S.Hrg.119-113

1[Senate Hearing 119-113]2[From the U.S. Government Publishing Office]34                                                        S. Hrg. 119-11356                        LESSONS FROM THE FIELD:7                    HOW SPORTS MEDICINE CAN IMPROVE8                      HEALTH OUTCOMES FOR SENIORS910=======================================================================1112                                HEARING1314                               BEFORE THE1516                       SPECIAL COMMITTEE ON AGING1718                          UNITED STATES SENATE1920                    ONE HUNDRED NINETEENTH CONGRESS2122                             FIRST SESSION2324                               __________2526                             WASHINGTON, DC2728                               __________2930                             JUNE 25, 20253132                               __________3334                           Serial No. 119-103536         Printed for the use of the Special Committee on Aging3738[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3940        Available via the World Wide Web: http://www.govinfo.gov4142                                __________4344                   U.S. GOVERNMENT PUBLISHING OFFICE4560-944 PDF                  WASHINGTON : 20254647-----------------------------------------------------------------------------------4849                       SPECIAL COMMITTEE ON AGING5051                     RICK SCOTT, Florida, Chairman5253DAVE McCORMICK, Pennsylvania         KIRSTEN E. GILLIBRAND, New York54JIM JUSTICE, West Virginia           ELIZABETH WARREN, Massachusetts55TOMMY TUBERVILLE, Alabama            MARK KELLY, Arizona56RON JOHNSON, Wisconsin               RAPHAEL WARNOCK, Georgia57ASHLEY MOODY, Florida                ANDY KIM, New Jersey58JON HUSTED, Ohio                     ANGELA ALSOBROOKS, Maryland59                              ----------60                McKinley Lewis, Majority Staff Director61                Claire Descamps, Minority Staff Director6263                         C  O  N  T  E  N  T  S6465                              ----------6667                                                                   Page6869Opening Statement of Senator Rick Scott, Chairman................     170Opening Statement of Senator Kirsten E. Gillibrand, Ranking71  Member.........................................................     27273                           PANEL OF WITNESSES7475E. Lyle Cain, Jr., M.D., Orthopedic Surgeon, Team Physician,76  Andrews Sports Medicine and Orthopaedic Center, University of77  Alabama, Birmingham, Alabama...................................     378Paul S. Legg, M.D., Orthopedic Surgeon and Team Physician,79  University of Charleston, Charleston, West Virginia............     680Matt Hasselbeck, Former NFL Quarterback, Nashville, Tennessee....     781Jennifer Raymond, Chief Strategy Officer, AgeSpan, Lawrence,82  Massachusetts..................................................     98384                                APPENDIX85                      Prepared Witness Statements8687E. Lyle Cain, Jr., M.D., Orthopedic Surgeon, Team Physician,88  Andrews Sports Medicine and Orthopaedic Center, University of89  Alabama, Birmingham, Alabama...................................    3390Paul S. Legg, M.D., Orthopedic Surgeon and Team Physician,91  University of Charleston, Charleston, West Virginia............    3592Matt Hasselbeck, Former NFL Quarterback, Nashville, Tennessee....    3893Jennifer Raymond, Chief Strategy Officer, AgeSpan, Lawrence,94  Massachusetts..................................................    409596                        Questions for the Record9798E. Lyle Cain, Jr., M.D., Orthopedic Surgeon, Team Physician,99  Andrews Sports Medicine and Orthopaedic Center, University of100  Alabama, Birmingham, Alabama...................................    45101Paul S. Legg, M.D., Orthopedic Surgeon and Team Physician,102  University of Charleston, Charleston, West Virginia............    47103Jennifer Raymond, Chief Strategy Officer, AgeSpan, Lawrence,104  Massachusetts..................................................    48105106                       Statements for the Record107108American Physical Therapy Association and the Academy of109  Geriatric Physcal Therapy (APTA Geriatrics) Statement..........    53110BPR Lab Statement................................................    56111The Watertown YMCA Statement.....................................    58112113                        LESSONS FROM THE FIELD:114                    HOW SPORTS MEDICINE CAN IMPROVE115                    HEALTH OUTCOMES FOR SENIORS116117                              ----------118119                        Wednesday, June 25, 2025120121                                        U.S. Senate122                                 Special Committee on Aging123                                                    Washington, DC.124    The Committee met, pursuant to notice, at 3:30 p.m., Room125G50, Dirksen Senate Office Building, Hon. Rick Scott, Chairman126of the Committee, presiding.127    Present: Senators Scott, McCormick, Justice, Tuberville,128Johnson, Moody, Husted, and Gillibrand.129130                 OPENING STATEMENT OF SENATOR131                      RICK SCOTT, CHAIRMAN132133    Chairman Scott. Good afternoon. The Special Committee on134Aging will come to order.135    As we have heard from expert witnesses in previous136hearings, staying active is one of the most effective ways for137older Americans to prevent disease, improve mental health, and138increase longevity.139    Too often, Congress holds hearings on problems, listens to140solutions, and then never takes action to keep the conversation141going and put good ideas into practice. It sounds crazy, but142that is the norm in Washington, and I do not think any of our143good members of the Aging Committee want to keep following this144broken tradition.145    I was excited to put this hearing together today, with the146Ranking Member, at the urging of my good friend, Alabama147Senator Tommy Tuberville, to ask an interesting question that148perhaps only a coach might come up with--how can we take the149lessons learned in sports medicine, and all the innovation that150goes into injury prevention and enhanced recovery for America's151elite athletes, and use that knowledge to improve the lives of152American seniors?153    Senator Tuberville has spent his life on the football154field, and he has seen just how much sports medicine has155changed over the years, and how the innovations in this field156have helped keep athletes healthier and recover from injuries157faster.158    The rest of us probably do not realize that some of the159most promising tools for healthy aging are already being used160on the sidelines of football fields, training rooms, and sports161clinics around the country.162    Now it is up to us to use our jobs in the Senate to embrace163innovation, wherever it is found, and help break the cycle of164good ideas coming to Washington to sit on a shelf.165    In today's hearing, we will explore how the science and166techniques developed for elite athletes can be applied to167enhance the lives of older Americans, enabling them to stay168stronger, recover more quickly, and maintain their independence169as they age.170    Sports medicine, with its emphasis on preventing injuries171and promoting proper recovery, offers a new pathway to172longevity and health for America's aging population. As we173consider how to support our seniors, we must draw lessons from174the best in the field, literally. The goal is not for seniors175to become athletes, but for them to benefit from the same176principles: injury prevention, rehabilitation, strength177training, and recovery. These are tools for everyone, whether178you are playing under the Friday night lights or walking your179grandkids to school.180    As many of you know, Florida has a vibrant senior181population and some of the best collegiate and professional182sports teams, and I am proud to support them.183    Today, we will hear from medical experts with real-world184experience in treating both athletes and older Americans. We185will also hear from a former professional quarterback who knows186firsthand how sports medicine can help protect against aging187injuries and lead to a longer, healthier life.188    Now I would like to recognize Ranking Member Gillibrand for189her opening statement.190191                 OPENING STATEMENT OF SENATOR192             KIRSTEN E. GILLIBRAND, RANKING MEMBER193194    Senator Gillibrand. Thank you, Chairman Scott, for today's195hearing. What an exciting topic that we get to talk about196today. It is great that we get to talk about innovative ways197that we can incorporate sports medicine into how we care for198our older adults, and I am particularly interested in how we199can increase physical activity and reduce falls for our200seniors.201    A fall can change a senior's life. One fall can take away a202senior's ability to live independently. One fall can make an203older American afraid to leave the house, increase loneliness,204and social isolation. One fall can create a lot of other health205problems.206    I remember when my grandmother broke her hip. It is a207common story. When you break your hip, it changes everything,208and you really are afraid of going out. You are afraid of being209active. You are afraid of doing all the things you used to do,210so we have to see what we can do.211    I know, even as I age myself--I am 58--mobility is my212number one concern. I have to make sure I have ankle mobility,213knee mobility, flexibility, all those things. I know how214important it is for anyone who is aging.215    Preventing a fall is more important now than ever. The CDC216just released a report this month showing that the death rates217from falls for seniors aged 65 to 74 rose more than 70 percent218in the last 20 years, but falls are not a normal part of aging.219    The good news is many things can be done to prevent falls220and optimize physical wellness among older Americans. I look221forward to working with my colleagues to support and strengthen222programs that help prevent falls and increase physical activity223for older adults. This includes strengthening critical federal224funding for the programs, including the Older Americans Act,225and protecting agencies and entities that perform the work. I226am proud to support programs to increase funding for the Older227Americans Act programs, including leading the Fiscal Year 2026228appropriations letter for fall prevention programs. I am also229proud to support the bipartisan Older Americans Act230reauthorization that was reintroduced last week.231    I look forward to hearing from our witnesses and figure out232how we can make sure people live healthy, active, and fall-free233lives.234    Chairman Scott. Thank you, Ranking Member Gillibrand.235    We are fortunate to have members of this Committee who have236real-world experience with sports medicine professionals and237coaching. With that I would like to recognize Senator238Tuberville to introduce our first witness.239    Senator Tuberville. Thank you, Mr. Chairman. It is my240pleasure today to introduce Dr. Lyle Cain from Birmingham,241Alabama. Dr. Cain is the Cofounder of Andrews Sports Medicine242and Orthopedic Center, which he is an orthopeadic surgeon243focusing on sports-related injuries to the knee, shoulder, and244elbow. Dr. Cain is a graduate of the University of Alabama and245the University of Alabama School of Medicine. After graduation,246he served as chief resident at the University of Tennessee247Campbell Clinic in Memphis, before completing his fellowship248focusing on orthopeadic sports medicine with Dr. James Andrews249at the American Sports Medicine Institute.250    He currently serves as the team physician for the251University of Alabama and is Medical Director for Jacksonville252State, Shelton State University, Tuskegee University, and the253University of West Alabama. He also serves as a consultant to254the Birmingham Barons and nine high schools in the Birmingham255area. Additionally, Dr. Cain leads an outreach program through256the University of West Alabama that provides medical services257to more than 40 schools in the West Alabama area, so thank you258today, Dr. Cain, for being here, and we look forward to hearing259from you.260261        STATEMENT OF E. LYLE CAIN, JR., M.D., ORTHOPEDIC262263            SURGEON, TEAM PHYSICIAN, ANDREWS SPORTS264265          MEDICINE AND ORTHOPAEDIC CENTER, UNIVERSITY266267                OF ALABAMA, BIRMINGHAM, ALABAMA268269    Dr. Cain. Thank you Chairman Scott, Ranking Member270Gillibrand, and members of the Committee for having me testify271today.272    My name is Lyle Cain. I am the Managing Partner of the273Andrews Sports Medicine Group, as Senator Tuberville said. I274have been a team physician for several high schools, colleges,275and professional teams, including the University of Alabama276Crimson Tide, for over 25 years--Roll Tide. I firmly believe277that the lessons learned while providing care for athletes at278all ages, especially in the field of injury prevention and279management, can help improve the health span of our aging280population.281    As you know, the combination of increased lifespan as well282as the demographics of the Baby Boomer generation have led to a283dramatic shift in the number of senior adults in the United284States, with nearly 20 percent of our population currently 65285years or older. This has tremendous consequences for our286healthcare system, both with increased utilization and287increased costs. A true team approach to the individual, using288the sports medicine system as a model, can help our senior289population maintain a better quality of life as they age.290    What is a team physician? The American Orthopeadic Society291for Sports Medicine defines a team physician as someone who292provides comprehensive health services for the care of athletes293and active people at all ages. The team physician is ultimately294responsible for the health, safety, and performance of our295athletes. Our duties include injury prevention and risk296reduction, acute injury evaluation and management, both during297competition and training, chronic condition and illness298treatment, coordination of care between providers, and299performance optimization.300    In sports medicine we also attempt to prevent injury by301encouraging rules changes and the development of protective302gear for each sport. We accomplish these duties through the303work of a larger team of providers, and as I will outline,304sports medicine is truly a team effort. The modern sports305medicine Team includes certified athletic trainers, who are306generally the primary point of contact for most athletes,307physical therapists, dietitians, primary care physicians,308orthopedic surgeons, psychologists, chiropractors, sports309performance specialists, certified strength and conditioning310coaches, and many others.311    Our relationship with the athlete generally starts when we312do a pre-participation physical on the athlete to assess their313health and physical readiness to play. This is a crucial step314and allows the physician and trainer to identify issues that315may predispose the athlete to future injury. We do a health316history, do a thorough examination, and often perform317additional testing, such as cardiac testing with318echocardiogram, and we develop an individual risk profile for319each athlete.320    In our aging population, the annual examination with your321primary care physician can provide this level of risk322assessment, but the reality is that issues that put the senior323adult at significant risk, such as balance loss, muscle loss,324cardiovascular fitness and endurance, and fall risk,325especially, are generally not evaluated at your annual exam.326Employing athletic trainers, physical therapists, and other327health care personnel to assess this risk could likely prevent328future falls and the associated health compromise in the older329population. In my own family's experience, my 90-year-old330father-in-law has seen tremendous results and better balance by331participating in a local fall prevention program provided by332physical therapists.333    Why is fall prevention so important? Well, as you334mentioned, falls are the number one cause of injury-related335death in the older population. Up to 30 percent of adults that336break a hip end up dying during that first year after surgery,337and even the patients that survive past the first year never338regain independence, requiring expensive care from339rehabilitation or long-term care facilities. It is estimated340that falls alone add $50 billion annually to the U.S. health341care system costs.342    The old orthopedic adage wisely states, "we are brought343into this world through the brim of the pelvis and often leave344through a fracture of the neck of the femur," and that345underscores the risk of mortality from hip fractures. Many of346these falls are preventable with risk assessment, regular347physical activity, resistance training, and fall prevention.348    How do we implement this program? Well, it definitely takes349a team. The medical team should be empowered to treat this350aging patient as an individual with risk assessment, medical351optimization, fitness and performance improvement, just like we352treat our athletes. Primary care physicians are often the353gatekeepers for our older patients, so we have to train these354primary care physicians in musculoskeletal medicine. The355American Sports Medicine Institute, and many programs like it,356train primary care physicians in non-surgical care, but this357requires an extra year of post-graduate training. Physical358therapy visits are generally limited by insurance plans, and359many do not include fall prevention.360    We need to continue NIH funding for this critical disease,361especially in my home State of Alabama at UAB. Just two weeks362ago, the American College of Sports Medicine Exercise is363Medicine program launched a program called the Active Aging364Initiative for Older Adults with a mission to integrate365physical activity by working into routine health care366examination and enhancing collaboration between health care367providers and exercise professionals.368    In closing, we give our athletes the best care possible to369prevent injury and optimize performance. We should do the same370for our senior citizens. Thank you.371    Chairman Scott. Thank you, Dr. Cain. Now I would like to372recognize Senator Justice to introduce our next witness.373    Senator Justice. Thank you, Mr. Chairman, Ranking Member.374You know, I sit here and just think - just a second, but not375very often do I have this opportunity, you know, because Dr.376Cain, I cannot tell you the number of times I have been in the377Andrews Institute, and I am sure you know that.378    Dr. Cain. Yes, sir.379    Senator Justice. Dr. Legg and I are long-lost friends and380everything. Coach Hasselbeck, you know, I have watched you381forever, and you are a coach, and I love it in every way, and382that only leaves Jennifer, the only one that I am not really in383contact with. Jennifer, thank you so much for all you do in384your wonderful State of Massachusetts and everything. I have385got Coach sitting right here beside me, and he is probably386wondering, what in the world is he going to say? Here is what I387would say, and this is all there is to it.388    My job right now is to introduce a man that absolutely is a389superstar in our state. Dr. Paul Legg, you know, believe it or390not, we graduated from the same high school. He was probably391higher in his class than I was, but nevertheless, a great,392great, great man, an incredible physician. The people of our393state depend on this man like you cannot imagine, and394especially, I am sure, the elderly, but many, many, many in our395state have visited and been recipients of his unbelievable396care.397    You know, Doc, you know me, and you know me really well. We398had so many interactions with COVID. For eight years I was the399Governor, and through COVID and all that, there were a lot of,400lot of, lot of, lot of situations to where