[Senate Hearing 119-113]
[From the U.S. Government Publishing Office]
S. Hrg. 119-113
LESSONS FROM THE FIELD:
HOW SPORTS MEDICINE CAN IMPROVE
HEALTH OUTCOMES FOR SENIORS
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HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
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JUNE 25, 2025
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Serial No. 119-10
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
60-944 PDF WASHINGTON : 2025
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SPECIAL COMMITTEE ON AGING
RICK SCOTT, Florida, Chairman
DAVE McCORMICK, Pennsylvania KIRSTEN E. GILLIBRAND, New York
JIM JUSTICE, West Virginia ELIZABETH WARREN, Massachusetts
TOMMY TUBERVILLE, Alabama MARK KELLY, Arizona
RON JOHNSON, Wisconsin RAPHAEL WARNOCK, Georgia
ASHLEY MOODY, Florida ANDY KIM, New Jersey
JON HUSTED, Ohio ANGELA ALSOBROOKS, Maryland
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McKinley Lewis, Majority Staff Director
Claire Descamps, Minority Staff Director
C O N T E N T S
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Page
Opening Statement of Senator Rick Scott, Chairman................ 1
Opening Statement of Senator Kirsten E. Gillibrand, Ranking
Member......................................................... 2
PANEL OF WITNESSES
E. Lyle Cain, Jr., M.D., Orthopedic Surgeon, Team Physician,
Andrews Sports Medicine and Orthopaedic Center, University of
Alabama, Birmingham, Alabama................................... 3
Paul S. Legg, M.D., Orthopedic Surgeon and Team Physician,
University of Charleston, Charleston, West Virginia............ 6
Matt Hasselbeck, Former NFL Quarterback, Nashville, Tennessee.... 7
Jennifer Raymond, Chief Strategy Officer, AgeSpan, Lawrence,
Massachusetts.................................................. 9
APPENDIX
Prepared Witness Statements
E. Lyle Cain, Jr., M.D., Orthopedic Surgeon, Team Physician,
Andrews Sports Medicine and Orthopaedic Center, University of
Alabama, Birmingham, Alabama................................... 33
Paul S. Legg, M.D., Orthopedic Surgeon and Team Physician,
University of Charleston, Charleston, West Virginia............ 35
Matt Hasselbeck, Former NFL Quarterback, Nashville, Tennessee.... 38
Jennifer Raymond, Chief Strategy Officer, AgeSpan, Lawrence,
Massachusetts.................................................. 40
Questions for the Record
E. Lyle Cain, Jr., M.D., Orthopedic Surgeon, Team Physician,
Andrews Sports Medicine and Orthopaedic Center, University of
Alabama, Birmingham, Alabama................................... 45
Paul S. Legg, M.D., Orthopedic Surgeon and Team Physician,
University of Charleston, Charleston, West Virginia............ 47
Jennifer Raymond, Chief Strategy Officer, AgeSpan, Lawrence,
Massachusetts.................................................. 48
Statements for the Record
American Physical Therapy Association and the Academy of
Geriatric Physcal Therapy (APTA Geriatrics) Statement.......... 53
BPR Lab Statement................................................ 56
The Watertown YMCA Statement..................................... 58
LESSONS FROM THE FIELD:
HOW SPORTS MEDICINE CAN IMPROVE
HEALTH OUTCOMES FOR SENIORS
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Wednesday, June 25, 2025
U.S. Senate
Special Committee on Aging
Washington, DC.
The Committee met, pursuant to notice, at 3:30 p.m., Room
G50, Dirksen Senate Office Building, Hon. Rick Scott, Chairman
of the Committee, presiding.
Present: Senators Scott, McCormick, Justice, Tuberville,
Johnson, Moody, Husted, and Gillibrand.
OPENING STATEMENT OF SENATOR
RICK SCOTT, CHAIRMAN
Chairman Scott. Good afternoon. The Special Committee on
Aging will come to order.
As we have heard from expert witnesses in previous
hearings, staying active is one of the most effective ways for
older Americans to prevent disease, improve mental health, and
increase longevity.
Too often, Congress holds hearings on problems, listens to
solutions, and then never takes action to keep the conversation
going and put good ideas into practice. It sounds crazy, but
that is the norm in Washington, and I do not think any of our
good members of the Aging Committee want to keep following this
broken tradition.
I was excited to put this hearing together today, with the
Ranking Member, at the urging of my good friend, Alabama
Senator Tommy Tuberville, to ask an interesting question that
perhaps only a coach might come up with--how can we take the
lessons learned in sports medicine, and all the innovation that
goes into injury prevention and enhanced recovery for America's
elite athletes, and use that knowledge to improve the lives of
American seniors?
Senator Tuberville has spent his life on the football
field, and he has seen just how much sports medicine has
changed over the years, and how the innovations in this field
have helped keep athletes healthier and recover from injuries
faster.
The rest of us probably do not realize that some of the
most promising tools for healthy aging are already being used
on the sidelines of football fields, training rooms, and sports
clinics around the country.
Now it is up to us to use our jobs in the Senate to embrace
innovation, wherever it is found, and help break the cycle of
good ideas coming to Washington to sit on a shelf.
In today's hearing, we will explore how the science and
techniques developed for elite athletes can be applied to
enhance the lives of older Americans, enabling them to stay
stronger, recover more quickly, and maintain their independence
as they age.
Sports medicine, with its emphasis on preventing injuries
and promoting proper recovery, offers a new pathway to
longevity and health for America's aging population. As we
consider how to support our seniors, we must draw lessons from
the best in the field, literally. The goal is not for seniors
to become athletes, but for them to benefit from the same
principles: injury prevention, rehabilitation, strength
training, and recovery. These are tools for everyone, whether
you are playing under the Friday night lights or walking your
grandkids to school.
As many of you know, Florida has a vibrant senior
population and some of the best collegiate and professional
sports teams, and I am proud to support them.
Today, we will hear from medical experts with real-world
experience in treating both athletes and older Americans. We
will also hear from a former professional quarterback who knows
firsthand how sports medicine can help protect against aging
injuries and lead to a longer, healthier life.
Now I would like to recognize Ranking Member Gillibrand for
her opening statement.
OPENING STATEMENT OF SENATOR
KIRSTEN E. GILLIBRAND, RANKING MEMBER
Senator Gillibrand. Thank you, Chairman Scott, for today's
hearing. What an exciting topic that we get to talk about
today. It is great that we get to talk about innovative ways
that we can incorporate sports medicine into how we care for
our older adults, and I am particularly interested in how we
can increase physical activity and reduce falls for our
seniors.
A fall can change a senior's life. One fall can take away a
senior's ability to live independently. One fall can make an
older American afraid to leave the house, increase loneliness,
and social isolation. One fall can create a lot of other health
problems.
I remember when my grandmother broke her hip. It is a
common story. When you break your hip, it changes everything,
and you really are afraid of going out. You are afraid of being
active. You are afraid of doing all the things you used to do,
so we have to see what we can do.
I know, even as I age myself--I am 58--mobility is my
number one concern. I have to make sure I have ankle mobility,
knee mobility, flexibility, all those things. I know how
important it is for anyone who is aging.
Preventing a fall is more important now than ever. The CDC
just released a report this month showing that the death rates
from falls for seniors aged 65 to 74 rose more than 70 percent
in the last 20 years, but falls are not a normal part of aging.
The good news is many things can be done to prevent falls
and optimize physical wellness among older Americans. I look
forward to working with my colleagues to support and strengthen
programs that help prevent falls and increase physical activity
for older adults. This includes strengthening critical federal
funding for the programs, including the Older Americans Act,
and protecting agencies and entities that perform the work. I
am proud to support programs to increase funding for the Older
Americans Act programs, including leading the Fiscal Year 2026
appropriations letter for fall prevention programs. I am also
proud to support the bipartisan Older Americans Act
reauthorization that was reintroduced last week.
I look forward to hearing from our witnesses and figure out
how we can make sure people live healthy, active, and fall-free
lives.
Chairman Scott. Thank you, Ranking Member Gillibrand.
We are fortunate to have members of this Committee who have
real-world experience with sports medicine professionals and
coaching. With that I would like to recognize Senator
Tuberville to introduce our first witness.
Senator Tuberville. Thank you, Mr. Chairman. It is my
pleasure today to introduce Dr. Lyle Cain from Birmingham,
Alabama. Dr. Cain is the Cofounder of Andrews Sports Medicine
and Orthopedic Center, which he is an orthopeadic surgeon
focusing on sports-related injuries to the knee, shoulder, and
elbow. Dr. Cain is a graduate of the University of Alabama and
the University of Alabama School of Medicine. After graduation,
he served as chief resident at the University of Tennessee
Campbell Clinic in Memphis, before completing his fellowship
focusing on orthopeadic sports medicine with Dr. James Andrews
at the American Sports Medicine Institute.
