Last year, I had to give up running. It was, as my sports medicine doctor counseled, “time”.
Since I was a teen, it had been my primary form of exercise and stress relief. But for months, I had been ignoring small signs of encroaching decrepitude: the popping and grinding in my right knee and hip joints whenever I stood up, bent down or took the stairs. The medical term for this is crepitus, yet I kept stubbornly persuading myself that I was still a “young” fiftysomething.
I had imbibed the common positive ageing message: “50 is the new 30.” Yet as far as the cells that make up my knee and hip tendons and cartilage are concerned, 50 is still very much 50. So much for the popular idea that our overall “biological age” can be far younger than our chronological age.
For decades, I had done everything experts recommend – eat well, sleep well, exercise – and yet my doctor was still telling me it was time to adapt to my changing body.
My physiatrist told me that many of his gen X patients, now in their late 40s and 50s, have bought into the idea that age shouldn’t be a factor when it comes to what exercise they do or how they do it. Each trendy sport or exercise sends a new wave of us into his office and others like it. For instance, a 2020 study found that nearly 91% of people showing up to the emergency room with injuries related to playing pickleball were over 50.
Many people approach their physical fitness as if they were a decade or two younger. My GP told me that patients over 50 are often frustrated by any suggestion that their routines might have to change. I started to see this denial of physical realities everywhere. One of my colleagues injured her shoulder doing CrossFit, then re-injured herself a few months later doing the same routine. A friend who has practiced yoga for decades fractured her chin in a fall from crow pose. When I suggested she modify her routine, she scoffed.
As a medical anthropologist, I wondered: had anti-ageing messaging accidentally created a new problem? Was our generation at risk not from under-exercising, like the boomer and silent generations before us, but from over-exercising?
How our bodies change as we age
Dr Emily Finkelstein, a geriatrician at Weill Cornell Medicine, loves that people in their 40s, 50s and 60s have internalized that exercise is important for healthy ageing and longevity. That being said, there are some practical considerations.
“Our muscle mass and our performance peak in our mid-30s,” Finkelstein said, “and start to naturally decline after that. We do need to be flexible in terms of what we’re doing and expecting of ourselves.”
As we edge past 45, we begin to lose critical muscle mass, which can decrease our strength and balance. Decreases in bone density can leave us more vulnerable to stress fractures from repetitive motions and stress. The cartilage in our joints thin, while tendons and ligaments stiffen. All of this means we’re more prone to injuries during physical activity. Recovery takes longer too.
“The thing that people don’t know and don’t learn,” Dr Rosanne Leipzig said, “is that ageing begins at birth, and your abilities are definitely going to change.” Leipzig knows quite a lot about this process, both as a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai and as someone in her 70s.
“You reach a maximum for your muscle mass, bone strength, ability to remember a list of words, all in your 30s. And everything starts to decline after that,” she said. “Ageing doesn’t mean that you can’t do what you did previously, but you probably can’t do as much in the same time period.”
Most experts agreed that messages like “50 is the new 30” can be helpful if they convince people not to write themselves off as they age. It’s OK to push ourselves a bit physically. But the flip side is an assumption that a 50-year-old body isn’t different from a 30-year-old body. It is.
“One of the best things we can do for our own healthy ageing is to be flexible and adaptable,” Finkelstein said. “We need to change our expectations and we need to change how we exercise as we get older.”
How to adapt to ageing bodies and avoid injury
In midlife, we should all learn to be more in tune with our bodies. That might mean taking more recovery time between intense workouts, doing more stretching and integrating more weights into our fitness routines.
A healthy adaptive approach to exercising as we age might involve regular self-monitoring and assessment of how our bodies feel both during and after workouts, and seeking input from a qualified medical professional when we start to notice any signs or symptoms of an encroaching problem, such as pain or discomfort.
Leipzig suggests that physicians begin conversations about adjustments by asking patients what it is they love about an activity they’re holding on to. A tennis player might really love the social aspect. In that case, they could switch to pickleball – which is less taxing, but similar – with a complementary strength-training and stretching regimen to prevent injuries.