this man rose to the401level of a superstar in my eyes in every way.402    There is no way I could be prouder than to introduce him403today, a West Virginia University graduate, an absolute404graduate of the same high school that I went to, Woodrow Wilson405High School, and absolutely a superstar in our state. Dr. Legg,406take over and take it from here, sir.407408          STATEMENT OF PAUL S. LEGG, M.D., ORTHOPEDIC409410           SURGEON AND TEAM PHYSICIAN, UNIVERSITY OF411412             CHARLESTON, CHARLESTON, WEST VIRGINIA413414    Dr. Legg. Chairman Scott, Ranking Member Gillibrand, and415honorable members of the Committee, my name is Dr. Paul Legg,416and I want to thank you for the opportunity to offer testimony417to the Special Committee on Aging.418    Thank you, Senator Justice, for the introduction, and go419Flying Eagles. I would also like to thank my wife of 34 years,420Lee, for her support of me and my career. My daughter, son-in-421law, and granddaughter are here today, and my son and daughter-422in-law are watching from South Carolina. I am grateful for423their support, as well.424    I would also like to state for the record the opinions425expressed today are my own and do not reflect the view or426position of my employer, Charleston Area Medical Center and427Vandalia Health.428    I am a practicing orthopeadic surgeon in Charleston, West429Virginia, having spent 27 years in private group practice and430the past two years as a hospital-employed surgeon for Vandalia431Health. I am board certified by the American Board of432Orthopeadic Surgery, with a Certificate of Added Qualifications433in Sports Medicine. For over 20 years I have also been the team434physician for the University of Charleston, an NCAA Division II435school with approximately 620 athletes.436    Sports medicine encompasses the prevention and care of437musculoskeletal injuries and medical conditions encountered in438sports. The lessons from the field, operating room, and439research are applicable to maintain physical function and440performance in competitive athletes of any age. The health441outcomes of seniors improve by keeping them healthy, active,442and injury-free as they age. Surgical techniques designed to443return competitive athletes to the field of play can also444benefit seniors with similar injuries.445    However, surgical techniques are only a small part of446sports medicine's influence on senior health. The manner in447which our athletes train and prepare offer many more lessons on448improving the health outcomes of seniors.449    According to the 2022 report by National Health Statistics,450only 13.9 percent of adults aged 65 or older meet federal451activity guidelines. The environmental factors related to low452physical activity are many: cars, mobile devices, sedentary453jobs, elevators, computers. Since very few people get adequate454exercise at work or throughout their days, exercise needs to be455added as a purposeful activity. Fitness is partly genetic and456measured by how far you go on an exercise test. Physical457activity is behavioral and requires motivation and commitment.458Increasing your physical activity will increase your fitness.459For example, walking is a low-intensity exercise and an460appropriate start for most seniors.461    Poor physical activity and nutrition top the list of the462most common health issues encountered by seniors. As we age,463our fitness declines. However, exercise can prevent this464decline in many patients. Strength training is one of the465activities that can improve health outcomes for seniors. The466established benefits of regular strength exercise include467strength and endurance, increased muscle mass, increased468resting metabolic rate, and preventing disability.469    Both research and experience indicate that resistance470training is safe for healthy older adults, for frail older471adults, and individuals with disease. Muscle disuse is a472preventable and reversible factor. Resistance training has473consistently show as a feasible and effective means of474counteracting muscle weakness and physical frailty. It improves475bone density, improves metabolic health, insulin sensitivity,476as well as improving psychological well-being and reducing the477risk for falls and fractures in older adults.478    What behaviors can we encourage senior adults to help start479and maintain exercise programs? The first step is making a480commitment to increase physical activity. They have to481establish protected time to forgo other activities that may482encroach on this scheduled time. Set small and realizable goals483for exercise but also think about and establish long-term484fitness goals. These barriers must also be addressed, which485includes lack of understanding, lack of awareness, and486unfortunately, lack of motivation.487    As I have seen in almost 30 years of clinical experience,488health outcomes in seniors can be improved with the lessons we489learn from sports medicine and sports science. It is the490planned and purposeful exercise and strength training used in491preparation for competitive athletic events that provide a492structure for exercise in senior adults. Advanced training493techniques can also move senior adults from just physical494activity into increasing levels of fitness.495    Thank you, Mr. Chairman. I look forward to answering your496questions.497    Chairman Scott. Thank you, Dr. Legg. Thanks for being here.498    Now I would like to introduce our next witness, Matt499Hasselbeck. Mr. Hasselbeck is a former NFL quarterback who500spent 18 seasons in the league, including leading the Seattle501Seahawks to a Super Bowl appearance in 2006. After retiring502from professional football, he became a well-respected analyst503with ESPN, where he was watched by millions of football fans504during Sunday NFL Countdown and Monday Night Countdown. He has505also been a vocal advocate for health recovery and smart506training, both on and off the field. He brings a unique507perspective on how the principles of elite athletic performance508could help everyday Americans stay active and healthy as they509age. Thanks for being here. I look forward to your testimony.510511            STATEMENT OF MATT HASSELBECK, FORMER NFL512               QUARTERBACK, NASHVILLE, TENNESSEE513514    Mr. Hasselbeck. Thank you so much for the kind intro. My515name is Matt Hasselbeck, and I am here to share my insights on516the significant role sports medicine has played throughout my517athletic career and its ongoing influence in my life.518    I played quarterback for five years at Boston College519followed by a lengthy NFL career. The NFL, if you do not know,520is commonly referred to by players and coaches as "Not For521Long." With the help of great sports medicine teams I was522fortunate to play for 18 years with the Green Bay Packers, the523Seattle Seahawks, the Tennessee Titans, and Indianapolis Colts.524    I grew up as the son of a football player. After an All-525American career at the University of Colorado, my dad played526tight end in the NFL for nine seasons. He played primarily with527the New England Patriots, but also with the Minnesota Vikings,528the New York Giants, and the Los Angeles Raiders, where he and529his teammates won Super Bowl XVIII. My brothers and I all530earned full scholarships to play college football, and my531brother, Tim, followed me as a longtime quarterback in the NFL.532Most of our wives were prominent Division one athletes as well,533and my wife was no doubt a better athlete in college than I534was.535    In the decade since my NFL career ended, I have primarily536worked in the sports media space. After spending eight years at537ESPN on shows like Sunday NFL Countdown, Monday Night538Countdown, and SportsCenter, I now work as an NFL analyst for539Fox Sports on the Colin Cowherd Show. I have also been serving540as a high school football coach for the past four years. After541winning a state championship in Massachusetts coaching my son,542last year we moved to Tennessee so I could coach on a staff543with my father and brother, where we coached two of my544quarterback nephews, Taylor and Isaiah. Taylor is currently545committed to play college football at the University of546Wyoming.547    Raising our own three kids and supporting their athletic548journeys has been the other major career for my wife and me.549Our two daughters are national champion lacrosse players from550Boston College. The younger one is preparing for a fifth year551after four knee surgeries earned her a medical red shirt. Our552son is a redshirt freshman quarterback at UCLA and is battling553for his own opportunity, much like I did at his age.554    During my 23 years of college and professional football, I555only had one surgery. This is unheard of. I attribute this to556many factors, one of which is the help of skilled athletic557trainers and sports medicine teams. Many of my teammates took a558"react and survive" approach to their health, while a559"proactive and thrive" approach is a mindset that helped me. I560attribute this mindset to the advice, care, and expertise of561the athletic training staff of my teams. Not only did they help562me prevent injuries, but they also contributed to helping me563heal faster and return to play.564    Staying healthy is priority number one for an NFL565quarterback. Injury prevention, recovery, and prioritizing566wellness were equally important to me as throwing touchdown567passes. My coaches would often tell us, "Your greatest ability568is your availability."569    Both during and after my NFL career, I have been dedicated570to making the game safer for future generations. I actively571participated in the NFLPA's Mackey-White Health and Safety572Committee and proudly served as a Vice-President of the NFLPA's573Executive Committee for six years. Our work successfully574fostered a significant culture change regarding brain injuries575and return-to-play protocols in football. In commitment to this576cause, upon my death I have pledged my brain to science through577the Concussion Legacy Foundation. I currently serve as the578Ambassador for the DiagnoseCTE.org study for men over 50, which579aims to develop a method to diagnose and differentiate brain580trauma while patients are still alive.581    In this new empty-nester era of our lives, my wife and I582have experienced the challenges of caring for our aging583grandparents and parents. We have leaned on the lessons learned584through athletics to help replicate the best outcomes for them585as they get older. For example, helping my mom set goals for586the activities she hopes to participate in with her grandkids587when she is older means that we have to start prepping for that588now, much like you would do as an athlete. My mom would love to589be able to play pickleball and ride bikes with her grandkids590when she is 75. Sometimes it is not that simple.591    Following a painful knee replacement surgery, my dad was592waiting to get healthy enough for the next knee replacement593surgery, when he tragically suffered a cardiac event this594April, which he did not survive. This heartbreaking event has595left my mom a widow after 50 years of marriage, and she now596faces new challenges, some of which are loneliness and597isolation, that she must overcome.598    Sadly, as a family, we are also dealing with the599significant challenge of my mother-in-law's Alzheimer's600disease. This illness has placed immense hardship on our601family, particularly affecting my father-in-law, who sacrificed602his profession to become her full-time caretaker.603    In conclusion, that is a glimpse into who I am, and I am604truly honored to be here today. The last time I visited this605building was during my eighth-grade class trip, and I had a606great time, and I hope that I will get to come back again.607Thanks for the invite.608    Chairman Scott. Thanks for being here, and sorry to hear609about your dad. Whenever your parents pass away you wake up and610think, oh, I have got to call one of them, and then you cannot611call them.612    Now I would like to recognize Ranking Member Gillibrand to613introduce our last witness.614    Senator Gillibrand. Thank you, Chairman Scott. I want to615introduce our final witness, Jennifer Raymond. Ms. Raymond616serves as the Chief Strategy Officer at AgeSpan, an Area Agency617on Aging in Lawrence, Massachusetts. Through her position as618Chief Strategy Officer, Ms. Raymond oversees AgeSpan's619evidence-based program, including its falls prevention efforts.620Additionally, she holds a Juris Doctorate and has been621recognized by the John A. Hartford Foundation as a National622Practice Change Leader.623    Thank you for being here. You can begin your testimony.624625         STATEMENT OF JENNIFER RAYMOND, CHIEF STRATEGY626           OFFICER, AGESPAN, LAWRENCE, MASSACHUSETTS627628    Ms. Raymond. Chairman Scott, Ranking Member Gillibrand, and629members of the Committee, thank you for the opportunity to come630and speak with you today. My name is Jennifer Raymond, and I am631honored to serve as the Chief Strategy Officer for AgeSpan, an632Area Agency on Aging located in Lawrence, Massachusetts. We are633one of 614 AAAs across the country, helping older adults remain634independent in their homes.635    On behalf of these agencies, as well as the older adults636and the family caregivers they serve, I want to first thank you637for your ongoing efforts to meet the needs of our aging638population through the Older Americans Act, and thank you for639your attention on the importance of physical wellness for older640adults.641    The consequences of physical inactivity among older adults642are catastrophic. They include a decline in overall function,643increased risk for chronic diseases, increased frailty, and a644heightened risk for depression and cognitive decline. Yet645despite these consequences, more than one in four older adults646are physically inactive. The reasons for inactivity are many647and varied: a fear of injury, lack of confidence in their648ability to exercise safely, and even a lack of motivation to649begin exercise.650    Throughout this country, Area Agencies on Aging and their651partners offer effective physical activity programs that both652promote exercise and help individuals overcome those653motivational and behavioral barriers that contribute to654inactivity. For example, there is May C. from Quincy, who was655able to safely abandon her walker after improving her balance656through an evidence-based program called A Matter of Balance,657and Maria A, who, despite her frailty, now participates in658virtual physical activity classes, from the comfort of her own659home, thanks to AAA's digital access program.660    One of the most important benefits of increased physical661activity for older adults relates to the prevention of falls.662Falls can be detrimental in a senior's life. They can result in663hip fractures, head trauma, other serious injury, and even664death. They often reduce mobility, take away a senior's ability665to live independently, and can make people afraid to leave666their home, increasing loneliness and isolation.667    Every year in this country, more than 14 million Americans66865 or older, that is one in four, suffers a fall. In 2021,669emergency room departments reported three million visits due to670older adult falls. The total health care costs for these falls671are over $80 billion per year. Of these costs, 67 percent is672paid for by Medicare, four percent by Medicaid, and 29 percent673by older adults and their families.674    Today, many Area Agencies on Aging partner with family675health centers, primary care providers, and managed care to676reduce falls risks. First, our health care partners screen and677identify older adults who are at risk for falls. Then they678refer these individuals to networks of AAAs for falls679intervention. This intervention might include a physical680activity program, it might include assistance with home681modifications to address home hazards, and even the provision682of medically tailored meals to make people more able and ready683for physical activity. These referrals from our health care684partners allow us to take a more holistic approach to685addressing the needs of the individual and create a shared care686plan to improve outcomes.687    There is much we can do to support older adults in their688desire to age in place, stay physically active, and avoid689falls. To further these goals, we must:690    Support robust funding for community-based physical691activity and falls prevention through the Older Americans Act,692specifically Titles IIID Evidence-Based Health Promotion and693Disease Prevention and Title IIIB Supportive Services.694    Educate health care providers about fall prevention through695tools like the STEADI program, which assists providers in696integrating falls prevention into their clinical practices.697    Encourage prescription for physical activity and falls698prevention by health care providers and allowing for699appropriate reimbursement for effective interventions offered700in the community.701    Continue investment in research related to physical702activity and falls prevention for all older adults, including703those with physical frailty, those with disability, and those704with cognitive decline.705    If we are serious about a healthy America, we cannot ignore706the impact of physical inactivity and falls among older adults.707Area Agencies on Aging stand ready to partner with health care,708older adults, and family caregivers to address this challenge.709Investments today will not only allow older adults to thrive710independently but will also help stem the costs for our health711care system for years to come.712    Thank you again for the opportunity to speak with you today713and for your support on this important issue. I look forward to714your questions and working together to support our country's715older adults.716    Chairman Scott. Thank you, Ms. Raymond. Thanks for what you717do.718    Now we will start with questions, and Senator Justice, if719you want to start.720    Senator Justice. Well, I could start with any of you, but I721really am really always intrigued by just this. You know, Dr.722Cain, you, at the Jimmy Andrews Institute, you probably have723many, many, many stories to tell, and with all that being said,724I would like you to just elaborate, if you could, just on this.725Over the years, you especially have seen so much progress being726made toward our seniors, and what can be done.727    Just elaborate, in your words, your experiences with Jimmy728Andrews I know are just limitless. Absolutely, in my opinion,729Jimmy is a terrific friend, been a friend forever and a day, so730please tell us more.731    Dr. Cain. Thank you, Senator Justice. Dr. Andrews has been732a great mentor to me, and you know, Dr. Andrews retired two733years ago and is now kind of in a stage where he is trying to734take care of his health more than he used to instead of working735so hard.736    You have a great point. We have had great advances in737sports medicine, taking care of teams, and medicine, in738general, over the past 30 years. The reality is I think in739medical care of our older patients most of our time is spent740dealing with complications on the back end. There is very741little time spent on preventative care. If you take the typical742primary care physicians that see an older patient, internal743medicine, family practice, or another physician, they spend744most of their time dealing with heart disease, high blood745pressure, and other things that are already, kind of the cat is746out of the bag and they are just trying to manage.747    I think the way we get on top of this and the way we treat748this better is we treat our older patients just like we treat749our younger athletes. We try to work on preventative programs,750things like Ms. Raymond is doing, and we spend more time with751our office visits talking about how to prevent disease than how752to treat diseases the patients already have.753    Senator Justice. Well, I know you are doing unbelievable754work, and, you know, I can tell you the many visits that I have755had there have ended up, in some way, somehow patched me756together, and