He currently serves as the team physician for the
University of Alabama and is Medical Director for Jacksonville
State, Shelton State University, Tuskegee University, and the
University of West Alabama. He also serves as a consultant to
the Birmingham Barons and nine high schools in the Birmingham
area. Additionally, Dr. Cain leads an outreach program through
the University of West Alabama that provides medical services
to more than 40 schools in the West Alabama area, so thank you
today, Dr. Cain, for being here, and we look forward to hearing
from you.
STATEMENT OF E. LYLE CAIN, JR., M.D., ORTHOPEDIC
SURGEON, TEAM PHYSICIAN, ANDREWS SPORTS
MEDICINE AND ORTHOPAEDIC CENTER, UNIVERSITY
OF ALABAMA, BIRMINGHAM, ALABAMA
Dr. Cain. Thank you Chairman Scott, Ranking Member
Gillibrand, and members of the Committee for having me testify
today.
My name is Lyle Cain. I am the Managing Partner of the
Andrews Sports Medicine Group, as Senator Tuberville said. I
have been a team physician for several high schools, colleges,
and professional teams, including the University of Alabama
Crimson Tide, for over 25 years--Roll Tide. I firmly believe
that the lessons learned while providing care for athletes at
all ages, especially in the field of injury prevention and
management, can help improve the health span of our aging
population.
As you know, the combination of increased lifespan as well
as the demographics of the Baby Boomer generation have led to a
dramatic shift in the number of senior adults in the United
States, with nearly 20 percent of our population currently 65
years or older. This has tremendous consequences for our
healthcare system, both with increased utilization and
increased costs. A true team approach to the individual, using
the sports medicine system as a model, can help our senior
population maintain a better quality of life as they age.
What is a team physician? The American Orthopeadic Society
for Sports Medicine defines a team physician as someone who
provides comprehensive health services for the care of athletes
and active people at all ages. The team physician is ultimately
responsible for the health, safety, and performance of our
athletes. Our duties include injury prevention and risk
reduction, acute injury evaluation and management, both during
competition and training, chronic condition and illness
treatment, coordination of care between providers, and
performance optimization.
In sports medicine we also attempt to prevent injury by
encouraging rules changes and the development of protective
gear for each sport. We accomplish these duties through the
work of a larger team of providers, and as I will outline,
sports medicine is truly a team effort. The modern sports
medicine Team includes certified athletic trainers, who are
generally the primary point of contact for most athletes,
physical therapists, dietitians, primary care physicians,
orthopedic surgeons, psychologists, chiropractors, sports
performance specialists, certified strength and conditioning
coaches, and many others.
Our relationship with the athlete generally starts when we
do a pre-participation physical on the athlete to assess their
health and physical readiness to play. This is a crucial step
and allows the physician and trainer to identify issues that
may predispose the athlete to future injury. We do a health
history, do a thorough examination, and often perform
additional testing, such as cardiac testing with
echocardiogram, and we develop an individual risk profile for
each athlete.
In our aging population, the annual examination with your
primary care physician can provide this level of risk
assessment, but the reality is that issues that put the senior
adult at significant risk, such as balance loss, muscle loss,
cardiovascular fitness and endurance, and fall risk,
especially, are generally not evaluated at your annual exam.
Employing athletic trainers, physical therapists, and other
health care personnel to assess this risk could likely prevent
future falls and the associated health compromise in the older
population. In my own family's experience, my 90-year-old
father-in-law has seen tremendous results and better balance by
participating in a local fall prevention program provided by
physical therapists.
Why is fall prevention so important? Well, as you
mentioned, falls are the number one cause of injury-related
death in the older population. Up to 30 percent of adults that
break a hip end up dying during that first year after surgery,
and even the patients that survive past the first year never
regain independence, requiring expensive care from
rehabilitation or long-term care facilities. It is estimated
that falls alone add $50 billion annually to the U.S. health
care system costs.
The old orthopedic adage wisely states, "we are brought
into this world through the brim of the pelvis and often leave
through a fracture of the neck of the femur," and that
underscores the risk of mortality from hip fractures. Many of
these falls are preventable with risk assessment, regular
physical activity, resistance training, and fall prevention.
How do we implement this program? Well, it definitely takes
a team. The medical team should be empowered to treat this
aging patient as an individual with risk assessment, medical
optimization, fitness and performance improvement, just like we
treat our athletes. Primary care physicians are often the
gatekeepers for our older patients, so we have to train these
primary care physicians in musculoskeletal medicine. The
American Sports Medicine Institute, and many programs like it,
train primary care physicians in non-surgical care, but this
requires an extra year of post-graduate training. Physical
therapy visits are generally limited by insurance plans, and
many do not include fall prevention.
We need to continue NIH funding for this critical disease,
especially in my home State of Alabama at UAB. Just two weeks
ago, the American College of Sports Medicine Exercise is
Medicine program launched a program called the Active Aging
Initiative for Older Adults with a mission to integrate
physical activity by working into routine health care
examination and enhancing collaboration between health care
providers and exercise professionals.
In closing, we give our athletes the best care possible to
prevent injury and optimize performance. We should do the same
for our senior citizens. Thank you.
Chairman Scott. Thank you, Dr. Cain. Now I would like to
recognize Senator Justice to introduce our next witness.
Senator Justice. Thank you, Mr. Chairman, Ranking Member.
You know, I sit here and just think - just a second, but not
very often do I have this opportunity, you know, because Dr.
Cain, I cannot tell you the number of times I have been in the
Andrews Institute, and I am sure you know that.
Dr. Cain. Yes, sir.
Senator Justice. Dr. Legg and I are long-lost friends and
everything. Coach Hasselbeck, you know, I have watched you
forever, and you are a coach, and I love it in every way, and
that only leaves Jennifer, the only one that I am not really in
contact with. Jennifer, thank you so much for all you do in
your wonderful State of Massachusetts and everything. I have
got Coach sitting right here beside me, and he is probably
wondering, what in the world is he going to say? Here is what I
would say, and this is all there is to it.
My job right now is to introduce a man that absolutely is a
superstar in our state. Dr. Paul Legg, you know, believe it or
not, we graduated from the same high school. He was probably
higher in his class than I was, but nevertheless, a great,
great, great man, an incredible physician. The people of our
state depend on this man like you cannot imagine, and
especially, I am sure, the elderly, but many, many, many in our
state have visited and been recipients of his unbelievable
care.
You know, Doc, you know me, and you know me really well. We
had so many interactions with COVID. For eight years I was the
Governor, and through COVID and all that, there were a lot of,
lot of, lot of, lot of situations to where this man rose to the
level of a superstar in my eyes in every way.
There is no way I could be prouder than to introduce him
today, a West Virginia University graduate, an absolute
graduate of the same high school that I went to, Woodrow Wilson
High School, and absolutely a superstar in our state. Dr. Legg,
take over and take it from here, sir.
STATEMENT OF PAUL S. LEGG, M.D., ORTHOPEDIC
SURGEON AND TEAM PHYSICIAN, UNIVERSITY OF
CHARLESTON, CHARLESTON, WEST VIRGINIA
Dr. Legg. Chairman Scott, Ranking Member Gillibrand, and
honorable members of the Committee, my name is Dr. Paul Legg,
and I want to thank you for the opportunity to offer testimony
to the Special Committee on Aging.
Thank you, Senator Justice, for the introduction, and go
Flying Eagles. I would also like to thank my wife of 34 years,
Lee, for her support of me and my career. My daughter, son-in-
law, and granddaughter are here today, and my son and daughter-
in-law are watching from South Carolina. I am grateful for
their support, as well.
I would also like to state for the record the opinions
expressed today are my own and do not reflect the view or
position of my employer, Charleston Area Medical Center and
Vandalia Health.
I am a practicing orthopeadic surgeon in Charleston, West
Virginia, having spent 27 years in private group practice and
the past two years as a hospital-employed surgeon for Vandalia
Health. I am board certified by the American Board of
Orthopeadic Surgery, with a Certificate of Added Qualifications
in Sports Medicine. For over 20 years I have also been the team
physician for the University of Charleston, an NCAA Division II
school with approximately 620 athletes.
Sports medicine encompasses the prevention and care of
musculoskeletal injuries and medical conditions encountered in
sports. The lessons from the field, operating room, and
research are applicable to maintain physical function and
performance in competitive athletes of any age. The health
outcomes of seniors improve by keeping them healthy, active,
and injury-free as they age. Surgical techniques designed to
return competitive athletes to the field of play can also
benefit seniors with similar injuries.
However, surgical techniques are only a small part of
sports medicine's influence on senior health. The manner in
which our athletes train and prepare offer many more lessons on
improving the health outcomes of seniors.
According to the 2022 report by National Health Statistics,
only 13.9 percent of adults aged 65 or older meet federal
activity guidelines. The environmental factors related to low
physical activity are many: cars, mobile devices, sedentary
jobs, elevators, computers. Since very few people get adequate
exercise at work or throughout their days, exercise needs to be
added as a purposeful activity. Fitness is partly genetic and
measured by how far you go on an exercise test. Physical
activity is behavioral and requires motivation and commitment.
Increasing your physical activity will increase your fitness.
For example, walking is a low-intensity exercise and an
appropriate start for most seniors.
