Better health in our 20s

20s Snapshot

Our 20s is an exciting and busy time – juggling fun (partying, travel, pushing boundaries) and more serious things (such as tertiary education, starting a career, forming new relationships).

It is also a time of our life when we enjoy peak health, resulting in many people taking their health for granted. The combined effect of this, and being busy, is often bad health habits such as skipping exercise, eating fast food, not enough sleep, etc.

20s Topics …

• Health challenges
• Main predictors of future health
• You can shape your future health
• Other factors that shape your health
• Early warning signs
• Target heart rates when exercising
• Health records and important documents
• What to do – today – to improve your health
• Checklist for the 20s and ageing well
• Your proactive health plan
• Appendix A: Tests to predict future health

Health challenges

When people get beyond the challenge of thinking “I am young, so I don’t need to worry about health problems”, it becomes easier to recognise the importance of being proactive and to do something about it.

Future challenges

The most reliable way to prevent health problems and to feel well, move easily and stay mentally sharp day-to-day is to be proactive.

Even if you already follow most of the proactive health principles in this Guide, it’s important to review the key predictors of future health in our 20s – physical fitness, cardiometabolic balance, stress management and sleep – to make sure they’re in good shape. Small adjustments now can strengthen your resilience and improve your well-being and quality-of-life for decades ahead.

Main predictors of future health

The following areas of health are strong predictors for people in their 20s of future quality-of-life. You may want to read a bit more about each of these areas further down the page or, alternatively, you can skip through to Appendix A that contains the tests that will enable you to know what your current state of health means for your future health and the proactive steps that will build resilience.

There is a preliminary self-assessment test which involves answering one simple question. If you score well, you may not want to do the other tests. If you don’t, the other tests are recommended. These are free, and can be done at home, except for the cardiometabolic tests (cholesterol, blood sugar etc) that need to be to be arranged with a doctor but can be bulk billed.

1. Physical fitness

2. Cardiometabolic health

Most people in their 20s enjoy good cardiometabolic health – blood pressure, blood sugar and visceral fat are not usually a problem. Some people may have elevated levels – indicating a higher risk of future diabetes, fatty liver and cardiovascular disease – but metabolic health in the 20s is less about the numbers and more about the habits that determine where those numbers are likely to go in the future: sleep, eating patterns, alcohol, weight stability. Establishing stable routines and becoming proactive in our 20s protects against midlife weight gain, insulin resistance, hypertension and fatty liver disease: Cardiometabolic.

3. Stress, sleep and lifestyle

The 20s are often a decade of disrupted rhythms – late nights, variable sleep, high study or work pressure, skipped meals, variable schedules, and socialising/drinking. These patterns feel harmless because we recover quickly in our 20s but they influence appetite, mood, energy and future metabolic regulation. In short, they can have long-term repercussions that don’t augur well for future health – see sleep and stress management below.

You can shape your future health

What should you focus on to improve your future health?

For most people in their 20s, focusing on the three areas above will make the biggest difference in shaping their future health, wellbeing and quality-of-life. But they’re not the only ones that matter – diet and nutrition, cognitive engagement, social connection and mental health management also play an important role in the 20s. Each of these areas is explored below.

To understand what is best for you to focus on, the tests in Appendix A will give you an insight into your future health and the steps to take.

Key areas of health that matter most in our 20s

Exercise

Aerobic exercise

Intensive exercise

It also has other benefits: it increases the number of mitochondria (those “little batteries” in your cells that produce energy) and more mitochondria means more energy; it strengthens the heart in ways that steady‑state exercise alone cannot; and it provides a short-term boost from the release of endorphins and, if you push harder, the rush of the “runners high”.

Strength and weight-bearing exercise

Flexibility and mobility – stretching

Stretching (dynamic stretching to warm up before exercise and static stretching after exercise) in our 20s makes a significant contribution towards protecting long‑term mobility, posture and joint health.

Regular stretching helps maintain the flexibility your joints were designed for, reduces the risk of overuse injuries and makes everyday movements easier and freer. It also supports better technique in both strength and aerobic training, which enhances the long‑term benefits of those activities.

To fully appreciate how important physical activity is, and what you should do, have a look at section 3 – Physical activity.

Cardiometabolic health

Cardiometabolic health refers to how well your cardiovascular system (heart and blood vessels) and metabolic system (how your body processes and uses energy) are functioning together. It’s shaped by factors such as blood pressure, cholesterol, blood sugar, body composition (muscle and fat), inflammation, and lifestyle behaviours like diet, exercise, sleep, and stress.

When all these factors are addressed, and you get regular checkups, as part of your proactive health lifestyle, the risk of future health problems such as heart disease, stroke and type 2 diabetes is lowered significantly.

Steps to improve cardiometabolic health

• Regular physical activity, both aerobic – cycling, swimming, brisk walking – and strengthening – whether weight-bearing (such as squats, lunges, step ups) or non-weight-bearing (such as machines, resistance bands, Pilates) – improve cardiometabolic health in a variety of ways if done regularly e.g. most days.
• A diet built around whole foods (vegetables, legumes, whole grains, lean proteins and healthy fats) helps stabilise blood sugar and reduces the metabolic strain caused by refined carbohydrates and sugary drinks.
• Limiting added sugars, highly processed foods and alcohol is important. Quitting smoking provides immediate and long‑term benefits for blood vessels and brain health.
• Maintaining a healthy waist circumference is particularly important, as excess visceral fat drives insulin resistance and inflammation (more information about this can be found in the resource section of the Guide here).
• Good sleep and stress management support metabolic balance.