I have made it this far anyway.757    Matt, I have got to ask you just this. You know, not to not758ask Dr. Legg wonderful questions, but Dr. Legg and I have been759around many, many, many times, on many, many different things.760    Matt, I watched you play. You were a superstar. You have761absolutely a family of thoroughbreds like you cannot imagine.762Through all of that you have a message to pass on to all of us,763and all the different things that you know that we could do764better at. You took care of yourself. You took care of yourself765in a really proactive way, and you are exactly right. NFL766athletes do not usually stay there long, and you stayed there767forever and a day, and made a contribution every single time768you went on the field, but tell us more. Tell us more about769really what we should be doing. I listened intently to all the770different folks in your family and all their incredible771accomplishments. Now I want to hear from Matt. Matt, what do772you think we really need to be doing?773    Mr. Hasselbeck. Well, thank you for your question. I mean,774I really agree with what both doctors said about being775proactive. Stability work, falling. You know, in football,776running backs do not want to fall, because you are down, so you777practice balance all the time. You practice with your eyes778open. You practice with your eyes closed. That is something779that I would do as a quarterback. It is something I would do780with my mom, and she would do with her mom.781    I think these are lessons, you know, using some of the782injuries that are common for quarterbacks, a high ankle sprain783is an injury that you have. We would do what we call pre-hab.784It is preventative rehab. We would do the rehab as if we had an785ankle sprain, a high ankle sprain, before we even had the786injury. Or even coming back from my one surgery, which I had787down in Alabama, which was not convenient, living in Seattle,788but it was great, and it was successful.789    One of the things that we did with the athletic trainers,790we practiced falling. You know, I went from being in a sling791for many, many weeks to, I had to somehow get from the sling to792back on the football field, getting tackled by guys like793Michael Strahan, and what are we doing in the meantime to get794there? Practicing falling was really a great return-to-play795protocol that helped me coming back from surgery, when I felt796frail, when I felt afraid to fall. Doing it in a controlled797environment is one of the things that gave me confidence, gave798me athleticism, and got me back to feeling like I could go799protect myself in the arena of athletics.800    Senator Justice. Thank you, sir. I practice falling right801now, but it is really not on purpose. Anyway, thank you so802much, sir.803    Chairman Scott. Senator Gillibrand.804    Senator Gillibrand. Thank you, Mr. Chairman. Jennifer805Raymond, the importance of federal funding for programs that806support older adults, you have discussed how AgeSpan provides807critical services for older adults in Massachusetts. Those808services include physical activity and fall prevention809programs. AgeSpan and other Area Agencies on Aging provide810those services through a partnership with the Federal811Government. The services are locally run and tailored to812individual communities, and the Federal Government helps with813funding, research, and technical expertise.814    Can you give some examples of AgeSpan programs that have815received federal support and how those programs have helped816older adults? Can you talk about what will happen to these817programs if their federal support disappears?818    Ms. Raymond. Thank you. You know, I think that it has been819over 50 years that Area Agencies on Aging and the people that820we serve have benefited from a really good partnership with the821Federal Government through the Older Americans Act. Through822Title IIID we have those evidence-based programs like A Matter823of Balance, Enhanced Fitness, all of those things that allow us824to provide programs to increase physical activity and reduce825falls in a safe and effective way, and programs that have826demonstrated some efficacy.827    In addition to that, the Older Americans Act, through Title828IIIB, has allowed us to provide a wide range of support829services. At my agency alone, we serve 28 cities and towns, and830we receive over 25,000 calls every year to our offices for831information and referrals. These are not people who have a case832manager. These are not people that we are serving, but these833are people who are wondering how they get services, who are834wondering how they get help in applying for Medicare, those835kinds of things. That information and referral support work is836funded through the Title IIIB of the Older Americans Act.837    In addition to that, I do not think we have to talk much838about the Meals on Wheels program, but home-delivered meals,839medically tailored meals, this year we provided over a million840meals to older adults who were frail and in home and otherwise841unable to receive nutrition and food services.842    Even beyond the Older Americans Act, we have benefited, and843many community-based organizations have benefited, from pilot844funding from the Administration on For Community Living, or845from CDC, in order to implement these evidence-based programs846in way that can be effective and improve health outcomes, but847at the same time look at how they save dollars.848    There is a wide range of ways that we continue to thrive849under the support from the Federal Government.850    Senator Gillibrand. Thank you, Jennifer. Dr. Cain and Dr.851Legg, can you talk a little bit about what happens to older852adults after they fall, and can you talk about the importance853of patient education on reducing falls?854    Dr. Cain. Thank you, Senator. I think, you know, once a855patient falls there are kind of two outcomes. One outcome is856they break something, they end up in the hospital, and they are857probably never the same, honestly. The other outcomes are that858they get lucky, they get scratched up, they go to the hospital,859get checked out, and they go home, but very rarely do we do any860fall prevention with those patients, even the ones that have861fallen, and we have our own families that we know that have862fallen, our grandparents or our parents, and you kind of count863your blessings that they made it and that they did not hurt864anything, but very rarely do fall prevention programs become865part of the treatment algorithm.866    I think for us, as physicians, backing up a second and867saying, hey, we are taking care of all these diseases and all868these problems that are caused by balance and fall issues. Why869not prevent those? I really like the program that Ms. Raymond870is talking about. I think having the primary care physicians as871the point person to encourage that is really important.872    Senator Gillibrand. Yes. Dr. Legg?873    Dr. Legg. When we talk about falls we tend to worry about874people who break their hips, and that is a very serious injury875and it creates fear afterwards, but also I see many patients876who break a shoulder or proximal humerus or a wrist, which is877sometimes just as devastating, because they are immobilized878which really throws off their balance and puts them at much879higher risk for additional injury. Preventative programs are880essential.881    We also have to look at how we can improve the thing that882makes them at high risk for fractures, and that is bone883density, and how do we improve that, how do we test for that. A884lot of it, again, is encouraging the patient to get the testing885done, and then encouraging them to be consistent and compliant886with the medications that help, because they do help and they887do reduce the risk of fractures.888    Once they have a fall, sometimes it is motivating them to889overcome the fear that they have to be active again. Many of890them often become scared and afraid of exercising, afraid of891movement, which puts them at even higher risk for medical892problems.893    Senator Gillibrand. Thank you. Thank you, Mr. Chairman.894    Chairman Scott. Coach Tuberville.895    Senator Tuberville. Thank you, Mr. Chairman. Thanks for896being here today. In 35 years of coaching, I saw a lot of897injuries. I think that there is tremendous improvement in898surgeries over the years, obviously the arthroscopic surgery.899Instead of slicing a knee open we do it a lot easier and a lot900quicker back on the field.901    Dr. Lee and Dr. Cain, talking about one other thing that is902really improved and how much we need to continue to educate903people and hopefully get more people in this profession is904physical therapy. My players, I would always tell them that the905surgery is what is easy. Therapy is the hard part, just getting906back on the field.907    Dr. Legg, you first.908    Dr. Legg. Physical therapists are essential to what we do909in sports medicine, and they are also essential to910rehabilitating our seniors who have any injury or surgery. I911use the physical therapists very often, now in joint912replacement surgery. As I have become older, my patients have913aged with me, and people who had arthroscopic procedures done914years ago, I am now replacing their knees and their shoulders,915and the physical therapists are the ones who really get them916back to movement and strength and activity, because a knee917replacement or a shoulder replacement is a painful operation,918and the physical therapists teach them what to do, but they919also encourage them to do it, and sometimes that is the hardest920thing.921    They are invaluable. My son played college football, and922need the physical therapist on several occasions to keep him in923the game. We need physical therapists and they are invaluable924in treating the patient.925    Dr. Cain. Thank you, Coach. As you know, the other part of926that equation that is really important is athletic trainers.927Certified athletic trainers are kind of the point person. Matt928Hasselbeck mentioned it in his talk, that they are the ones929that kept him from getting hurt, and I think the combination of930an athletic trainer and a physical therapist are really931critical in the team model, and really not only for injury932prevention, treatment of injuries, rehab after surgery. They933are the ones that do the grunt work.934    You know, we, as the physicians, we may see the player for935injury evaluation and surgery, but these are the people that936are with them every day. I think that is really the model you937need for the older population is you need those providers, ATCs938and physical therapists, in the system and keyed in to where939they help the older patient follow through with those demands,940to make sure they are doing their exercises, to make sure they941are doing them correctly, and to treat them just like we treat942an athlete.943    You know, the athletes are in the training room every day,944all day. Obviously, we do not have that ability as we age to be945in the training room all day, but you need someone that keeps946up with the person longitudinally and makes sure that they947understand what they are supposed to do. We have a shortage of948both. Our critical shortage is in athletic trainers. They have949to get a master's degree now to graduate and to be certified,950and there are just not that many kids going into it now. We951have a critical shortage of trainers. We do not have enough952physical therapists, and physical therapy visits are not953covered very well by insurance, so it is a big problem for954seniors trying to get treatment.955    Senator Tuberville. Thank you. Matt, if you and Ms. Raymond956would answer this question. Another improvement I have seen957over the years, obviously, and this is as much for adults our958age as anybody, nutrition and supplements. It has been a huge959improvement.960    Matt, your thoughts on supplements? I know you have taken961many over the years, and try to eat right also, right?962    Mr. Hasselbeck. Yes, I think we could improve the cafeteria963here, from what I saw today, by the way.964    I would just like to also add, I think that when you get965hurt it is very depressing. You know, it is embarrassing. You966feel isolated and it is depressing, and the athletic trainers967are just a confidence giver to you, and a daily sort of like a968pep-in-your-step person in your life, so it is very important,969and they advise you also on the best way to recover. Hey, you970can't do this right now, but what can you do? Well, we can make971better choices with our nutrition, or maybe it is protein. I972know for athletes, protein is a very, very important thing. I973know for older people, protein is a really important thing.974    I cannot speak enough. I think about the best friends that975I had on my football teams. A lot of times it was a teammate,976but usually there was an athletic trainer in there, as well,977because that was literally the person that every single day. To978hear that there is a shortage, and there are a lot of people979that get into athletic training because they were athletes as980high school kids, and they love sports, but genetically they981cannot play professionally, but you can still get a Super Bowl982ring as an athletic trainer, if maybe there is a pathway to983study that in college, and if we invest in that, I would be all984for that. It meant a lot to me.985    Senator Tuberville. Ms. Raymond?986    Ms. Raymond. When you all are talking about the athletic987trainers and the role that the athletic trainers play as part988of the larger team, I think of the equivalent in our community-989based organizations, those case managers, the community health990workers who are working with the older adults every day and991saying, "Yes, I know you are frustrated that you are not able992to play pickleball the way that you did last year because of993your hip injury. Let's talk about walking. Let's talk about994doing some chair exercises that will get that mobility going.995By the way, we will also sort of talk about medically tailored996meals that we can bring in that will add to your ability to be997able to feel well enough to do that activity."998    I think that team approach is one of the key ways that we,999on the social care side, also think of as really strongly to be1000able to support older adults in their physical activity.1001    Senator Tuberville. Thank you.1002    Chairman Scott. Senator Husted.1003    Senator Husted. Thank you, Mr. Chairman. Thanks to all of1004you for being here today. My wife is a physical therapist,1005Coach, so I know exactly how valuable they can be. Because what1006I have witnessed as a former athlete and a coach and also with1007a wife who was a marathon runner into her 40's and is a1008physical therapist is that things build on one another, how an1009injury or a sore knee, you do not walk anymore. You maybe do1010not walk as much. You start to eat a little bit more. You start1011to put on a little weight. These things can really begin to1012compound on you, just like healthy habits can, as well.1013    I ask any of you who would want to respond to this, how do1014we reach people with this message? What are the most effective1015ways that you have found to help people understand that, hey--1016and at what age does somebody really have to start paying more1017close attention to the issues that will compound and then1018affect them and make it very difficult for them as they get1019older? I welcome all of you to comment or give your thoughts on1020that, how you reach people, what do we all look at here.1021    Dr. Cain. I will start. I think there are some simple1022educational materials, simple public service announcement type1023things. I am 57. I think when you are in your mid 50's you1024probably need to start thinking about this. It is not 65.1025Because you are starting to lose balance. You are starting to1026have, you know, your body changes physically, as we all know,1027as we get older. Not only can you not see very well but your1028joints do not move as well, and you get other problems.1029    Senator Husted. The effects of gravity do, for some reason,1030get a lot worse as you get older, right?1031    Dr. Cain. No doubt. I think if you give it just some simple1032stats. I mean, there is a state that is pretty well documented1033that a simple physical education treatment program--so doing1034balance training, fall prevention, and not falling--probably1035adds 10 years to your life, compared to not being physically1036active.1037    If you have a simple public service announcement that says,1038"Hey, if you are physically active at this level, you are going1039to add 10 years to your life," think about all the people1040taking all these supplements and doing all these longevity1041courses and all these things to try to live longer. That is the1042simplest method to live longer. I think we just have to educate1043people.1044    Dr. Legg. This becomes important very early, Senator. We1045know, through studies, that something we call sarcopenia, or1046loss of muscle mass, starts between age 35 and 40, and it goes1047five percent a year, so we really need to start earlier.1048    We also know that through some of the test which are older1049tests, in the 1970's, Dr. Robert Bruce, that what we call VO21050max, okay, for the most important muscle, the heart, and how we1051develop energy through our muscles, that starts to decline1052also, and the good thing is that decline can be improved and1053reversed until about age 70, and then it is very difficult1054after that to reverse much of the aging process to the heart.1055    Inactivity is bad, but we also know that someone who is1056very sedentary, the people who make those first steps into1057activity gets the greatest benefit from being active. Now, the1058steps become a little more incremental as you go up, but it is1059just that first movement from sedentary to any kind of1060activity.1061    When I have sometimes students or residents I tell them1062that you have to listen to your senior patients, but you also1063have to be a motivational speaker. You have got some answers1064for them. You have just got to convince them that they need to1065do it.1066    Mr. Hasselbeck. Can I just add quick? We use this phrase1067all the time--sitting is the new smoking. We sit so much. Even1068as a professional athlete you sit all day in meetings, practice1069for two hours. Getting up, and VO2 max training is very1070important, but Zone two training, power walking, a brisk walk,1071is very important, I think, for someone in their 30's, 40's,107250's. Having that foundational piece is super important, and1073doing that in groups, messaging, but also as friends, make that1074normal.1075    Right now sitting all day is normal. Make power walking1076normal. That is the advice I would give my friends.1077    Ms. Raymond. I agree with much of what is said now. It is1078very exciting for us when we are able to take a more upstream1079approach, when we are able to reach people before they have1080diabetes or before they have COPD and be able to work with them1081on the kinds of behaviors that will prevent that. It is very1082exciting when we get to work with family caregivers and the1083older adults and see the family caregiver say, "Gosh, I'm 40,1084I'm 50. Now is the time for me to start this physical activity1085so I can be more independent as I age."1086    At the same time, we are coming across folks who are in1087their 70's, in their 80's, and even in their 90's, that are1088looking for ways to be physically active. They have chronic1089pain, so they worry that physical activity is going to1090exacerbate that.1091    We are able to have those community health workers and case1092managers sit with an older adult, who thinks they cannot1093exercise, and talk to them about what is important to them, not1094what is the matter with them but what matters to them.1095    I remember an individual named George with diabetes, COPD,1096chronic pain, did not feel like he could do anything. His case1097manager talked to him and said, "Well, what is important to1098you?" He said, "I want to play with my grandchildren. I want to1099be