Poor physical activity and nutrition top the list of the
most common health issues encountered by seniors. As we age,
our fitness declines. However, exercise can prevent this
decline in many patients. Strength training is one of the
activities that can improve health outcomes for seniors. The
established benefits of regular strength exercise include
strength and endurance, increased muscle mass, increased
resting metabolic rate, and preventing disability.
Both research and experience indicate that resistance
training is safe for healthy older adults, for frail older
adults, and individuals with disease. Muscle disuse is a
preventable and reversible factor. Resistance training has
consistently show as a feasible and effective means of
counteracting muscle weakness and physical frailty. It improves
bone density, improves metabolic health, insulin sensitivity,
as well as improving psychological well-being and reducing the
risk for falls and fractures in older adults.
What behaviors can we encourage senior adults to help start
and maintain exercise programs? The first step is making a
commitment to increase physical activity. They have to
establish protected time to forgo other activities that may
encroach on this scheduled time. Set small and realizable goals
for exercise but also think about and establish long-term
fitness goals. These barriers must also be addressed, which
includes lack of understanding, lack of awareness, and
unfortunately, lack of motivation.
As I have seen in almost 30 years of clinical experience,
health outcomes in seniors can be improved with the lessons we
learn from sports medicine and sports science. It is the
planned and purposeful exercise and strength training used in
preparation for competitive athletic events that provide a
structure for exercise in senior adults. Advanced training
techniques can also move senior adults from just physical
activity into increasing levels of fitness.
Thank you, Mr. Chairman. I look forward to answering your
questions.
Chairman Scott. Thank you, Dr. Legg. Thanks for being here.
Now I would like to introduce our next witness, Matt
Hasselbeck. Mr. Hasselbeck is a former NFL quarterback who
spent 18 seasons in the league, including leading the Seattle
Seahawks to a Super Bowl appearance in 2006. After retiring
from professional football, he became a well-respected analyst
with ESPN, where he was watched by millions of football fans
during Sunday NFL Countdown and Monday Night Countdown. He has
also been a vocal advocate for health recovery and smart
training, both on and off the field. He brings a unique
perspective on how the principles of elite athletic performance
could help everyday Americans stay active and healthy as they
age. Thanks for being here. I look forward to your testimony.
STATEMENT OF MATT HASSELBECK, FORMER NFL
QUARTERBACK, NASHVILLE, TENNESSEE
Mr. Hasselbeck. Thank you so much for the kind intro. My
name is Matt Hasselbeck, and I am here to share my insights on
the significant role sports medicine has played throughout my
athletic career and its ongoing influence in my life.
I played quarterback for five years at Boston College
followed by a lengthy NFL career. The NFL, if you do not know,
is commonly referred to by players and coaches as "Not For
Long." With the help of great sports medicine teams I was
fortunate to play for 18 years with the Green Bay Packers, the
Seattle Seahawks, the Tennessee Titans, and Indianapolis Colts.
I grew up as the son of a football player. After an All-
American career at the University of Colorado, my dad played
tight end in the NFL for nine seasons. He played primarily with
the New England Patriots, but also with the Minnesota Vikings,
the New York Giants, and the Los Angeles Raiders, where he and
his teammates won Super Bowl XVIII. My brothers and I all
earned full scholarships to play college football, and my
brother, Tim, followed me as a longtime quarterback in the NFL.
Most of our wives were prominent Division one athletes as well,
and my wife was no doubt a better athlete in college than I
was.
In the decade since my NFL career ended, I have primarily
worked in the sports media space. After spending eight years at
ESPN on shows like Sunday NFL Countdown, Monday Night
Countdown, and SportsCenter, I now work as an NFL analyst for
Fox Sports on the Colin Cowherd Show. I have also been serving
as a high school football coach for the past four years. After
winning a state championship in Massachusetts coaching my son,
last year we moved to Tennessee so I could coach on a staff
with my father and brother, where we coached two of my
quarterback nephews, Taylor and Isaiah. Taylor is currently
committed to play college football at the University of
Wyoming.
Raising our own three kids and supporting their athletic
journeys has been the other major career for my wife and me.
Our two daughters are national champion lacrosse players from
Boston College. The younger one is preparing for a fifth year
after four knee surgeries earned her a medical red shirt. Our
son is a redshirt freshman quarterback at UCLA and is battling
for his own opportunity, much like I did at his age.
During my 23 years of college and professional football, I
only had one surgery. This is unheard of. I attribute this to
many factors, one of which is the help of skilled athletic
trainers and sports medicine teams. Many of my teammates took a
"react and survive" approach to their health, while a
"proactive and thrive" approach is a mindset that helped me. I
attribute this mindset to the advice, care, and expertise of
the athletic training staff of my teams. Not only did they help
me prevent injuries, but they also contributed to helping me
heal faster and return to play.
Staying healthy is priority number one for an NFL
quarterback. Injury prevention, recovery, and prioritizing
wellness were equally important to me as throwing touchdown
passes. My coaches would often tell us, "Your greatest ability
is your availability."
Both during and after my NFL career, I have been dedicated
to making the game safer for future generations. I actively
participated in the NFLPA's Mackey-White Health and Safety
Committee and proudly served as a Vice-President of the NFLPA's
Executive Committee for six years. Our work successfully
fostered a significant culture change regarding brain injuries
and return-to-play protocols in football. In commitment to this
cause, upon my death I have pledged my brain to science through
the Concussion Legacy Foundation. I currently serve as the
Ambassador for the DiagnoseCTE.org study for men over 50, which
aims to develop a method to diagnose and differentiate brain
trauma while patients are still alive.
In this new empty-nester era of our lives, my wife and I
have experienced the challenges of caring for our aging
grandparents and parents. We have leaned on the lessons learned
through athletics to help replicate the best outcomes for them
as they get older. For example, helping my mom set goals for
the activities she hopes to participate in with her grandkids
when she is older means that we have to start prepping for that
now, much like you would do as an athlete. My mom would love to
be able to play pickleball and ride bikes with her grandkids
when she is 75. Sometimes it is not that simple.
Following a painful knee replacement surgery, my dad was
waiting to get healthy enough for the next knee replacement
surgery, when he tragically suffered a cardiac event this
April, which he did not survive. This heartbreaking event has
left my mom a widow after 50 years of marriage, and she now
faces new challenges, some of which are loneliness and
isolation, that she must overcome.
Sadly, as a family, we are also dealing with the
significant challenge of my mother-in-law's Alzheimer's
disease. This illness has placed immense hardship on our
family, particularly affecting my father-in-law, who sacrificed
his profession to become her full-time caretaker.
In conclusion, that is a glimpse into who I am, and I am
truly honored to be here today. The last time I visited this
building was during my eighth-grade class trip, and I had a
great time, and I hope that I will get to come back again.
Thanks for the invite.
Chairman Scott. Thanks for being here, and sorry to hear
about your dad. Whenever your parents pass away you wake up and
think, oh, I have got to call one of them, and then you cannot
call them.
Now I would like to recognize Ranking Member Gillibrand to
introduce our last witness.
Senator Gillibrand. Thank you, Chairman Scott. I want to
introduce our final witness, Jennifer Raymond. Ms. Raymond
serves as the Chief Strategy Officer at AgeSpan, an Area Agency
on Aging in Lawrence, Massachusetts. Through her position as
Chief Strategy Officer, Ms. Raymond oversees AgeSpan's
evidence-based program, including its falls prevention efforts.
Additionally, she holds a Juris Doctorate and has been
recognized by the John A. Hartford Foundation as a National
Practice Change Leader.
Thank you for being here. You can begin your testimony.
STATEMENT OF JENNIFER RAYMOND, CHIEF STRATEGY
OFFICER, AGESPAN, LAWRENCE, MASSACHUSETTS
Ms. Raymond. Chairman Scott, Ranking Member Gillibrand, and
members of the Committee, thank you for the opportunity to come
and speak with you today. My name is Jennifer Raymond, and I am
honored to serve as the Chief Strategy Officer for AgeSpan, an
Area Agency on Aging located in Lawrence, Massachusetts. We are
one of 614 AAAs across the country, helping older adults remain
independent in their homes.
On behalf of these agencies, as well as the older adults
and the family caregivers they serve, I want to first thank you
for your ongoing efforts to meet the needs of our aging
population through the Older Americans Act, and thank you for
your attention on the importance of physical wellness for older
adults.
The consequences of physical inactivity among older adults
are catastrophic. They include a decline in overall function,
increased risk for chronic diseases, increased frailty, and a
heightened risk for depression and cognitive decline. Yet
despite these consequences, more than one in four older adults
are physically inactive. The reasons for inactivity are many
and varied: a fear of injury, lack of confidence in their
ability to exercise safely, and even a lack of motivation to
begin exercise.
Throughout this country, Area Agencies on Aging and their
partners offer effective physical activity programs that both
promote exercise and help individuals overcome those
motivational and behavioral barriers that contribute to
inactivity. For example, there is May C. from Quincy, who was
able to safely abandon her walker after improving her balance
through an evidence-based program called A Matter of Balance,
and Maria A, who, despite her frailty, now participates in
virtual physical activity classes, from the comfort of her own
home, thanks to AAA's digital access program.