High blood sugar and prediabetes

If your blood sugar is heading towards the prediabetic range, in addition to the steps taken above to improve cardiometabolic health in general, it can help to spread your carbohydrate intake more evenly across the day and avoid large, carbohydrate‑heavy meals that cause sharp glucose spikes. Periodic checks of fasting glucose or HbA1c can also provide useful feedback on how your lifestyle changes are working.

Stress and sleep

Stress management

Contrary to the carefree image of the 20s, it is one of the most stressful decades of adult life. It’s a period of constant transition – study, work, relationships, financial independence, and identity formation – all while the brain’s emotional‑regulation systems are still developing.

Stress in this decade tends to be chronic, rather than acute, caused by pressure to perform, belong and “figure life out.” It can upset the body’s stress response system (especially cortisol regulation) that is still maturing. This can cause persistent inflammation, insulin resistance and visceral fat accumulation – all precursors to metabolic syndrome, weight gain, depression and cardiovascular disease in the future. Because coping skills are still being refined, stress can easily spill into sleep disruption, fatigue, poor diet and emotional volatility in the short-term.

These patterns, if left unchecked, can shape long‑term habits that influence both physical and mental health. They can also trigger or accelerate mental health issues which are quite prevalent before the age of 25: Mental health management

Developing healthy patterns in our early 20s – such as protecting downtime, recognising your limits, building routines that support mental wellbeing, and learning how to switch off – helps prevent burnout and builds emotional resilience. These skills don’t just make your 20s easier to navigate; they become long‑term protective factors that support better health, stronger relationships, and a higher quality of life in every decade that follows.

It’s important to take steps to manage stress by taking time out, doing regular exercise and habits that calm the nervous system such as deep breathing exercises and mindfulness.

Sleep

Other factors that shape your health

In addition to the predictors of future health covered above, there are other factors in our 20s that are also reasonably strong predictors of future health and quality-of-life including diet and nutrition, check-ups/screenings, social connection and mental health management.

Diet and nutrition

Diet (see section 2 – Diet/Nutrition) is crucially important so it’s wise to make sure you are eating the right foods. But what are the “right” foods? Many people think this means avoiding fast or highly processed foods and eating lots of vegetables. That’s a good start but it doesn’t go far enough.

The right diet needs to include a wide variety of vegetables, legumes, grains and fruits – it is the variety that is essential for nourishment of your microbiome i.e. your gut bacteria, which play a critical role in good health.

Checkups and Screenings

A single comprehensive check‑up in your early 20s can identify blood pressure, cholesterol, and blood sugar trends long before they become problems. Screening for mental health, sexual health, and skin changes is equally important, as these are areas where early detection makes a lasting difference. For most young adults, the goal isn’t frequent testing but pattern awareness – knowing your normal values and tracking how they change over time. This decade is about building familiarity with your own health data so you can recognise shifts quickly and act before they matter.Irregular sleep alone can alter appetite hormones, increase cravings for high energy foods, and nudge weight upward over time. Chronic stress in this decade can hard wire elevated cortisol patterns that influence abdominal fat storage, mood stability and future cardiovascular risk.

Social connection

Relationship development in our 20s has a much bigger role in shaping long-term well-being than most people would imagine. It doesn’t mean having a busy social calendar. It’s about developing supportive, good-quality, reciprocal relationships that help us grow as people.

During childhood and adolescence, we learn the fundamentals of relationships in environments that are structured – school, family and teams. In our 20s, the context is less structured. Relationships require more nuanced communication and emotional maturity to read social cues, how to communicate and handle conflict. Relationships are also more diverse, complex and consequential. It is a time when we develop the adult skills of communication that often shape our social world for decades to come.

Mental health management

Mental‑health issues tend to peak before age 25, with as many as 1 in 3 young adults experiencing a significant challenge in any given year. This is also a time of major transitions – study, work, relationships, financial pressure, leaving home – while the brain’s emotional‑regulation systems are still developing. These factors make it especially important to manage stress and protect work-life balance.

If a mental‑health concern does arise, it’s important to reach out early – whether to a GP, a counsellor, or another qualified professional – so that support can be put in place before things escalate. Early help is one of the strongest protective factors for long‑term well-being.

Early warning signs

The 20s is a time to pay attention to what your body is telling you because a lot of early warning signs can be addressed, and lifestyle changes made, before they turn into health problems. Putting on weight is one example – if addressed early by adjusting diet, and increasing exercise, the serious problems that are often associated with being overweight – heart disease; diabetes; thyroid dysfunction; etc – can be avoided.

Listening to your body means not dismissing an early warning sign as unimportant no matter how minor it may seem – sometimes, a minor change can be an indication of a more serious problem on its way. On the other hand, an early warning sign might be “normal stress” or “just ageing”.