able to have that relationship with them that I had with my1100grandparents, and I can't do that now." That was the trigger to1101say, "Well, let's start with this walking class. Let's start1102with brisk walking. Let's move on from something there."1103    Even though our goal is to reach people on the upstream,1104there are still many powerful ways for us to encourage and1105support traditional older adults who want to be physically1106active.1107    Senator Husted. Thank you. Thank you, Mr. Chairman.1108    Senator Johnson. Thank you. I apologize for not being here1109earlier. We have crazy schedules. I have taken over for Senator1110Scott as Chair.1111    First of all, I think it is an interesting hearing. Being1112elderly myself nowadays, I do not really--mentally I am not1113elderly, but I certainly feel it in my body.1114    Dr. Cain, can you just talk a little bit about the1115importance of protein? That is one thing I am hearing more and1116more about, and it is actually very difficult to eat as much1117protein as we see recommended. Can you just kind of address1118that issue?1119    Dr. Cain. Sure. Thank you, Senator. I think protein has1120become kind of the most critical element we know in nutrition1121to keep you healthy. We have found over years that super-high1122protein diets are actually very good for you, and the more1123protein you eat, from a relative standpoint, the higher your1124muscle mass, the higher your health, the more energy you have,1125and a lot of senior adults have a very poor appetite, and they1126do not get much protein. Things like protein supplements,1127protein shakes, I encourage my patients all the time.1128    There are studies recently about creatine. Just a little1129powder of creatine, five grams of creatine, a small scoop a day1130can increase your longevity.1131    I think protein is really critical. It is hard to get it by1132eating just steak or fish or meat, so I think you almost have1133to have a supplement to get enough protein.1134    Senator Johnson. I do kid my wife because she does all the1135health research in our family, and she is buying different1136supplements all the time. It is like, you do not even need1137really need to eat a meal. You have got more than enough right1138there. Talk about it, maybe Dr. Legg. Talk a little bit about1139nutrition versus the supplements, and is it equivalent? I mean,1140can you do it through supplementation? Just kind of talk about1141that balance. Part of our problem is you read different things1142from different people, and you are not quite sure what is the1143truth.1144    Dr. Legg. The difficulty with many supplements is that1145supplements really are not under the oversight of the FDA. They1146are tested in the same way as drugs are tested. We know that1147many supplements have a lot of testing. Dr. Cain mentioned1148creatine. It is kind of the "it" supplement at this time. It1149seems to be one very safe and also a very good supplement to1150help increase muscle mass. We also know that now it may help1151bones, and then if you take it long enough it may help our1152brains also.1153    Now, what I like to encourage people, as far as nutrition,1154is to be as unprocessed as possible. It is difficult these1155days, but food that is unprocessed I think is the best. I think1156that supplements are needed for the areas of deficiency. Yes,1157protein is something that everyone needs.1158    Now, testing can be done if you have certain areas that1159maybe you need vitamin D, maybe you need vitamin C. Those are1160very important. We know the heart benefits of omega fatty1161acids. Those are also very good supplements for people to take.1162    It is just really finding, based on your diet and your1163activity, what you may need, and you can coordinate that with1164your family physician, but there is a lot of information out1165there, and again, I encourage my patients to try to be as non-1166processed as possible with their nutrition and then supplement1167in areas where they may be missing.1168    Senator Johnson. Okay. Secretary Kennedy, I think, is1169actually looking at that in terms of the MAHA movement, and1170people like Dr. Casey Means has had the same message.1171    You mentioned those supplements do not have the same1172rigorous standards for testing. Are there testing labs? I mean,1173when you are looking for a supplement is there something that1174can guide you, that you can be reasonably assured that this is1175coming from a quality lab, not some cheap import that might1176have questionable ingredients? Again, I think that is a serious1177concern.1178    Dr. Legg. It is, and I tend to have people get supplements1179from what I call reputable sources. I tell them to buy at a--I1180hate to say it this way--a notable chain, maybe grocery store,1181or nutrition store. I tell them to be sometimes wary of where1182they buy it online.1183    There are certifying agencies for nutritional supplements,1184and they do give really a third-party look at what is safe and1185even sometimes what can be effective. I tell them to use1186reliable sources of where they buy their supplements.1187    Senator Johnson. Okay. Well, Mr. Hasselbeck, not to make1188this too personal, but before I did this silly thing, become a1189U.S. Senator, I actually a pretty good exercise routine. I1190would go home and I would be watching the news, so why not hop1191on a Lifecycle or a Nordic Track. That worked for me pretty1192well, and then all of a sudden, you know, my Ranking Member1193here would testify it is kind of hard with our kind of1194schedules. I literally was losing muscle mass.1195    What I have decided to do is, for example, making a Keurig1196coffee. It is about a 3-minute process, and there are1197calisthenics you can do. I have seen that has been incredibly1198helpful to me. I have seen just on, for example, X, they have1199different Chinese methods, you know, different types of1200exercises, and they work very well. I would imagine you know1201something about exercise. Do you have a routine or something1202you can recommend for seniors?1203    Mr. Hasselbeck. Well, I would just say a couple of things.1204First, just real quick, I would like to piggyback up on the1205protein and the creatine. I one-hundred percent agree with1206that. I think there is a stigma with creatine, like it is not1207safe. It has been around for years. It is safe. As an athlete1208you are deathly afraid of testing positive with something like1209a substance or non-reputable source, but even that is1210dangerous. We always, as an athlete, went by the NSF1211certification process. That at least gave you the strongest1212sense of like what they are saying is in the ingredients is1213what is in the ingredients, but for us just plain powder and1214plain creatine are pretty safe.1215    To your question about the routine, I think, as an athlete,1216we have it easy because we set goals. I played until I was 401217in the NFL. I was still playing when I was 40. My friends that1218were 40, they were like, "How are you doing it?" It is like, "I1219don't know. I think it is just use it or lose it." I set goals.1220I had a game every week. I had a goal that I had to attain.1221    Much like I spoke about earlier with my mother, "Mom, what1222do you want to do when you're 75 years old?" "Well, I want to1223be able to board an airplane by myself. I want to be able to1224put my luggage up by myself. I want to be able to pick up my1225grandkids." What do you want to do when you are 85?" It was1226like the same thing.1227    When you have those goals, I think it is so easy to come up1228with what the exercises are going to be. You know, I want to be1229able to get up out of a chair without using both hands to help1230me get up. Well, then I know the exercises we need to do, and1231you can see a physical therapist, an athletic trainer, your1232doctor, to help accomplish those goals.1233    To answer your question, setting goals is the number one1234way to accomplish them. My dad used to say this all the time,1235"A goal without a plan is just a wish." That would be my1236answer.1237    Senator Johnson. Okay. Senator Gillibrand, do you have any1238further questions?1239    Senator Gillibrand. Yes. I have a few. We are filibustering1240because we want the Chairman to come back and ask his own1241questions, so we are going to ask you a lot of questions and1242keep you busy.1243    I want to go to Mr. Hasselbeck. I read about the stigma of1244seeking medical treatment, including preventive treatment,1245especially for athletes and older adults. Can you talk about1246what we can do to reduce these stigmas so that people can get1247the help they need?1248    Mr. Hasselbeck. Yes. I think there is, in particular, with1249what our family is going through right now, it is hard1250sometimes to ask for help, and when I was in the NFL, my first1251year in the NFL was 1998. At that time, if you ever had a1252concussion or you ever had a brain injury, and the athletic1253trainer, the doctor, a teammate, or a coach said, "Hey, how are1254you," you would just say, "I'm fine." No matter what. Even if1255you could not see straight, you were dizzy, you were throwing1256up, you would just say, "I'm fine." That was the only1257acceptable answer if you were going to be tough.1258    We worked really hard through my last year in the NFL,1259which I believe was 2015. We sort of made it cool to be honest1260with the medical team. There was a little bit of distrust, like1261maybe they are not going to think I am tough enough, or, you1262know, I do not know what it was, but it was really hard to kind1263of change the culture in football, in pro football, which we1264believed tricked down to college and high school, where it1265became normal to, if the doctor asked you a question, or the1266athletic trainer, just be honest with them, and that was really1267hard for our community to do that.1268    I think I do see some similarities with if you are a1269caretaker of a loved one at home, maybe sometimes it is hard to1270just ask for help, but that was a tough thing for us. I mean,1271even just the learning process, looking in the mirror through1272that process was one that was a lot tougher than I thought, as1273an athlete.1274    Senator Gillibrand. Well, I remember reading a story about1275dehydration and how a high school coach was not allowing the1276players to hydrate, and a boy died, because you were not1277perceived as tough enough. I hope that that trend of, again,1278for the professional athletes, so it does trickle down to high1279school and college, is that your wellness is the most important1280thing for the players, that part of the team's goal is to make1281sure you are 100 percent well, whether it is mental, physical,1282injuries, or the like.1283    Mr. Hasselbeck. Yes, and I would just say, and the medical1284professionals here can speak to this better than me, but as a1285high school coach we are trained for heat illness and heat1286exhaustion and those types of things.1287    I remember when my dad was playing in the NFL it was seen1288as a sign of weakness if you were to ever give your players1289water breaks, and now we know, through science, that that is1290foolishness.1291    I think as a player and as someone who loves sports and1292loves the game of football, inviting the medical community to1293really help us learn and not just do things the way that we1294have always done it--and I would say the same thing for the1295aging community. I think we can start way earlier than 65 if we1296want good outcomes when people are 70 and 75.1297    Senator Gillibrand. Smart. Jennifer, can you talk a little1298bit about some of the evidence-based physical activity or fall1299prevention programs at your AAA, and could you talk about the1300importance of evidence-based programs and how we can support1301the development of more proven interventions to help seniors?1302    Ms. Raymond. Sure. One of the evidence-based programs that1303gets offered very, very widely across our communities and1304across the country is an evidence-based program called Enhanced1305Fitness, and Enhanced Fitness is all about physical activity.1306This is a group class, up to 25 people in a class. It is run by1307a trained, certified leader who understands not only how to do1308the exercises, how to do them safely, and how to look out for1309challenges that the older adults may be having while they are1310exercising--balance, strength training, mobility, all of that1311being part of the program.1312    One of the things that makes a program work best is just1313what others have said, the goal-setting component. How am I1314going to get from where I am in Week one, where I can barely do1315the stretching from a standing position, to where I want to be1316in Week eight, and how do I do a little bit at a time in order1317to do that. That is an evidence-based program that has had some1318significant research behind it, as well. It might cost around1319$1,000 to $1,200 a class--you know, not one class but the full1320evidence-based program--and retrospective CMS studies showed1321that people who participate in that program save health care1322costs of around $1,000 a year. You figure 25 people in that1323class, you are going to make up for it.1324    That is what is incredibly important about the evidence-1325based programs and the federal support for it. We want to be1326good stewards of federal dollars. We want to initiate and offer1327programs that have good outcomes, that are going to help a1328person stay independent longer, that are going to increase1329their ability to stay strong, that are going to increase their1330ability to be mobile, but at the same time, are going to bend1331that cost curve over a long term.1332    Senator Gillibrand. Thank you so much, Jennifer.1333    Chairman Scott. First off, thanks again to everybody for1334being here.1335    Mr. Hasselbeck, how many hours a day do you have to spend1336time to make sure you are healthy? What does it take?1337    Mr. Hasselbeck. Would you say right now, or----1338    Chairman Scott. Right now. What is the difference?1339    Mr. Hasselbeck. Well, I spoke earlier about what I am1340terming Zone two training. These ideas are not necessarily my1341ideas. They are ideas that get talked to me by people that I1342trust. I do believe that kind of Zone two cardiovascular, it is1343going to be good for my heart, heart health, it is good for1344brain health, it is good for muscle, it is good for bone1345density, it is good for all the things.1346    I think strength training at least two to three times a1347week, and I think breaking a sweat, you know, heart rate over1348100, at least, I would say five to six days a week, that to me1349would be seemingly like the floor of what I would consider to1350be healthy exercise.1351    Chairman Scott. What do you do on your diet?1352    Mr. Hasselbeck. Diet, I think I would agree with what has1353been shared already today--high protein, less sugar, or very,1354very little sugar if you can, not a lot of refined carbs. I am1355a little bit guilty on that right now.1356    Truly and honestly I think, again, setting goals and having1357people and community kind of holding you accountable and having1358fun with it, that is what I saw as an athlete. I think even now1359as a former athlete, I have been to a few funerals lately, and1360I have seen a lot of my former teammates, a lot of them are1361offensive linemen. Those guys are having so much fun getting1362fit and losing weight, and they are on a roll with it, and I do1363believe that the fact that they are doing it together is1364encouraging. Like I do not want to say competitiveness, but1365almost like you are cheering each other on, in a way. That is1366inspiring, it is contagious, and it has a multiplying effect,1367which is really, really cool to see.1368    Chairman Scott. Dr. Cain, Dr. Legg, in your communities,1369like if you were going to go brag about somebody that has a1370great program for a senior, which one would you brag about?1371    Dr. Cain. Yes. I mentioned in my opening comments, Senator1372Scott, I think in our community the fall prevention programs1373have been really helpful. I have had my own mother and my own1374father-in-law in those programs, one at 85, one at 90, and I1375think physical therapists, athletic trainers that are not bound1376to some of the time constraints of a primary care physician can1377spend more time with the older patient, get them comfortable1378with the program, have ability to make sure they are safe doing1379it, you know, with things like wobble boards and balance1380maneuvers, that can really make a dramatic impact on the1381patient's risk of falling.1382    I think the fall prevention programs are really the key to1383our community trying to keep people healthy.1384    Chairman Scott. Dr. Legg?1385    Dr. Legg. In my community, we have something called the1386West Virginia Health Right, which is a free and charitable1387clinic that started many years ago that has grown. Some of the1388new services they offer are nutrition, which they have at two1389different locations, and exercise classes at the same1390locations.1391    The great thing for patients in the Kanawha Valley is that1392they are free. Patients can learn about nutrition, learn about1393cooking, but they can also go and participate in exercise1394class, which includes aerobic exercise training as well as1395strength training. I work at this clinic. It is a very well-1396organized place, so it is a great opportunity for people in1397Charleston.1398    Chairman Scott. Ms. Raymond, besides the program you have,1399where you live is there anybody that you could send a senior to1400that would be all-encompassing, to say if you do these things,1401you are going to do what both of the physicians talked about.1402You are going to live longer, you are going to be happier, and1403all those things?1404    Ms. Raymond. You know, we do take a community-wide approach1405to this kind of work, so being able to partner with the1406federally Qualified Health Centers, the family health centers1407who are seeing a lot of folks who are at risk for fall, and1408being able to partner with that physician group is important.1409Partnering with the YMCA's PACE programs, there are a lot of1410these kinds of programs.1411    I think the incredibly important part for us is that we are1412often the first folks that an older adult is seeing or coming1413to, us and the Senior Center, and so making sure that we1414understand the wide range of community resources that are there1415is incredibly important.1416    Chairman Scott. Mr. Hasselbeck, you do not have to give1417this name, but somebody that you would say is 80 years old,1418that you would say, boy, they have done it right, who would you1419look at and say, you know, they have done it, you know, to stay1420healthier longer.1421    Mr. Hasselbeck. Well, my grandmother passed away this past1422year. She was in her mid0990's. She had 12 kids. I think the1423great-grandkids kept her very active, but she is someone that I1424would point to in my life that I am eye-witness to that stayed1425very active. She was a great golfer. She golfed with the women1426in her neighborhood. She was kind of infamous. She was a left-1427handed golfer.1428    You know, I think just her daily activities. She stayed1429active cooking. She stayed active, again, like reaching down,1430picking up grandkids, holding them, passing them off. Those are1431activities. I think, seriously, like I have talked with my1432mother about this, what are the activities that you want to be1433doing when you are that age? If it is that, let's go get a1434dumbbell, and let's practice squatting. A 30-pound dumbbell is1435probably like a 20-pound toddler. You know, what are the1436activities? If you want to be able to do certain things, maybe1437we need to walk steps a bunch of time. Maybe we need to focus1438on walking steps sideways, both ways. If you want to play1439pickleball.1440    Training like an athlete, but knowing that the exercise1441that we are trying to train for, it maybe is not an athletic1442event. You know, it is traveling on an airplane without me1443feeling like you need someone to