VO2 max is the maximum rate at which your body can take in and use oxygen during intense exercise. It is a strong marker of aerobic fitness and general health, and it improves with a combination of high-intensity intervals and large volumes of easy aerobic work.
It is usually expressed in millilitres of oxygen per kilogram of bodyweight per minute. It reflects the whole oxygen transport chain: How much blood the heart can pump, how well that blood carries oxygen, and how effectively the working muscle extracts and uses it. For most trained people, the heart's pumping capacity is the main limitation.
A laboratory test with a mask and a graded protocol is the accurate method. Field estimates from watches and fitness tests are convenient and useful for tracking change over time, but the absolute numbers should be treated loosely.
Genetics set a large part of both the starting point and the ceiling. Training age, bodyweight, and current fitness all matter. Because the figure is expressed per kilogram, changes in bodyweight alter it without any change in cardiovascular function.
Beyond sport, cardiorespiratory fitness is consistently associated with better long-term health outcomes, and it is one of the more modifiable markers available. For athletes, a higher ceiling supports repeated efforts and faster recovery between them.
The underlying physiology is covered in Exercise Physiology and Energy Systems.