New Findings What is the topic of this review? The limits to maximal aerobic capacity. What advances does it highlight? A synthesis of data and ideas about what limits maximal aerobic capacity demonstrates the central roles of cardiac output, stroke volume and red blood cell mass in the complex physiological responses to maximal exercise. In healthy humans these factors, along with skeletal muscle blood flow, dominate systemic delivery of oxygen to the contracting muscles and set the upper limit of aerobic energy production by skeletal muscles. In elite athletes and patients with pulmonary disease the lungs can also limit oxygen uptake and delivery. In this paper we review the physiological determinants of VO2max and discuss the role this variable plays as a determinant of endurance exercise performance. Because the ability to sustain a given pace during a competitive athletic event requires competitors to `manage` fatigue and go as fast as possible without fatiguing prematurely, VO2max is one of the variables that sets the physiological upper limit for sustained energy production by the contracting skeletal muscles.
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