But since risk of injury naturally rises as we age, it’s also important to have a backup plan for if and when we overdo it. When I talked to Dr Melissa Leber, associate professor of orthopedics and emergency medicine at the Icahn School of Medicine, she had just finished working at the US Open. Leber has a lot of experience dealing with athletes – both professional and amateur – who have pushed themselves a bit too hard.
“Some people are really good at adjusting and they’re comfortable with their bodies changing,” Leber said. “Others go hardcore. I’ve seen some patients who don’t even want a day off.”
Leber counsels patients to switch things up while allowing their body to recover. So, if you’re a runner with an injury, try a modified strength-training routine and a lower-impact activity, like swimming. Then, when you start running again, run fewer times a week or for shorter distances. To avoid injury or overuse, experts recommend one or two rest days a week, at minimum.
Strength training is also very important. “The stronger you are,” Leber said, “the more you will avoid injury and falls. And when you do fall, you will fall differently. Your balance will be better, and you’ll recover from injury faster.”
As a rule, Leber advises that someone in their 50s should spend 50% of their total exercise time on strength training and 50% doing cardio. By age 60, that metric should be 60% strength and 40% cardio. By 70, cardio should only comprise 30% of a workout.
All of the experts I spoke to agree that pain should never be ignored – and it’s never a good idea to push through the pain without seeing your doctor. That being said, Finkelstein pointed out that most general physicians aren’t all that well-trained in exercise physiology. For specific recommendations pertaining to exercise regimens, it’s better to see a physiatrist, specialist in physical medicine and rehabilitation or certified physical trainer.
“I wish we were all better trained in that,” Finkelstein said, “because it’s so important.”
To compound this, conversations about how to maintain muscle mass, bone health, aerobic capacity and cardiovascular fitness take more time than the average physician can spend with their patients. Many people fill that gap with advice from fitness influencers online.
Cultivating realistic expectations of ageing
Finkelstein worries about the effect of the media – especially social media, with its legions of wellness and anti-ageing influencers. “Take these supplements, do this exercise program, join this fitness routine: you name it, people are serving it up,” she said. “I worry a lot about that in terms of the reliability of those people and the science behind what they’re offering, and people being vulnerable to that because you want to do what you can to stay healthy and youthful.”
Popular media also loves to feature “superagers” – people whose mental and/or physical abilities are comparable to people 20-30 years younger. And while it’s good to see, say, an 87-year-old running a marathon, it may lead to false expectations about normal ageing. Superagers are rare; only about 10% of the general population fit all the criteria for inclusion in the category.
In other words, it’s not very realistic for those of us in our middle age or older to think we’ll rack up those personal bests forever. As the experts kept pointing out, the best approach to exercising as we age is realistic and adaptive. A runner who adapts to the changes of their ageing body and trains effectively may still be able to run the Boston marathon, but the time it takes for them to cross the finish line will necessarily lengthen.
Part of the problem might be optimism bias. While we may logically understand that bodies change, we don’t think we are actually changing. Maybe that’s because we’re living in a culture that is obsessed not only with longevity, but with looking younger. The number of cosmetic procedures has increased 42.5% globally over the last four years, and Americans spent an estimated $20bn on cosmetic surgery in 2024.
“In our society, we have a huge problem with accepting the fact that things are going to change,” Leipzig said. “People are in better shape in general than they ever have been, if they’re privileged enough to be able to take care of their needs, but it leads them to think they will never die. It leads to ageism.”
And that’s the rub: being overly concerned with how much “younger” you are for your age is just another form of bias – one that you can hold against your future self. “Fifty is the new 30” simply underscores our misconception that being healthy means not ageing at all. It would be healthier if we occasionally reminded ourselves that ageing is a privilege; that “50 is 50” and “80 is 80” – and there’s absolutely nothing wrong with that.
