Hi Blake,
Its been a while since I've seen you on here, but its been a while since I've been here, myself.
I'm going on 45 next May and my PFT's are still in the high 90's.
The most I could see that helped me and I wouldn't wanna change is my decision at the age of 18 to get involved in the Martial Arts because I found it an interest of mine that I felt would last me a long time to continue in excercise as well as a "way of life" for myself.
I'm still involved in the Martial Arts, though work and other things tend to get in the way, sometimes.
I also think my career has a bit to do with it in the fact that I did what I could to not be exposed to elements which would inhibit my health. I'm not sure what your career goals are, but I hope they are also in consideration of your working environment.
Coming to live in Japan is sort of a toss-up for me for something I'd do differently. In regards to CF care, there is absolutely none, but on the contrary, the diet and lifestyle in Japan seems to match my needs very well.
I hope this is helpful for how you will decide to manage your health for the long-run.
best to you,
Fred