assuming they need to completely change their life overnight.
They start thinking about inflammation, weight loss, hormones, sleep, exercise, stress, recovery, nutrition, and energy all at once. Eventually health starts feeling less like something they can improve and more like this giant problem they are constantly trying to catch up to. I see this all the time with patients. Someone comes in trying to improve their health, and they already have a long list of things they are attempting to fix simultaneously. They are trying to completely clean up their diet, exercise every day, improve sleep, lose weight, reduce stress, hydrate better, and somehow sustain all of it perfectly despite having work, responsibilities, kids, and a normal life layered on top of everything else. Usually what happens is they stay consistent for a couple weeks, get overwhelmed, fall off, and then feel like they failed. Health Is Built Through Momentum One of the concepts we come back to constantly in our practice is health momentum. The body functions as an interconnected system. Your physical health influences your hormonal health. Hormonal health affects metabolism, energy, mood, and recovery. Sleep quality affects inflammation, nervous system regulation, and resilience. Mental and emotional health influence physical health far more than most people realize. Everything affects everything else. That is why small improvements in one area often create changes in several others at the same time. Someone starts walking consistently and begins sleeping better. Better sleep improves recovery and energy, which makes movement easier to sustain. As movement becomes more consistent, inflammation, blood sugar regulation, and overall physical function often start improving too. The body responds very powerfully to repeated positive inputs. Most People Try To Build Too Much At Once I had a patient recently who came in struggling with chronic pain, inflammation, low activity levels, and weight gain. Like many people, he was trying to overhaul his entire health all at the same time. He had a long list of changes he wanted to make, but none of them were happening consistently enough to create real momentum. When we looked deeper at his daily habits, one thing stood out immediately: he was averaging roughly 2,000 steps per day. So instead of building a complicated plan, we focused entirely on movement consistency. The initial goal was simply getting to 5,000 steps per day. Once that became sustainable, we gradually pushed toward 7,500 steps daily, which is where research starts showing significant improvements in overall health outcomes. As that momentum started building, other habits became easier to maintain naturally. He gradually replaced soft drinks with carbonated water, his blood sugar became more stable, his energy improved, and over time his pain levels, mood, and weight all started moving in a healthier direction as well. Six months later, he had lost around twenty pounds and felt dramatically different physically and mentally. The biggest shift was not one dramatic intervention. It was finally creating enough consistency that healthier behaviors stopped feeling like a constant battle. The Body Responds Better To Consistency Than Intensity I think many people misunderstand how health transformation actually happens. They assume progress requires extreme discipline, a perfect routine, or some major life overhaul that starts immediately. But the body usually responds better to consistency than intensity. Walking every day changes physiology. Improving sleep habits changes physiology. Getting outside in the morning sunlight changes physiology. Small improvements in hydration, movement, recovery, and stress management all begin influencing multiple systems over time. Initially those habits may not feel significant, but once they start stacking together, momentum begins building much faster than people expect. The First Five Days Matter More Than Most People Think One thing we often discuss with patients is making sure a habit happens consistently during the first five days. Research on habit formation shows that early consistency dramatically increases the likelihood that a behavior becomes sustainable long term. That is why I usually encourage people to start with something manageable enough that they know they can maintain it consistently. For one person that may be getting outside every morning for ten minutes. For someone else it may be improving hydration. For another person it may be adding a short walk at the end of the day or turning screens off earlier at night. The specific habit matters less than building enough consistency for momentum to start developing. Because once momentum starts building, healthier decisions begin reinforcing each other naturally. One Healthy Habit Usually Leads To Another One of the fascinating things about human physiology is that improvements in one system often create positive effects in several others. Better movement improves metabolic health and recovery. Better recovery improves sleep and energy. Better sleep improves inflammation, hormone regulation, and nervous system function. Over time, those systems begin reinforcing each other in a very powerful way. That is why people are often shocked by how different they feel six months after making what initially seemed like a relatively small change. Health momentum tends to build gradually at first, and then suddenly people realize their energy is better, they are moving better, sleeping better, recovering better, and functioning differently overall. The process usually starts much smaller than people expect. Start Creating Momentum You do not need to completely overhaul your life overnight. You do not need a perfect routine before you begin. And you do not need to fix every aspect of your health immediately in order to start moving in the right direction. Sometimes the most important thing you can do is identify one habit you know you can sustain consistently and begin there. That may be improving hydration, walking a little more each day, getting outside in the morning, improving sleep habits, or replacing one unhealthy behavior with a healthier one. Small actions repeated consistently create very large changes in human physiology over time. And once momentum starts building, the process of improving your health becomes much more sustainable and much more powerful than most people realize. Derrick Hines, D.P.T., MS O.M.T. Acadiana Pain & Performance Rehab  One of the conversations I have fairly often with patients and even other practitioners is around the idea that a certain treatment “doesn’t work.”
