Metabolic equivalent of task
The metabolic equivalent of task (MET), often abbreviated as MET, is a standardized physiological unit that quantifies the intensity of physical activities by expressing their energy cost as a multiple of the resting metabolic rate (RMR). One MET is defined as the rate of energy expenditure required for quiet sitting, equivalent to an oxygen consumption of 3.5 milliliters of oxygen per kilogram of body weight per minute (mL O₂/kg/min).[1] This measure allows for the comparison of energy demands across diverse tasks without needing individualized calculations of absolute caloric burn.[2] The concept of MET originated in 1941, when A. P. Gagge, A. C. Burton, and H. C. Bazett introduced it as part of a system for describing human heat exchange with the environment under thermal comfort conditions, defining 1 MET as approximately 50 kcal/m²/h or 18.7 Btu/h/ft² based on average adult values.[3] It evolved into a key tool in exercise physiology during the late 20th century, particularly with the creation of the Compendium of Physical Activities in 1989 by William Haskell and Barbara Ainsworth at the University of Minnesota, which assigned standardized MET values to over 400 activities to address inconsistencies in physical activity assessments for epidemiological studies.[4] Subsequent updates to the Compendium—in 2000, 2011, and 2024—have refined these values using measured oxygen uptake data, expanding its utility to include modern activities like video gaming and improving precision for research and public health applications.[4] METs are applied across fields such as exercise prescription, cardiology, and public health to estimate energy expenditure, classify activity intensity, and evaluate functional capacity. For instance, activities are categorized as light (1.6–3.0 METs, e.g., casual walking), moderate (3.0–6.0 METs, e.g., brisk walking), or vigorous (≥6.0 METs, e.g., running), helping to meet guidelines like 150–300 minutes of moderate-intensity activity per week for adults.[5] In clinical contexts, peak MET achievement during exercise testing predicts prognosis—such as <5 METs indicating poor cardiovascular outcomes—while preoperative assessments use MET levels to stratify surgical risks, with inability to perform >4 METs signaling elevated perioperative complications.[2] Despite its convenience, MET assumptions can vary by age, fitness, and body composition, prompting ongoing refinements for accuracy.Definitions
Physiological basis
The metabolic equivalent of task (MET) is defined as the ratio of the metabolic rate during a specific physical activity to the metabolic rate at rest. This ratio captures the relative increase in energy demands imposed by the activity compared to baseline physiological function.[6] Energy expenditure during physical activities is fundamentally tied to cellular respiration processes, where oxygen consumption serves as the primary physiological proxy for metabolic work. In aerobic metabolism, which predominates in sustained tasks, oxygen is essential for oxidizing substrates to generate adenosine triphosphate (ATP), the energy currency of cells; thus, measuring oxygen uptake provides a direct indicator of the rate at which energy is produced and utilized.[7][8] MET standardizes activity intensity by expressing it relative to rest, enabling consistent evaluation of workload irrespective of individual variations in body composition or baseline metabolism. This normalization facilitates cross-individual comparisons in exercise physiology, as it accounts for differences in resting energy needs while focusing on the proportional escalation during activity.[6] The MET concept originated in mid-20th-century exercise physiology to quantify task demands systematically, building on early efforts to relate human energy output to environmental interactions. Seminal work in 1941 introduced a unit for metabolic heat production at rest as a benchmark for activity evaluation.Quantitative formulations