How do you know the difference?

There is a long list of early warning signs and symptoms in section 7 – Early warning signs – including “what’s normal, and what’s not”. However, many signs or symptoms are indeterminate and can point to different problems, so it is always wise to be sure by checking with your GP.

Target heart rates for exercising

Although it is a common misconception that fat burning only happens in zone 2, it does in fact happen in all zones although zone 2 is optimal for sustained aerobic fat metabolism. It is also a misconception that a higher heart rate always means better fitness – training in lower zones also builds endurance and supports recovery.

Goal	Zone	BPM age 20	Activity Examples
Light exercise or recovery	Zone 1 (50–60%)	100-120	Gentle walking, yoga, light stretching
Aerobic / Fat burning	Zone 2 (60–70%)	120-140	Brisk walking, steady swimming, light cycling
Cardiovascular endurance	Zone 3 (70–80%)	140-160	Jogging, moderate cycling, swim intervals
Speed & power	Zone 4–5 (80–100%)	160-200	Sprinting, HIIT, hill climbs

Health records & important documents

1. Make a list of proactive steps you are going to take and when you are going to start on each one.
2. Check those areas of your current health that are predictors of future health and quality-of-life to decide what areas you should focus on.
3. Make a commitment to become more proactive and tell someone close to you about your decision, what you are going to do and when.

Below is a short checklist and a template for a proactive health plan that should be adapted by you for your specific circumstances, level of fitness and state of health. The more you cross-reference the links in this section about the 20s to the relevant part of the Proactive Health Guide, the better your personal plan will be.

Checklist for the 20s and ageing well

• Establish regular exercise (strength + cardio)
• Build bone density through weight‑bearing activity
• Protect your skin from sun exposure
• Learn healthy sleep routines
• Build balanced eating habits
• Avoid smoking and limit alcohol
• Develop stress‑management skills

Your proactive health plan

You may want to do this on an Excel spreadsheet so that you can put in the starting date and have a column for each day of the month to keep track of how well you are progressing with your plan. Ideally, each day you will put a tick or a cross against each step that you have decided to embark on. Remember, consistency is the key – it is better to do a little bit every day, and continue doing it until it becomes a habit (see section 9 – Healthy people have better habits), than to do too much and burn out. That means – don’t set your sights too high when you start.

If you also want to track changes to various aspects of your health after embarking on your plan, have a look at section 10.2 – Track your progress

Proactivity focus	Details of what I am going to do	How often	Day 1
Deep breathing – see section 6.3 Breathing	I breathe deeply [in for 4 seconds; hold for 4; out for 4; and hold again for 4] and do it for 1-2 minutes whenever I need a deep breathing boost. The trigger to remind me to do this is … [e.g. when I start to lose concentration OR when I feel tense or under stress OR when I don’t feel happy, etc]	Multiple times throughout the day
Diet & nutrition – see section 2 Diet/Nutrition	I eat a wide variety of vegetables, fruits, legumes and whole grains by adding …. [state specifically what foods you are going to add to your diet]	Daily
	I limit sugar intake, processed foods and salt [be specific what you are going to reduce or eliminate from your diet]	Daily
	I boost my microbiome with probiotic and prebiotic foods [state the specific foods e.g. fermented foods – yoghurt, sauerkraut, etc]	Daily
Exercise – see section 3 Physical Activity	I do 30 minutes of … [e.g. brisk walking] twice per week before breakfast	Tuesday & Friday
	I swim for 30 minutes once per week	Saturday
	I do weights [or use resistance bands] to preserve muscle twice per week	Monday & Thursday
	I do balance exercises (e.g. tai chi, yoga) twice per week	Saturday Wednesday
	I play tennis [or golf, etc] once per week	Sunday
	I do a minimum of 10,000 steps every day	Daily
Medications	I check for interactions or side effects with GP or pharmacist if there are any changes in the way I feel and for any new drug	Insert date
Mental health	I stay mentally active by … (e.g. puzzles, reading) See section 4.2	Daily
	I learn … [e.g. about the 100 years war OR a new language OR a musical instrument]	Daily
	I work on brain health [specify what you are going to do] See cognitive training section 4.2	Insert when
	I work on being positive See section 5.2	Insert when
	I take part in a purposeful activity [ e.g. volunteering or a project such as renovating part of your garden] See section 4.2	Insert date
Mindfulness – see section 5.3 Mindfulness	I engage in mindfulness regularly during each day. The trigger to remind me to do this is … [when I daydream OR when I find my posture is poor OR when I lose concentration OR when I walk through a doorway OR … etc]	Multiple times per day
Screenings & check-ups	Blood test including PSA and blood sugar; Colonoscopy; Mammogram; Skin cancer check; Eye test; Bone density scan, etc	Insert dates (month and year) for each one
Sleep hygiene – see section 6.1 Sleep	I go to bed at 10pm and get up at 6:30am	Each day
	No screens 1 hour before bed	Each day
	Address snoring or sleep apnoea with GP	Insert date
Social connections	I join a community group or interest-based club [be specific about what and when]	Insert date
	I stay engaged with friends and family, or community groups [be specific about what you are going to do and when] See section 4.2	Weekly or monthly
Symptoms & early warning signs	I monitor changes to the way I feel and keep a written record of any signs that I think are unusual. See section 7.2	Ongoing
Vaccinations – see section 6.8 Vaccinations	I get an annual flu and pneumonia shot; I get a Covid 19 booster	Insert date for each one
Other	This is for other issues that may be important for you

APPENDIX A: TESTS TO PREDICT FUTURE HEALTH

What your future health has in store for you and what you can do to shape it in your 20s

This appendix gives you simple ways to find out what various aspects of your current health can tell you about your future health. No need for special equipment or expensive testing – most checks can be done at home and are free. There are also suggestions about what proactive steps you can take based on your results.

