Understanding RMR & V02 Max

Understanding RMR

What is Resting Metabolic Rate (RMR)?

Metabolism, quite simply, is the conversion of food to energy.

Metabolic rate is a measure of how much food, or fat, is converted to energy in a day. Resting metabolic rate (RMR) is the measurement of how much food, or energy, is required to maintain basic body functions such as heartbeat, breathing, and maintenance of body heat while you are in a state of rest. That energy is expressed in calories per day. So an RMR test shows how many calories you burn at rest, doing nothing more than sitting in a chair.

How Does It Work?

Indirect calorimetry (a measurement of metabolic rate) relies on the fact that burning 1 calorie (Kilocalorie) requires 208.06 milliliters of oxygen. Because of this very direct relationship between caloric burn and oxygen consumed, measurements of oxygen uptake (VO2) and caloric burn rate are virtually interchangeable.

Oxygen uptake requires a precise measurement of the volume of expired air and of the concentrations of oxygen in the inspired and expired air. The process requires that all of the air a person breathes out be collected and analyzed while they rest quietly. The KORR™ indirect calorimeters contain a precision air flow sensor that measures the volume of expired air, and an oxygen sensor that measures the concentration of oxygen. Once the factors of humidity, temperature and relative humidity are accounted for, the KORR™ instrument provides the most accurate results available in a compact metabolic analyzer.

Why Test RMR to Treat Obesity?

  • Proof of “normal” metabolism

Most overweight people are convinced they have a slow metabolism. The truth is that statistically, most overweight and obese individuals have average or higher than average metabolic rates. Taking a measurement removes this excuse. Seeing that their bodies can indeed burn calories can be very encouraging and motivating.

  • Stabilize weight loss

Regardless of the method used to lose weight, a patient’s RMR will decrease after weight loss. The decrease is actually below the level predicted by fat-free mass (FFM). Although the cause is unclear, it appears that in most cases, if a patient can maintain his new weight for 6 months, his RMR will eventually rise to the expected level. Pinpointing the precise number of calories necessary to maintain is key to surviving this crucial period.

  • Pinpoint caloric weight loss zone

When restricting calories, knowing a baseline RMR is invaluable. KORR Metabolic Analyzers calculate a “weight loss zone” for 1 ½ pound a week weight loss, or practitioners can use the RMR to calculate a caloric goal unique for their patients.

  • Detection and Diagnosis of hypo-metabolism

In cases where a patient has a clinically low metabolic rate, further diagnosis and treatment by a physician will be required before successful weight loss can be achieved.

  • Assess the effect of weight loss treatment on metabolism

Once calories are restricted, medications are introduced, or an exercise plan has been implemented, the human body will respond. This is especially true of significant interventions, such as bariatric surgery. The caloric goals of a dietary plan will rarely sustain a patient throughout an entire weight loss regimen. The result is the dreaded “plateau.” Periodic assessment of RMR will show the effects of the treatments and allow adjustments to the caloric goals.

Why Test RMR for Nutritional Assessment?

  • Proper nutritional care is VITAL for the hospitalized patient. Studies show that hospital stays are reduced an average of 60% when nutritional status is evaluated and needs are met.
  • The formulas that predict caloric needs for nutritional assessment (Harris Benedict, Miffin, etc) are inadequate for certain populations, especially sick or hospitalized patients. RMR is recommended for the following populations:All patients receiving parental or enteral nutrition
    • Hypermetabolic patients (burns, trauma, sepsis, head injury)
    • Starvation-adapted or malnourished patients
    • Extremely obese patients (>=200% of ideal body weight)
    • Patients with non-healing wounds
    • Patients with abnormal body composition (multiple sclerosis, cerebral palsy, cystic fibrosis, spinal cord injury, amputations).
    • Patients who can benefit from education about appropriate calorie intake.

How to add RMR Testing

How to add RMR testing to my practice


Frequently Asked Questions (FAQ)

Below are some frequently asked questions about RMR. If you have a question that is not anwered below, please contact us at 1-800-895-4048 or fill out our contact form on our contact page.

Why measure RMR rather than use predictive formulas?

