Better health in our 40s

40s Snapshot

If you haven’t already done so, it is essential in your 40s to develop good health habits, and get rid of the bad ones, or at least some of them. This is because it’s necessary to build resilience to deal with the health risks that increase in the coming decades and because our bodies respond very positively to changes in our 40s.

40s Topics …

• Health challenges and resilience
• Predictors of future health
• You can shape your future health
• Other factors for current and future health
• Risks and early warning signs
• Screenings & check-ups
• Target heart rates when exercising
• Health records and directives
• What to do – today – to improve your health
• Health checklist – for the 40s and ageing well
• Your proactive health plan
• Tests to predict future health: Appendix A

Health challenges and building resilience in our 40s

Challenges

These “shortcuts” often start in the 30s and, by the time the 40s arrive, they become habits that are hard to shrug off. Unfortunately, this is a time when the body becomes less forgiving of bad habits and a time when health risks accelerate – cardiovascular risk; insulin resistance; muscle and bone loss; stress and its effect on mental health.

The odds are in your favour

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

The sections below explain what proactive steps will strengthen those parts of your health that are likely to matter most for you in the years ahead to protect your ongoing well-being and quality-of-life.

Appendices B and C list other health issues that can appear in your 50s – not to alarm you, but to help you stay ahead of them.

The risk of remaining reactive

When you know how, making changes isn’t hard – healthy people simply have better habits, and those habits can be learned at any age: Healthy people have better habits.

Main predictors of future health in our 40s

The following areas of health are strong predictors for people in their 40s of future health and 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 and strength

2. Cardiometabolic health

Elevated blood pressure, cholesterol, blood sugar or visceral fat levels predict a higher risk of hypertension, type 2 diabetes, heart attack and stroke in your 50s and 60s. Even borderline levels of these markers in our 40s is a strong indicator that proactive steps should be taken: Cardiometabolic

3. Stress and emotional regulation

Stress in our 40s affects sleep, inflammation and nervous conditions in the short-term and increases the risk of burnout, anxiety, depression, immune suppression and heart disease in the long-term: Stress.

You can shape your future health

What should you focus on to improve your future health?

For most people in their 40s, focusing on the three areas above will make the biggest difference in shaping future health, well-being and quality-of-life. But these are not the only areas of health that matter for the 40s – diet and nutrition, cognitive engagement, social connection and sleep quality also play an important role. 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 proactive steps to strength it.

Key areas of health that matter most in our 40s

Physical activity

Aerobic exercise

Intensive exercise

Strength – weight-bearing exercise

Strengthening your muscles makes your mitochondria stronger and, in turn, more efficient at producing energy and better at handling stress and inflammation.

Flexibility and mobility – stretching

You may not notice it, but hips tend to get tighter, shoulders stiffer and your range of motion declines in your 40s, often due to long hours of sitting. Regular stretching – dynamic stretching to warm up before exercise and static stretching after exercise – protects long‑term mobility, posture and joint health.

Maintaining good mobility in your 40s reduces the risk of overuse injuries and preserves a sense of physical ease as you age.

There is a lot more information about the importance of physical activity in section 3 of the Guide – Physical activity.

Cardiometabolic health

The good news is that adjustments in our 40s can be very effective in strengthening our cardiometabolic health.

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.

Even modest improvements in these areas can help stabilise blood pressure, cholesterol and blood sugar, reduce inflammation and maintain insulin sensitivity.

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 management

You may want to reassess priorities or adjust your work-life balance. As a minimum, try engaging in regular physical activity, meaningful social connection, hobbies and habits that calm the nervous system, such as deep breathing exercises and mindfulness (see section 6.2 – Stress Management).

Other factors for current and future health

In addition to the main predictors (above) of future health, there are other factors that are important for good health in our 40s – and need to be managed – that are also predictors of future health and quality-of-life including diet and nutrition, cognitive engagement, social connections and sleep quality.

Diet and nutrition

Poor diet and weight management are predictors of higher risk of type 2 diabetes, fatty liver and heart disease. So, it’s wise to make sure you are eating the right foods. But what are the “right” foods?