One of the most important benefits of increased physical
activity for older adults relates to the prevention of falls.
Falls can be detrimental in a senior's life. They can result in
hip fractures, head trauma, other serious injury, and even
death. They often reduce mobility, take away a senior's ability
to live independently, and can make people afraid to leave
their home, increasing loneliness and isolation.
Every year in this country, more than 14 million Americans
65 or older, that is one in four, suffers a fall. In 2021,
emergency room departments reported three million visits due to
older adult falls. The total health care costs for these falls
are over $80 billion per year. Of these costs, 67 percent is
paid for by Medicare, four percent by Medicaid, and 29 percent
by older adults and their families.
Today, many Area Agencies on Aging partner with family
health centers, primary care providers, and managed care to
reduce falls risks. First, our health care partners screen and
identify older adults who are at risk for falls. Then they
refer these individuals to networks of AAAs for falls
intervention. This intervention might include a physical
activity program, it might include assistance with home
modifications to address home hazards, and even the provision
of medically tailored meals to make people more able and ready
for physical activity. These referrals from our health care
partners allow us to take a more holistic approach to
addressing the needs of the individual and create a shared care
plan to improve outcomes.
There is much we can do to support older adults in their
desire to age in place, stay physically active, and avoid
falls. To further these goals, we must:
Support robust funding for community-based physical
activity and falls prevention through the Older Americans Act,
specifically Titles IIID Evidence-Based Health Promotion and
Disease Prevention and Title IIIB Supportive Services.
Educate health care providers about fall prevention through
tools like the STEADI program, which assists providers in
integrating falls prevention into their clinical practices.
Encourage prescription for physical activity and falls
prevention by health care providers and allowing for
appropriate reimbursement for effective interventions offered
in the community.
Continue investment in research related to physical
activity and falls prevention for all older adults, including
those with physical frailty, those with disability, and those
with cognitive decline.
If we are serious about a healthy America, we cannot ignore
the impact of physical inactivity and falls among older adults.
Area Agencies on Aging stand ready to partner with health care,
older adults, and family caregivers to address this challenge.
Investments today will not only allow older adults to thrive
independently but will also help stem the costs for our health
care system for years to come.
Thank you again for the opportunity to speak with you today
and for your support on this important issue. I look forward to
your questions and working together to support our country's
older adults.
Chairman Scott. Thank you, Ms. Raymond. Thanks for what you
do.
Now we will start with questions, and Senator Justice, if
you want to start.
Senator Justice. Well, I could start with any of you, but I
really am really always intrigued by just this. You know, Dr.
Cain, you, at the Jimmy Andrews Institute, you probably have
many, many, many stories to tell, and with all that being said,
I would like you to just elaborate, if you could, just on this.
Over the years, you especially have seen so much progress being
made toward our seniors, and what can be done.
Just elaborate, in your words, your experiences with Jimmy
Andrews I know are just limitless. Absolutely, in my opinion,
Jimmy is a terrific friend, been a friend forever and a day, so
please tell us more.
Dr. Cain. Thank you, Senator Justice. Dr. Andrews has been
a great mentor to me, and you know, Dr. Andrews retired two
years ago and is now kind of in a stage where he is trying to
take care of his health more than he used to instead of working
so hard.
You have a great point. We have had great advances in
sports medicine, taking care of teams, and medicine, in
general, over the past 30 years. The reality is I think in
medical care of our older patients most of our time is spent
dealing with complications on the back end. There is very
little time spent on preventative care. If you take the typical
primary care physicians that see an older patient, internal
medicine, family practice, or another physician, they spend
most of their time dealing with heart disease, high blood
pressure, and other things that are already, kind of the cat is
out of the bag and they are just trying to manage.
I think the way we get on top of this and the way we treat
this better is we treat our older patients just like we treat
our younger athletes. We try to work on preventative programs,
things like Ms. Raymond is doing, and we spend more time with
our office visits talking about how to prevent disease than how
to treat diseases the patients already have.
Senator Justice. Well, I know you are doing unbelievable
work, and, you know, I can tell you the many visits that I have
had there have ended up, in some way, somehow patched me
together, and I have made it this far anyway.
Matt, I have got to ask you just this. You know, not to not
ask Dr. Legg wonderful questions, but Dr. Legg and I have been
around many, many, many times, on many, many different things.
Matt, I watched you play. You were a superstar. You have
absolutely a family of thoroughbreds like you cannot imagine.
Through all of that you have a message to pass on to all of us,
and all the different things that you know that we could do
better at. You took care of yourself. You took care of yourself
in a really proactive way, and you are exactly right. NFL
athletes do not usually stay there long, and you stayed there
forever and a day, and made a contribution every single time
you went on the field, but tell us more. Tell us more about
really what we should be doing. I listened intently to all the
different folks in your family and all their incredible
accomplishments. Now I want to hear from Matt. Matt, what do
you think we really need to be doing?
Mr. Hasselbeck. Well, thank you for your question. I mean,
I really agree with what both doctors said about being
proactive. Stability work, falling. You know, in football,
running backs do not want to fall, because you are down, so you
practice balance all the time. You practice with your eyes
open. You practice with your eyes closed. That is something
that I would do as a quarterback. It is something I would do
with my mom, and she would do with her mom.
I think these are lessons, you know, using some of the
injuries that are common for quarterbacks, a high ankle sprain
is an injury that you have. We would do what we call pre-hab.
It is preventative rehab. We would do the rehab as if we had an
ankle sprain, a high ankle sprain, before we even had the
injury. Or even coming back from my one surgery, which I had
down in Alabama, which was not convenient, living in Seattle,
but it was great, and it was successful.
One of the things that we did with the athletic trainers,
we practiced falling. You know, I went from being in a sling
for many, many weeks to, I had to somehow get from the sling to
back on the football field, getting tackled by guys like
Michael Strahan, and what are we doing in the meantime to get
there? Practicing falling was really a great return-to-play
protocol that helped me coming back from surgery, when I felt
frail, when I felt afraid to fall. Doing it in a controlled
environment is one of the things that gave me confidence, gave
me athleticism, and got me back to feeling like I could go
protect myself in the arena of athletics.
Senator Justice. Thank you, sir. I practice falling right
now, but it is really not on purpose. Anyway, thank you so
much, sir.
Chairman Scott. Senator Gillibrand.
Senator Gillibrand. Thank you, Mr. Chairman. Jennifer
Raymond, the importance of federal funding for programs that
support older adults, you have discussed how AgeSpan provides
critical services for older adults in Massachusetts. Those
services include physical activity and fall prevention
programs. AgeSpan and other Area Agencies on Aging provide
those services through a partnership with the Federal
Government. The services are locally run and tailored to
individual communities, and the Federal Government helps with
funding, research, and technical expertise.
Can you give some examples of AgeSpan programs that have
received federal support and how those programs have helped
older adults? Can you talk about what will happen to these
programs if their federal support disappears?
Ms. Raymond. Thank you. You know, I think that it has been
over 50 years that Area Agencies on Aging and the people that
we serve have benefited from a really good partnership with the
Federal Government through the Older Americans Act. Through
Title IIID we have those evidence-based programs like A Matter
of Balance, Enhanced Fitness, all of those things that allow us
to provide programs to increase physical activity and reduce
falls in a safe and effective way, and programs that have
demonstrated some efficacy.
In addition to that, the Older Americans Act, through Title
IIIB, has allowed us to provide a wide range of support
services. At my agency alone, we serve 28 cities and towns, and
we receive over 25,000 calls every year to our offices for
information and referrals. These are not people who have a case
manager. These are not people that we are serving, but these
are people who are wondering how they get services, who are
wondering how they get help in applying for Medicare, those
kinds of things. That information and referral support work is
funded through the Title IIIB of the Older Americans Act.
In addition to that, I do not think we have to talk much
about the Meals on Wheels program, but home-delivered meals,
medically tailored meals, this year we provided over a million
meals to older adults who were frail and in home and otherwise
unable to receive nutrition and food services.
Even beyond the Older Americans Act, we have benefited, and
many community-based organizations have benefited, from pilot
funding from the Administration on For Community Living, or
from CDC, in order to implement these evidence-based programs
in way that can be effective and improve health outcomes, but
at the same time look at how they save dollars.
There is a wide range of ways that we continue to thrive
under the support from the Federal Government.
Senator Gillibrand. Thank you, Jennifer. Dr. Cain and Dr.
Legg, can you talk a little bit about what happens to older
adults after they fall, and can you talk about the importance
of patient education on reducing falls?
Dr. Cain. Thank you, Senator. I think, you know, once a
patient falls there are kind of two outcomes. One outcome is
they break something, they end up in the hospital, and they are
probably never the same, honestly. The other outcomes are that
they get lucky, they get scratched up, they go to the hospital,
get checked out, and they go home, but very rarely do we do any
fall prevention with those patients, even the ones that have
fallen, and we have our own families that we know that have
fallen, our grandparents or our parents, and you kind of count
your blessings that they made it and that they did not hurt
anything, but very rarely do fall prevention programs become
part of the treatment algorithm.