help you. It is walking1444through a large airport. Maybe it is going for walks.1445    Near the end of my dad's life, knee replacements were the1446thing that slowed him down. He was otherwise completely1447healthy, but the knee replacements kind of shut him down, in a1448way. He could not do the very basic activities. It was kind of1449tough. I think if we had been more proactive about that kind of1450stuff.1451    There is life span and then there is health span. Sure, you1452lived until you were 75, but how old were you when you stopped1453really living? I think that is the mindset. Again, I took a1454proactive approach as a player. I saw players take a reactive1455approach to their career. They did not play very long. I played1456longer than anybody in my draft class, and I was a sixth-round1457pick on the practice squad.1458    I do think that mindset is very, very important.1459    Chairman Scott. Dr. Legg and Dr. Cain, tell us a 80 year1460old success story in your community, and what did they do?1461    Dr. Legg. I have a colleague who just retired two years1462ago. An orthopeadic surgeon who operated until age 84. What he1463did was he remained active. He exercised on a regular basis.1464One of his favorite exercises was dancing. That allowed him to1465stay sharp, both physically and mentally, to operate to that1466age. To me, Tony Majestro was a success story. He is still1467vital. He is not operating anymore, but I was always amazed1468that he could carry on orthopeadic surgery until that age.1469    Dr. Cain. My own father-in-law, that I have mentioned1470several times today, Pete Tidwell, is now 90, and played tennis1471well into his 80's. He is one of those guys that never sat1472still, was always active. When my kids were little, his1473grandkids, he was always playing with them out in the yard,1474throwing the football, even in his 70's and 80's.1475    I think he has been a pretty good mentor as far as what1476activity level can do for your health, for your mind, for your1477health span. Even at 90 he still wants to play tennis. His body1478does not let him do a lot of it. He is still super active,1479still leaves the house and drives to work every day, comes by1480our house and sees the grandkids every day. I think that is1481really what we all want as we age, is to be around our family,1482be healthy enough to be independent, for the most part, and he1483is a good example of that.1484    Chairman Scott. Have either of you two seen sports clinics1485that have really good senior care with it? Like are your1486practices seeing any seniors?1487    Dr. Cain. Our practice probably sees more seniors than1488athletes, actually, even though we are called a sports medicine1489clinic. A lot of that, unfortunately, is reactive. It is1490dealing with knee replacements, like Matt's dad, and patients1491that are kind of into the long-term care stage, where we are1492trying to get rid of problems that have been going on for1493several years.1494    I think it is hard to be proactive because patients usually1495do not come into clinic unless they have a problem, to see us.1496We are associated with physical therapy and athletic training1497clinics that see patients for fall prevention. Most patients do1498not really seek medical help unless they have a problem, so we1499end up being on the opposite side, most of the time,1500unfortunately.1501    Dr. Legg. We see the same thing in our office. When I see1502seniors, they are coming in for knee arthritis, hip arthritis,1503shoulder arthritis. Now, we want to treat that to keep them1504moving, but that is the place where we see them.1505    Now, we also see them at all stages. It is not always1506surgery. We do multiple, non-operative treatments to relieve1507pain to keep them active, but that is the point we see, an1508orthopeadic office, that you see these patients, when they are1509coming in for the treatment of established arthritis.1510    Chairman Scott. You know, I used to be in the health care1511business, and one of the things that I have watched is that1512there are not a lot of people that are actually trying to find1513the cause of the problem, and a lot of it is because that is1514not how you get reimbursed. You do not get reimbursed to find a1515cause of the problem. You get reimbursed to do a procedure.1516    Have either of you two, in your practices, found that, one,1517is there a reimbursement system to find the root cause, and are1518people actually willing to spend the money to find the root1519cause of their problems?1520    Dr. Cain. I think just like being active, in general, some1521of it is just personal drive, either encouraged by friends or1522family or other physicians. I think the reimbursement scheme,1523not to get too deep into a wormhole over Medicare, but I think,1524in general, the reimbursement scheme of Medicare physician1525reimbursement schedules makes it hard for physicians to devote1526a lot of time to preventative care, because the fee schedule is1527set in such a way that reimbursement goes down every year,1528costs go up every year. I think, unfortunately, our time with1529senior patients probably gets less every year, even if we do1530not mean to.1531    I think there are some barriers as far as reimbursement,1532but I think most of it is just the perception of why you go to1533a doctor. Most people go to a doctor for treatment of a1534problem, not for prevention of a problem.1535    Dr. Legg. The one area we do have some success, especially1536treating arthritis in the lower extremities, is we now ask many1537patients for weight reduction prior to surgery, and often we1538have patients come back who have lost a substantial amount of1539weight and say, "My knees and my hips just don't hurt as much1540anymore."1541    Chairman Scott. Shocking.1542    Dr. Legg. Yes. They often delay surgery because of that,1543and so we do that daily now. I am having discussions about1544weight reduction before surgery, but it is successful, and when1545people lose a substantial amount of weight I tell them, "You go1546to the front of the line. You are ready. You have worked hard."1547We know that it lowers surgical risk and improves surgical1548outcomes, but also people come back and say, "I feel better."1549    Chairman Scott. Mr. Hasselbeck, you coach younger people,1550right? Can you tell people, you know who is going to take care1551of their body and their mind and who is going to, unless they1552get a surprise injury, is going to have a longer career in1553sports than the people that are not?1554    Mr. Hasselbeck. No, I do not think you can tell that, but I1555do get the exact same questions from parents of high school1556athletes as I hear when I am talking to my parents and their1557friends. It is around supplementation. It is around nutrition.1558A lot of times it is these questions about protein powers. It1559is about creatine, and there really is a stigma around1560supplements, because it is the Wild, Wild West. It is not1561regulated. You know, you do not actually know what is going1562into some of these supplements.1563    I would also say that I think it is really important, if1564you have to supplement extra protein into your diet, you need1565to do it, whether you are a high school athlete or you are the1566grandparent of a high school athlete. I also think with1567creatine there is this thing out there where creatine makes you1568gain weight. On the same side, when you were talking about1569women, there is a pushback on creatine. I think we would now1570agree, in the medical community, that creatine is really1571healthy and has great benefits for men and women.1572    It is ironic that they are the exact same question for1573teenage boys, is what I usually get, and for the advice that I1574am giving my mom and her friends.1575    Chairman Scott. I take creatine, and I do protein powders.1576On my program I am supposed to have more than, I think, 1201577grams of protein a day. I eat more protein. I just wish there1578were more different varieties. You get bored of the same stuff.1579    Mr. Hasselbeck. I would just say, you know, as a1580quarterback, one of the best quarterback coaches that I ever1581had was Andy Reid. One of the things he would say is, he would1582always just say, "Stay low in the pocket." I am sure there were1583like 12 things he could have said to fix, but he just said,1584"Stay low in the pocket." It was a real attainable goal for me.1585I think when it comes to nutrition, and I think the doctors1586might agree with this, or something you are telling your1587patients, if it is an attainable goal like, "Hey, I don't know1588if I can do everything, but I can do that," the protein goal1589and the exercise goal I think are two of the simplest, most1590attainable, and they fix a lot of different things.1591    I know I mentioned Zone two cardio. It is good for heart1592health, good for brain health, which are the main things that I1593think men in my situation are concerned about, going forward.1594    Chairman Scott. How important is brain health as you age,1595for all of you?1596    Dr. Cain. I think in a lot of ways it is more important1597than physical health, really. Brain health is what allows you1598to be aware of your physical shortcomings, to be more active,1599to do things like take more protein.1600    You know, I would argue in your protein diet, if you are1601trying to get 120 grams of protein, it is tough to do. The fact1602that you are trying, you are probably getting 100, which is a1603whole lot better than you do if you did not know you needed to1604get 120.1605    I think incremental gains, incremental things are really1606important. We know that protein, for instance, helps your1607cognitive health later on, and certainly from a health care1608standpoint, as bad as it is to be broken down physically, I1609think it is a lot worse to be broken down mentally. I think1610brain health is probably more important than physical health1611for most of us.1612    Dr. Legg. Brain health follows physical health. There has1613been discussion on creatine today, and Matt mentioned that1614people worry about weight gain with creatine. We know that some1615of the older ways to use creatine included a very high loading1616dose. It was about 20 milligrams a day, which did cause a lot1617of gastrointestinal upset and water retention.1618    Now, we know that five milligrams a day, or five grams a1619day is probably plenty. You can get up to the levels you need,1620but it is going to take you about 20 days to get there, not1621four days to get there. We know as time goes with the buildup1622of creatine, again, there is a muscular effect, and then there1623becomes a bone effect, and then eventually the body can get to,1624I will call, a steady state where there probably is some brain1625effect when you get to that level and you have used it long1626enough.1627    It is a good supplement, and can be used by most everybody1628now.1629    Chairman Scott. Well, thank you to each of you for being1630here. Thank you for caring. I hope our seniors take advantage1631of the information. It seems to me, I mean, we all have to1632figure this out on our own. There is nobody that is going to do1633it for us.1634    Thanks to each of you for being here. Thanks for what you1635do.1636    [Whereupon, at 4:57 p.m., the hearing was adjourned.]16371638=======================================================================16391640                                APPENDIX16411642=======================================================================16431644                      Prepared Witness Statements16451646=======================================================================16471648                 U.S. Senate Special Committee on Aging16491650    "Lessons from the Field: How Sports Medicine can Improve Health1651                         Outcomes for Seniors"16521653                             June 25, 202516541655                      Prepared Witness Statements16561657                        E. Lyle Cain, Jr., M.D.16581659    Thank you Chairman Scott, Ranking Member Gillibrand and1660members of the committee for inviting me to testify in the1661hearing today.1662    My name is Lyle Cain. I am the Managing Partner and1663Orthopaedic Surgeon at the Andrews Sports Medicine and1664Orthopaedic Center in Birmingham, Alabama. I have been a Team1665Physician for several high school, college, and professional1666teams, including the University of Alabama Crimson Tide, for1667over 25 years. ROLL TIDE! I firmly believe that the lessons1668learned while providing care for athletes at All Ages,1669especially in the field of injury prevention and management,1670can help improve the HealthSpan of our aging population.1671    As you know, the combination of increased lifespan and1672demographics of the "Baby Boomer" generation have led to a1673dramatic shift in the number of senior adults in the United1674States with nearly 20% of our population now 65 years and1675older. This has tremendous consequences for our HealthCare1676system, both with increased utilization and increased costs. A1677true "Team approach" to the individual, using the Sports1678Medicine system as a model, can help our senior population1679maintain a better quality of life as they age.1680    What is a "Team Physician"? The American Orthopaedic1681Society for Sports Medicine (AOSSM) defines a Team physician as1682someone who provides comprehensive health services for the care1683of athletes and active people at all ages. The Team Physician1684is ultimately responsible for the health, safety, and1685performance of our athletes. Our duties include injury1686prevention and risk reduction, acute injury evaluation and1687management (both during competition and training), chronic1688condition and illness treatment, coordination of care between1689providers and performance optimization. In sports medicine, we1690also attempt to prevent injury by encouraging rules changes and1691development of protective gear for each sport. We accomplish1692these duties through the work of a large Team of Providers, and1693as I will outline, sports medicine is truly a "Team Effort".1694The modern Sports medicine Team includes Certified Athletic1695Trainers (who are generally the primary point of contact for1696the athlete), Physical Therapists, Dietitians, Primary Care1697Physicians, Orthopedic surgeons, Psychologists, Chiropractors,1698Sports Performance Specialists, Certified strength and1699conditioning coaches, and many others.1700    Our relationship with the athlete generally begins when we1701perform a pre-participation physical examination to assess1702their health and physical readiness to play. This is a crucial1703step and allows the physician and athletic trainer to identify1704issues that may predispose the athlete to future injury. We1705obtain a health history, do a thorough examination, and often1706perform additional testing (such as cardiac testing with1707echocardiogram) to develop an individual risk profile for each1708athlete. In the aging population, the annual examination with1709your primary care physician can provide this level of risk1710assessment; but the reality is that issues that put the senior1711adult at significant risk, such as balance loss, muscle loss1712(sarcopenia), cardiovascular fitness and endurance, and fall1713risk are generally not evaluated. Employing athletic trainers,1714physical therapists and other health care personnel to assist1715in annual risk assessment could likely prevent future falls and1716the associated health compromise in the older population. In my1717own family's experience, my wife's 90 year-old father has seen1718tremendous results and better balance by participating in a1719local fall prevention program provided by physical therapists.1720    Why is fall prevention so important? Falls are the #1 cause1721of injury-related death in adults over 65. Up to 30% of adults1722die within one year of a hip fracture sustained from a fall,1723and many patients that survive past the first year never regain1724independence, requiring expensive care from rehabilitation or1725long-term care facilities. It is estimated that falls alone add1726$50 billion annually to the US healthcare system costs. The old1727orthopeadic adage wisely states "we are brought into this world1728through the brim of the pelvis, and often leave through a1729fracture of the neck of the femur", emphasizing the risk of1730mortality from hip fractures in the older patient. Many of1731these falls are preventable with risk assessment, regular1732physical activity including resistance training and fall1733prevention programs.1734    How do we implement this program? It definitely takes a1735Team. The medical team should be empowered to treat the aging1736patient with individual risk evaluation, medical optimization,1737fitness and performance improvement just like we treat our1738athletes. Primary care physicians are often the healthcare1739"gate keeper", so we must train these doctors in1740musculoskeletal medicine. The American Sports Medicine1741Institute, and many programs like it, train primary care1742physicians in non-surgical care of the active person, but this1743requires an extra year of post-graduate training. Certified1744athletic trainers are a valuable part of the team, but we are1745seeing a critical shortage of young people entering the field1746due to the time commitment in training (now requiring a Masters1747level degree), long work hours, and relatively low pay.1748Physical therapy visits are generally limited by insurance1749plans, and many do not include fall prevention coverage. We1750must continue to advance programs that educate the aging1751population on the benefits of exercise, muscle mass1752improvement, and fall prevention. NIH funding is also critical,1753especially in my home State of Alabama. In fact, just two weeks1754ago, the American College of Sports Medicine (ACSM) Exercise is1755Medicine program launched the Active Aging Initiative for Older1756Adults with a mission to integrate physical activity into1757routine healthcare by enhancing collaboration between1758healthcare providers and exercise professionals and expanding1759access to evidence-based exercise opportunities. Wearable1760Technology, such as fitness trackers and Apple watches, can1761provide feedback concerning individual performance progress and1762gains.1763    In closing, we give our athletes the best care possible to1764prevent injury and optimize performance. We should do the same1765for our senior citizens.17661767                 U.S. Senate Special Committee on Aging17681769    "Lessons from the Field: How Sports Medicine can Improve Health1770                         Outcomes for Seniors"17711772                             June 25, 202517731774                      Prepared Witness Statements17751776                           Paul S. Legg, M.D.17771778    Chairman Scott, Ranking Member Gillibrand, and Honorable1779Members of the Committee,1780    Thank you for this opportunity to offer testimony to the1781Senate Special Committee on Aging. The opinions expressed1782herein are my own and do not reflect the view or position of my1783employer.1784    My name is Dr. Paul Legg. I am a practicing orthopaedic1785surgeon in Charleston, West Virginia, having spent 27 years in1786private group practice and the past two years as a hospital-1787employed surgeon for Vandalia Health. I am board certified by1788the American Board of Orthopaedic Surgery with a certificate of1789additional qualification in sports medicine. I am also the1790orthopaedic surgeon for the University of Charleson, an NCAA1791Division II school with approximately 620 athletes.1792    Sports medicine encompasses the prevention and care of1793musculoskeletal injuries and medical conditions encountered in1794sports. Lessons from the field, operating room, and research1795are applicable to maintain the physical function and1796performance in competitive athletes at any age. The health1797outcomes of seniors improve by keeping them healthy, active,1798and injury-free as they age. Surgical techniques designed to1799return competitive athletes to the field of play can also1800benefit seniors with similar injuries. For example, small1801incision or percutaneous repair of Achilles tendons is such a1802technique. Using this percutaneous technique in patients1803decreases operative time, wound complications, scarring, and1804infection.