Protein-rich foods will preserve muscle mass and vitamins – calcium and vitamin D – are needed to support bone health. There is a lot more information about the right diet, including foods that contain the necessary vitamins and nutrients, in section 2 – Diet and nutrition.

Cognitive engagement – having a purpose and ongoing learning

To keep our brains sharp, it is important to keep learning – acquiring new skills or engaging in complex tasks help to maintain neural connections. Other important factors include social engagement and purposeful activities such as hobbies, mentoring and creative pursuits that have been shown to enhance mental clarity, and boost motivation: What’s good for your brain.

The other side of the coin is managing cognitive risks: What’s bad for your brain.

In addition to a wide variety of health benefits to be gained from positive thinking, it contributes to mental health by lowering stress levels and protecting against anxiety. Mindfulness can also contribute to good mental health – it can reduce forgetfulness, improve focus/concentration and increase situational awareness: Mindfulness.

Social engagement

The competing demands of our 40s tend to shrink social networks without us realising it’s happening. Yet strong relationships in the 40s are a significant contributor to our future well-being – they provide emotional stability, perspective and a buffer against chronic stress. What’s important is not the number of social connections, but the quality, so it’s important to retain those close social connections – people who you trust and who support you. This helps protect mental health, reduces burnout risk, and strengthens resilience, all of which are important especially heading into midlife transitions.

Sleep quality

Risks and early warning signs in our 40s

Many risks don’t give any advance warning. Conditions like hypertension, cardiovascular disease and cancer can often develop silently, without any symptoms – see No early warning signs in section 8.  

But many do have early warning signs. For example, our metabolism slows down in our 40s which often means putting on weight. If addressed early by adjusting diet and increasing exercise, the serious problems associated with being overweight – heart disease; diabetes; thyroid dysfunction; etc – can be avoided.  

Have a look at the table below that deals with risks which either emerge or increase in our 40s. There is also 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’s always wise to be sure by checking with your GP.

Health Risk	Signs or symptoms	Notes
Arthritis	Morning stiffness, discomfort after repetitive tasks in hands, hips or knees	Rheumatoid arthritis can start from the 30s onwards
Cancer	Indeterminate or no early warning signs	The risk of skin (melanoma), prostate , breast and bowel cancer rises during the 40s. Screening becomes important
Depression or anxiety	Irritability; low energy, mood or motivation; poor sleep; changes in appetite; loss of interest in activities and/or social connection	This decade often involves significant life transitions, hormonal changes, and increased pressures from career, finances and family responsibilities that can contribute to poor mental health
Diabetes: Type 2	Being overweight and lack of exercise; often there are no signs or they are mistaken for normal ageing	The risk increases in the 40s; screening is important for blood glucose and kidney function for people at risk (family history, obesity, etc) is important.
Heart disease, high blood pressure and stroke	Being overweight and breathlessness after mild physical activity are possible indicators but there are not always any early signs	The risk arises in the 40s so blood pressure and cholesterol should be checked; if any symptoms or family history, checks should be done annually.
Obesity and visceral fat	Visceral fat wraps around vital organs such as the liver, pancreas and intestines. It can be present even in people with flat bellies and low body fat percentages.	Metabolism slows down so obesity becomes harder to redress See section 2.4 – Weight management

Screenings & check-ups for the 40s

There are other recommended tests in the table below. Further reading: The Truth About Hidden Health Risks in Your 40s and 50s.

Test / checkup	Recommendation
Bowel cancer	2 yearly testing now recommended from age 45
Breast cancer	Mammogram – available every 2 years from age 40
Cervical cancer	HPV screening every 5 years from age 25 to 75
Cardiovascular / heart health	Annual cholesterol, blood sugar and blood pressure checks especially if there is a family history or any symptoms
Diabetes & kidneys	Testing for blood glucose and kidney function every 3 years or more often if hypertension, obesity or a family history of diabetes
General health	GP visit recommended annually for broad review of health
Perimenopause	Assessment from mid 40s when symptoms usually emerge
Prostate cancer	Discuss with your GP getting PSA included in your next blood test
Skin cancer	Annual checkup is recommended

It is, of course, advisable to get screenings done more regularly if there are any early warning signs or increased risk factors, such as your lifestyle or family history.

