Andrew Irwin, MD, CSCS

Vital Capacity

Clinical medicine, organized around how you train.

Vital Capacity is being built for a small number of patients who want their care organized around performance, prevention, and a longer, healthier life. It will combine advanced labs, VO₂ max testing, DEXA body composition, age- and risk-appropriate cancer screening, and a medical plan that evolves as labs, training, and body change.

Join the founding interest listDownload The 7 Tests

Or take the Capacity Quiz — 12 questions across six systems. Your weakest one named, and the first thing to do about it.

Built by Andrew Irwin, MD, CSCS. Internal medicine physician. Ironman and Hyrox competitor. Founding patients deliberately limited.

Model
Performance medicine
Practice
A small founding cohort, by application
Entry
Annual full diagnostic day, then longitudinal care
Core data
VO₂ max, DEXA, strength, advanced lipid panel, cancer screening
Principle
Clinical medicine and exercise physiology, integrated

The promise

A clinic for longer, healthier lives.

My promise is to use the data that decides how the next decades actually go — cardiometabolic, performance, longevity — to help patients stay strong, capable, and hard to break.

Who this is for

  • Your basic labs look fine, but you suspect the metabolic and cardiovascular story is incomplete.
  • You train seriously and want medical care that integrates load, recovery, injury risk, and how you'll perform over decades.
  • You want a doctor who understands your training and can communicate directly with your coach or trainer.
  • You want VO₂ max, DEXA, advanced lipid panel, fasting insulin, cancer screening, and wearable trends interpreted together.
  • You want medical follow-through organized around a longer, healthier life — what to treat, repeat, refer, adjust, or watch.

Who this isn't for

  • Full-scope primary care, urgent care, or 24/7 access.
  • Supplement stacks, daily programming, meal plans, or a lab-report subscription.
  • Lab dashboards and longevity reports without medical follow-through.

Sample case · composite for illustration

A breakdown of every metric, the areas to improve, and the medical plan that follows.

A future patient should leave knowing what's limiting performance and elevating future disease risk, the evidence behind it, the first actions, the retest plan, and the medical decisions that need follow-up.

VO2 max

Cardio

58

96th percentile

ApoB

Treatable risk

98

risk-enhanced

Lp(a)

Family context

62

genetic signal

Fasting insulin

Metabolism

14

above target

Vital Capacity Client Arc Report

Elite fitness, hidden metabolic risk

Composite

M.K. / 47 / C-suite

VO2 max

58

96th percentile

ApoB

98

risk-enhanced

Lp(a)

62

genetic signal

Fasting insulin

14

above target

Primary bottleneck

Cardio is elite. Metabolism isn't keeping up.

Physician recommendation

Start moderate-intensity statin therapy concurrently with lifestyle intervention. Family history, Lp(a), ApoB, and borderline blood pressure make delay the wrong default.

Top actions

  • Eliminate fasted high-intensity sessions.
  • Anchor meals: protein and fiber first.
  • Reduce training volume 15-25% for six weeks.

Retest clock

  • Fasting insulin and glucose at week 8.
  • OGTT with insulin at week 12.
  • ApoB and lipid panel at 3-4 months.

Coordination flags

  • Sports dietitian if adherence stalls.
  • Cardiology trigger if symptoms or CAC shift.
  • Family screening context for inherited risk.

Prepared by Andrew Irwin, MD, CSCS. This sample reflects a composite teaching case and the intended standard for future Vital Capacity clinical documentation.

Inside the assessment

The five systems we test.

A longer, healthier life depends on five connected systems. Most care looks at one at a time. This practice maps all five — in one place, with one physician — and names the one limiting you now.

01

The Engine

Cardiorespiratory

How well you use oxygen

How well your heart and lungs deliver oxygen to working muscle. The ceiling that shapes both performance today and how long you stay capable.

02

The Fuel System

Metabolic

How you handle fuel

How your body handles fuel — glucose, insulin, where fat is stored. The system that drives most preventable disease over the next thirty years.

03

Load Tolerance

Musculoskeletal

How your body holds up under load

Whether your body can carry the load you place on it. What determines if you stay strong and mobile into your eighties.

04

The Infrastructure

Vascular

Where your heart risk really sits

The long-term trajectory of your heart and arteries, independent of how you feel today. The system most often caught too late.

05

Regulation

Recovery

How well you bounce back

Whether you're adapting to the load — or breaking down quietly while the numbers still look fine. The earliest signal something else is going wrong.

Each system gets a clinical question and the data to answer it. The full method lives on the services page.

Year over year

The Performance Arc. Your medical record of how you age — owned for life.

Built with your physician, year by year. The document showing how you age — written down, kept current, and yours to keep.

Year 1

Baseline

All five systems mapped for the first time. The starting plan, written and explained.

Year 3

Trajectories

Two full years of trends across labs, performance, and recovery. The plan adapts as your body tells us where it's headed.

Year 5

Multi-year arcs

What's actually changed across all five systems. What worked, what didn't, and what your data means for the family members who share it.

Year 10+

Clinical biography

A decade of your physiology in one document. The clearest record anyone will have of how you aged.

Andrew Irwin, MD, CSCS

Founder

Andrew Irwin, MD, CSCS

Internal medicine physician. Certified Strength and Conditioning Specialist. Ironman and Hyrox competitor. Years on both sides of medicine and performance.

I have worked in Himalayan villages with no internet and no backup. I have taken care of patients whose bodies were too weak to tolerate the treatments meant to save them. I have also lived the training side personally, where the data matters and vague advice falls apart.

When I take a patient on, I make the clinical decisions: which tests, which treatments, which referrals. Explain the reasoning and follow what happens over time.

Vital Capacity is the attempt to build the kind of medical relationship that should exist for serious adults who want to stay strong, capable, and hard to break for decades.

Read the full story

Future availability

Applications will open in phases.

The first group will be small by design. The full practice will also stay small — deliberately capped.

The first step is an application, then a deep diagnostic day. Together they decide whether ongoing care makes sense.

Subscribers will be notified first when the interest list opens.

Join the founding interest list

Start here

Start with The 7 Tests. Follow what comes next.

Subscribers hear first — when applications open, and on everything Vital Capacity publishes between now and then.

Join the founding interest listDownload The 7 Tests

Or take the Capacity Quiz — 12 questions across six systems, your weakest one named in the results.