The Longevity Testing Playbook: Where to Get VO2 Max, DXA, and ApoB Screens (Plus Affordable Alternatives)

The conversation around longevity emphasizes that proactive, early measurement of key physiological markers is necessary to manage healthspan and prevent death from the major diseases later in life. Experts recommend moving away from reactive "Medicine 2.0" (which treats disease once it appears) toward preventative "Medicine 3.0". This requires testing markers like VO2 max (the strongest measurable predictor of lifespan), ApoB (the true causal driver of atherosclerotic cardiovascular disease), and Bone Mineral Density (BMD) or DXA scans. The philosophy is that you must look for the "iceberg" of chronic disease long before it causes symptoms.

The primary pain point for the audience is the accessibility and financial cost of these crucial preventative tests. Many conventional doctors or the traditional medical system are seen as unwilling to order advanced metrics like ApoB or VO2 max testing unless the patient is already showing symptoms or is "sick". This lack of accessibility forces individuals to choose between paying potentially tens of thousands of dollars out of pocket for specialized consultations/testing or risking missing early signs of chronic disease. Furthermore, viewers are concerned about the ethical and financial implications of gaining this advanced data, worrying that health findings (like genetic predisposition scores) could lead to them being denied insurance coverage.

Focus on training the two most important, highly predictive metrics—VO2 Max and Muscular Strength—which require minimal equipment to significantly improve mortality risk. For VO2 max, those in the top 2% have a 400% lower mortality risk than those in the bottom 25%. Improving strength is essential, as the average 80-year-old man can triple his strength in 90 days with linear progression training.

Dr. Peter Attia
Dr. Attia is the primary expert addressing these highly technical metrics, advocating for aggressive prevention based on data.

• Clarity, Depth, Practicality: Dr. Attia stresses that VO2 Max is the most important measurable predictor of lifespan, emphasizing that aerobic fitness is critical to maintain mitochondrial and muscle function. He also highlights the need for DXA scans to evaluate bone density and the importance of ApoB over conventional LDL-C testing for cardiovascular risk. He points out the high cost of comprehensive screening tools, citing a $2,500 whole-body MRI scanner from Prenuvo.
• Unique Perspectives/Actionable Advice: He frames health not in terms of lifespan but healthspan—the quality of life up until the very end, which requires training the body now for the physical challenges of the "Marginal Decade". He suggests that maintaining grip strength and performing eccentric/plyometric movements are crucial indicators and training points for reducing the risk of fatal falls after age 65.

Dr. Topol (Referred to in related discussion)
Dr. Topol, in an interview format, contributed to the conversation about the future of advanced health assessment.

• Clarity, Depth, Practicality: The discussion around Dr. Topol covered the potential use of AI to comb through lab results to determine risk, as well as the utility of polygenic risk scores for predicting future illness. This approach focuses on synthesizing large amounts of individual data to identify predispositions early, aligning with the "Medicine 3.0" goal of deep prevention.

Focus on improving your baseline strength and movement skills by incorporating eccentric loading (the lowering phase of an exercise) to improve tendon elasticity and reduce fall risk, especially if you are over 40.

Common Mistake
Fix

• Mistake: Relying on consumer wearables (e.g., Apple Watch) for accurate VO2 max estimates.
  Fix: Understand that these devices are unreliable because true VO2 max requires a maximal effort, lab-grade test. Instead, focus on increasing your Zone 2 time (cardio where you can talk but not sing).
• Mistake: Avoiding heavy weights due to fear of injury or existing conditions (like spinal arthritis).
  Fix: Seek physician clearance and adapt the lifting protocol for bone density. Heavy resistance training has been shown to improve bone density even in women with osteoporosis (LYFTMORE study). The goal is loading the bone safely.
• Mistake: Assuming that LDL-C (LDL cholesterol) is the only necessary cardiovascular risk metric.
  Fix: Request an ApoB test. ApoB is considered the true causal driver of atherosclerosis, and a reading of 98 mg/dL in a young adult was seen as eye-opening.

• “Regarding the 1h58m07s mark on the $2500 MRI scanner from Prenuvo Vancouver / biograph.. is there an equally good recommendation for CT Scans (2 millisieverts)?”
• “The segment about VO2 max had me very curious…if you need “fancy”equipment and you must exert yourself to the absolute max, how on earth is the Apple Watch getting away with telling people their vO2 max? Let alone after a short, casual walk around my neighborhood? My watch has been telling me for years that my VO2 max is 21 which is knocking on deaths door apparently…with zero improvement despite literal years of trying to improve it with exercise. Now I’m questioning if it’s even remotely accurate…”
• “I was so surprised that Peter did not specify that jack should use a power plate to increase bone density which is supposedly the best method to increase bone density and is well known to be the best. Your response would be great to understand why a power plate exercise was not recommended.”

While gold-standard testing like high-level VO2 Max, DXA, and ApoB panels are critical benchmarks advocated by longevity experts, the reality is that the medical system often gatekeeps this data due to cost and a focus on treatment over prevention. For the average person, the most empowering and immediate action is to aggressively train the two largest modifiable variables—cardiorespiratory fitness (VO2 Max) and muscular strength—through consistent, progressively overloaded resistance training and Zone 2 cardio, thus acquiring the major health benefits without needing the expensive, hard-to-access test data upfront.