Target heart rates for exercising

Your target heart rate will depend on your objective, your age and your level of fitness. The first step is to work out your maximum heart rate (MHR) which is obtained by subtracting your age from 220. Therefore, a person who is 40 has a maximum heart rate of 180 bpm (beats per minute). If his/her goal is aerobic activity, the rule of thumb is to aim for 60-70% of your MHR i.e. a heartbeat between 108 and 126 bpm. There is more information on the table below.

Although it is a common misconception that fat burning only happens in zone 2, it does in fact happen across 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, whereas training in lower zones also. In fact, training in lower zones can build endurance and support recovery.

Goal	Zone	BPM age 40	Activity Examples
Light exercise or recovery	Zone 1 (50–60%)	90-108	Gentle walking, yoga, light stretching
Aerobic / Fat burning	Zone 2 (60–70%)	108-126	Brisk walking, steady swimming, light cycling
Cardiovascular endurance	Zone 3 (70–80%)	126-144	Jogging, moderate cycling, swim intervals
Speed & power	Zone 4–5 (80–100%)	144-180	Sprinting, HIIT, hill climbs

Health records & directives

Health records: If you are injured or suddenly fall ill away from home, and need to be treated urgently, your medical records could be critical to the outcome of your treatment. That’s why it’s important to ensure they are accessible online. Talk to your doctor about this: see section 6.11 – Important Health Documents

Why a Will is not enough: If you are in an accident or become very ill, perhaps incapacitated, or even in a coma, who will pay your bills, arrange banking and otherwise manage your affairs?

What to do – today – to improve your health

1. Make a commitment to become more proactive and tell someone close to you about your decision, what you are going to do and when.
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 list of proactive steps you are going to take and when you are going to start on each one.

Below is a brief checklist for the 40s 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.

Checklist – for the 40s and ageing well

• Aerobic exercise for cardiovascular health
• Weight-bearing exercise for muscular health
• Maintain a balanced diet with adequate protein
• Get bone density check if at risk
• Beware of mental health if under stress
• Keep up sun protection; annual skin check
• Keep an eye on weight and waist circumference
• Prioritise sleep despite life pressures
• Manage stress proactively
• Monitor blood pressure and cholesterol
• Strengthen social connections

Your proactive plan

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

What your future health has in store for you and how you can shape it in your 40s

This appendix provides simple ways to find out what various aspects of your current health might be telling you about your future health. No need for special equipment or expensive testing – most tests 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 a 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 increased cardiovascular risk, early mobility decline and higher stress load in your 50s. “Good, very good or excellent” predicts better metabolic health and stronger cognitive ageing.

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 40s 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 650 metres or more without being overly puffed indicates good aerobic capacity for the 50s, lower long-term cardiovascular risk and slower biological ageing.
• Amber zone – 580-650 metres suggests below optimal aerobic fitness and higher risk of cardiovascular disease and reduced mobility in later decades.
• Red zone – less than 580 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 per 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 – 45 seconds or less indicates good aerobic capacity and lower risk of future cardiovascular issues.
• Amber zone – 46-60 seconds suggests reduced aerobic capacity, higher future cardiovascular risk and reduced future mobility.
• Red zone – taking more than 60 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 – 17 or more times indicates good lower‑body strength; good predictor of mobility in later decades.
• Amber zone – 14-16 times indicates higher risk of mobility limitations in later life.
• Red zone – 13 or less times 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 – 18 or more incline push-ups for men, and 11 or more for women, in one minute indicates good upper‑body strength for the 50s, a lower risk of shoulder or neck issues and good long-term functional capacity (lifting, carrying, etc).
• Amber zone – 9-17 times for men, and 5-10 or more for women, indicates higher risk of mobility limitations in in later life.
• Red zone – 8 or less for men, or 4 or less for women, 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. 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 – 58-70 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 – 71-80 bpm 3-4 mornings per week indicates that your 60s is likely to involve a higher likelihood of chronic stress; higher chance of developing hypertension; and increased long-term cardiovascular risk (if the trend continues).
• Red zone – above 80 bpm or below 58 on 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 50s, 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.