Recently, I was talking with another doctor about a patient case, and somewhere in the conversation he said, “Physical therapy doesn’t work for that condition.” And my immediate response was: What do you mean by physical therapy? Because that definition changes the entire conversation. We Have Reduced Physical Health Into Something Far Too Small If physical therapy simply means stretches, exercises, hot packs, electrical stimulation, and a few rehab drills, then yes, there are situations where that approach is not enough. But that is also an incredibly narrow way to think about physical health. When we look at patients in our practice, we are not just looking at muscles and joints. We are looking at the systems that create physical health in the first place. The nervous system, immune system, cellular health, metabolism, movement quality, recovery capacity, and very often mental and emotional health all influence how someone feels and functions physically. And all of those systems influence each other continuously. That is why two people can walk in with similar symptoms and respond completely differently to the exact same treatment plan. The Problem Is Often Bigger Than The Symptom A patient may improve strength but still have a nervous system stuck in a chronic stress response. Someone else may improve mobility while poor sleep and inflammation continue limiting tissue healing and recovery. Another person may temporarily reduce pain while underlying metabolic dysfunction continues affecting energy production and resilience. The body compensates extremely well until it cannot anymore. And when symptoms finally become noticeable, they are often connected to several systems underperforming at the same time rather than one isolated issue. That is where many people get stuck. A treatment may improve one area while another major contributor to the problem continues driving dysfunction underneath the surface. Healthcare Often Separates Problems That Are Deeply Connected I think this is one of the biggest limitations in modern healthcare right now. We tend to separate everything into categories: physical therapy mental health pain management exercise nutrition recovery As if those systems are operating independently from each other. But sleep quality affects inflammation. Inflammation affects pain sensitivity and tissue healing. Stress affects nervous system regulation and recovery capacity. Poor metabolic health affects cellular energy production. Movement quality affects circulation, stability, tissue resilience, and joint health. You cannot completely separate those things because the body does not separate them. The longer you work with patients, the more obvious this becomes. Good Practitioners Look For The Weakest System When someone is not improving, the conversation should not immediately become: “Well, that treatment just doesn’t work.” The better question is: What system are we missing? Because if the symptoms are not improving overall, there is usually a system contributing to the problem that has not been identified or addressed effectively yet. That is how we approach physical health in our practice. We try to identify the system functioning at the lowest level and improve it as effectively and efficiently as possible. Then we look at the systems being negatively impacted by that dysfunction and improve those too. Sometimes that involves rehabilitation and movement. Sometimes it involves sleep, stress management, recovery, supplementation, peptides, lifestyle change, or nervous system regulation. Sometimes mental and emotional health become a major part of the conversation because those things directly influence physiology and healing capacity. The point is that physical health is never just physical. If You Feel Stuck, Keep Looking Deeper One of the most damaging things a patient can hear is: “There is nothing else you can do.” Because in many cases, that statement really means: “We have not identified the primary driver yet.” The body is designed to heal, adapt, and recover when the systems involved are supported appropriately. That process is not always simple. Sometimes it requires testing. Sometimes it requires a different practitioner or a more comprehensive approach. Sometimes it requires looking beyond the obvious symptom and asking deeper questions. But reducing complex human physiology down to “this treatment works” or “this treatment does not work” misses how interconnected the body really is. So if you feel like you have tried everything already, I would encourage you not to stop searching for answers too early. Instead of only asking: “What treatment should I try next?” Start asking: “What system has not been addressed yet?” Derrick Hines, D.P.T., MS O.M.T. Acadiana Pain & Performance Rehab |
AuthorDerrick Hines, D.P.T. is the owner of Acadiana Pain and Performance Rehab. The information in this blog is personal opinion and not to be used as medical advice. Archives
May 2026
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