These predictive tests and suggestions are based on synthesis of data from medical research and population studies including the Harvard Study of Adult Development (https://www.adultdevelopmentstudy.org/) and the WHO Healthy Ageing Frameworks (https://www.who.int/initiatives/decade-of-healthy-ageing). They should be used as general guidelines rather than personalised advice.

PRELIMINARY: SELF-ASSESSMENT TEST

This test comprises one simple question: how you rate your current health? Excellent? Very good? Good? Fair? Poor?

A rating of “Fair” or “Poor” predicts higher risk of stress‑related issues, sleep problems and early metabolic changes in your 30s. “Good” or better predicts strong long‑term resilience.

This is clearly a subjective test and, although it is a reasonably good predictor of future physical, emotional and cognitive health, it is not as accurate as the objective tests that follow. It also does not identify what areas of your health may need attention or what proactive steps would be of the most benefit. It is therefore a good idea to do the cognitive ageing test and the other individual tests below.

COGNITIVE AGEING TEST

It’s important to know how well your brain is likely to age, especially because the earlier you take steps to offset the chance of accelerated cognitive ageing, the more effective it will be. The research is clear – even people who score badly on the tests below can still meaningfully change their cognitive future by taking the right steps.

The tests, and what the results mean, are based on work done by Professor Anstey at ANU.

How to score

Please choose the option for each cognitive ageing test (1-15) that best describes you over the past 12 months and then tally the results based on the following scoring: low risk = 0 points; moderate risk = 1 point; high risk = 2 points (except for questions 3 and 4 where the score for high risk = 3 points).

What your total score means

How to interpret your results is explained after the last cognitive ageing test below. In general, the lower your total score for all the tests combined, the slower your “cognitive ageing” is likely to be. This means a higher likelihood of:

• staying mentally sharp and capable;
• learning, and remembering, new things more easily;
• managing complex tasks more effectively;
• being more adaptable e.g. to change and switching tasks;
• retaining mental resilience against stress and illness;
• ageing better e.g. remaining independent; and
• enjoying a higher quality of life for longer.

SECTION A: LIFESTYLE FACTORS

Test 1. Physical activity

• Low risk – I do 150 minutes or more of moderate physical activity per week or a minimum of 75 minutes of vigorous physical activity.
• Moderate risk – I do 60-150 minutes or more of moderate physical activity per week or a minimum of 30-75 minutes of vigorous physical activity.
• High risk – I do less than 60 minutes of moderate physical activity per week or less than 30 minutes of vigorous physical activity.

Proactive steps

Suggestions about physical activity can be found below under the individual aerobic and strength tests. If you would like additional information, there is more detail in the Exercise section above and more again in the resource section of the Guide: http://proactivehealthguide.com.au/3-exercise/#3-Exercise.

Test 2. Diet quality

• Low risk – I have a very good diet. I eat a variety of fruit, vegetables and whole foods on a daily basis.
• Moderate risk – My diet is not as good as described for the green zone. I consume less variety and some processed foods.
• High risk – I frequently consume processed foods and do not consume a wide variety of fruit, vegetables or whole foods.

Proactive steps

Suggestions can be found in the Diet and nutrition section above. If you would like additional information, there is more detail in the resource section of the Guide: http://proactivehealthguide.com.au/2-diet-nutrition/#2-DietNutrition.

Test 3. Alcohol

• Low risk – I have 10 or less standard drinks per week with no binge drinking.
• Moderate risk – I have 11-20 standard drinks per week or occasional binge drinking [5 or more standard drinks].
• High risk – I have 20 or more standard drinks per week or I binge drink at least once per week.

Proactive steps

Self-evident: reduce consumption.

Test 4. Smoking

• Low risk – I have never smoked OR I used to smoke but I quit more than 20 years ago and only ever smoked likely i.e. less than 5 cigarettes per day.
• Moderate risk – I am a very light smoker (1-2 cigarettes per week) OR I used to smoke but quit 5-20 years ago
• High risk – I smoke every day OR I smoke at least several cigarettes per day on a regular basis.

Proactive steps

Self-evident: reduce or, preferably, stop.

Test 5. Cognitive engagement

• Low risk – I engage in regular cognitive activities e.g. reading, learning, puzzles or hobbies.
• Moderate risk – I engage in occasional cognitive activity.
• High risk – I rarely engage in cognitive activity.

Proactive steps

Suggestions can be found in the Cognitive engagement section above.