The metabolic equivalent of task (MET) is quantitatively defined as the ratio of the metabolic rate for a given physical activity to the resting metabolic rate.[9] By international convention, 1 MET corresponds to an oxygen consumption (\dot{\text{VO}}_2) of 3.5 milliliters per kilogram of body mass per minute (mL/kg/min) while sitting quietly at rest.[1] This standard value equates approximately to an energy expenditure of 1 kilocalorie per kilogram of body mass per hour (kcal/kg/h).[10] An alternative formulation adjusts for individual variability in resting metabolic rate (RMR), which can differ based on factors such as age, sex, body composition, and fitness level; in this approach, MET is computed as the metabolic rate during activity divided by the person's measured RMR (typically expressed in mL/kg/min or kcal/kg/h).[9][11] This individualized ratio provides a more precise estimate than the fixed 3.5 mL/kg/min benchmark, which represents an average for young adults but overestimates RMR in older or smaller individuals and underestimates it in larger or more active ones.[11] In mechanical terms, 1 MET approximates 1 watt of power output per kilogram of body mass, derived from the energy equivalent of oxygen consumption (where 1 liter of O_2 yields about 20.1 kJ of energy, adjusted for respiratory efficiency); refinements may incorporate body surface area (e.g., in m²) for applications like cardiac stress testing to normalize across body sizes.[12][1] The standard equation for calculating MET values is: \text{MET} = \frac{\dot{\text{VO}}_{2,\text{activity}} - \dot{\text{VO}}_{2,\text{rest}}}{3.5 \, \text{mL/kg/min}} where \dot{\text{VO}}_{2,\text{activity}} is the oxygen uptake during the activity and \dot{\text{VO}}_{2,\text{rest}} is the resting value (assumed as 3.5 mL/kg/min unless measured individually).[9] This formulation yields the net MET increment above rest. For gross MET (total including baseline), divide the full activity \dot{\text{VO}}_2 by 3.5 mL/kg/min.[1] The 3.5 mL/kg/min denominator derives from early measurements of basal oxygen uptake in a reference 70-kg, 40-year-old man at rest (approximately 250 mL/min total \dot{\text{VO}}_2, normalized per kg); this value, derived from basal conditions, is conventionally applied to sitting rest.[1]History and Development
Origins of the MET concept
The term metabolic equivalent of task (MET) was first coined in 1941 by A. P. Gagge, A. C. Burton, and H. C. Bazett as part of a system for describing human heat exchange with the environment under thermal comfort conditions. They defined 1 MET as approximately 50 kcal/m²/h or 18.7 Btu/h/ft², based on average adult values for resting energy expenditure.[6] This provided an early standardized unit for expressing metabolic rates relative to rest. The concept built on foundational studies of basal metabolic rate (BMR) conducted in the early 1900s. Researchers such as Francis G. Benedict and J. Arthur Harris developed predictive equations for BMR in 1919, based on measurements of oxygen consumption under standardized resting conditions, which established a benchmark for resting energy needs influenced by factors like age, sex, and body weight. These BMR investigations provided the physiological reference point for later activity-based metrics, emphasizing the need to express energy costs relative to rest to account for individual variability. In the 1950s, the MET concept took shape through compilations of energy expenditure data aimed at standardizing the caloric costs of occupations and physical tasks, particularly in industrial physiology and military training. Reginald Passmore and John V.G.A. Durnin published a seminal review in 1955 that synthesized calorimetry measurements from diverse activities, including factory labor (2–5 kcal/min), mining (3.5–7.1 kcal/min), and military marching or load-carrying (up to 10 kcal/min), to inform nutritional requirements and work efficiency in demanding environments. This work shifted focus from absolute caloric values to relative assessments, highlighting the practical utility of ratios to resting metabolism for comparing activity intensities across populations. The standardization of the MET value in exercise physiology occurred in the early 1960s. In 1960, Bruno Balke recommended the use of the MET with a standardized resting value of 3.5 mL O₂/kg/min, defining it as the ratio of activity oxygen uptake to this resting value, enabling straightforward quantification of physical demands without individual BMR adjustments.[4] This definition was widely adopted by the American College of Sports Medicine (ACSM) in the 1970s for exercise testing protocols, as outlined in its inaugural 1975 guidelines for graded exercise prescription, which used METs to classify intensity levels and assess functional capacity. A pivotal milestone came in 1989 when Barbara Ainsworth, William Haskell, and colleagues developed the first Compendium of Physical Activities through a collaboration involving researchers at Stanford University and the University of Minnesota, assigning MET values to over 400 tasks to enhance comparability in epidemiological research on physical activity and health outcomes.[4]Compendia and standardization efforts