I think for us, as physicians, backing up a second and
saying, hey, we are taking care of all these diseases and all
these problems that are caused by balance and fall issues. Why
not prevent those? I really like the program that Ms. Raymond
is talking about. I think having the primary care physicians as
the point person to encourage that is really important.
Senator Gillibrand. Yes. Dr. Legg?
Dr. Legg. When we talk about falls we tend to worry about
people who break their hips, and that is a very serious injury
and it creates fear afterwards, but also I see many patients
who break a shoulder or proximal humerus or a wrist, which is
sometimes just as devastating, because they are immobilized
which really throws off their balance and puts them at much
higher risk for additional injury. Preventative programs are
essential.
We also have to look at how we can improve the thing that
makes them at high risk for fractures, and that is bone
density, and how do we improve that, how do we test for that. A
lot of it, again, is encouraging the patient to get the testing
done, and then encouraging them to be consistent and compliant
with the medications that help, because they do help and they
do reduce the risk of fractures.
Once they have a fall, sometimes it is motivating them to
overcome the fear that they have to be active again. Many of
them often become scared and afraid of exercising, afraid of
movement, which puts them at even higher risk for medical
problems.
Senator Gillibrand. Thank you. Thank you, Mr. Chairman.
Chairman Scott. Coach Tuberville.
Senator Tuberville. Thank you, Mr. Chairman. Thanks for
being here today. In 35 years of coaching, I saw a lot of
injuries. I think that there is tremendous improvement in
surgeries over the years, obviously the arthroscopic surgery.
Instead of slicing a knee open we do it a lot easier and a lot
quicker back on the field.
Dr. Lee and Dr. Cain, talking about one other thing that is
really improved and how much we need to continue to educate
people and hopefully get more people in this profession is
physical therapy. My players, I would always tell them that the
surgery is what is easy. Therapy is the hard part, just getting
back on the field.
Dr. Legg, you first.
Dr. Legg. Physical therapists are essential to what we do
in sports medicine, and they are also essential to
rehabilitating our seniors who have any injury or surgery. I
use the physical therapists very often, now in joint
replacement surgery. As I have become older, my patients have
aged with me, and people who had arthroscopic procedures done
years ago, I am now replacing their knees and their shoulders,
and the physical therapists are the ones who really get them
back to movement and strength and activity, because a knee
replacement or a shoulder replacement is a painful operation,
and the physical therapists teach them what to do, but they
also encourage them to do it, and sometimes that is the hardest
thing.
They are invaluable. My son played college football, and
need the physical therapist on several occasions to keep him in
the game. We need physical therapists and they are invaluable
in treating the patient.
Dr. Cain. Thank you, Coach. As you know, the other part of
that equation that is really important is athletic trainers.
Certified athletic trainers are kind of the point person. Matt
Hasselbeck mentioned it in his talk, that they are the ones
that kept him from getting hurt, and I think the combination of
an athletic trainer and a physical therapist are really
critical in the team model, and really not only for injury
prevention, treatment of injuries, rehab after surgery. They
are the ones that do the grunt work.
You know, we, as the physicians, we may see the player for
injury evaluation and surgery, but these are the people that
are with them every day. I think that is really the model you
need for the older population is you need those providers, ATCs
and physical therapists, in the system and keyed in to where
they help the older patient follow through with those demands,
to make sure they are doing their exercises, to make sure they
are doing them correctly, and to treat them just like we treat
an athlete.
You know, the athletes are in the training room every day,
all day. Obviously, we do not have that ability as we age to be
in the training room all day, but you need someone that keeps
up with the person longitudinally and makes sure that they
understand what they are supposed to do. We have a shortage of
both. Our critical shortage is in athletic trainers. They have
to get a master's degree now to graduate and to be certified,
and there are just not that many kids going into it now. We
have a critical shortage of trainers. We do not have enough
physical therapists, and physical therapy visits are not
covered very well by insurance, so it is a big problem for
seniors trying to get treatment.
Senator Tuberville. Thank you. Matt, if you and Ms. Raymond
would answer this question. Another improvement I have seen
over the years, obviously, and this is as much for adults our
age as anybody, nutrition and supplements. It has been a huge
improvement.
Matt, your thoughts on supplements? I know you have taken
many over the years, and try to eat right also, right?
Mr. Hasselbeck. Yes, I think we could improve the cafeteria
here, from what I saw today, by the way.
I would just like to also add, I think that when you get
hurt it is very depressing. You know, it is embarrassing. You
feel isolated and it is depressing, and the athletic trainers
are just a confidence giver to you, and a daily sort of like a
pep-in-your-step person in your life, so it is very important,
and they advise you also on the best way to recover. Hey, you
can't do this right now, but what can you do? Well, we can make
better choices with our nutrition, or maybe it is protein. I
know for athletes, protein is a very, very important thing. I
know for older people, protein is a really important thing.
I cannot speak enough. I think about the best friends that
I had on my football teams. A lot of times it was a teammate,
but usually there was an athletic trainer in there, as well,
because that was literally the person that every single day. To
hear that there is a shortage, and there are a lot of people
that get into athletic training because they were athletes as
high school kids, and they love sports, but genetically they
cannot play professionally, but you can still get a Super Bowl
ring as an athletic trainer, if maybe there is a pathway to
study that in college, and if we invest in that, I would be all
for that. It meant a lot to me.
Senator Tuberville. Ms. Raymond?
Ms. Raymond. When you all are talking about the athletic
trainers and the role that the athletic trainers play as part
of the larger team, I think of the equivalent in our community-
based organizations, those case managers, the community health
workers who are working with the older adults every day and
saying, "Yes, I know you are frustrated that you are not able
to play pickleball the way that you did last year because of
your hip injury. Let's talk about walking. Let's talk about
doing some chair exercises that will get that mobility going.
By the way, we will also sort of talk about medically tailored
meals that we can bring in that will add to your ability to be
able to feel well enough to do that activity."
I think that team approach is one of the key ways that we,
on the social care side, also think of as really strongly to be
able to support older adults in their physical activity.
Senator Tuberville. Thank you.
Chairman Scott. Senator Husted.
Senator Husted. Thank you, Mr. Chairman. Thanks to all of
you for being here today. My wife is a physical therapist,
Coach, so I know exactly how valuable they can be. Because what
I have witnessed as a former athlete and a coach and also with
a wife who was a marathon runner into her 40's and is a
physical therapist is that things build on one another, how an
injury or a sore knee, you do not walk anymore. You maybe do
not walk as much. You start to eat a little bit more. You start
to put on a little weight. These things can really begin to
compound on you, just like healthy habits can, as well.
I ask any of you who would want to respond to this, how do
we reach people with this message? What are the most effective
ways that you have found to help people understand that, hey--
and at what age does somebody really have to start paying more
close attention to the issues that will compound and then
affect them and make it very difficult for them as they get
older? I welcome all of you to comment or give your thoughts on
that, how you reach people, what do we all look at here.
Dr. Cain. I will start. I think there are some simple
educational materials, simple public service announcement type
things. I am 57. I think when you are in your mid 50's you
probably need to start thinking about this. It is not 65.
Because you are starting to lose balance. You are starting to
have, you know, your body changes physically, as we all know,
as we get older. Not only can you not see very well but your
joints do not move as well, and you get other problems.
Senator Husted. The effects of gravity do, for some reason,
get a lot worse as you get older, right?
Dr. Cain. No doubt. I think if you give it just some simple
stats. I mean, there is a state that is pretty well documented
that a simple physical education treatment program--so doing
balance training, fall prevention, and not falling--probably
adds 10 years to your life, compared to not being physically
active.
If you have a simple public service announcement that says,
"Hey, if you are physically active at this level, you are going
to add 10 years to your life," think about all the people
taking all these supplements and doing all these longevity
courses and all these things to try to live longer. That is the
simplest method to live longer. I think we just have to educate
people.
Dr. Legg. This becomes important very early, Senator. We
know, through studies, that something we call sarcopenia, or
loss of muscle mass, starts between age 35 and 40, and it goes
five percent a year, so we really need to start earlier.
We also know that through some of the test which are older
tests, in the 1970's, Dr. Robert Bruce, that what we call VO2
max, okay, for the most important muscle, the heart, and how we
develop energy through our muscles, that starts to decline
also, and the good thing is that decline can be improved and
reversed until about age 70, and then it is very difficult
after that to reverse much of the aging process to the heart.
Inactivity is bad, but we also know that someone who is
very sedentary, the people who make those first steps into
activity gets the greatest benefit from being active. Now, the
steps become a little more incremental as you go up, but it is
just that first movement from sedentary to any kind of
activity.
When I have sometimes students or residents I tell them
that you have to listen to your senior patients, but you also
have to be a motivational speaker. You have got some answers
for them. You have just got to convince them that they need to
do it.
