1) Mary Ann previously had a normal VO2max for her age and gender, which was enough for a sedentary lifestyle. Her new training program provided an overload that caused her body to adapt over the long term. 2) As Mary Ann engaged in running, swimming, and cycling for months, her cardiovascular system adapted and her VO2max increased. However, the degree of improvement can vary greatly between individuals. 3) Mary Ann's increased VO2max is due to adaptations in her heart, lungs, blood vessels, muscle mitochondria, and blood management that occurred as a result of her endurance training. These adaptations allow for more efficient oxygen use and energy production during exercise.

1. MOOC Science of Exercise, Coursera / Final Assignment / January 2018
1/2
Previously to this training programme, Mary Ann had a normal VO2max for her age and
gender. This VO2max was enough for a sedentary lifestyle and her body was in a stable
internal body environment, it was in homeostasis.
Her new training programme was an overload to her body, which tends to respond (short-
term) and adapt (long-term) under stress in order to achieve a new homeostatic state. The
specificity principle says that only stimulated systems or muscles adapt. As Mary Ann has been
running, swimming and cycling for months, great endurance exercises during a relevant period
of time, it caused an adaptation in her cardiovascular system and consequently, an increase
in her VO2max.
This improvement is clearly a consequence of her (well planned) training, but the magnitude
of the improvement varies greatly from person to person (principle of individuality). It means
another sedentary 27-year-old female with the same initial VO2max that follows the same
training is likely to improve to a different degree. Finally, it is worth to remember that this
improvement in VO2max is largely reversible and once the training ceases it can return to the
previous level after a few months without training.
Now that we have reviewed the principles of exercise physiology, let’s look in detail at Mary
Ann’s body adaptations. But first of all, what is the meaning and importance of VO2max value?
VO2max is the maximum Oxygen (O2) a person can use, measured in mg.kg-1.min-1, and it
reflects the adaptations to exercise, especially endurance training. It is a great indicator of the
cardiovascular and health levels in general. High VO2max means the person can perform
moderate intensity exercises for long periods (1 hour or more) or do her/his daily tasks
without getting tired.
VO2 max is defined by the Fick equation as:
VO2max = Cardiac Output x (a-v)O2 difference
Where Cardiac Output is defined as:

2. MOOC Science of Exercise, Coursera / Final Assignment / January 2018
2/2
Cardiac Output = Stroke Volume x Heart Rate (HR)
Stroke volume is the volume of blood pumped from the left ventricle per heartbeat. As an
indicative value, the stroke volume of a healthy 70 kg man is 70 mL. But this value is likely to
increase in trained people. High VO2max implies a healthy and big heart.
Heart rate (HR) is usually defined as the number of heart beats per minute. The maximum HR
does not increase with training. It decreases with age and, during a given exercise or rest, it is
lower for trained people. So, since the HR does not increase, an increase in maximum cardiac
output reflects an increase in stroke volume.
Finally, (a-v)O2 difference is the difference between arterial O2 concentration and venous O2
concentration. It should be high (for high VO2max) and it measures the amount of O2
absorbed by mitochondria, within cells. The arterial O2 concentration is affected by the lungs'
ability to transfer O2 from the air to the blood. A high VO2max implies efficient and big lungs.
More haemoglobin (red blood cells) in blood also helps absorbing more O2 and training in
altitude (less O2 available) is meant to increase haemoglobin.
The venous O2 concentration should be low, meaning the mitochondria were able to absorb
most of the available O2 from the blood. The efficient usage of available O2 by mitochondria
also implies good blood flow in the muscles, efficient vasodilation and vasoconstriction, good
vascularization and developed capillaries to deliver oxygenated blood where it is needed.
More O2 absorbed means more ATP (energy) consumed. Since the ATP storage in the muscles
is very low, more ATP consumed demands (and develops the ability of) more ATP production.
More ATP production requires more O2 and implies more and bigger mitochondria to produce
and store enough ATP. We have more mitochondria in muscles type I (the slow muscles).
ATP can be produced without oxygen from carbohydrates, but much less ATP is produced
compared to the aerobic way. This is why we get tired quickly during an extreme effort (or
vigorous intensity exercises). There are also fewer mitochondria and capillaries in fast muscles
type II.
The aerobic way is much more efficient but slower at producing ATP, so it is the preferred way
for moderate intensity exercises. Another characteristic is it also uses fats which is an excellent
energy source, as shown below.
Glucose (sugars) + 6O2 -> 30 ATP + 6CO2 + 6H2O
Palmite (fats) + 23 O2 --> 108 ATP + 16 CO2
All these adaptations (on the heart, lungs, arteries, capillaries, mitochondria and blood
management) happened in Mary Ann’s body as a consequence of her endurance training
allowing this increase in VO2max from 38 to 52 ml/kg/min.