The Compendium of Physical Activities was initially developed in 1989 as a collaborative effort among researchers to standardize the classification and energy expenditure estimation of physical activities, with its first edition published in 1993. This foundational version included 477 specific activities organized under 19 major headings, drawing from existing metabolic studies to assign metabolic equivalent of task (MET) values. Subsequent updates expanded and refined the database: the 2000 edition added 129 new activities and modified 94 existing codes to incorporate emerging data on energy costs, while the 2011 update introduced 217 new codes, increasing the total to 821 and ensuring 68% of entries were based on directly measured METs from controlled studies. The most recent 2024 adult compendium represents the third major update, adding 303 new activities and adjusting 176 existing MET values based on a systematic review of literature from 2011 to March 2023, resulting in a total of 1,114 activities for adults aged 19–59 years.[13][14][13] The development process for each compendium edition involves rigorous systematic reviews of peer-reviewed studies on energy expenditure, prioritizing data from direct or indirect calorimetry measurements to derive MET values, which are then standardized relative to resting metabolic rate. Activities are coded using a five-digit system for precise identification and comparability across research; for instance, code 17152 is assigned to walking at 2.0 to 2.4 mph on a level, firm surface. This methodology ensures consistency in epidemiological studies by linking codes to evidence-based MET intensities, with updates removing outdated entries and incorporating new physiological data to reflect contemporary lifestyles and measurement technologies. The process emphasizes transparency, with full bibliographies provided for each MET assignment to allow verification and further research.[13][15][14] To address age-specific variations in energy expenditure, international adaptations have extended the framework beyond the original adult focus. The Youth Compendium, published in 2018, tailors MET estimates (denoted as METy) for children and adolescents aged 6–18 years across 196 activities in 16 categories, using youth-specific oxygen consumption data and imputation models for missing values to account for developmental differences. Similarly, the Older Adult Compendium, released in 2024, provides MET values (MET60+) for 99 activities relevant to individuals aged 60 and older, derived from 68 studies and adjusted for age-related declines in resting metabolism. These adaptations promote broader applicability in population health research.[16] Global standardization efforts have been advanced by organizations such as the World Health Organization (WHO) and the American College of Sports Medicine (ACSM), which integrate MET-based metrics into their physical activity guidelines to facilitate cross-cultural comparisons and policy implementation. The WHO's 2020 guidelines recommend accumulating 150–300 MET-minutes per week of moderate-intensity activity for adults, relying on compendium-derived values for intensity classification, while ACSM endorses the compendium in its position stands and educational resources to ensure uniform assessment in exercise prescription worldwide. These initiatives underscore the compendium's role in harmonizing data across diverse populations and settings.[17][18][19] Recent advances in the 2024 adult update highlight efforts to enhance inclusivity by incorporating data from studies on diverse populations, including young-to-middle-aged Chinese adults, and addressing gaps in non-Western activities such as futsal and culturally specific household tasks. New entries reflect modern trends, including e-sports under a dedicated video games heading and remote work options like treadmill desks, drawn from 701 papers yielding 2,356 energy expenditure measurements to better represent global variability in physical demands. This iterative refinement continues to evolve the compendium as a dynamic tool for equitable health surveillance.[13]Measurement Approaches
Direct assessment methods