Mr. Hasselbeck. Can I just add quick? We use this phrase
all the time--sitting is the new smoking. We sit so much. Even
as a professional athlete you sit all day in meetings, practice
for two hours. Getting up, and VO2 max training is very
important, but Zone two training, power walking, a brisk walk,
is very important, I think, for someone in their 30's, 40's,
50's. Having that foundational piece is super important, and
doing that in groups, messaging, but also as friends, make that
normal.
Right now sitting all day is normal. Make power walking
normal. That is the advice I would give my friends.
Ms. Raymond. I agree with much of what is said now. It is
very exciting for us when we are able to take a more upstream
approach, when we are able to reach people before they have
diabetes or before they have COPD and be able to work with them
on the kinds of behaviors that will prevent that. It is very
exciting when we get to work with family caregivers and the
older adults and see the family caregiver say, "Gosh, I'm 40,
I'm 50. Now is the time for me to start this physical activity
so I can be more independent as I age."
At the same time, we are coming across folks who are in
their 70's, in their 80's, and even in their 90's, that are
looking for ways to be physically active. They have chronic
pain, so they worry that physical activity is going to
exacerbate that.
We are able to have those community health workers and case
managers sit with an older adult, who thinks they cannot
exercise, and talk to them about what is important to them, not
what is the matter with them but what matters to them.
I remember an individual named George with diabetes, COPD,
chronic pain, did not feel like he could do anything. His case
manager talked to him and said, "Well, what is important to
you?" He said, "I want to play with my grandchildren. I want to
be able to have that relationship with them that I had with my
grandparents, and I can't do that now." That was the trigger to
say, "Well, let's start with this walking class. Let's start
with brisk walking. Let's move on from something there."
Even though our goal is to reach people on the upstream,
there are still many powerful ways for us to encourage and
support traditional older adults who want to be physically
active.
Senator Husted. Thank you. Thank you, Mr. Chairman.
Senator Johnson. Thank you. I apologize for not being here
earlier. We have crazy schedules. I have taken over for Senator
Scott as Chair.
First of all, I think it is an interesting hearing. Being
elderly myself nowadays, I do not really--mentally I am not
elderly, but I certainly feel it in my body.
Dr. Cain, can you just talk a little bit about the
importance of protein? That is one thing I am hearing more and
more about, and it is actually very difficult to eat as much
protein as we see recommended. Can you just kind of address
that issue?
Dr. Cain. Sure. Thank you, Senator. I think protein has
become kind of the most critical element we know in nutrition
to keep you healthy. We have found over years that super-high
protein diets are actually very good for you, and the more
protein you eat, from a relative standpoint, the higher your
muscle mass, the higher your health, the more energy you have,
and a lot of senior adults have a very poor appetite, and they
do not get much protein. Things like protein supplements,
protein shakes, I encourage my patients all the time.
There are studies recently about creatine. Just a little
powder of creatine, five grams of creatine, a small scoop a day
can increase your longevity.
I think protein is really critical. It is hard to get it by
eating just steak or fish or meat, so I think you almost have
to have a supplement to get enough protein.
Senator Johnson. I do kid my wife because she does all the
health research in our family, and she is buying different
supplements all the time. It is like, you do not even need
really need to eat a meal. You have got more than enough right
there. Talk about it, maybe Dr. Legg. Talk a little bit about
nutrition versus the supplements, and is it equivalent? I mean,
can you do it through supplementation? Just kind of talk about
that balance. Part of our problem is you read different things
from different people, and you are not quite sure what is the
truth.
Dr. Legg. The difficulty with many supplements is that
supplements really are not under the oversight of the FDA. They
are tested in the same way as drugs are tested. We know that
many supplements have a lot of testing. Dr. Cain mentioned
creatine. It is kind of the "it" supplement at this time. It
seems to be one very safe and also a very good supplement to
help increase muscle mass. We also know that now it may help
bones, and then if you take it long enough it may help our
brains also.
Now, what I like to encourage people, as far as nutrition,
is to be as unprocessed as possible. It is difficult these
days, but food that is unprocessed I think is the best. I think
that supplements are needed for the areas of deficiency. Yes,
protein is something that everyone needs.
Now, testing can be done if you have certain areas that
maybe you need vitamin D, maybe you need vitamin C. Those are
very important. We know the heart benefits of omega fatty
acids. Those are also very good supplements for people to take.
It is just really finding, based on your diet and your
activity, what you may need, and you can coordinate that with
your family physician, but there is a lot of information out
there, and again, I encourage my patients to try to be as non-
processed as possible with their nutrition and then supplement
in areas where they may be missing.
Senator Johnson. Okay. Secretary Kennedy, I think, is
actually looking at that in terms of the MAHA movement, and
people like Dr. Casey Means has had the same message.
You mentioned those supplements do not have the same
rigorous standards for testing. Are there testing labs? I mean,
when you are looking for a supplement is there something that
can guide you, that you can be reasonably assured that this is
coming from a quality lab, not some cheap import that might
have questionable ingredients? Again, I think that is a serious
concern.
Dr. Legg. It is, and I tend to have people get supplements
from what I call reputable sources. I tell them to buy at a--I
hate to say it this way--a notable chain, maybe grocery store,
or nutrition store. I tell them to be sometimes wary of where
they buy it online.
There are certifying agencies for nutritional supplements,
and they do give really a third-party look at what is safe and
even sometimes what can be effective. I tell them to use
reliable sources of where they buy their supplements.
Senator Johnson. Okay. Well, Mr. Hasselbeck, not to make
this too personal, but before I did this silly thing, become a
U.S. Senator, I actually a pretty good exercise routine. I
would go home and I would be watching the news, so why not hop
on a Lifecycle or a Nordic Track. That worked for me pretty
well, and then all of a sudden, you know, my Ranking Member
here would testify it is kind of hard with our kind of
schedules. I literally was losing muscle mass.
What I have decided to do is, for example, making a Keurig
coffee. It is about a 3-minute process, and there are
calisthenics you can do. I have seen that has been incredibly
helpful to me. I have seen just on, for example, X, they have
different Chinese methods, you know, different types of
exercises, and they work very well. I would imagine you know
something about exercise. Do you have a routine or something
you can recommend for seniors?
Mr. Hasselbeck. Well, I would just say a couple of things.
First, just real quick, I would like to piggyback up on the
protein and the creatine. I one-hundred percent agree with
that. I think there is a stigma with creatine, like it is not
safe. It has been around for years. It is safe. As an athlete
you are deathly afraid of testing positive with something like
a substance or non-reputable source, but even that is
dangerous. We always, as an athlete, went by the NSF
certification process. That at least gave you the strongest
sense of like what they are saying is in the ingredients is
what is in the ingredients, but for us just plain powder and
plain creatine are pretty safe.
To your question about the routine, I think, as an athlete,
we have it easy because we set goals. I played until I was 40
in the NFL. I was still playing when I was 40. My friends that
were 40, they were like, "How are you doing it?" It is like, "I
don't know. I think it is just use it or lose it." I set goals.
I had a game every week. I had a goal that I had to attain.
Much like I spoke about earlier with my mother, "Mom, what
do you want to do when you're 75 years old?" "Well, I want to
be able to board an airplane by myself. I want to be able to
put my luggage up by myself. I want to be able to pick up my
grandkids." What do you want to do when you are 85?" It was
like the same thing.
When you have those goals, I think it is so easy to come up
with what the exercises are going to be. You know, I want to be
able to get up out of a chair without using both hands to help
me get up. Well, then I know the exercises we need to do, and
you can see a physical therapist, an athletic trainer, your
doctor, to help accomplish those goals.
To answer your question, setting goals is the number one
way to accomplish them. My dad used to say this all the time,
"A goal without a plan is just a wish." That would be my
answer.
Senator Johnson. Okay. Senator Gillibrand, do you have any
further questions?
Senator Gillibrand. Yes. I have a few. We are filibustering
because we want the Chairman to come back and ask his own
questions, so we are going to ask you a lot of questions and
keep you busy.
I want to go to Mr. Hasselbeck. I read about the stigma of
seeking medical treatment, including preventive treatment,
especially for athletes and older adults. Can you talk about
what we can do to reduce these stigmas so that people can get
the help they need?
Mr. Hasselbeck. Yes. I think there is, in particular, with
what our family is going through right now, it is hard
sometimes to ask for help, and when I was in the NFL, my first
year in the NFL was 1998. At that time, if you ever had a
concussion or you ever had a brain injury, and the athletic
trainer, the doctor, a teammate, or a coach said, "Hey, how are
you," you would just say, "I'm fine." No matter what. Even if
you could not see straight, you were dizzy, you were throwing
up, you would just say, "I'm fine." That was the only
acceptable answer if you were going to be tough.
We worked really hard through my last year in the NFL,
which I believe was 2015. We sort of made it cool to be honest
with the medical team. There was a little bit of distrust, like
maybe they are not going to think I am tough enough, or, you
know, I do not know what it was, but it was really hard to kind
of change the culture in football, in pro football, which we
believed tricked down to college and high school, where it
became normal to, if the doctor asked you a question, or the
athletic trainer, just be honest with them, and that was really
hard for our community to do that.