SECTION B – MEDICAL and PHYSICAL FACTORS

Test 6. Blood pressure

• Low risk – My BP is normally less than 130/80.
• Moderate risk – My BP is normally in the range 130-139/80-89.
• High risk – My BP is normally more than 140/90 OR I am on blood pressure medication.

Proactive steps

Suggestions can be found in the Cardiometabolic health section above.

Test 7. Diabetes or pre-diabetes

• Low risk – I am neither diabetic nor pre-diabetic.
• Moderate risk – I am pre-diabetic.
• High risk – I am diabetic.

Proactive steps

Suggestions can be found in the Cardiometabolic health section above.

Test 8. Cholesterol

• Low risk – My LDL cholesterol is normal (less than 2.6).
• Moderate risk – My LDL cholesterol is between 2.6 and 3.3.
• High risk – My LDL is over 3.3 OR I am on lipid medication.

Proactive steps

Suggestions can be found in the Cardiometabolic health section above.

Test 9. Hearing

• Low risk – I have no difficulty hearing.
• Moderate risk – I have mild difficulty hearing and do not wear hearing aids
• High risk – I have significant difficulty hearing and do not wear hearing aids.

Proactive steps

If in any doubt, get tested. The tests are usually free of charge.

Test 10. Head injury and loss of consciousness

• Low risk – I have never had a head injury when I have lost consciousness.
• Moderate risk – I have had one head injury when I lost consciousness.
• High risk – I have had multiple head injuries when I lost consciousness.

Proactive steps

Protecting your head from future injury is critically important – repeated impacts carry the greatest long-term risk. Because head injury interacts with other risk factors, keeping your cardiovascular and metabolic health in good shape – including blood pressure, cholesterol, glucose, weight and physical activity – provides strong protection for the brain. Staying mentally active, socially engaged and maintaining good sleep habits all help build cognitive reserve and support long‑term brain health.

If you notice ongoing symptoms such as headaches, memory problems or difficulty concentrating, it’s wise to discuss them with a health professional.

SECTION C – PSYCHOLOGICAL and SOCIAL FACTORS

Test 11. Mood

• Low risk – My mood is generally stable i.e. I feel positive or neutral most days. Any ups and downs pass quickly and do not affect my motivation, relationships or daily activities.
• Moderate risk – I occasionally suffer from low mood in the sense of feeling down or flat but it lasts no more than a day or two before I bounce back. It does not affect my ability to work, socialise or manage daily tasks.
• High risk – At times I feel depressed or in a low mood that lasts for two weeks or more. It reduces my motivation, energy and enjoyment of life and affects my ability to concentrate. It affects my work, relationships or daily tasks. It means I lose interest, avoid social contact and sometimes feel overwhelmed by routine responsibilities.

Proactive steps

Regular routines, consistent sleep, daily physical activity and staying socially connected all help stabilise mood and reduce the stress hormones that accelerate cognitive ageing. Engaging your mind through reading, learning, hobbies or creative activities also helps build cognitive reserve. Reducing alcohol, managing stress and spending time outdoors can also make a difference.

If low mood is persistent, worsening or affecting your daily life, seeking support from a qualified health professional is important.

Test 12. Social connection

• Low risk – I meet most of the following criteria for this risk group: I have ongoing relationships and  weekly contact with friends, family or groups in person, by phone or video; I have at least one person I can rely on for emotional or practical support; I participate in social, community or group activities at least monthly; I feel connected and not alone.
• Moderate risk – I meet most of the following criteria for this risk group: I have social contact with friends, family or groups in person, by phone or video at least once a month but they are not close or meaningful relationships; I have one person I can generally rely on for support but it feels limited or inconsistent; I sometimes feel alone or disconnected; I participate in social or community group activities occasionally but not on a regular basis.
• High risk – I meet most of the following criteria for this risk group: I have social contact with friends, family or groups in person, by phone or video less than once a month; I have no one I can generally rely on for support; I feel alone or disconnected much of the time; I lost my social network and have not rebuilt connections; I live alone and have very little social interaction.

Proactive steps

Suggestions can be found in the Social Engagement section above.

Test 13. Sleep

• Low risk – I have 7-9 hours of restorative sleep most nights.
• Moderate risk – My sleep is disrupted by stress or lifestyle factors OR I have difficulty falling asleep and/or staying asleep 1-2 nights per week.
• High risk – I regularly suffer from insomnia OR wake without feeling rested OR feel tired/sleepy most days OR I suspect I have sleep apnoea (snoring, gasping, pauses in breathing).

Proactive steps

Suggestions can be found above and in the resource section of the guide: Sleep.

SECTION D – COGNITIVE SELF-ASSESSMENT

Test 14. Memory

• Low risk – I forget things occasionally, but these lapses do not affect my daily tasks, and I am able to recall recent events, conversations and appointments with normal effort. My memory feels appropriate for my age.
• Moderate risk – I sometimes forget names, appointments or why I walked into a room, or I misplace items more often than I would like. These lapses are noticeable but not disruptive – they do not affect my day‑to‑day living, efficiency or reliability.
• High risk – I forget appointments or conversations regularly, or I repeat myself or ask the same questions without realising, or I often lose items or lose track of tasks, or I have difficulty following complex instructions. These lapses interfere with my day‑to‑day living, efficiency or reliability, and may be noticeable to others.