Direct assessment of the metabolic equivalent of task (MET) relies on indirect calorimetry as the gold standard laboratory technique for precisely quantifying energy expenditure through physiological gas exchange measurements during physical activities.[20] This method uses open-circuit spirometry to capture and analyze expired air, determining oxygen uptake (VO₂) and carbon dioxide output (VCO₂) to compute the metabolic rate.[21] By establishing the actual energy cost of activities, indirect calorimetry provides the empirical foundation for MET calculations, ensuring accuracy beyond predictive estimates.[22] The standard protocol involves steady-state exercise testing, where participants perform controlled activities on treadmills or cycle ergometers at predetermined intensities to achieve a stable metabolic response.[23] Steady state is typically reached after 3 to 5 minutes of submaximal effort, during which VO₂ stabilizes; values are then averaged over 1 to 2 minutes for reliability.[24] Treadmill protocols often vary speed and grade to simulate walking or running, while ergometer tests adjust power output in watts, allowing replication of specific tasks like those in occupational or recreational contexts.[25] The measured VO₂, normalized to body weight in mL/kg/min, is divided by the conventional resting value of 3.5 mL/kg/min to derive the MET.[26] Specialized equipment, known as metabolic carts, facilitates these assessments by integrating gas analyzers—such as paramagnetic sensors for O₂ and nondispersive infrared analyzers for CO₂—with flow meters and computer software for real-time data processing.[27] Systems operate in breath-by-breath or mixing-chamber modes to calculate the respiratory exchange ratio (RER) alongside VO₂, enabling verification of steady-state conditions (RER ≈ 0.8–1.0 for aerobic exercise).[28] Heart rate is routinely monitored via electrocardiography or telemetry to gauge overall cardiovascular response, though it functions as an indirect proxy for intensity rather than a primary MET determinant.[29] These direct methods play a pivotal role in validating and refining MET assignments in standardized resources, such as the Adult Compendium of Physical Activities, where post-2011 publications using indirect calorimetry have updated over 200 activity codes with measured values.[22] For example, American College of Sports Medicine (ACSM) protocols for treadmill-based testing employ indirect calorimetry to calibrate metabolic equations for walking and cycling, demonstrating close alignment between measured and predicted energy costs in controlled studies (e.g., differences <5% at moderate intensities).[26] Such validations ensure that compendium METs reflect real-world physiological demands, supporting applications in exercise science and public health.[30]Indirect estimation techniques
Indirect estimation techniques for metabolic equivalent of task (MET) values rely on non-invasive, practical methods suitable for field-based or population-level assessments, often approximating energy expenditure without direct measurement of oxygen consumption. These approaches prioritize accessibility and scalability over laboratory precision, enabling estimates in everyday settings through self-reported data, motion sensors, or physiological proxies like heart rate. Validation against gold-standard methods, such as indirect calorimetry, demonstrates reasonable accuracy for group-level inferences but highlights individual variability due to factors like body composition and activity type. Self-report tools provide a cost-effective means to estimate METs by capturing participants' recollections of activities, which are then mapped to standardized energy costs. The International Physical Activity Questionnaire (IPAQ), developed in 1998 and widely adopted for global surveillance, uses short or long forms to query time spent in moderate, vigorous, and walking activities across domains like work, transport, and leisure. Responses are scored in MET-minutes per week by multiplying reported durations by assigned MET values—such as 3.3 METs for walking and 4.0 METs for moderate-intensity tasks—allowing aggregation into low, moderate, or high activity categories. Validation studies confirm IPAQ's utility for estimating total physical activity energy expenditure, though it tends to overestimate vigorous efforts compared to objective measures. Similarly, the Bouchard Activity Diary, introduced in 1983, records activities in 15-minute intervals over three days, including a weekend, with each period coded to a MET value based on compendia like those from Ainsworth et al. This diary has been validated against doubly labeled water for total energy expenditure in free-living adults and children, showing correlations up to r=0.85, making it suitable for longitudinal tracking in diverse populations. Wearable devices, including