Predictive formulas have been used for years because an actual measurement through Indirect Calorimetry has not been practical. But the truth is, while predictions might hold their ground statistically, when applied to individuals, they are woefully inadequate. In an examination of published articles examining the validity of various predictive equations, Frankenfield, Roth-Yousey and Compher found that even the best equation (Miffin-St Jeor) was only within 10% of measured results. While 10% may seem statistically acceptable, for the individual desiring to lose weight, an RMR estimate that is 10% higher (2200 kCals) than an actual measurement of 2000 kCals a day would be significant. That additional caloric intake would result in 21 pounds gained in one year! Additionally, these same researchers noted that errors and limitations with equations exist when applied to individuals, and that “RMR estimation errors would be eliminated by valid measurement of RMR with indirect calorimetry.” (Frankenfield D, et al, J Am Diet Assoc. 2005 May;105(5):775-89.)

Additional researchers at the University of Pennsylvania noted that the obese have Resting Energy Expenditures that are particularly difficult to predict. Their findings read, “Caloric prescription for weight reduction must be tailored to individuals rather than recommending the same caloric intake to persons with varying metabolic rates.” (Foster GD, et al, Metabolism. 1988 May;37(5):467-72.)

What is the effect of dieting on RMR?

Each individual will react differently to dietary changes which is why a true measurement of RMR is so valuable. But if a patient reduces calories, don’t be surprised if their RMR also goes down. This may or may not be in conjunction with weight loss. It is critical to measure those changes periodically to make the necessary adjustments in diet and exercise to keep patients on track and avoid the dreaded “plateau.” (Martin)

Does RMR change after weight loss?

Often after a significant weight loss, RMR is depressed even lower than expected relative to the change in body composition. Most researchers point to this as a key factor in the high rate of weight regain among the formerly obese. Identifying this post-diet RMR is a vital step that is key to long term weight loss success. It gives the information necessary to set an appropriate caloric goal for maintenance and teach a patient to eat within the constraints of their new metabolic requirements. (JequierElliot)

What is the effect of resistance training on RMR?

When calorie intake remains unchanged, even a minimal resistance training program (10-15 mins per session, 3 times per week) can result in an increase in RMR. (Kirk)

If calorie intake is decreased, most studies indicate that strength training can reduce the loss of fat-free mass (lean muscle) but not prevent the decline in RMR that invariably comes with dieting.(Geliebter)

But studies are difficult to compare and summarize due to the many differences in the resistance training protocols and experimental designs. Researchers at West Virginia University found success maintaining RMR through intensive high volume resistance training designed to affect more muscle groups and by increasing protein intake to 80 g/day. (Bryner)

What is the effect of aerobic exercise on RMR?

Although many studies have been done regarding this question, there is not a simple answer to this question due to the many variables involved: the type, duration, frequency and intensity of exercise, degree of energy deficit, total daily calorie intake, and distribution of calories between fats, proteins, and carbohydrates. A conservative summary of the existing research would be that RMR does decrease significantly in response to a diet of less than 1000 Kcals per day, and that the addition of moderate intensity aerobic exercise (50%-70% maximum aerobic capacity) performed for 30-60 minutes, 4-5 times per week decreases this response but does not return RMR to baseline. (Connolly)

Does RMR decline with age? Why?

Resting Metabolic Rate declines slightly as individuals’ age. The cause is not clear. One reason may be due in part to a slowed metabolic rate of individual organs, such as the brain, liver, heart, and kidneys. These organs alone account for 60% of RMR in adults, and all but the heart decrease in mass with advancing age. Another cause may be a tendency for decline in physical activity and a sedentary lifestyle that leads to a decrease in lean mass and bone mineral density. (St-Onge)

Is RMR affected by pregnancy?

Studies show a considerable variation in the individual metabolic response to pregnancy, and thus the additional energy required to support a pregnancy. The individual increases in RMR can range from 456 KJ/d to 3389 KJ/d. Though clinicians often recommend an additional energy intake of 1250 KJ/d to their pregnant patients, the data suggests that this single recommendation is not justified. Metabolic testing would more precisely indicate the caloric needs of individual pregnant patients. (Kopp-Hoolihan LE)

What is the application for pediatric patients?

In a study performed at the Children’s Hospital of Philadelphia, the pediatric population of both obesity and failure to thrive ages 2 months to 20 years were evaluated using both Resting Energy Expenditure and predictive equations. The predictive equations were Harris Benedict, the Food & Agriculture/World Health Org/United Nations Univ., and 2 from Schofield. The results showed such a wide variability in REE measurements with poor correlation to predictive equations that the researchers concluded that REE should be measured in patients for whom knowledge of caloric expenditure is required for clinical care. (Kaplan AS)

How is RMR affected by eating disorders?

