Improving health and function in midlife


In a recent study, midlife patients with improved physical component scores saw reductions in back pain, stiffness, forgetfulness, and other factors associated with health and function.

Improving health and function in midlife | Image Credit: © Monkey Business - © Monkey Business -

Improving health and function in midlife | Image Credit: © Monkey Business - © Monkey Business -

There are multiple modifiable factors associated with improvements in health and function for midlife women, according to a recent study published in JAMA Network Open.

Several changes in health and function occur during midlife, with multiple limitations in health in function appearing during this time and lasting into late adulthood. These limitations may also be associated with chronic conditions which develop before or during midlife.

Women may be able to improve their health during midlife, maintaining good physical health and function to improve aging. Midlife functioning has been associated with mortality and dependent living, and several modifiable factors have been associated with successful aging.

Investigators conducted a cohort study to determine factors associated with improvements in midlife health. Data was gathered from the Study of Women’s Health Across the Nation (SWAN), a multisite community-based study on menopause transition and midlife in US women. There were 3302 participants with visits in 1996 and 1997.

Participants were aged 42 to 52 years, hadn’t taken hormone therapy in the past 3 months, had an intact uterus and at least 1 ovary, identified as an eligible race and ethnicity, and had 1 or more menses in the previous 3 months.

Clinically significant improvements in the physical component score (PCS) of the 36-item Short-Form Health Survey (SF-36) were measured as the primary outcome of the study. The SF-36 contains 8 subscales and 2 summary scores, including the PCS.

The PCS has 20 items and 8 domains: physical function, role limitations from physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations from emotional problems, and mental health. Scores range from 0 to 100, with higher scores indicating improved outcomes.

Patients received the SF-36 at SWAN visits 6, 8, 10, 12, 13, and 15. PCS changes in the previous 10 or more years were examined, with visit 8 considered the first visit and visit 15 considered the last visit. An improvement in PCS score of 5 or more points during the study period was the primary outcome. The PCS at visit 8 was defined as the baseline PCS.

Variables measured included age, race and ethnicity, alcohol use, smoking level, marital status, smoking status, sleep quality, financial strain, presence of comorbid conditions, physical activity, body mass index (BMI), medication use, and common symptoms and problems. Variables were recorded at visit 8.

There were 1807 women included in the final analysis, aged a mean 54.5 years. Women in the SWAN cohort excluded from the analysis were compared with those in the analytic cohort. In the analytic cohort, 15% of women saw clinically significant improvements to their PCS during a median 11.1 years.

At baseline, patients who saw improved PCS experienced back pain in 40% of cases, stiffness in 55%, osteoarthritis in 50%, and osteoporosis in 17%. The mean PCS improvement in this population was 10.3 points from visit 8 to visit 15, with the most significant improvements occurring from visit 8 to visit 10.

A reduction in back pain was seen in 6% of women with improved PCS, reduced stiffness in 8%, and reduced forgetfulness in 5%. Physical activity saw greater increases in those with improved PCS compared to those without. 

BMI fluctuated over time in both groups, and sleep disturbance was initially higher in the improved PCS group but decreased over time to a similar rate as the non-improved group. Clinically significant improvements in PCS were associated with lower BMI, no financial strain, no sleep disturbance, fewer medications, no osteoarthritis, and higher physical activity score.

These results associated multiple factors with improvements in health and functioning. Investigators concluded these results could be used to create interventions for improving physical health during midlife.


Santacroce LM, Avis NE, Colvin AB, Ruppert K, Karvonen-Gutierrez C, Solomon DH. Physical and behavioral factors associated with improvement in physical health and function among US women during midlife. JAMA Netw Open. 2023;6(5):e2311012. doi:10.1001/jamanetworkopen.2023.11012

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