I think I do see some similarities with if you are a
caretaker of a loved one at home, maybe sometimes it is hard to
just ask for help, but that was a tough thing for us. I mean,
even just the learning process, looking in the mirror through
that process was one that was a lot tougher than I thought, as
an athlete.
Senator Gillibrand. Well, I remember reading a story about
dehydration and how a high school coach was not allowing the
players to hydrate, and a boy died, because you were not
perceived as tough enough. I hope that that trend of, again,
for the professional athletes, so it does trickle down to high
school and college, is that your wellness is the most important
thing for the players, that part of the team's goal is to make
sure you are 100 percent well, whether it is mental, physical,
injuries, or the like.
Mr. Hasselbeck. Yes, and I would just say, and the medical
professionals here can speak to this better than me, but as a
high school coach we are trained for heat illness and heat
exhaustion and those types of things.
I remember when my dad was playing in the NFL it was seen
as a sign of weakness if you were to ever give your players
water breaks, and now we know, through science, that that is
foolishness.
I think as a player and as someone who loves sports and
loves the game of football, inviting the medical community to
really help us learn and not just do things the way that we
have always done it--and I would say the same thing for the
aging community. I think we can start way earlier than 65 if we
want good outcomes when people are 70 and 75.
Senator Gillibrand. Smart. Jennifer, can you talk a little
bit about some of the evidence-based physical activity or fall
prevention programs at your AAA, and could you talk about the
importance of evidence-based programs and how we can support
the development of more proven interventions to help seniors?
Ms. Raymond. Sure. One of the evidence-based programs that
gets offered very, very widely across our communities and
across the country is an evidence-based program called Enhanced
Fitness, and Enhanced Fitness is all about physical activity.
This is a group class, up to 25 people in a class. It is run by
a trained, certified leader who understands not only how to do
the exercises, how to do them safely, and how to look out for
challenges that the older adults may be having while they are
exercising--balance, strength training, mobility, all of that
being part of the program.
One of the things that makes a program work best is just
what others have said, the goal-setting component. How am I
going to get from where I am in Week one, where I can barely do
the stretching from a standing position, to where I want to be
in Week eight, and how do I do a little bit at a time in order
to do that. That is an evidence-based program that has had some
significant research behind it, as well. It might cost around
$1,000 to $1,200 a class--you know, not one class but the full
evidence-based program--and retrospective CMS studies showed
that people who participate in that program save health care
costs of around $1,000 a year. You figure 25 people in that
class, you are going to make up for it.
That is what is incredibly important about the evidence-
based programs and the federal support for it. We want to be
good stewards of federal dollars. We want to initiate and offer
programs that have good outcomes, that are going to help a
person stay independent longer, that are going to increase
their ability to stay strong, that are going to increase their
ability to be mobile, but at the same time, are going to bend
that cost curve over a long term.
Senator Gillibrand. Thank you so much, Jennifer.
Chairman Scott. First off, thanks again to everybody for
being here.
Mr. Hasselbeck, how many hours a day do you have to spend
time to make sure you are healthy? What does it take?
Mr. Hasselbeck. Would you say right now, or----
Chairman Scott. Right now. What is the difference?
Mr. Hasselbeck. Well, I spoke earlier about what I am
terming Zone two training. These ideas are not necessarily my
ideas. They are ideas that get talked to me by people that I
trust. I do believe that kind of Zone two cardiovascular, it is
going to be good for my heart, heart health, it is good for
brain health, it is good for muscle, it is good for bone
density, it is good for all the things.
I think strength training at least two to three times a
week, and I think breaking a sweat, you know, heart rate over
100, at least, I would say five to six days a week, that to me
would be seemingly like the floor of what I would consider to
be healthy exercise.
Chairman Scott. What do you do on your diet?
Mr. Hasselbeck. Diet, I think I would agree with what has
been shared already today--high protein, less sugar, or very,
very little sugar if you can, not a lot of refined carbs. I am
a little bit guilty on that right now.
Truly and honestly I think, again, setting goals and having
people and community kind of holding you accountable and having
fun with it, that is what I saw as an athlete. I think even now
as a former athlete, I have been to a few funerals lately, and
I have seen a lot of my former teammates, a lot of them are
offensive linemen. Those guys are having so much fun getting
fit and losing weight, and they are on a roll with it, and I do
believe that the fact that they are doing it together is
encouraging. Like I do not want to say competitiveness, but
almost like you are cheering each other on, in a way. That is
inspiring, it is contagious, and it has a multiplying effect,
which is really, really cool to see.
Chairman Scott. Dr. Cain, Dr. Legg, in your communities,
like if you were going to go brag about somebody that has a
great program for a senior, which one would you brag about?
Dr. Cain. Yes. I mentioned in my opening comments, Senator
Scott, I think in our community the fall prevention programs
have been really helpful. I have had my own mother and my own
father-in-law in those programs, one at 85, one at 90, and I
think physical therapists, athletic trainers that are not bound
to some of the time constraints of a primary care physician can
spend more time with the older patient, get them comfortable
with the program, have ability to make sure they are safe doing
it, you know, with things like wobble boards and balance
maneuvers, that can really make a dramatic impact on the
patient's risk of falling.
I think the fall prevention programs are really the key to
our community trying to keep people healthy.
Chairman Scott. Dr. Legg?
Dr. Legg. In my community, we have something called the
West Virginia Health Right, which is a free and charitable
clinic that started many years ago that has grown. Some of the
new services they offer are nutrition, which they have at two
different locations, and exercise classes at the same
locations.
The great thing for patients in the Kanawha Valley is that
they are free. Patients can learn about nutrition, learn about
cooking, but they can also go and participate in exercise
class, which includes aerobic exercise training as well as
strength training. I work at this clinic. It is a very well-
organized place, so it is a great opportunity for people in
Charleston.
Chairman Scott. Ms. Raymond, besides the program you have,
where you live is there anybody that you could send a senior to
that would be all-encompassing, to say if you do these things,
you are going to do what both of the physicians talked about.
You are going to live longer, you are going to be happier, and
all those things?
Ms. Raymond. You know, we do take a community-wide approach
to this kind of work, so being able to partner with the
federally Qualified Health Centers, the family health centers
who are seeing a lot of folks who are at risk for fall, and
being able to partner with that physician group is important.
Partnering with the YMCA's PACE programs, there are a lot of
these kinds of programs.
I think the incredibly important part for us is that we are
often the first folks that an older adult is seeing or coming
to, us and the Senior Center, and so making sure that we
understand the wide range of community resources that are there
is incredibly important.
Chairman Scott. Mr. Hasselbeck, you do not have to give
this name, but somebody that you would say is 80 years old,
that you would say, boy, they have done it right, who would you
look at and say, you know, they have done it, you know, to stay
healthier longer.
Mr. Hasselbeck. Well, my grandmother passed away this past
year. She was in her mid0990's. She had 12 kids. I think the
great-grandkids kept her very active, but she is someone that I
would point to in my life that I am eye-witness to that stayed
very active. She was a great golfer. She golfed with the women
in her neighborhood. She was kind of infamous. She was a left-
handed golfer.
You know, I think just her daily activities. She stayed
active cooking. She stayed active, again, like reaching down,
picking up grandkids, holding them, passing them off. Those are
activities. I think, seriously, like I have talked with my
mother about this, what are the activities that you want to be
doing when you are that age? If it is that, let's go get a
dumbbell, and let's practice squatting. A 30-pound dumbbell is
probably like a 20-pound toddler. You know, what are the
activities? If you want to be able to do certain things, maybe
we need to walk steps a bunch of time. Maybe we need to focus
on walking steps sideways, both ways. If you want to play
pickleball.
Training like an athlete, but knowing that the exercise
that we are trying to train for, it maybe is not an athletic
event. You know, it is traveling on an airplane without me
feeling like you need someone to help you. It is walking
through a large airport. Maybe it is going for walks.
Near the end of my dad's life, knee replacements were the
thing that slowed him down. He was otherwise completely
healthy, but the knee replacements kind of shut him down, in a
way. He could not do the very basic activities. It was kind of
tough. I think if we had been more proactive about that kind of
stuff.
There is life span and then there is health span. Sure, you
lived until you were 75, but how old were you when you stopped
really living? I think that is the mindset. Again, I took a
proactive approach as a player. I saw players take a reactive
approach to their career. They did not play very long. I played
longer than anybody in my draft class, and I was a sixth-round
pick on the practice squad.
I do think that mindset is very, very important.
Chairman Scott. Dr. Legg and Dr. Cain, tell us a 80 year
old success story in your community, and what did they do?
Dr. Legg. I have a colleague who just retired two years
ago. An orthopeadic surgeon who operated until age 84. What he
did was he remained active. He exercised on a regular basis.
One of his favorite exercises was dancing. That allowed him to
stay sharp, both physically and mentally, to operate to that
age. To me, Tony Majestro was a success story. He is still
vital. He is not operating anymore, but I was always amazed
that he could carry on orthopeadic surgery until that age.