Proactive steps

Suggestions can be found under Cognitive engagement above and the links there to the resource section of the Guide.

Test 15. Attention/concentration

• Low risk – I can follow conversations, instructions and focus on tasks with normal effort.
• Moderate risk – I sometimes lose focus during long tasks and I occasionally need to re-read things but these lapses are intermittent and manageable.
• High risk – I have difficulty remaining focused even for short tasks and I frequently make mistakes due to inattention. These lapses interfere with my day-to-day life.  

Proactive steps

Suggestions can be found under Cardiometabolic health above and the links there to the resource section of the Guide.

INTERPRETATION OF RESULTS

Low risk: 0-10 points

Your lifestyle and health profile indicate healthy cognitive ageing. Maintain your healthy habits but continue to monitor risk factors i.e. those areas where you did not score well.

Moderate risk: 11-21 points

Your risk of faster cognitive ageing is increased. It’s never too late to modify the risk by taking steps to improve underperforming areas. Small changes now can significantly improve future cognitive health.

High risk: 22-32 points

You have many risk factors associated with faster cognitive ageing so it’s important to take steps as soon as possible to address underperforming areas.

AEROBIC CAPACITY

Aerobic capacity in our 20s is a strong predictor of long-term health including the risk of cardiovascular disease, future mobility, quality-of-life and even long-term brain health. You can do either the walking test (test 1) or test or the stair-climbing test (test 2), or both.

Test: Walk for 6 minutes

Walk briskly as far as possible in six minutes on a flat surface.

Outcome and what it predicts

• Green zone–being able to walk 700 metres or more without being overly puffed indicates good aerobic capacity for the 20s, lower long-term cardiovascular risk and slower biological ageing.
• Amber zone – 630-700 metres suggests below optimal aerobic fitness and higher risk of cardiovascular disease and reduced mobility in later decades.
• Red zone – less than 630 metres predicts a higher risk of heart disease and increased risk of frailty later decades.

Proactive steps

• Green zone – maintain at least 150 minutes of moderate activity per week including one long exercise session and one faster session each week.
• Amber zone – aim for a brisk 30 minute walk five days per week and one 20 minute interval training session (1 minute fast; 1 minute easy)
• Red zone – aerobic activity needs to be increased starting with at least 10-15 minutes of brisk walking 4-5 days per week and gradually increase this until you reach 30 minutes. Your goal is to end up doing the activity recommended for the green zone.

Test 2: Stair climb – three flights

Time how long it takes to climb 3 flights at a steady pace.

Outcome and what it predicts

• Green zone – 35 seconds or less indicates good aerobic capacity and lower risk of future cardiovascular issues.
• Amber zone – 36-45 seconds suggests reduced aerobic capacity, higher future cardiovascular risk and reduced future mobility.
• Red zone – taking more than 45 seconds indicates significantly higher risk of heart disease and reduced functional capacity in later life.

Proactive steps

• Green zone – maintain regular aerobic activity, preferably at least 150 minutes per week of moderate activity (walking, cycling, swimming). Include one longer session (40-60 minutes) and one brisker session each week.
• Amber zone – aim for a brisk 30 minute walk five days per week and one 20 minute interval training session (1 minute fast; 1 minute easy). Ideally, include one stairclimbing session per week of 5-8 continuous minutes.
• Red zone – aerobic activity needs to be increased starting with at least 10-15 minutes of brisk walking 4-5 days per week and gradually increase this until you reach 30 minutes. Your goal is to end up doing the activity recommended for the green zone.

STRENGTH

It is recommended to do both the lower body (test 1) and the upper body (test 2).

Test 1: Lower body: 30 seconds sit-to-stand

With arms crossed, stand up and sit down as many times as possible in 30 seconds from a standard chair seat (43-45 cm high).

Outcome and what it predicts

• Green zone – 33 or more times indicates good lower‑body strength; good predictor of mobility in later decades.
• Amber zone – 28-32 times indicates higher risk of mobility limitations in the future.
• Red zone – less than 28 indicates a more significant decline in strength which predicts a higher risk of mobility decline, falls and reduced independence.

Proactive steps

• Green zone – do, or keep doing, at least 2 lower body strength sessions (e.g. squats, lunges, step-ups, sit-to-stand) per week each comprising 2-3 sets with 8-12 repetitions per exercise. It should feel moderately hard by the last few repetitions.
• Amber zone – lower body strength sessions (e.g. squats, lunges, step-ups, sit-to-stand) should be added to your exercise program starting with 2 sets of 8 repetitions per exercise once or twice per week and gradually increase the difficulty and the number of repetitions so you end up doing at least two sessions per week with each session comprising 3 sets of 12 repetitions.
• Red zone – follow the suggestions for the Amber zone but start with exercises that are not as difficult (e.g. partial squats and lunges, lower step-ups and sit-to-stand start using a higher chair); increase the frequency and difficulty gradually until you get to the level suggested for the green zone.

