Bette Davis famously said: "Old age is no place for sissies."

With that in mind, baby boomers have worked hard to be active and healthy. Armed with countless studies, tests and recommendations, the generation born between 1946-64 - numbering 76 million in the United States - has dutifully jogged, lifted, stretched, dieted and detoxed to get and stay in shape.

But try as they might, many are coasting into middle age carrying extra pounds, their blood pressure, blood sugar and cholesterol inching up. An analysis of the annual National Health Interview Survey published last year in the journal Health Affairs said there are signs Americans in their 40s and 50s are less healthy today than previous generations.

Has the damage been done? Is it hopeless? Not at all, say physicians and researchers.

Even small changes in diet and exercise during middle age can have a dramatic impact on health and longevity, they say.

But what changes do you make? A problem for boomers is the mountain of available health information, much of it conflicting. Is strength training better than aerobics? Do we need vitamins? High fat or low fat for weight loss? A glass of wine or abstinence?

There's a lot at stake. Life expectancy is rising - 78.2 years for a 50-year-old man and 82.1 years for a 50-year-old woman - so boomers face decades of ill health if they don't make changes, at a time when such potent foes as diabetes, arthritis, heart disease, stroke and cancer are rearing their heads.

The Tribune asked cardiologist Charles Karaian, director of the Presbyterian heart program, and physician Carla Herman, chief of the division of geriatrics at the University of New Mexico School of Medicine, to outline steps boomers can take to make the years ahead less bumpy. The recommendations were fleshed out with health research information from the Wall Street Journal.

"The message for folks hitting midlife is it's time to wake up and do something. You absolutely can make a difference," Herman says. "You can reduce the risk of disease and disability."

At the top of Karaian's list is smoking: Don't start, and if you smoke, stop.

"It's the No. 1 cause of heart disease," he says. "Within five to 10 years of quitting smoking, a person's risk of heart attack becomes as low as if they had never smoked."

Here are the other suggestions:

Drop the weight

Some of the worst health problems revolve around obesity. "It's an epidemic," Karaian says.

He says the best way to take off pounds, and keep them off, is a low-fat diet. Less than 30 percent of a person's daily caloric intake should come from fat, Karaian says.

Your grocery cart should reflect that ratio. Look inside. Two thirds of what you buy should be fruits and vegetables, whole grains and beans, and one third animal protein, Karaian says.

Herman says to distinguish between good and bad fats: the good fats being those in olive oil, cold-water fish and raw nuts. Artery-clogging trans fats common in snack foods should be avoided, she says.

And put down the salt shaker.

"You need about 250 milligrams a day to live, and the average person consumes 4,000 to 6,000 milligrams a day," Karaian says. "Excess dietary salt is associated with high blood pressure."

10,000 steps

Karaian says it's essential to keep moving, to stay active.

"We joke that people have remotes to run their remotes," he says. "But it's not funny."

An organized exercise program is great, but equally important is activity throughout the day, Karaian says.

He wears a pedometer and aims for 10,000 steps a day, or about four miles of activity. That means parking at the back of the lot, climbing the stairs, doing just one task at a time - instead of combining.

"Just keep moving," he says.

Herman's advice: "Turn off the TV, walk, bike - whatever you can do."

A study funded by the National Institutes of Health showed participants with a mean age of 51 at high risk of diabetes were able to slash their risk in half through modest weight loss and exercise.

Pump iron

Strength, or resistance, training builds muscle and helps the heart, studies show.

Muscle mass declines by about 5 percent per decade after age 40. Strength training prevents problems such as sarcopenia, a loss of muscle mass that puts people at risk for falls and fractures.

It also reduces levels of homocysteine, a blood marker linked to heart attacks and strokes. A study by the University of Virginia in Charlottesville showed that six months of resistance training three times a week cut homocysteine levels more than 5 percent while people who didn't train saw a 6 percent rise in levels.

Eat green

Research suggests that green, leafy vegetables such as spinach and kale, which are high in antioxidants that protect tissues from degrading, can prevent age-related diseases and preserve cognitive function.

A Harvard Medical School study found that women who ate eight servings or more a week of green, leafy vegetables had the cognitive function of someone 1.7 years younger.

The government recommends five to 13 servings a day of fruits and vegetables, but even a few have been shown to have benefits.