Studies indicate that these types of disorders can cause adaptive changes in metabolic rate, but these changes are highly individual and unpredictable. The question becomes relevant during nutritional therapy when it is time to set a caloric prescription. Caloric requirements based on empirical data or predicative formulas have been shown to be highly inaccurate for this population. For example, normal weight bulimics show evidence of a higher than predicted REE when binge eating, with a decrease in REE once eating behavior is controlled. For those suffering from anorexia nervosa, refeeding is associated with an increase in REE that cannot be explained by increased body mass. In each of these cases, consistent measuring of RMR throughout the treatment process is warranted to maintain the correct caloric prescription to aid recovery. (SchebendachKrahnLeonard)

How does caffeine affect RMR?

As with any chemical ingested, rate of absorption, individual tolerance, and dosage relative to body weight all factor in to a person’s unique response. Under controlled conditions, studies suggest that caffeine can raise RMR at a rate relative to the dose ingested: around a 4% increase with 100 mg of caffeine, increasing up to as much as 15% with 500 mg (equivalent to 5 cups of coffee). It is a short lived increase – no more than 3 hours. This potential effect is why caffeine consumption is discouraged prior to testing with KORR products. (Dulloo,Acheson)

Understanding VO2

What is a VO2 Max Test?

A VO2 Max Test is a measurement that reflects a person’s ability to perform sustained exercise. It is generally considered the best indicator of cardiovascular fitness and aerobic endurance. The actual measurement is “milliliters of oxygen used in one minute per kilogram of body weight.” It is suitable for a wide range of individuals, from the sedentary to elite athletes.

How is VO2 Max Measured

VO2 Max is the maximum rate of oxygen consumption that can be attained during the most intense exercise possible. The measurement requires that the subject breathe into an oxygen consumption analyzer during an all-out effort (usually on a treadmill or bicycle) as part of a graded exercise protocol. These protocols involve specific increases in the speed and intensity of the exercise. While exercising, the person wears a mask to collect all the air he breathes in and out for a measurement of the volume of exhaled gas and the concentration of oxygen in that exhaled gas. This determines how much oxygen is used during each minute of the exercise test.

A person’s oxygen consumption rises in a linear relationship with exercise intensity — up to a point. There are specific physiological markers (AeT, AT) that can be detected throughout the test as oxygen consumption is measured. Eventually, oxygen consumption plateaus even if the exercise intensity increases. When the person is no longer able to keep up with the oxygen demands of his muscles and complete fatigue forces him to stop exercising, then his oxygen consumption has reached a maximum, and VO2 Max can be calculated. The test usually takes between 10 and 15 minutes.

Why Test VO2 Max?

A complete VO2 Fitness test can give trainers and clients the tools to set realistic goals and assess improvement. Studies show that previously sedentary people training at 75% of aerobic power for 30 minutes, 3 times a week over 6 months increase VO2 Max an average of 15-20%. Many people are inefficient exercisers, with no understanding of what specific heart rate, intensity or duration would best help them reach their specific goals such as fat burning, endurance training, or cardio conditioning. An initial VO2 Max test can clarify the specific target heart rates that will enable each individual to reach their fitness goals more effectively, with less fatigue and fewer injuries. Periodic retesting provides motivating feedback as the fitness program progresses.

The test also determines the number of calories burned during every level of exercise, providing valuable information when designing a weight loss program. And if CO2 is measured during the test, a Respiratory Exchange Ratio (RER) can determine the proportion of energy coming from carbohydrates and fats at various levels of exercise intensity. Since physical conditioning and exercise intensity affect these proportions, this information can be very helpful when designing a workout intended to burn fat.

VO2 Max testing is a valuable tool for serious athletes to assess performance and evaluate training regimens. Even though extensive training can sometimes cause an athlete to reach a plateau in VO2 Max, he can still use his VO2 Max test results to make further improvements in performance. This is accomplished as he pushes to increase anaerobic threshold (AT) and maintain that threshold for longer periods of time. This enhances both endurance and cardiovascular performance.

What is Aerobic Threshold?

Aerobic threshold (AeT) is the first rise or breakpoint in the ventilatory response to increasing rate or grade of exercise. (Sharkey 2002) CardioCoach detects the rise in the ventilatory response and correlates it to your heart rate. The aerobic threshold defines the minimal level of effort that can produce improvement in cardiovascular fitness.