accelerometers and commercial fitness trackers, estimate METs by analyzing motion patterns and integrating auxiliary data like heart rate to infer energy demands. Accelerometers, such as those in research-grade ActiGraph monitors, detect body accelerations to classify activities and apply proprietary or machine learning-based algorithms to derive MET equivalents; for instance, vector magnitude counts are calibrated against lab-measured VO2 to predict intensities from sedentary (1-2 METs) to vigorous (>6 METs). Consumer devices like Fitbit and Apple Watch extend this by combining triaxial accelerometry with optical heart rate sensing, using regression models trained on large datasets to output real-time MET estimates during daily tasks. Studies in free-living conditions report mean absolute percentage errors of 10-20% for these devices against indirect calorimetry, with better performance for locomotion than non-ambulatory activities like cycling. Recent advancements incorporate machine learning to personalize estimates based on user demographics, improving accuracy for heterogeneous groups. Heart rate-based estimation leverages the linear relationship between heart rate (HR) and oxygen uptake (VO2) during steady-state exercise to approximate METs without gas analysis. Individualized regression models, calibrated via submaximal tests, predict VO2 from HR data, then convert to METs using the formula MET = VO2 (mL/kg/min) / 3.5. A widely used equation, developed by Keytel et al. in 2005, computes energy expenditure in kJ/min as a function of HR, age, weight, and sex—for men: EE = -55.0969 + 0.6309 × HR + 0.1988 × weight (kg) + 0.2017 × age (years); for women: EE = -20.4022 + 0.4472 × HR - 0.1263 × weight + 0.074 × age—followed by conversion to VO2 and METs. This method, applicable via chest straps or wearables, achieves prediction errors below 15% for submaximal activities when personalized, though it underperforms at low intensities due to HR's non-specificity to movement efficiency. The doubly labeled water (DLW) technique serves as a reference for validating indirect MET estimates in free-living conditions by measuring total energy expenditure over 7-14 days through isotopic dilution of deuterium and oxygen-18 in body water. Administered orally, the isotopes track CO2 production via urine sampling, yielding average daily MET equivalents when divided by basal metabolic rate; it has confirmed the validity of self-reports and wearables, with accelerometers showing 10-25% underestimation of free-living METs compared to DLW-derived values. Despite its expense and inability to resolve task-specific METs, DLW remains essential for calibrating population algorithms, as demonstrated in studies benchmarking devices against this criterion.Applications
Physical activity evaluation
The metabolic equivalent of task (MET) provides a standardized unit for quantifying physical activity intensity, enabling the aggregation of activity data to evaluate overall daily or episodic levels. To assess total physical activity, MET-minutes or MET-hours are calculated by multiplying the MET value of an activity by its duration in minutes or hours, then summing these values across bouts or an entire day.[31] For example, 30 minutes of brisk walking at 4 METs yields 120 MET-minutes, and weekly totals are obtained by accumulating such values from all activities.[32] This approach allows for a comprehensive summary of activity volume, often targeting 500–1,000 MET-minutes per week as a benchmark for health benefits in population assessments.[31] Physical activity levels are categorized based on MET intensity to classify patterns from low to high effort. Sedentary activities involve ≤1.5 METs, such as sitting or reclining; light-intensity activities range from 1.6 to 2.9 METs, including leisurely walking; moderate-intensity activities span 3.0 to 5.9 METs, like brisk walking or light housework; and vigorous-intensity activities involve ≥6.0 METs, such as jogging or heavy yard work.[5] These categories facilitate the evaluation of lifestyle patterns, distinguishing between prolonged sedentary behavior and active episodes to identify health risks associated with inactivity.[33] In population surveillance, MET-based metrics track trends in physical activity and compliance with health recommendations. The National Health and Nutrition Examination Survey (NHANES) employs MET values derived from self-reported and objective data to monitor activity levels across demographics, revealing shifts in sedentary time and moderate-to-vigorous activity over time.