I was lying on my side at physical therapy, halfway through a set of leg raises to strengthen a butt muscle gone soft, when a therapist attending to a 41-year-old woman with knee pain said something that made my ears perk up.
“After they turn 40, they all come in here with lower-body problems,” she said, referring to us, the patients.
Until that moment, I hadn’t considered the possibility that a perplexing parade of injuries I’d experienced since my 44th birthday — to my foot, my lower back, my hamstring, hip and elbow — was connected to my age. I do the kind of physical activity — high-intensity yoga, running and rowing — that should theoretically keep my whole body strong. Yet doctors and physical therapists kept telling me that certain muscles were very weak, causing my other joints and muscles to overwork, leading to injury.
I stumbled into my 40s largely ignorant of the changes to come, not just to my muscles but also to my hormone levels. We may be prepared for wrinkles and gray hair, but the decline in strength and increased risk of injury, even among very active people at this stage in life, is little recognized and far too infrequently discussed.
New research shows that the bodies of men and women may age in waves, with one significant acceleration in our mid-40s (and another in our early 60s). Acknowledging our 40s as a turning point can help demystify this era, allowing us to see it for what it is: a crucial time to counter some aspects of aging and the more punishing health problems that could lie ahead.
Fortunately, there’s good science on how to do that, specifically through strength training and hormone therapy, the latter more often recommended for women than men. Rarely are people in their 40s getting these messages.
Scientists agree that as we age, our cells, tissues and systems deteriorate. In its most severe form, that deterioration can lead to age-related diseases such as cancer, arthritis and Alzheimer’s. Because the risk of developing these diseases rises after age 65 — and because people over 65 make up an increasingly bigger proportion of America’s population — those groups typically come to mind when we think about aging.
But in our 40s we will inevitably confront the cold, hard reality of biology, too: Our bodies won’t stay as strong, or repair or metabolize like they used to. This is despite the fact that we’ve been told 40 is the new 30.
Vonda Wright, a 57-year-old orthopedic surgeon in Florida, is one of a growing number of doctor-influencers on Instagram and other platforms trying to educate people in midlife about optimizing health and athletic performance.
She says the 12 so-called hallmarks of aging — the ways that cells, tissues and systems degrade as we age — start appearing in our 30s and speed up when we reach our 40s. “Why suddenly are people in their mid-40s who have always felt like themselves finding they can’t squeeze out the performance anymore?” Dr. Wright told me. “It’s because, No. 1, the hallmarks of aging are catching up to us, and No. 2,” in the case of women, we’re rapidly losing estrogen. (Men also lose testosterone over time, but typically at a slower rate than women lose estrogen.)
While we tend to think of estrogen and testosterone as fueling reproduction, they also send signals to muscle cells to replicate and grow. When levels run low it can be harder for those cells to turn over and develop, leading to weaker muscles.
More doctors like Dr. Wright are now talking to many of their patients in midlife about menopausal hormone therapy, in part because for some women, it may be more beneficial than they realize. They’re also encouraging them to build strength and power to avoid devastating injuries such as fractures that can land people in the operating room.
It wasn’t that long ago that cardiovascular exercise was the default activity recommended for health. But the evidence now shows that incorporating strength training as you age not only counters weakening muscles and prevents injuries but also is good for metabolism, the heart and the brain. Late last year, the American Heart Association updated its guidelines to recommend this kind of training for cardiovascular health.
Yet only 28 percent of adults in the United States get the recommended amount of exercise, which includes lifting weights at least twice a week. Though I’d dabbled in strength training, it was only when I started paying attention to experts on aging that I realized this was probably the most important part of my exercise routine. I also discovered I had to lift heavier, meaning 10-pound dumbbells and up, to stress my body enough to get all the possible benefits.
So, yes, science suggests our 40s are a pivotal time when our bodies begin to assert their limits. For those of us who have always been active, the goal of exercise may have to evolve. For me, I’m now thinking less about chasing peak performance and more about challenging my weakening muscles and avoiding injuries.
To focus on strength training in our 40s is to acknowledge this change and also to realize we can fortify our bodies with new capabilities. For people who don’t regularly exercise, that could mean building a body that’s stronger and fitter than it ever has been. Certainly, the strength training advocates I’ve encountered embody something that, to me, feels powerful and new: incredibly fit middle-aged people training for health, performance and longevity.
These days, whether I am doing a leg lift to heal my hamstring or a dead lift to coax my muscles out of frailty, I find a deep pleasure in the burn. And I’m far less intimidated by the notion of turning 50 — it’s just another decade to get ripped.
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