Midlife gets a bad rap – it's associated with words like 'crisis' and 'spread'.
There's no doubt that middle age can bring challenges, such as a tendency to gain weight and more aches and pains. But what if the negative stereotype was turned upside-down, and midlife was seen as an opportunity to focus on improving your health?
Figures from the OECD show that the average woman lives to age 83, so at 50, you have around 30 years left.
This makes midlife an ideal time for a health makeover.
"It's a unique opportunity [to spend] 12 or 18 months working on building back up the reserves that you've left depleted for a long time," says specialist sports physiotherapist Trish Wisbey-Roth.
Many women have put their health on hold while raising families and establishing careers, which often continues until they become physically or emotionally unwell, Trish explains, and they often come to this crossroads in their forties or early fifties.
She adds that one of the biggest hurdles women face is menopause.
Women's bodies respond differently to menopause, but typical challenges include mood swings, decreased bone density, and a higher prevalence of pain in muscles and tendons.
"You can make a choice of living with those things and then gradually decreasing how much you do," says Trish, or "make changes that support healthy ageing.
"A lot of women, including myself, don't really want to admit that they're getting older. The reality is that time moves on, but how time influences you is really up to you."
Women live about three years longer than men, however they are "almost four times more likely to have a severe disability or limitation than men, so we're living longer but not well," says Professor Cassandra Szoeke, the director of the Women's Healthy Ageing Project at the University of Melbourne.
She explains that the leading causes of death in women – including dementia – take decades to develop.
Research has shown it takes about 30 years for amyloid – a protein found in brains with Alzheimer's disease – to rise from normal to disease-causing levels, says Professor Szoeke.
Similarly, the blood vessel changes leading to heart disease and stroke develop over decades.
This means midlife choices have profound ramifications for how well you age.
"If you're not doing things at 50, then you're not protecting yourself at 80," Professor Szoeke says.
"We're looking for healthy living, not being disabled or frail."
Good nutrition is key to living better for longer.
Professor Szoeke acknowledges that nutrition information can be confusing, but the most important thing is having a generally healthy diet.
"We found that women who are eating junk food as a pattern had more amyloid in their brain."
Her research has shown that the Mediterranean diet can reduce morbidity, and that high-density lipoprotein (good cholesterol) is particularly important for women.
"In our studies we found that it was the most important cholesterol for cognition."
She recommends eating green leafy vegetables and avoiding processed foods or excessive fat.
Reviewing your smoking and drinking is vital, says geriatrician Professor Maria Fiatarone Singh.
"You don't have to give up on the idea of preventive health even if you've been a smoker your whole life or drinking excessively," she says.
"The risk of heart disease, asthma and stroke come down very, very quickly [after quitting]. The risk of things like lung cancer is a little slower but it does come down."
Another crucial strategy is physical activity.
Professor Maria Fiatarone Singh explains that, after menopause, bone and muscle mass decline at about one per cent per year and that preventing that loss is an important predictor for quality of life and health as you get older.
She explains that maintaining muscle, tendon and bone requires strength training. "It's not a lot of exercise in terms of time but it is intense," she says.
Her recommendations include lifting weights that feel heavy at least two, preferably three, days per week. Aim for three sets of eight repetitions.
Trish agrees that exercise is vital.
"The research shows that as soon as you lose your ability to move, you get sick fairly quickly. We all want to be one of those 80-year-old women who is still walking in the park and can catch the train or bus into town… but you can't do that if you can't walk."
It's not enough to simply walk around the shops or do housework, and women should consider adding hills or steps to their walk.
"It has to be a significant load on the muscle and tendon."
She advises getting a program from a physiotherapist or exercise physiologist and starting with about two-kilogram weights. Going too heavy too fast can lead to injury.
Women also tend to lose upper body strength, so training for the arms is important.
Professor Szoeke adds that research shows doing something every day is the strongest predictor of good cognition.
"When you're dealing with something that's slowly trying to damage you over 30 years, the thing that you enjoy doing every day is going to keep you healthiest," she says.
She adds that physical activity and diet can reduce high blood pressure – associated with increased rates of dementia, heart disease and stroke – but regular health checks are a good idea, so you can get treatment if necessary.
Professor Szoeke notes that having strong social networks is part of ageing well.
Her research has found that women who were grandparenting had improved cognition compared to those who weren't.
However, those who were grandparenting five days a week had the worst cognition of all.
"If you take too much on, it can be too stressful and that can impact your health," she says. "Given women are the majority of carers in our community, I think that's important to remember."
Professor Fiatarone Singh emphasises that relationship quality is more important than quantity.
Why nurturing relationships benefit health isn't fully understood, but it probably involves the way stress affects the immune system and cell metabolism, she says.
Her work has shown that a sense of belonging and purpose seem to promote long and healthy living, with centenarians regularly citing this reason for vitality in old age, she says.
"A key element of life in general is having the capacity, desire and opportunity to care for someone or something else besides yourself."
She agrees that midlife is an ideal time to take stock of your health and make positive changes.
"Even though the decline with ageing is what everybody talks about, [there's an] opportunity to improve with age."
Our experts acknowledge that change can be hard. Here's how to keep on track…
Professor Maria Fiatarone Singh:
Set your own goals: "It's really about what's important to the individual and everybody has a different set of priorities."
Change one thing: "If you're smoking, eating poorly, not exercising and having a lot of stress, trying to change everything at once is impossible." Success gives you a sense of mastery that can lead to more success.
Reward your accomplishments rather than berating yourself for failures.
Professor Cassandra Szoeke:
Make changes that fit easily into your lifestyle: "Make small changes that you can do every year for 30 years, and make them something that you want to do."
Make exercise social. Organise to meet someone for a walk, gym session or yoga and you're more likely to turn up. "There will be other people who are thinking it's time to lose a bit of weight."
Start slowly and build up gradually. Address any issues you have first, then see what your body can tolerate.
Seek professional help. "We have all these highly educated health professionals and if you have a private health fund at least some of that is usually covered," she says.
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