What is Anaerobic Threshold?

The anaerobic threshold (AT) is defined as the level of exercise intensity at which lactic acid builds up in the body faster than it can be cleared away.  Lactic acid build up generally leads to muscle fatigue and soreness. Vigorous effort can be sustained for an extended duration at exercise intensity levels below the anaerobic threshold. AT can be detected by 2 different means: Ventilatory Threshold, or Respiratory Exchange Ratio threshold.

Respiratory Exchange Ratio (RER) is the ratio of expired carbon dioxide to oxygen uptake at the level of the lung. When Carbon dioxide production exceeds oxygen uptake, the RER crosses 1.00. This is anaerobic threshold.

Ventilatory Threshold (VT) is the point during progressive exercise in which ventilation increases disproportionately to oxygen uptake. Ventilation increases to rid the body of the excess Carbon dioxide from lactic acid build up. AT is detected by pinpointing the take off (rising) point in the Ve/VO2 ratio.  (Meyers, 1996)

What is the difference between Anaerobic Threshold and Lactate Threshold?

Lactate Threshold is a reference to the accumulation of Lactate in the blood. There are some inconsistencies in the terminology, though. Some use the term to denote the initial rise in lactic acid production. More often, Lactate Threshold is used to describe the maximum steady state effort that can be maintained without lactate continually increasing.  This abrupt increase in blood lactate levels is also referred to as the lactate turn point (LT), lactate inflection point (LIP), or onset of blood lactate accumulation (OBLA). (Roberts & Robergs 1997)

The Anaerobic Threshold is defined as the level of exercise intensity at which lactic acid builds up in the body faster than it can be cleared away.  Because this is measured by Ventilatory responses (Ve/VO2 or VO2/VCO2), it is often more accurately termed Ventilatory Threshold (VT). (Meyers, 1996)

What is the difference between RER and RQ?

Respiratory Exchange Ratio (RER) is the ratio of expired carbon dioxide to oxygen uptake at the level of the lung.

Respiratory Quotient (RQ) is the ratio of expired carbon dioxide to oxygen uptake at the level of tissue or cells. Sometimes this term is used interchangeably with RER, but that is incorrect. A VO2 Max test measures RER. (Meyers, 1996)


Frequently Asked Questions (FAQ)

Below are some frequently asked questions about V02 Max. If you have a question that is not anwered below, please contact us at 1-800-895-4048 or fill out our contact form on our contact page.

Do you need to measure CO2 to detect Anaerobic Threshold?

The key to determining Anaerobic Threshold (AT) during a VO2 Max test is to detect the point when the body is forced to expel the surplus CO2 produced as a result of excess lactate. This can be determined one of 2 ways:

  1. Measuring VCO2/VO2 (volume CO2/volume O2) and detecting the point when that ratio (RER) equals 1.00. This is the Respiratory Exchange Ratio method.
  2. Measuring Ve/VO2 (Minute Ventilation/volume O2) and detecting the respiratory compensation point. This is the ventilatory equivalent method.

Multiple studies (1,2) have shown that both methods are valid and reliable for determining AT among healthy subjects. KORR offers products that utilize both methods of AT detect to best meet customer needs. A comparison of methodologies in detection of the anaerobic threshold. Dickson K, Barvik S., Aarsland T, Snapinn S, KarlssonJ. Circulation 1990 Jan;81(1 Suppl):II38-46. A new method for detecting anaerobic threshold by gas exchange. William L. Beaver, Karlman Wasserman, and Brian J. Whipp Journal of Applied Physiology 60:2020-2027, 1986

How does VO2 Max differ between men and women?

Women typically tend to have a lower VO2 Max than men.

Does VO2 Max change with age?

For men and women, VO2 Max will decrease by 10% per decade regardless of age and exercise activity.

Is VO2 Max affected by a person's size?

VO2 Max is unique to each person and directly proportional to their height, weight, and body surface area. VO2 Max correlates 0.63 with body mass, 0.85 with fat-free body mass, and 0.91 with active muscle tissue.

Does where I live affect my VO2 Max?

VO2 Max is reduced for residents of temperate or tropical areas (compared to those living in circumpolar regions). Also, VO2 Max is reduced by approximately 26% at an altitude of 4,000 meters. This reduction increases as altitude increases.

Utilizing Your Results

Understand fat metabolism during exercise

Dr. Edward F Coyle, University of Texas at Austin