\1\ Patients also return earlier to pre-injury1805activity. However, surgical techniques are only a small part of1806sports medicine s influence on senior health. The manner in1807which our athletes train and prepare offer many more lessons on1808improving the health outcomes of seniors.1809---------------------------------------------------------------------------1810    \1\ Hsu AR, Jones CP, Cohen BE, and others. Clinical Outcomes and1811Complications of Percutaneous Achilles Repair System Versus Open1812Technique for Acute Achilles Tendon Ruptures [Internet]. Foot Ankle1813Int. 2015 Nov;36(11);1279-86. Available from: https://1814pubmed.ncbi.nlm.nih.gov/26055259/. doi: https://doi.org/10.1177/18151071100715589632.1816---------------------------------------------------------------------------1817    According to the 2022 report by the National Health1818Statistics, only 13.9 percent of adults aged 65 and older met1819the federal activity guidelines.\2\ The environmental factors1820related to low physical activity rates include automobiles,1821television, computers, mobile devices, remote controls,1822elevators, suburban roads with no sidewalks, sedentary jobs,1823and eating out/fast food. Since very few people get adequate1824exercise at work or throughout their days, exercise needs to be1825added as a purposeful activity. Fitness is partly genetic and1826is measured by how far you go on an exercise test. Physical1827activity is behavioral and requires motivation and commitment.1828Increasing your physical activity will increase your fitness.1829---------------------------------------------------------------------------1830    \2\ Elgaddai N, Kramarow E. Characteristics of Older Adults Who Met1831Federal Physical Activity Guidelines for Americans: United States, 20221832[Internet]. U.S. Centers for Disease Control and Prevention; 2022 Nov183325 [cited 2025 June]. Available from: https://www.cdc.gov/nchs/data/1834nhsr/nhsr215.pdf. Aerobic physical activity guidelines for adults1835recommend at least 150 to 300 minutes a week of moderate-intensity1836aerobic activity or 75 to 150 minutes of vigorous activity a week.1837---------------------------------------------------------------------------1838    Poor physical activity and nutrition top the list of most1839common health issues encountered by seniors.\3\ Dr. Jerome Fleg1840tested healthy patients over 20 years and found that we get1841less fit as we get older and fitness sharply declines after age184275.\4\ In 1975, Dr. Robert Bruce demonstrated that physical1843fitness as measured by VO2 max decreases as we age, even in1844healthy individuals.\5\ VO2 max is a measure of your body s1845maximal rate of oxygen consumption. When we re exercising or1846just sitting down our body takes in air from the lungs,1847distributes it throughout the body via the heart and blood1848vessels, and then pulls oxygen from that blood into our1849muscles, tissues, and cells. In the cells, mitochondira use1850oxygen to produce energy in the form of adenosine triphosphate1851(ATP). VO2 max declines with age. This occurs in part due to1852decreased cardiac output and decline in mitrochondrial number1853and quality. These changes mean that either less oxygen is1854taken up by the muscle or the oxygen that is taken up isn t1855utilized to the same extent, which can limit our aerobic energy1856production and exercise capacity. While VO2 max declines with1857age, we can prevent some decline in patients. Continuing to1858exercise can boost mitochondrial capacity, preserve cardiac1859function, and may even prevent some of the age-related declines1860in heart rate and strength with age.1861---------------------------------------------------------------------------1862    \3\ McNaughton SA, Crawford D, Ball K, and others. Understanding1863Determinants of Nutrition, Physical Activity and Quality of Life Among1864Older Adults: The Wellbeing, Eating and Exercise for a Long Life (WELL)1865Study [Internet]. Health Qual Life Outcomes; 2012 Sep 12;10:109.1866Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3479030/. doi:1867https://doi.org/10.1186/1477-7525-10-109.1868    \4\ Fleg JL, Morrell CH, Bos AG, and others. Accelerated1869Longitudinal Decline of Aerobic Capacity in Healthy Older Adults.1870Circulation [Internet]. 2005 Aug;112(5):674-82. Available from: https:/1871/pubmed.ncbi.nlm.nih.gov/16043637/. doi: https://doi.org/10.1161/1872circulationaha.105.545459.1873    \5\ See Quinn E. The Bruce Protocol Treadmill Test [Internet].1874VerywellFit; 2024 July [cited 2025 June]. Available from: https://1875www.verywellfit.com/the-bruce-treadmill-test-protocol-3120269.1876---------------------------------------------------------------------------1877    Seniors need aerobic fitness, but they also need strength1878training. Loss of strength and loss of muscle mass (sarcopenia)1879begins roughly at age 40. Muscle mass declines five percent per1880decade starting at age 40. Strength-trained men and women start1881with higher peak strength and loose strength at a slower rate.1882Muscle mass increases only with intensive and prolonged1883resistance training. The established benefits of regular1884strength (resistance) exercise include increased strength and1885endurance, increased/maintained muscle mass, increased resting1886metabolic rate, and preventing disability.1887    Both research and clinical experience indicate that1888resistance training is safe for health older adults, frail1889older adults, and individuals with disease. Muscle disuse is a1890preventable and reversible factor. Resistance exercise training1891has been consistently shown as a feasible and effective means1892of counteracting muscle weakness and physical frailty;1893improving physical performance; increasing muscle, fiber, area;1894improving muscle quality; improving bone density; improving1895metabolic health and insulin sensitivity; improving1896psychological well-being; and reducing risk for falls and1897fractures and older adults.1898    What behaviors can we encourage in senior adults to help1899start and maintain an exercise program? The first step is1900making a commitment to increase physical activity. Established1901protected time to exercise and forgo other activities that may1902encroach on this scheduled time. Develop a habit. Set small and1903realizable goals for exercise as you begin but also think about1904and establish long-term goals for overall fitness. Barriers to1905exercise must also be addressed, which include lack of1906understanding, lack of awareness, lack of funds, and lack of a1907plan.1908    What can we learn from sports medicine and athletes?1909Athletes train and prepare for competition. Their training1910includes aerobic exercise and strength training. Their exercise1911is planned and purposeful. We need to view exercise like1912personal hygiene regular and routine practices that improve1913overall health.1914    Sports medicine has also introduced specific training1915techniques that improve fitness. These techniques were designed1916to improve performance of competitive athletes. Yet, these1917principles can be used by all ages, including senior adults.1918The Norwegian 4x4 protocol is a high intensity interval1919training method that involves four minutes of near maximum1920intensity exercise followed by three minutes of light activity1921repeated four times. A study in 2020 demonstrated a lower all-1922cause mortality trend with 4x4 interval training, compared with1923controls and moderate intensity continuous training.\6\ Fartlek1924is another type of interval training that is based on even1925shorter intervals of increased activity with intermittent light1926activity or rest. Fartlek, which is Swedish for speed play,1927tends to be less structured than other interval techniques.1928These high intensity interval training techniques can be used1929with a variety of exercises including walking, running,1930cycling, elliptical, and rowing.\7\1931---------------------------------------------------------------------------1932    \6\ Acala JJ, Roche-Willis D, Astorino TA. Characterizing the Heart1933Rate Response to the 4x4 Interval Exercise Protocol. Int J Environ Res1934Public Health [Internet]. 2020 Jul 15;17(14):5103. Available from:1935https://pmc.ncbi.nlm.nih.gov/articles/PMC7399937/. doi: https://1936doi.org/10.3390/ijerph17145103.1937    \7\ See Zickl D, Latter, P. What Is a Fartlek Run and How Can It1938Help You Get Faster? [Internet]. Runner s World; 2020 Dec 8 [cited 20251939June]. Available from: https://www.runnersworld.com/training/a34824872/1940fartlek-run/.1941---------------------------------------------------------------------------1942    Health outcomes in seniors can be improved with lessons1943learned from sports medicine and sports science. Surgical1944techniques and rehab protocols help return seniors to pre-1945injury function and activity. Planned and purposeful exercise1946and strength training used in preparation for competitive1947athletic events provide a structure for exercise and senior1948adults. Advanced training techniques can move senior adults1949beyond just physical activity and into increasing levels of1950fitness.19511952                 U.S. Senate Special Committee on Aging19531954    "Lessons from the Field: How Sports Medicine can Improve Health1955                         Outcomes for Seniors"19561957                             June 25, 202519581959                      Prepared Witness Statements19601961                            Matt Hasselbeck19621963    My name is Matt Hasselbeck, and I am here to share my1964insights on the significant role Sports Medicine has played1965throughout my athletic career and its ongoing influence in my1966life.1967    I played quarterback for five years at Boston College1968followed by a lengthy NFL career. The NFL, if you don't know,1969is commonly referred to by players and coaches as "Not For1970Long", but, with the help of great sports medicine teams I was1971fortunate to play for 18 years with the Green Bay Packers,1972Seattle Seahawks, Tennessee Titans, and Indianapolis Colts. I1973grew up as the son of a football player. After an All-American1974career at the University of Colorado, my dad played tight end1975in the NFL for nine seasons. He played primarily with the New1976England Patriots, but also with the Minnesota Vikings, the New1977York Giants, and the Los Angeles Raiders, where he and his1978teammates won Super Bowl XVIII. My brothers and I all earned1979full scholarships to play college football, and my brother Tim1980followed me as a longtime quarterback in the NFL. Most of our1981wives were prominent Division one athletes as well, and my wife1982was no doubt a better athlete in college than I was.1983    In the decade since my NFL career ended, I have primarily1984worked in the sports media space. After spending eight years at1985ESPN on shows like Sunday NFL Countdown, Monday Night1986Countdown, and SportsCenter, I now work as an NFL analyst for1987Fox Sports on the Colin Cowherd Show. I've also been serving as1988a high school football coach the past four years. After winning1989a state championship in Massachusetts coaching my son, last1990year we moved to Tennessee so I could coach on a staff with my1991father and brother, where we coached two of my quarterback1992nephews Taylor and Isaiah. Taylor is currently committed to1993play college football at the University of Wyoming.1994    Raising our own three kids and supporting their athletic1995journeys has been the other major career for my wife and me.1996Our two daughters are National Champion lacrosse players from1997Boston College; the younger one is preparing for a fifth year1998after three knee surgeries earned her a medical redshirt. Our1999son is a redshirt freshman quarterback at UCLA and is battling2000for his own opportunity much like I did at his age.2001    During my 23 years of college and professional football, I2002only had one surgery. This is unheard of! I attribute this to2003many factors, one of which is the help of skilled athletic2004trainers and sports medicine teams. Many of my teammates took a2005"react and survive" approach to their health, while a2006"proactive and thrive" approach is a mindset that helped me. I2007attribute this mindset to the advice, care, and expertise of2008the athletic training staffs of my teams. Not only did they2009help me prevent injuries, but they also contributed to helping2010me heal faster and return to play. Staying healthy is priority2011#1 for an NFL quarterback. Injury prevention, recovery, and2012prioritizing wellness were equally important to me as throwing2013touchdown passes. My coaches would often tell us, "Your2014greatest ability is your availability".2015    Both during and after my NFL career, I have been dedicated2016to making the game safer for future generations. I actively2017participated in the NFLPA's Mackey-White Health and Safety2018Committee and proudly served as a Vice-President of the NFLPA's2019Executive Committee for six years. Our work successfully2020fostered a significant culture change regarding brain injuries2021and return-to-play protocols in football. In commitment to this2022cause, upon my death I have pledged my brain to science through2023the Concussion Legacy Foundation. I currently serve as the2024ambassador for the DiagnoseCTE.org study for men over 50 which2025aims to develop a method to diagnose and differentiate brain2026trauma while patients are still alive.2027    In this new empty nester era of our lives, my wife and I2028have experienced the challenges of caring for our aging2029grandparents and parents. We have leaned on the lessons learned2030through athletics to help replicate the best outcomes for them2031as they get older. For example, helping my mom set goals for2032the activities hopes to participate in with her grandkids when2033she is older means that we have to start prepping for that now,2034much like you would do as an athlete. My mom would love to be2035able to play pickleball and ride bikes with her grandkids when2036she is 75.2037    Sometimes it's not as simple. Following a painful knee2038replacement surgery, my dad was waiting to get healthy enough2039for the next one, when he tragically suffered a cardiac event2040this April, which he did not survive. This heartbreaking event2041has left my mom a widow after 50 years of marriage and she now2042faces new challenges, some of which are loneliness and2043isolation, that she must overcome. Sadly, as a family, we are2044also dealing with the significant challenge of my mother-in-2045law's Alzheimer's disease. This illness has placed immense2046hardship on our family, particularly affecting my father-in-law2047who sacrificed his profession to become her full-time2048caretaker.2049    In conclusion, that's a glimpse into who I am, and I'm2050truly honored to be here today. The last time I visited this2051building was during my 8th-grade class trip, and I had a2052wonderful time. I always hoped I'd get to come back again. I2053look forward to answering your questions.20542055                 U.S. Senate Special Committee on Aging20562057    "Lessons from the Field: How Sports Medicine can Improve Health2058                         Outcomes for Seniors"20592060                             June 25, 202520612062                      Prepared Witness Statements20632064                            Jennifer Raymond20652066    Chairman Scott, Ranking Member Gillibrand, and members of2067the Committee, thank you for the opportunity to speak before2068you today. My name is Jennifer Raymond, and I am honored to2069serve as the Chief Strategy Officer for AgeSpan, an Area Agency2070on Aging located in Lawrence, Massachusetts. We are one of 6142071AAAs across the country, helping our older adults stay2072independent. On behalf of these agencies, as well as the older2073adults and family caregivers they serve, I want to first thank2074you for your ongoing efforts to meet the needs of our aging2075population through the Older Americans Act.2076    Thank you for your attention on the importance of physical2077wellness for older adults. The consequences of physical2078inactivity among older adults are catastrophic. They include a2079decline in overall function, increased risk for chronic2080diseases, increased frailty and a heightened risk for2081depression and cognitive decline. Despite these consequences,2082more than one in four older Americans are physically2083inactive.\1\ The reasons for inactivity are many and varied: a2084fear of injury, lack of confidence in their ability to exercise2085safely, and even a lack of motivation to begin exercise.2086---------------------------------------------------------------------------2087    \1\ Watson KB, Carlson SA, Gunn JP, et all. Physical Inactivity2088Among Adults Aged 50 and Older-United States, 2014. MMWH Mor Mortal2089Wkly Rep 2016;65:954-958. DOI:http://dx.doi.org/10.15585/mmwr.mm6536a3.2090---------------------------------------------------------------------------2091    Across Massachusetts and throughout this country, Area2092Agencies on Aging (AAAs) and their partners offer effective2093physical activity programs that both promote exercise and help2094individuals overcome the motivational and behavioral barriers2095that contribute to inactivity. For example, May C. from Quincy,2096who was able to safely abandon her walker after improving her2097balance through an evidence-based program called A Matter of2098Balance, and Maria A, who, despite her frailty, now2099participates in virtual physical activity classes, from the2100comfort of her own home thanks to our AAA's digital access2101program.2102    One of the most important benefits of increased physical2103activity for older adults relates to the prevention of falls.2104Falls can be detrimental to a senior's life. They can result in2105hip fractures, head trauma, other serious injury, and even2106death. They often reduce mobility, take away a senior's ability2107to live independently and can make people afraid to leave their2108home, increasing loneliness and isolation.2109    Every year in this country, more than 14 million Americans211065 or older (or one out of every four) suffer a fall.\2\ In21112021, emergency room departments reported three million visits2112due to older adult falls.\3\ The total health care costs for2113these falls are over $80 billion per year.\4\ Of these costs,211467% is paid for by Medicare, 4% by Medicaid, and 29% by older2115adults and their families.\5\2116---------------------------------------------------------------------------2117    \2\ Kakara R, Bergen G, Burns E, Stevens M. Nonfatal and Fatal2118Falls Among Adults Aged =65 Years-United States, 2020-2021. MMWR2119Morbidity and Mortality Weekly Report. 