Test 2: Upper body: 1 minute of inclined push-ups

Place your hands on the edge of a kitchen bench or sturdy table, no wider than shoulder‑width. Walk your feet back until your body forms a 45° angle to the floor. Keep your body in a straight line from shoulders to heels. Then bend your elbows – keeping them angled back not flared out – and lower your chest stopping when your upper and lower arm form roughly a 90° angle. This should mean your chest is 10-15 cm from the edge. Then straighten your arms fully. This constitutes one full push-up.

Outcome and what it predicts

• Green zone – 25 or more incline push-ups for men, and 14 or more for women, in one minute indicates good upper‑body strength for the 20s, a lower risk of shoulder or neck issues and good long-term functional capacity (lifting, carrying, etc).
• Amber zone – 15-24 times for men, and 8-14 times for women, in one minute indicates higher risk of mobility limitations in later years.
• Red zone – 14 or less for men, and 8 or less for women, in one minute indicates a more significant decline in strength which predicts a higher risk of mobility decline, falls and reduced independence.

Proactive steps

• Green zone – do, or keep doing, at least 2 upper body strength sessions (e.g. push-ups, rowing and core exercises) per week each comprising 2-3 sets with 8-12 repetitions per exercise. It should feel moderately hard by the last few repetitions.
• Amber zone – upper body strength sessions (e.g. incline push-ups, rowing and core exercises) should be added to your exercise program starting with 2 sets of 8 repetitions per exercise once or twice per week and gradually increase the difficulty and the number of repetitions so you end up doing at least two sessions per week with each session comprising 3 sets of 12 repetitions.
• Red zone – follow the suggestions for the Amber zone but start with exercises that are not as difficult (e.g. wall-push-ups, rowing exercises using resistance bands); increase the frequency and difficulty gradually until you get to the level suggested for the green zone.

CARDIOMETABOLIC HEALTH

Blood pressure; cholesterol; triglycerides; and blood sugar tests need to be arranged with your doctor and can usually be bulk billed. The proactive steps listed after Test 4 apply also to tests 1, 2 and 3.

Test 1: Blood pressure

Outcome and what it predicts

• Green zone – 120/80 or less indicates a lower long-term risk of heart attack, stroke and kidney disease.
• Amber zone – 120-139 systolic or 80-89 diastolic (e.g. 135/85) indicates a higher chance of developing hypertension in the 60s and higher long-term cardiovascular risk if the trend continues.
• Red zone – 140/90 or higher predicts a higher long-term risk of heart attack, stroke and kidney disease and a higher likelihood of needing medical treatment. In our 50s, this is a strong indicator that proactive steps should be taken.

Test 2: Cholesterol

Bad cholesterol (LDL) and what it predicts

• Green zone – less than 2.6 predicts a lower chance of cholesterol building up on the artery walls and lower long-term risk of heart attack or stroke.
• Amber zone – 2.6-3.3 indicates an increased likelihood of plaque build‑up and a higher chance of developing cardiovascular disease starting in the 60s.
• Red zone – above 3.3 indicates a stronger likelihood of plaque formation and higher long‑term risk of heart attack and stroke. In our 50s, this level is a strong signal that proactive steps are needed.

Good cholesterol (HDL) and what it predicts

• Green zone – more than 1.0 for men 1.2 for women indicates better natural protection against cholesterol build‑up and lower cardiovascular risk..
• Amber zone – 0.9-1.0 indicates reduced protective effect and a higher chance of cholesterol accumulating in arteries.
• Red zone – less than 0.9 indicates little natural protection and higher long‑term risk of cardiovascular disease. Low HDL is an important warning sign and should not be ignored..

Test 3: Triglycerides

What they predict

• Green zone – less than 1.7 indicates a healthy metabolism and lower risk of artery inflammation. In our 50s indicates better long-term cardiovascular health.
• Amber zone – 1.7-2.2 indicates a higher chance of cholesterol accumulating in arteries and therefore increased cardiovascular risk in the coming decade.
• Red zone – 2.3 and above indicates higher risk of heart disease, stroke and diabetes.

Test 4: Blood sugar

The following relates to HbA1c – a measurement of blood sugar averaged over the last 2-3 months. It is a better predictor of long-term health than fasting glucose level which is a snapshot of the sugar level at the time of the test.

What it predicts

• Green zone – less than 5.7% indicates lower risk of developing insulin resistance or type 2 diabetes.
• Amber zone – 5.7-6.4% indicates higher chance of developing type 2 diabetes in your 60s.
• Red zone – 6.5% and above indicates a higher risk of cardiovascular disease including diabetes. This level in the 50s indicates that proactive steps should be taken.

Proactive steps for blood pressure, cholesterol, triglycerides and blood sugar

• Green zone – maintain a healthy lifestyle including regular physical activity (at least 150 minutes per week walking, cycling, swimming, or similar); 2 strength sessions per week for upper and lower body; a balanced diet with a variety of fruits and vegetables; and a consistent sleep routine.
• Amber zone – the goal is to have a healthy lifestyle as described for the green zone including the adoption of a Mediterranean style diet; increasing fibre; reducing salt and processed foods. Also, if overweight, the goal should be a 5-10% weight reduction.
• Red zone – in addition to the recommendations for the amber zone, it is wise to consider medical advice relating to diet and possible medication.