[34] This enables public health analyses, such as estimating the proportion of adults meeting activity thresholds and correlating MET-derived volumes with outcomes like obesity prevalence.[35] MET-weighted activities integrate with energy balance assessments to estimate total daily energy expenditure (TDEE). By assigning MET values to all waking and sleeping hours—typically 1 MET for rest or sleep—and summing MET × duration × body weight, TDEE approximates kcal burned over 24 hours, aiding evaluations of caloric needs and weight management.[36] For instance, a day's activities totaling an average of 1.5 METs across 24 hours for a 70 kg person yields roughly 2,520 kcal in TDEE.[37] Wearables can provide MET estimates to support such daily evaluations.[31]Exercise prescription and guidelines
The World Health Organization (WHO) and the American College of Sports Medicine (ACSM) incorporate MET values into their physical activity guidelines to recommend weekly exercise volumes for health benefits in adults. WHO advises at least 150–300 minutes of moderate-intensity aerobic physical activity or 75–150 minutes of vigorous-intensity activity per week, or an equivalent combination.[17] Similarly, ACSM endorses ≥150 minutes of moderate-intensity (3–5.9 METs) or ≥75 minutes of vigorous-intensity (≥6 METs) cardiorespiratory exercise weekly, with combinations calibrated to similar MET-minute totals for flexibility in prescription.[38] These targets aim to enhance cardiorespiratory fitness while minimizing injury risk through scalable intensity. MET-based intensity zones align with subjective and objective markers for precise exercise dosing. Moderate intensity (3–5.9 METs) corresponds to Borg Rating of Perceived Exertion (RPE) scores of 12–14 ("somewhat hard") on the 6–20 scale, while vigorous intensity (≥6 METs) aligns with RPE 15–17 ("hard" to "very hard").[39] Target heart rate zones, derived from MET equivalents via percentage of heart rate reserve (%HRR) or maximal oxygen uptake (%VO2max), further support this: moderate efforts typically fall at 40–60% VO2R (equivalent to 3–6 METs relative to an individual's peak), and vigorous at 60–85% VO2R (>6 METs).[38] These correlations enable clinicians to cross-validate intensity without direct MET measurement. Personalized exercise prescriptions using MET adjust for baseline fitness to ensure safety and progression. For beginners or sedentary individuals, programs often initiate aerobic exercise at 3–4 METs (e.g., light walking or cycling) to build tolerance before advancing to guideline targets.[38] In cardiac rehabilitation, prescriptions tailor MET levels to stress test results, starting at 40–60% of achieved peak METs (typically 3–5 METs initially) and progressing by 0.5–1 MET every 1–2 weeks to optimize recovery without overload.[40] MET informs targeted programs for outcomes like weight loss or rehabilitation by selecting activities with defined intensities. For weight management, moderate sessions such as brisk walking (≈3.5 METs) accumulate toward 500–1,000 MET-minutes weekly, equivalent to the recommended 150–300 minutes of moderate-intensity activity, to promote caloric expenditure sustainably.[26] In cardiac rehab, vigorous options like jogging (≈8 METs) are reserved for higher-fitness patients, contrasting with lower-intensity alternatives to match recovery phases and reduce cardiovascular strain.[41]Reference Values
Activity-specific MET assignments
The Metabolic Equivalent of Task (MET) values for specific activities are compiled in standardized resources like the 2024 Adult Compendium of Physical Activities (for ages 19-59), which categorizes them into broad groups such as household chores, occupational tasks, leisure pursuits, and sports to facilitate consistent use in research and practice.[26] These assignments are derived by averaging energy expenditure data from empirical studies using indirect calorimetry, where METs represent the ratio of activity-specific oxygen consumption to a resting rate of 3.5 mL/kg/min.[26] Variability arises from factors like intensity levels and measurement precision, with compendium entries using 5-digit codes—the first two digits denoting the category (e.g., 05 for household activities) and the last three specifying the activity—to indicate data quality and allow for updates based on new evidence.[26] Household activities typically range from light to moderate intensity, such as sweeping floors at 3.3 METs or mowing the lawn with a push mower at 6.0 METs (moderate effort).