2023;72:938-943. DOI: 10.15585/2120mmwr.mm7235a1.2121    \3\ Centers for Disease Control and Prevention, National Center for2122Injury Prevention and Control. Web-based Injury Statistics Query and2123Reporting System (WISQARS) [online]. Accessed March 11, 2024.2124    \4\ Haddad YK, Miller GF, Kakara R, et al. Healthcare spending for2125non-fatal falls among older adults, USA Injury Prevention 2024;30:272-2126276.2127    \5\ Haddad YK, Miller GF, Kakara R, et al. Healthcare spending for2128non-fatal falls among older adults, USA Injury Prevention 2024;30:272-2129276.2130---------------------------------------------------------------------------2131    Today, many AAAs partner with family health centers,2132primary care providers, and managed care to reduce falls risks.2133First, our health care partners screen and identify older2134adults at risk for falls. Then, they refer those individuals to2135networks of AAAs for falls intervention. This might include a2136physical activity program, assistance with home modifications2137to address falls hazards, and even the provision of medically2138tailored meals to make them more ready for physical activity.2139These referrals allow us to take a more holistic approach to2140addressing the needs of the individual and create a shared care2141plan to improve outcomes.2142    There is much we can do to support older adults in their2143desire to age in place, stay physically active, and avoid2144falls. To further these goals, we must:2145      1. Support robust funding for community-based physical2146activity and falls prevention through the Older Americans Act,2147specifically Titles IIID Evidence-Based Health Promotion and2148Disease Prevention and Title IIIB Supportive Services.2149      2. Educate health care providers about falls prevention2150through tools like the STEADI program, which assists providers2151in integrating falls prevention to their clinical practices.2152      3. Encourage prescription for physical activity and falls2153prevention by health care providers and allowing for2154appropriate reimbursement for effective interventions offered2155in the community.2156      4. Continue investment in research related to physical2157activity and falls prevention for all older adults, including2158those with physical frailty, those with disability, and those2159with cognitive decline.2160    If we are serious about a healthy America, we cannot ignore2161the impact of physical inactivity and falls among older adults.2162Area Agencies on Aging stand ready to partner with health care,2163older adults, and family caregivers to address this challenge.2164Investments today will not only allow older adults to thrive2165independently but will also help stem the costs for our health2166care system for years to come.2167    Thank you again for the opportunity to speak with you today2168and for your support on this issue. I look forward to your2169questions and working together to support our country's older2170adults.21712172=======================================================================21732174                        Questions for the Record21752176=======================================================================21772178                 U.S. Senate Special Committee on Aging21792180    "Lessons from the Field: How Sports Medicine can Improve Health2181                         Outcomes for Seniors"21822183                             June 25, 202521842185                        Questions for the Record21862187                         Dr. E. Lyle Cain, Jr.21882189                   Ranking Member Kirsten Gillibrand21902191    Question:21922193    Your online biography notes that you have an interest in2194"the emerging field of biological treatment options" for2195healing injuries. Our country has made remarkable strides with2196developing new treatments and medical procedures. The National2197Institutes of Health has played a significant role - in fact,2198NIH is responsible for more than 80% of the world's grant2199investment in biomedical research.2200    Can you discuss some of the emerging biological treatment2201options for injuries, and the potential those options hold for2202patients - including older adults?22032204    Response:22052206    Thank you Senator Gillibrand. Most of the emerging biologic2207treatment options involve isolating specific growth factors to2208treat individual diseases. Our current options include Platelet2209Rich Plasma (isolated from the patient's own blood) and Bone2210Marrow or Fat-derived Mesenchymal Stem Cells (isolated for the2211patient's bone marrow or fat). These biologic treatments are2212full of many chemical factors and enzymes secreted by the cells2213that can be both helpful and sometimes harmful. Scientists are2214currently running trials supported by the NIH to better2215determine which specific factors and cells are best for each2216specific condition or disease.22172218    Question:22192220    What will it mean for your patients if the development of2221new treatment options slows, or ends all together?22222223    Response:22242225    The loss of research support to improve the treatment2226options will have a negative effect on my patients, leading to2227less medical breakthroughs that may save lives.22282229                        Senator Raphael Warnock22302231    Question:22322233    Falls are the leading cause of injury-related death amongst2234older adults, resulting in roughly $80 billion in medical costs2235every year\1\ and contributing to three million emergency2236department visits annually.\2\ The Centers for Disease Control2237and Prevention (CDC) Stopping Elderly Accidents, Deaths &2238Injuries (STEADI) Initiative collaborates with healthcare2239providers to provide clinical resources for falls screening,2240assessments, and interventions.\3\ Georgia, alongside 22 other2241states, also receives funding through the CDC Core State Injury2242Prevention Program (Core SIPP) to address fall prevention.\4\2243However, these programs are at risk due to significant proposed2244Fiscal Year 2026 budget cuts to the CDC.\5\2245---------------------------------------------------------------------------2246    \1\ Older Adult Falls Data, Centers for Disease Control and2247Prevention (October 28, 2024), https://www.cdc.gov/falls/data-research/2248index.html.2249    \2\ Facts about Falls, Centers for Disease Control and Prevention2250(May 9, 2024), https://www.cdc.gov/falls/data-research/facts-stats/2251index.html.2252    \3\ STEADI - Older Adult Fall Prevention, Centers for Disease2253Control and Prevention, https://www.cdc.gov/steadi/index.html.2254    \4\ CDC Core, Georgia Department of Public Health, https://2255dph.georgia.gov/health-topics/injury-prevention-program/cdc-core.2256    \5\ Fiscal Year 2026 Centers for Disease Control and Prevention2257Justification of Estimates for Appropriation Committees, Department of2258Health and Human Services, https://www.cdc.gov/budget/documents/fy2026/2259fy-2026-cdc-cj.pdf.2260---------------------------------------------------------------------------2261    What unique challenges might older adults in rural areas2262face regarding access to falls prevention resources in a2263primary care setting?2264    Response:22652266    Many older adults in rural communities are not able to2267access these programs because of the distance needed to find2268appropriate resources. Online and web-based models are helpful,2269but can never really replace personal, hands-on expertise.22702271                 U.S. Senate Special Committee on Aging22722273    "Lessons from the Field: How Sports Medicine can Improve Health2274                         Outcomes for Seniors"22752276                             June 25, 202522772278                        Questions for the Record22792280                            Dr. Paul S. Legg22812282                   Ranking Member Kirsten Gillibrand22832284    Question:22852286    America's population is rapidly aging. I understand that2287you have seen some of the consequences of that aging, as a2288large share of your patients are now over 60 years old.2289However, new doctors may not be completely prepared to provide2290patient care tailored to the needs of older patients. For2291example, medical schools typically offer rotations in2292specialties like pediatrics, cardiology, surgery, and emergency2293medicine - but often leave geriatrics off the list.2294    As someone who has experience treating patients over the2295age of 60, what advice do you have for new doctors who are2296about to serve an aging population?22972298    Response:22992300    Treating senior adults should include the ability to2301recommend and /or prescribe exercise programs for patients. New2302physicians should be prepared to inform patients on the2303importance of exercise to maintain health and to help prevent2304certain diseases. New physicians can provide simple exercise2305programs to their patients and use local resources that2306patients can access for physical activity. I often recommend2307Dr. Ben Levine's Exercise Prescription for Life as a simple and2308easily adaptable program for exercise. New physicians must be2309prepared to motivate patients to exercise. The most difficult2310task is convincing patients that exercise is essential to good2311health, and motivating them to develop and maintain a2312consistent program.23132314                 U.S. Senate Special Committee on Aging23152316    "Lessons from the Field: How Sports Medicine can Improve Health2317                         Outcomes for Seniors"23182319                             June 25, 202523202321                        Questions for the Record23222323                            Jennifer Raymond23242325                   Ranking Member Kirsten Gillibrand23262327    Question:23282329    Health care expenditure for non-fatal falls in 2020 was 802330billion dollars. Instead of treating falls, we should be2331preventing them. A preventive approach would save the health2332care system billions of dollars and prevent needless suffering2333for many seniors. Many of the programs funded by the Older2334Americans Act, including those provided in your agency, focus2335on health promotion and disease prevention.2336    Why is it so important to take an upstream approach to2337health and aging? Could you give us some examples?23382339    Response:23402341    Thank you for this question. Taking an upstream approach to2342both health and aging is critical if we want to both improve2343health outcomes and contain the rising costs of poor health.2344Taking an upstream approach also more proactively looks that2345the root causes of poor health outcomes, and the drivers of2346positive health outcomes and allows us to tackle potential2347problems before they manifest into costly and chronic health2348conditions. This might mean enhanced investment in physical2349activity programs (and safe places for people to access2350physical activity), increased access to affordable nutrients2351that improve physical health, and transportation and access to2352community wide physical activity centers. It also means that2353this access is accompanied by education and training related to2354health care and the ability to make incremental behavior change2355to adapt healthy behaviors at all ages.23562357                        Senator Raphael Warnock23582359    Question:23602361    Falls are the leading cause of injury-related death amongst2362older adults, resulting in roughly $80 billion in medical costs2363every year\1\ and contributing to three million emergency2364department visits annually.\2\ The Centers for Disease Control2365and Prevention (CDC) Stopping Elderly Accidents, Deaths &2366Injuries (STEADI) Initiative collaborates with healthcare2367providers to provide clinical resources for falls screening,2368assessments, and interventions.\3\ Georgia, alongside 22 other2369states, also receives funding through the CDC Core State Injury2370Prevention Program (Core SIPP) to address fall prevention.\4\2371However, these programs are at risk due to significant proposed2372Fiscal Year 2026 budget cuts to the CDC.\5\2373---------------------------------------------------------------------------2374    \1\ Older Adult Falls Data, Centers for Disease Control and2375Prevention (October 28, 2024), https://www.cdc.gov/falls/data-research/2376index.html.2377    \2\ Facts about Falls, Centers for Disease Control and Prevention2378(May 9, 2024), https://www.cdc.gov/falls/data-research/facts-stats/2379index.html.2380    \3\ STEADI - Older Adult Fall Prevention, Centers for Disease2381Control and Prevention, https://www.cdc.gov/steadi/index.html.2382    \4\ CDC Core, Georgia Department of Public Health, https://2383dph.georgia.gov/health-topics/injury-prevention-program/cdc-core.2384    \5\ Fiscal Year 2026 Centers for Disease Control and Prevention2385Justification of Estimates for Appropriation Committees, Department of2386Health and Human Services, https://www.cdc.gov/budget/documents/fy2026/2387fy-2026-cdc-cj.pdf.2388---------------------------------------------------------------------------2389    What steps can Congress take to protect and strengthen2390community-based partnerships, like the STEADI Initiative and2391Core SIPP, to ensure that evidence-based fall prevention2392resources are adequately accessible to older adults?23932394    Response:23952396    Thank you for this question. The integration of the social2397care provided by community-based organizations with the2398clinical care provided by health care practitioners has proven2399in many cased to both improve health outcomes and advance cost2400containment. The STEADI Initiative and Core SIPP are just two2401such examples. To better support these and similar2402partnerships, Congress should:24032404      1. Support robust funding for community-based physical2405activity and falls prevention activities through the Older2406Americans Act, specifically Titles III D Evidence-Based Health2407Promotion and Disease Prevention and Title III B Supportive2408Services.24092410      2. Invest in an educated health care provider workforce2411that advances falls and falls prevention activities in their2412community through tools like the STEADI program, which was2413created by the Centers for Disease Control and Prevention to2414assist health care providers in integrating falls prevention in2415their clinical practices.24162417      3. Incentivize prescription for physical activity and2418falls prevention by health care providers and allowing for2419appropriate reimbursement for effective interventions offered2420in the community.24212422      4. Continue investment in research related to physical2423activity and falls prevention activities for all older adults:2424those who have the capacity to be more active, those with2425physical frailty, those with disability, and those with2426cognitive decline include Alzheimer's Disease and Related2427Dementia.2428=======================================================================24292430                       Statements for the Record24312432=======================================================================24332434                 U.S. Senate Special Committee on Aging24352436    "Lessons from the Field: How Sports Medicine can Improve Health2437                         Outcomes for Seniors"24382439                             June 25, 202524402441                       Statements for the Record24422443  American Physical Therapy Association and the Academy of Geriatric2444              Physcal Therapy (APTA Geriatrics) Statement24452446    On behalf of the 100,000 member physical therapists,2447physical therapist assistants, and students of physical2448therapy, the American Physical Therapy Association and the2449Academy of Geriatric Physcal Therapy (APTA Geriatrics), an2450Academy of the American Physical Therapy Association, submit2451the following comments in response to the Senate Special2452Committee on Aging hearing, "Lessons from the Field: How Sports2453Medicine Can Improve Health Outcomes for Seniors"2454    APTA is dedicated to building a community that advances the2455physical therapy profession to improve the health of society.2456As experts in rehabilitation, prehabilitation, and2457habilitation, physical therapists play a unique role in society2458in prevention, wellness, fitness, health promotion, and2459management of disease and disability for individuals across the2460age span, helping individuals improve overall health and2461prevent the need for avoidable health care services. APTA2462Geriatrics supports PTs, assistants and student with their2463mission to optimize the experience of aging by 1) promoting2464value, quaity, and accessiblity of geriatric care. 2) Prpviding2465life-long learning and mentorship that promotes innovative2466person-centered care. 3) Buidling a passionate community for2467those call end committed to improving the human experience.2468    Physical therapists are doctorally trained movement experts2469who help to optimize people's physical function, movement,2470performance, health, quality of life, and well-being. Physical2471therapists evaluate, diagnose, and manage movement conditions2472for individuals, and they also provide contributions to public2473health services aimed at improving population health and the2474human experience. Physical therapists have a designated2475specialy certification in geriatrics that demonstrated advanced2476practice in providing services for older adults complex needs2477across the care spectrum from skilled nursing facilities to2478senior games and fitness/wellness. Physical therapists working2479with older adults address the 5M's of geriatric care: Mobiltiy,2480Mind, Medications, Multi-complexity and What Matters Most.2481Physical therapist assistants (PTAs) are educated and licensed2482or certified clinicians who provide care under the direction2483and supervision of a licensed physical therapist. PTAs also2484have an advanced proficieny program for geriatrics. PTs and2485PTAs care for people of all ages and abilities.24862487The Role of Physical Therapy in Building Strength and Improving2488Balance24892490    Older Americans are most at risk for experiencing a fall2491and suffering from debilitating conditions that may result from2492such incidences. In fact, according to the Centers for Disease2493Control and Prevention, more than one out of four older2494Americans fall each year. Falling once doubles the chance of2495falling again. Every 19 minutes, an older adult will die2496because of a fall. A fall can result in serious injuries,2497potentially leading to loss of independence, misuse of opioids,2498and decreased ability to do meaningful activities. All told,2499accidental falls among older adults result in three million2500emergency room visits and one million hospital stays annually.2501The average falls-related hospitalization costs $30,000 and2502falls rank fifth in terms of the highest personal health care2503spending. Older adult falls cost $50 billion in medical costs2504annually, with 75% paid by Medicare and Medicaid.2505    Physical therapists have a critical role in preventing2506falls, especially among older segments of the population.2507Through PT care, patients can significantly reduce the risk of2508a fall and potentially avoid serious injuries that could likely2509be difficult and costly to treat. Physical therapists are2510movement experts with knowledge and skills in identifying,2511measuring, and improving balance system deficits, functional2512limitations, and strength and flexibility deficits that have2513been shown to contribute to falls.25142515    The physical therapist's role in falls prevention includes,2516but is not limited to:25172518      Assessing the multifactorial risk for falling:25192520      Designing an individualized plan for a patient's fall-2521prevention needs;25222523      Providing home safety assessments and modifications to2524make a patient's home as safe from fall hazards as possible;25252526      Educating about the risk factors associated with falls;25272528      Providing appropriate exercises and balance training;25292530      Working with other health care professionals to address2531any underlying medical conditions that could increase the risk2532of falling; and25332534      Providing recommendations on evidence-based community2535programs.25362537    Physical therapists also address the identified deficits2538following physical examination and objective tests of movement2539patterns. Physical therapists are a vital component of2540multifactorial interventions that address modifiable risk2541factors for falls including medications, environment and2542personal factors. Interventions provided by physical therapists2543are targeted and dosed to provide the ability of the nervous2544system to adapt to changing situations and environments since2545balance requires both anticipated actions and reaction2546responses. . Improvements in the interactions between2547components of the balance systems through physical therapist2548management leads to enhanced effectiveness of the activities2549and participation that support what matters most to each2550person. .2551    Physical therapy may also reduce long-term opioid2552medication as an effective means to decrease preventable falls2553in community-dwelling older adults. Physical therapists provide2554tailored patient teach-back methods and motivational2555interviewing to assess readiness and intervene to improve gaps2556in