These predictors and suggestions are based on generalised data from medical research and population studies and therefore should be used as guidelines rather than personalised advice.

STRESS and EMOTIONAL REGULATION

Test 1: Sleep

Sleep is a strong predictor of long-term physical, emotional and cognitive health. The simple test involves calculating how many nights per week you: fall asleep within 30 minutes; stay asleep without long waking periods; and wake up feeling reasonably restored?

Outcome and what it predicts

• Green zone – 5-7 nights per week indicates a well‑regulated stress system and emotional stability, lower risk of depression/anxiety, better cognitive ageing and lower risk of long-term cardiovascular disease.
• Amber zone – 3-4 nights per week indicates a higher chance of developing chronic stress and sleep problems, increased risk of weight gain and reduced emotional resilience, including irritability, in the next decade.
• Red zone – 2 or less nights per week indicates higher long-term risk of depression/anxiety, higher risk of a weaker metabolism (including diabetes), increased cardiovascular risk and faster cognitive ageing. It is a strong warning sign that should not be ignored.

Proactive steps

• Green zone – maintain a consistent sleep schedule and avoid bad habits that sometimes creep up such as phone or TV screens close to bedtime, late coffee, etc.
• Amber zone – advisable to adjust sleep habits, including consistent bed and wake times, limit caffeine after midday, reduce screen time 30-60 minutes before bed – [link to sleep]; increase physical activity (1-2 extra sessions of light to moderate activity per week) and reduce alcohol intake (even small reductions help) (e.g. 20 minutes walking per day).
• Red zone – sleep hygiene needs to be given priority – [link]; add the following to your daily routine: relaxation practices; more physical activity; and stress management. Consider professional sleep therapy advice if poor sleep persists, especially if it affects mood, energy or daily function.

Test 2: Resting heart rate

Your BPM (beats per minute) can be tested by counting your pulse to determine how many mornings per week your resting heart rate in the healthy range for your age – measure it first thing in the morning, before getting out of bed. It will give you an indication of your levels of stress and cardiovascular issues.

Outcome and what it predicts

• Green zone – 50-65 bpm 5-7 mornings per week indicates lower long-term cardiovascular risk; better stress resilience; low risk of developing high blood pressure; and better long-term cognitive and emotional stability.
• Amber zone – 66-75 bpm 3-4 mornings per week indicates a higher risk of chronic stress; higher chance of developing hypertension; and increased long-term cardiovascular risk (if the trend continues).
• Red zone – above 75 or below 50 bpm 3 or more mornings per week indicates an even higher long-term risk of heart disease and stroke; higher likelihood of chronic stress; and greater risk of fatigue, burnout and emotional dysfunction over time.

Proactive steps

• Green zone – maintain a healthy lifestyle including regular physical activity (both aerobic and strength 2-3 times per week), consistent sleep habits and stress management routines (breathing, stretching and time outdoors).
• Amber zone – consistent sleep (bed and wake-up times); increase physical activity (1-2 extra sessions of light to moderate activity per week such as a daily 20 minute brisk walk, cycling or swimming); reduce alcohol intake (even small reductions help); stress management (breathing, stretching and time outdoors).
• Red zone – increase exercise and manage stress (see Amber zone); give priority to sleep quality; reduce alcohol and caffeine; consider discussing persistent high RHR with a GP.

Test 3: Perceived stress

This test involves a self-assessment of your stress level by applying a score of 0-2 to each of the following statements. You need to rate how often each statement has been true over the previous two weeks. A score of 0 = never; 1 = sometimes; and 2 = often. Then add up the total of all five items:

1. I’ve felt overloaded or under pressure.
2. I’ve found it hard to switch off mentally.
3. I’ve felt tense, wound‑up, or on edge.
4. I’ve felt that small things have irritated me more than usual.
5. I’ve felt tired in a way that rest didn’t fully fix.

Outcome and what it predicts

• Green zone – a score between 0 and 3 on one or less days per week means you’re managing stress well.
• Amber zone – a score of between 4 and 6 means on 2-3 days per week indicates you’re carrying a moderate stress load and small changes now can prevent chronic stress patterns.
• Red zone – a score of between 7 and 10 and 4-7 days per week means your stress level is high and indicates a high risk of burnout, mood problems and stress related physical health issues. In your 20s, high perceived stress is a strong predictor of poor health outcomes later in life. Your system is overloaded and more vulnerable to fatigue, poor sleep and emotional exhaustion.

Proactive steps

• Green zone – maintain routines that support calmness (walking, nature, hobbies); retain boundaries around work and personal time; maintain habits that keep stress low such a simple daily pauses and deep breathing.
• Amber zone – identify one or two sources of stress you can reduce; add daily relaxation practices; increase light physical activity; improve sleep consistency and strengthen social connections.
• Red zone – give priority to rest, sleep, and recovery; add structured daily relaxation (breathing, guided relaxation, stretching); reduce non‑essential commitments where possible; increase physical activity (such as walking, yoga). If the stress is persistent or overwhelming, discuss with your GP.