Pop a pill

Physicians recommend taking a multivitamin, particularly one with 2.4 micrograms a day of B12 and 1,000 international units of D. Older people have trouble metabolizing vitamins B12 and D, which are better absorbed in supplement form.

A B12 deficiency can cause anemia and raise the risk of developing Alzheimer's disease. Vitamin D, which we get largely from sun exposure, is vital to calcium absorption, bone health and muscle strength. Aging skin absorbs less vitamin D, and sunscreens and hats further block the light.

Herman said men and women should take a calcium supplement for bone health.

Karaian says to be wary of other supplements.

"We don't know the long-term safety," he says. "The dosages are uncertain, there are no manufacturing standards, and there are potential drug interactions."

Brush and floss

Karaian says studies show people with bad teeth are at higher risk for heart problems.

In a study published in the journal Stroke, people with severe periodontal, or gum, disease had a 4.3 times greater risk of stroke than people with either mild or no periodontal disease. The theory is that infection and bacteria in the mouth causes inflammation in the blood, which can lead to blood clots that cause strokes and heart attacks.

Gum disease can be prevented by brushing and flossing at least once a day, and getting cleanings from a dental hygienist twice a year, Herman says.

Get your Z's

"Sleep has been one of those constant complaints, but we never before appreciated how important it is and how it is linked to good health," Herman says.

She says insomnia can cause a variety of ills: weight gain, diabetes, depression, cognitive decline and dementia.

"It's a particular problem for women," she says. "Early on, they were raising kids, always half asleep. Then they hit menopause."

She says treatment can be found at sleep clinics, which focus on behavioral modification.

And sleep apnea, a condition in which people stop breathing for short periods of time during sleep, becomes more common in the 40s and 50s as muscle tone in the mouth diminishes and the tongue falls back to cover the windpipe.

Research has linked apnea to high blood pressure, stroke and diabetes. A 2003 article in the Journal of the American Medical Association said about one in five adults has at least mild sleep apnea, which can be treated with masks, surgery and dental devices.

Stay in touch

Studies show that people with good social support systems have better health, Herman says.

"There's less stress, less depression, and people who are connected to a spouse, friends, church - whatever - live longer."

A study published in Lancet that followed 1,200 people in Stockholm, Sweden, for three years showed that those with a limited social network had a 60 percent higher risk of developing dementia.

And an active sex life has been shown to have benefits for health and longevity. A study published in 1997 that followed 918 Welsh men over a decade showed those who had the highest frequency of orgasms had half the risk of death during a 10-year period than those with the lowest frequency.

Mole watch

Skin cancer is a particular threat of midlife.

The average age of onset of melanoma, the deadliest form, is 50, and of other skin cancers is 60.

Wear sunscreen and moisturizer, Herman says. And the American Cancer Society recommends that everyone 40 and older get a yearly body check from a doctor.

New procedures such as dermascopy, which uses a magnifying instrument to study the skin's surface, make it possible to diagnose skin cancers earlier.

Use it or lose it

Herman says studies show that doing crossword puzzles, Sudoku or other word games helps keep people intellectually engaged and mentally sharp. The same goes for learning a foreign language or musical instrument, reading books and dancing.

Research shows the ability to act on new information, multitask and remember things gradually declines beginning in the 20s. It becomes more noticeable after age 40.

In a 2003 study in the New England Journal of Medicine, people who read, played board games, played musical instruments or danced had a 63 percent reduction in the risk of dementia.

Don't get down

Depression occurs in all phases of life, but it becomes particularly dangerous as we age. It is linked to alcoholism, heart disease, diabetes and dementia, Herman says.

"It's such a treatable condition, with antidepressants and counseling," Herman says. "Being aware of it as a common disease, it should be screened for as we age."

Among older people, the highest risk of suicide is among while males.

Symptoms include insomnia, fatigue, weight change, irritability, feelings of worthlessness and a lack of productivity at work.

Herman says it's important to seek out health care and information as we age.

"In general, the longer you live, the longer you're going to live," she says. "The issue is quality of life versus length of life. People want to be able to function actively as long as they can."

Karaian says that for some, it's an uphill battle.

"I'm amazed. Some people take better care of their cars than their bodies," he says. "It's weird."

The Wall Street Journal contributed to this story.

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