client understanding of falls risk factors to mitigate their2557falls risk.25582559The Economic Value of Physical Therapy25602561    "The Economic Value of Physical Therapy in the United2562States," a recently released APTA report, showcases the cost-2563effectiveness and economic value of physical therapist services2564for a broad range of common conditions. The report compares2565physical therapy with alternative care across a suite of health2566conditions commonly seen within the U.S. health care system.2567The report underscores and reinforces the importance of2568including physical therapists and physical therapist assistants2569as part of multidisciplinary teams focused on improving2570outcomes for seniors and decreasing downstream costs. We urge2571the Committee to consider the insights provided in this report2572to support access to, coverage of, and payment for physical2573therapist services, and to support policies that position2574physical therapists as entry-point providers for seniors to2575ensure beneficiaries have timely access to proven, cost-2576effective care.25772578Policy Recommendations25792580    Preventing falls is critical; however, access to falls2581screening and prevention services is often limited. The APTA2582endorses the following policy recommendations to increase2583patient access to physical therapy that can significantly2584reduce the risk of falls in the older adult population.25852586      Recommendation #1: APTA urges Congress to pass H.R. 11712587- the Stopping Addiction and Falls for the Elderly (SAFE) Act.2588This bipartisan legislation introduced in the U.S. House by2589Reps. Carol Miller, R-W.Va., and Melanie Stansbury, D-N.M.2590would ensure that Medicare beneficiaries, identified by their2591physicians as having experienced a fall the year before their2592Initial Preventive Physical Examination (known as the "Welcome2593to Medicare" visit), would be referred to a physical therapist2594for falls screening and preventive services. This bill also2595enables beneficiaries who've been enrolled in Medicare for at2596least a year and who choose to participate in an annual2597wellness visit (different from an annual physical) to be2598referred for a separate falls risk assessment and potential2599additional PT services if the annual wellness visit reveals2600that they've fallen within the previous year.26012602      Recommendation #2: APTA urges Congress to pass S.668/2603H.R. 3183 - the SAFE STEPS for Veterans Act introduced Sens.2604Angus King, I-Maine, and Mike Rounds, R-S.D., and in the House2605by Reps. Nikki Budzinski, D-Ill., Lois Frankel, D-Fla., Jen2606Kiggans, R-Va., Jack Bergman, R-Mich., and Gus Bilirakis, R-2607Fla. This bipartisan legislation introduced by addresses2608preventing falls among older veterans and would require annual2609falls risk assessments to be carried out by a licensed physical2610therapist for veterans receiving extended care services2611throughout the Department of Veterans Affairs (VA). It would2612also establish an Office of Falls Prevention and create a falls2613prevention coordinator within the Veterans Health2614Administration to serve as a point person on federal panels2615focused on falls prevention.26162617      Recommendation #3: APTA recommends Congress reauthorize2618and fully fund programs under the Older Americans Act (OAA).2619The OAA was enacted in 1965 with the goal of supporting older2620Americans to live at home and in the community with dignity and2621independence for as long as possible. OAA supports various2622programs and services, including information and referral,2623congregate and home-delivered meals, health and wellness2624programs, in-home care, transportation, elder abuse prevention,2625caregiver support, and adult day care. As Congress may consider2626ways to improve the efficiency and effectiveness of OAA2627services and programs, APTA recommends that federal grants2628authorized by OAA be utilized to promote timely assessments of2629seniors for the risk of falling that can be performed by2630physical therapists. Timely access to such an assessment could2631help seniors and their caregivers prevent falls that lead to2632devastating outcomes and would help reduce health care costs in2633the U.S.26342635    Should you have any questions, please contact APTA2636Congressional Affairs Specialist Steve Kline at2637stevekline@apta.org. Thank you for your time and consideration.26382639                 U.S. Senate Special Committee on Aging26402641    "Lessons from the Field: How Sports Medicine can Improve Health2642                         Outcomes for Seniors"26432644                             June 25, 202526452646                       Statements for the Record26472648                           BPR Lab Statement26492650    BPR Lab, a multidisciplinary group of geriatric physicians,2651board-certified healthcare architects, and bioethicists,2652appreciate the opportunity to submit comments for the Special2653Committee's hearing on physical activity in older adults. Our2654area of expertise is the impact our built environment has on2655the mobility and physical activity of older adults.2656    It has long been known that architecture shapes the2657activities of people within a building. What is new is the2658extent to which architecture impacts the health of its2659occupants. In some cases, those effects are similar in scale2660and scope to that of medications and procedures. The study of2661these effects, Evidence-Based Design (EBD), seeks to uncover2662these relationships. Our work at BPR Lab focuses on leveraging2663EBD to increase the benefits and reduce the harms to people in2664healthcare facilities through an understanding of causes and2665effects. Fall prevention and promotion of mobility are two such2666effects with far reaching personal and financial costs.2667    Opportunities to improve these effects through architecture2668stand as an untapped vector to increase quality of life for2669older Americans and stem taxpayer costs. Falls are the leading2670cause of injury and among the leading causes of death among2671older Americans. In 2020 over 42,000 Americans died due to2672falls.\1\ Medical care related to falls of adults over 65 years2673old was estimated to be $50 billion annually (2018),\2\ of2674which approximately $29 billion and $9 billion came from2675Medicare and Medicaid funding, respectively.\3\ In 2020, that2676number had risen to $80 billion\4\ and by 2030 the cost is2677expected to exceed $100 billion annually.2678---------------------------------------------------------------------------2679    \1\ Santos-Lozada AR. Trends in Deaths From Falls Among Adults Aged268065 Years or Older in the US, 1999-2020. JAMA. 2023 May 9;329(18):1605-26811607. doi: 10.1001/jama.2023.3054.2682    \2\ Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C.2683Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriatr2684Soc. 2018 Apr;66(4):693-698. doi: 10.1111/jgs.15304. Epub 2018 Mar 7.2685PMID: 295121202686    \3\ National Center for Injury Prevention and Control (U.S). Cost2687of Older Adult Falls. Published 2020 July 9. Accessed 2025 June 22.2688https://stacks.cdc.gov/view/cdc/1227472689    \4\ Haddad YK, Miller GF, Kakara R et al. Healthcare spending for2690non-fatal falls among older adults, USA. Injury Prevention. 2023;30(4)2691https://doi.org/10.1136/ip-2023-0450232692---------------------------------------------------------------------------2693    While the CDC's Stopping Elderly Accidents, Deaths, and2694Injuries campaign (STEADI) is a well-known U.S. Government2695effort to reduce falls in older adults,\5\ there are lacunas2696with which the Special Committee could help. Among the2697implemented recommendations made by Geriatric medical societies2698is the screening of home environments for elements within that2699increase the risk of falls in older adults.\6\ However, a2700variety of structural factors continue to limit the practice of2701basing long term care facility design decisions on empirical2702data. While the knowledge is highly translatable, the2703mechanisms that support and promote medical research do not2704have a parallel in the architecture and construction of2705healthcare facilities. Our work promotes a non-regulatory2706mechanism for the incorporation of EBD.2707---------------------------------------------------------------------------2708    \5\ Centers for Disease Control and Prevention (CDC). About STEADI.2709Published 2024 April 22. Accessed 2025 June 22. https://www.cdc.gov/2710steadi/about/index.html2711    \6\ Centers for Disease Control and Prevention (CDC). Check for2712Safety: A Home Fall Prevention Checklist for Older Adults. Published27132017. Accessed 2025 June 22. https://www.cdc.gov/steadi/pdf/steadi-2714brochure-checkforsafety-508.pdf2715---------------------------------------------------------------------------2716    As healthcare-built environments are studied more,2717physicians and architects are understanding the relationship2718between design elements and different health outcomes better.2719While the interaction can be complex and much remains to be2720known, what we do know demonstrates the personal, ethical, and2721financial value of action, considering the frequency of falls2722in older adults and their cost to the health system and U.S.2723Government. For example, a recent study demonstrated that2724simply changing lightbulbs in a long-term care home to increase2725short-wavelength light during the day and decrease it overnight2726decreased falls by 43% compared to a control site.\7\ As2727professionals in this area, we continue to observe preventable2728harms and the missed opportunities to reduce falls in older2729adults. Whether in hospitals, long-term care facilities, or in2730home environments, evidence-based practices for fall reduction2731are inconsistently and optionally applied. We also see the2732benefits of improving environments, often with additional2733expertise from our colleagues in Physical and Occupational2734Therapy.2735---------------------------------------------------------------------------2736    \7\ Grant LK, St Hilaire MA, Heller JP, Heller RA, Lockley SW,2737Rahman SA. Impact of Upgraded Lighting on Falls in Care Home Residents.2738J Am Med Dir Assoc. 2022;23(10):1698-1704.e2. doi:10.1016/2739j.jamda.2022.06.0132740---------------------------------------------------------------------------2741    We applaud the Senate Special Committee on Aging's focus on2742fall reduction in older adults. As the US population ages, this2743topic will become increasingly germane to many Americans and2744their loved ones. The potential cost-savings to the federal2745government and for families' out-of-pocket expenses by2746implementing evidence-based practices to reduce falls in older2747adults is immense, in addition to the basic improvement in2748older adults' quality of life.27492750Recommendations27512752    We urge the following specific actions:27532754      Congress should establish an Advisory Committee to2755develop a National Falls Prevention Plan and advise CMS to2756address falls prevention through home modifications and2757mobility-focused interventions. The evidence base is sufficient2758to support the proposed pilot program for Medicare coverage of2759home modifications when recommended by a medical professional,2760to decrease the rates of falls in the home.27612762      The federal government should support ongoing research2763into design-based fall reduction strategies. The federal2764government has the capacity to study relationships between2765health outcomes and design elements due to its access to large2766and inter-related datasets. The federal government should2767continue to partner with researchers in both academia and2768private industry to publicly disseminate research of high2769quality.27702771      The federal government's potential investment into built2772environment modifications should support interventions2773recommended by medical and design professionals who demonstrate2774evidence to support their ability to reduce falls. As evidence2775grows, the federal government should adjust their reimbursement2776based on the recommendations of medical and professionals with2777relevant professional experience and minimal conflicts of2778interest.27792780    Thank you for the opportunity to provide our views on this2781important topic. Our views do not represent those of our2782employers but are based on the authority of our respective2783professions. We look forward to working with you to reduce the2784risk of older adults' falls through evidence-based design2785interventions.27862787    Sincerely,27882789    David A. Deemer, MD, MA2790    Geriatric & Palliative Medicine Fellow2791    Icahn School of Medicine at Mount Sinai2792    New York, NY27932794    Diana C. Anderson, MD, M.Arch, FACHA2795    Geriatric Medicine Physician2796    Boston University School of Medicine2797    Boston, MA27982799    Stowe L. Teti, MA, HEC-C2800    Clinical Ethicist2801    Inova Fairfax Medical Campus2802    Woodburn, VA28032804    William J. Hercules, FAIA, FACHA, FACHE2805    CEO2806    WJH Health2807    Orlando, FL28082809                 U.S. Senate Special Committee on Aging28102811    "Lessons from the Field: How Sports Medicine can Improve Health2812                         Outcomes for Seniors"28132814                             June 25, 202528152816                       Statements for the Record28172818                      The Watertown YMCA Statement28192820    I am Michelle Graham, Senior Director of Health and2821Wellness at the Watertown Family YMCA. I will briefly share our2822work locally and at the state and national level to advance the2823health and wellbeing of aging adults.2824    At the Y, we are committed to strengthening communities by2825connecting people of all ages, abilities and backgrounds to2826their potential, their purpose and each other. Nationally,2827YMCAs engage 17 million Americans annually, and nearly four2828million are over age 55, including 2.5 million over age 65.2829Older adults make up nearly one-quarter of our members.2830    In New York State, YMCAs operate in all 62 counties through2831140 branches, reaching over 890,000 members each year.2832Statewide the Y serves 217,562 older adults. This includes over283313,000 adults and seniors who have found safe housing and2834community at the Y and 10,000 who participated in evidence-2835based programs focused on preventing and managing chronic2836diseases like diabetes, hypertension, and arthritis. Programs2837at the Y promote longevity beyond building stronger bodies -our2838participants reported feeling emotionally supported and more2839socially connected through a sense of belonging.2840    In the greater Watertown NY area, we reach over 21,0002841individuals annually, with almost 1400 visits daily and over28423,500 adults throughout the year.2843    As a nation, we spend 90% of our health care dollars2844treating chronic disease and far too little trying to prevent2845disease and injury. At the Y, we know from experience that2846investing up front in prevention and control of disease and2847injury will save lives and reduce health care spending.2848    The Watertown YMCA is proud of the role we have played in2849delivering evidence-based lifestyle health programs to address2850falls and chronic disease that our national resource office -2851YMCA of the USA - has worked to scale with public health2852partners at CDC and with our state and local health2853departments.2854    Our Y just completed year one of a four-year New York State2855YMCA Falls Prevention Initiative led by the Alliance of NYS2856YMCAs, which is funded through a federal grant by the2857Administration for Community Living. According to CDC, $502858billion is spent annually on medical costs related to older2859adult falls each year. And, according to the NYS Department of2860Health, falls account for $1.7 billion in hospitalization2861charges and $145.3 million in annual outpatient emergency2862department charges in the state. Fall injuries are increasing2863despite the ability to prevent them.2864    In year one of the falls prevention funding, NY Ys2865supported more than 400 older adults across the state, part of2866a larger goal to reach over 2,000 by the end of four years.2867This includes the launch of a statewide virtual program to2868remove barriers to access, especially in rural communities.2869Importantly, the program has delivered powerful outcomes,2870including:28712872      50% of older adults in the program report changes in2873social isolation and loneliness.2874      96% reported that they plan to continue participating in2875exercise.2876      80% of participants said they feel more comfortable2877talking to their family about falls because of this program.2878      71% felt more comfortable talking with their health care2879provider about falls.2880      83% report being more satisfied with life because of2881this program.2882      63% made safety modifications to their home because of2883the program.28842885    Beyond preventing falls, NYS YMCAs are fostering meaningful2886connections, encouraging lifelong habits of active living, and2887supporting whole-body health for older adults and this is only2888the beginning. Continued funding will sustain and expand this2889work, the full impact of which we are only just beginning to2890see, toward a vision where more Ys in the state and across the2891country can make a difference.2892    Our Y is also working to address one of the leading drivers2893of health care costs diabetes. One in four health care dollars2894goes to treat diabetes. If we prevent it, we also avoid serious2895and costly complications from the disease, including limb loss,2896blindness, and kidney disease. The good news is we know that we2897can prevent or delay 58% of diabetes in adults and 71% in older2898adults with modest weight loss through the National Diabetes2899Prevention Program.2900    The Y is recognized for its diabetes prevention work with2901the Centers for Medicare and Medicaid Innovation. During a2902national study, the YMCA s delivered the National Diabetes2903Prevention Program to 8,000 Medicare recipients and saved2904$2,650 per participant while preventing or delaying diabetes2905among the majority of recipients.2906    Our Y also offers evidence-based physical activity,2907nutrition and lifestyle health programs for people living with2908arthritis, cancer, hypertension, and childhood obesity. I would2909be happy to discuss any of these in more detail with the2910Committee.2911    The Y is deeply concerned about proposals that eliminate2912funding for chronic disease and injury prevention and control2913programs. We urge Congress to continue supporting funding for2914falls prevention among older adults and funding for evidence-2915based chronic disease prevention and control programs. Loss of2916these dollars will cut deeply into state health department2917funding and will eliminate support for most of the programs I2918have shared with you today.2919    Every dollar invested in community-based organizations like2920YMCAs organizations with trusted relationships and on-the-2921ground credibility have a myriad of important results but let2922me leave you with a story about Barb. Barb is a valued member2923of our YMCA community and lives alone. While she originally2924joined the Y for fitness, she quickly discovered that the Y is2925so much more than a gym. Barb now regularly takes part in our2926Healthy Aging programs, including Enhance Fitness, Tai Chi for2927Arthritis, and Silver Sneakers. Before class, she enjoys2928walking the track with the new friends she's made at the Y. In2929a recent conversation, Barb shared, "I feel supported and2930welcome at the Y. I'm getting stronger and have made so many2931new friends. The YMCA has truly changed my life. I look forward2932to coming every week."2933    At the Y, it's not just about physical wellness, it's also2934about building social connections and reducing loneliness. We2935re honored to have Barb, and others like her, as part of our2936community and are proud of the meaningful difference the YMCA2937continues to make in their lives.29382939                                [all]