[42] Occupational tasks often involve sedentary to light efforts, exemplified by light office work at 1.5 METs, with modern updates including active workstations like treadmill desks at 2.8 METs (walking 1.0-2.0 mph).[42] Leisure activities cover low-energy options like seated video gaming at 1.3 METs, while sports and conditioning can reach vigorous levels, such as running at 6.7 mph (10.5 METs) or moderate bicycling at 12–13.9 mph (8.0 METs).[42] The 2024 compendium introduces METs for contemporary activities, including vigorous virtual reality fitness gaming at 9.8 METs and e-bike commuting at 6.8 METs, reflecting evolving lifestyles and technology.[42] To illustrate representative MET assignments across categories, the following table summarizes selected activities from the 2024 compendium, focusing on averaged values with noted intensity ranges where applicable:| Category | Activity Example | MET Value | Code |
|---|---|---|---|
| Household | Cleaning, sweeping floors, general | 3.3 | 05010 |
| Household | Lawn mowing, push mower, moderate effort | 6.0 | 08110 |
| Occupational | Sitting, light office work | 1.5 | 11580 |
| Occupational | Treadmill desk, walking 1.0–2.0 mph | 2.8 | 11004 |
| Leisure | Seated video game, handheld controller | 1.3 | 22040 |
| Leisure | Fishing, standing, casting | 3.5 | 04040 |
| Sports | Walking, 3.0 mph, moderate pace | 3.8 | 17190 |
| Sports | Bicycling, 12–13.9 mph, moderate effort | 8.0 | 01030 |
| Modern | E-bike for transportation | 6.8 | 16005 |
| Modern | VR fitness gaming, vigorous intensity | 9.8 | 22360 |
| Sports | Running, 6.7 mph | 10.5 | 12060 |
| Leisure | Dancing, general, moderate effort | 5.0 | 03010 |
| Household | Cooking or food preparation, standing | 3.5 | 05049 |
| Occupational | Construction, heavy lifting | 8.0 | 11050 |
Demographic and peak MET considerations
Peak metabolic equivalent of task (MET) capacity declines progressively with age, reflecting reductions in cardiovascular efficiency, muscle mass, and maximal oxygen uptake (VO2max). As of the 2021 FRIEND update, in young adults aged 20-29 years, the 50th percentile peak MET value (treadmill testing) is approximately 13.3 for men and 10.5 for women, equivalent to VO2max values of 46.5 and 36.6 ml/kg/min, respectively. By ages 60-69 years, these values drop to about 7.0 METs for men and 5.6 METs for women (VO2max of 24.6 and 19.6 ml/kg/min), and further to 5.9 METs for men and 4.9 METs for women in the 70-79 age group. This age-related decline averages 0.7-1.0 MET per decade after age 30, accelerating in later years due to physiological changes such as decreased cardiac output and sarcopenia. Additionally, resting metabolic rate (RMR), the basis for 1 MET (standardized at 3.5 ml/kg/min), is lower in older adults, often around 2.6 ml/kg/min, necessitating adjustments to MET calculations for accurate energy expenditure estimates in this population to avoid overestimation. For adults over 60, the Older Adult Compendium provides age-adjusted MET values.[43][44][45] Sex differences in peak MET capacity arise primarily from greater skeletal muscle mass and higher hemoglobin levels in males, leading to superior oxygen transport and utilization. Men consistently exhibit 20-30% higher peak MET values than women across age groups; for example, in the 40-49 age range, the 50th percentile is approximately 10.1 METs for men compared to 7.3 METs for women. Data from national surveys like NHANES indicate similar patterns, with men achieving higher exercise capacities (e.g., 8.0 METs vs. 6.7 METs in middle-aged adults), though these differences narrow slightly in older age due to menopause-related changes in women. These disparities underscore the need for sex-specific reference values in assessing aerobic fitness.[46][47] Other demographic factors influence MET capacity and estimation. Obesity is associated with lower peak MET values for a given activity intensity due to increased body mass, which elevates absolute energy demands while reducing relative efficiency; individuals with higher body mass index (BMI) often achieve 1-2 fewer METs during maximal exercise compared to normal-weight peers. Fitness level, quantified as VO2max expressed in METs, directly reflects aerobic capacity, with higher values (e.g., >10 METs) indicating better cardiovascular health and lower mortality risk, independent of age or sex.[47][48]| Age Group (years) | 50th Percentile Peak METs (Men) | 50th Percentile Peak METs (Women) |
|---|---|---|
| 20-29 | 13.3 | 10.5 |
| 30-39 | 11.3 | 8.1 |
| 40-49 | 10.1 | 7.3 |
| 50-59 | 8.3 | 6.5 |
| 60-69 | 7.0 | 5.6 |
| 70-79 | 5.9 | 4.9 |