Dr. Cain. My own father-in-law, that I have mentioned
several times today, Pete Tidwell, is now 90, and played tennis
well into his 80's. He is one of those guys that never sat
still, was always active. When my kids were little, his
grandkids, he was always playing with them out in the yard,
throwing the football, even in his 70's and 80's.
I think he has been a pretty good mentor as far as what
activity level can do for your health, for your mind, for your
health span. Even at 90 he still wants to play tennis. His body
does not let him do a lot of it. He is still super active,
still leaves the house and drives to work every day, comes by
our house and sees the grandkids every day. I think that is
really what we all want as we age, is to be around our family,
be healthy enough to be independent, for the most part, and he
is a good example of that.
Chairman Scott. Have either of you two seen sports clinics
that have really good senior care with it? Like are your
practices seeing any seniors?
Dr. Cain. Our practice probably sees more seniors than
athletes, actually, even though we are called a sports medicine
clinic. A lot of that, unfortunately, is reactive. It is
dealing with knee replacements, like Matt's dad, and patients
that are kind of into the long-term care stage, where we are
trying to get rid of problems that have been going on for
several years.
I think it is hard to be proactive because patients usually
do not come into clinic unless they have a problem, to see us.
We are associated with physical therapy and athletic training
clinics that see patients for fall prevention. Most patients do
not really seek medical help unless they have a problem, so we
end up being on the opposite side, most of the time,
unfortunately.
Dr. Legg. We see the same thing in our office. When I see
seniors, they are coming in for knee arthritis, hip arthritis,
shoulder arthritis. Now, we want to treat that to keep them
moving, but that is the place where we see them.
Now, we also see them at all stages. It is not always
surgery. We do multiple, non-operative treatments to relieve
pain to keep them active, but that is the point we see, an
orthopeadic office, that you see these patients, when they are
coming in for the treatment of established arthritis.
Chairman Scott. You know, I used to be in the health care
business, and one of the things that I have watched is that
there are not a lot of people that are actually trying to find
the cause of the problem, and a lot of it is because that is
not how you get reimbursed. You do not get reimbursed to find a
cause of the problem. You get reimbursed to do a procedure.
Have either of you two, in your practices, found that, one,
is there a reimbursement system to find the root cause, and are
people actually willing to spend the money to find the root
cause of their problems?
Dr. Cain. I think just like being active, in general, some
of it is just personal drive, either encouraged by friends or
family or other physicians. I think the reimbursement scheme,
not to get too deep into a wormhole over Medicare, but I think,
in general, the reimbursement scheme of Medicare physician
reimbursement schedules makes it hard for physicians to devote
a lot of time to preventative care, because the fee schedule is
set in such a way that reimbursement goes down every year,
costs go up every year. I think, unfortunately, our time with
senior patients probably gets less every year, even if we do
not mean to.
I think there are some barriers as far as reimbursement,
but I think most of it is just the perception of why you go to
a doctor. Most people go to a doctor for treatment of a
problem, not for prevention of a problem.
Dr. Legg. The one area we do have some success, especially
treating arthritis in the lower extremities, is we now ask many
patients for weight reduction prior to surgery, and often we
have patients come back who have lost a substantial amount of
weight and say, "My knees and my hips just don't hurt as much
anymore."
Chairman Scott. Shocking.
Dr. Legg. Yes. They often delay surgery because of that,
and so we do that daily now. I am having discussions about
weight reduction before surgery, but it is successful, and when
people lose a substantial amount of weight I tell them, "You go
to the front of the line. You are ready. You have worked hard."
We know that it lowers surgical risk and improves surgical
outcomes, but also people come back and say, "I feel better."
Chairman Scott. Mr. Hasselbeck, you coach younger people,
right? Can you tell people, you know who is going to take care
of their body and their mind and who is going to, unless they
get a surprise injury, is going to have a longer career in
sports than the people that are not?
Mr. Hasselbeck. No, I do not think you can tell that, but I
do get the exact same questions from parents of high school
athletes as I hear when I am talking to my parents and their
friends. It is around supplementation. It is around nutrition.
A lot of times it is these questions about protein powers. It
is about creatine, and there really is a stigma around
supplements, because it is the Wild, Wild West. It is not
regulated. You know, you do not actually know what is going
into some of these supplements.
I would also say that I think it is really important, if
you have to supplement extra protein into your diet, you need
to do it, whether you are a high school athlete or you are the
grandparent of a high school athlete. I also think with
creatine there is this thing out there where creatine makes you
gain weight. On the same side, when you were talking about
women, there is a pushback on creatine. I think we would now
agree, in the medical community, that creatine is really
healthy and has great benefits for men and women.
It is ironic that they are the exact same question for
teenage boys, is what I usually get, and for the advice that I
am giving my mom and her friends.
Chairman Scott. I take creatine, and I do protein powders.
On my program I am supposed to have more than, I think, 120
grams of protein a day. I eat more protein. I just wish there
were more different varieties. You get bored of the same stuff.
Mr. Hasselbeck. I would just say, you know, as a
quarterback, one of the best quarterback coaches that I ever
had was Andy Reid. One of the things he would say is, he would
always just say, "Stay low in the pocket." I am sure there were
like 12 things he could have said to fix, but he just said,
"Stay low in the pocket." It was a real attainable goal for me.
I think when it comes to nutrition, and I think the doctors
might agree with this, or something you are telling your
patients, if it is an attainable goal like, "Hey, I don't know
if I can do everything, but I can do that," the protein goal
and the exercise goal I think are two of the simplest, most
attainable, and they fix a lot of different things.
I know I mentioned Zone two cardio. It is good for heart
health, good for brain health, which are the main things that I
think men in my situation are concerned about, going forward.
Chairman Scott. How important is brain health as you age,
for all of you?
Dr. Cain. I think in a lot of ways it is more important
than physical health, really. Brain health is what allows you
to be aware of your physical shortcomings, to be more active,
to do things like take more protein.
You know, I would argue in your protein diet, if you are
trying to get 120 grams of protein, it is tough to do. The fact
that you are trying, you are probably getting 100, which is a
whole lot better than you do if you did not know you needed to
get 120.
I think incremental gains, incremental things are really
important. We know that protein, for instance, helps your
cognitive health later on, and certainly from a health care
standpoint, as bad as it is to be broken down physically, I
think it is a lot worse to be broken down mentally. I think
brain health is probably more important than physical health
for most of us.
Dr. Legg. Brain health follows physical health. There has
been discussion on creatine today, and Matt mentioned that
people worry about weight gain with creatine. We know that some
of the older ways to use creatine included a very high loading
dose. It was about 20 milligrams a day, which did cause a lot
of gastrointestinal upset and water retention.
Now, we know that five milligrams a day, or five grams a
day is probably plenty. You can get up to the levels you need,
but it is going to take you about 20 days to get there, not
four days to get there. We know as time goes with the buildup
of creatine, again, there is a muscular effect, and then there
becomes a bone effect, and then eventually the body can get to,
I will call, a steady state where there probably is some brain
effect when you get to that level and you have used it long
enough.
It is a good supplement, and can be used by most everybody
now.
Chairman Scott. Well, thank you to each of you for being
here. Thank you for caring. I hope our seniors take advantage
of the information. It seems to me, I mean, we all have to
figure this out on our own. There is nobody that is going to do
it for us.
Thanks to each of you for being here. Thanks for what you
do.
[Whereupon, at 4:57 p.m., the hearing was adjourned.]
=======================================================================
APPENDIX
=======================================================================
Prepared Witness Statements
=======================================================================
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Prepared Witness Statements
E. Lyle Cain, Jr., M.D.
Thank you Chairman Scott, Ranking Member Gillibrand and
members of the committee for inviting me to testify in the
hearing today.
My name is Lyle Cain. I am the Managing Partner and
Orthopaedic Surgeon at the Andrews Sports Medicine and
Orthopaedic Center in Birmingham, Alabama. I have been a Team
Physician for several high school, college, and professional
teams, including the University of Alabama Crimson Tide, for
over 25 years. ROLL TIDE! I firmly believe that the lessons
learned while providing care for athletes at All Ages,
especially in the field of injury prevention and management,
can help improve the HealthSpan of our aging population.
As you know, the combination of increased lifespan and
demographics of the "Baby Boomer" generation have led to a
dramatic shift in the number of senior adults in the United
States with nearly 20% of our population now 65 years and
older. This has tremendous consequences for our HealthCare
system, both with increased utilization and increased costs. A
true "Team approach" to the individual, using the Sports
Medicine system as a model, can help our senior population
maintain a better quality of life as they age.
What is a "Team Physician"? The American Orthopaedic
Society for Sports Medicine (AOSSM) defines a Team physician as
someone who provides comprehensive health services for the care
of athletes and active people at all ages. The Team Physician
is ultimately responsible for the health, safety, and
performance of our athletes. Our duties include injury
prevention and risk reduction, acute injury evaluation and
management (both during competition and training), chronic
condition and illness treatment, coordination of care between
providers and performance optimization. In sports medicine, we
also attempt to prevent injury by encouraging rules changes and
development of protective gear for each sport. We accomplish
these duties through the work of a large Team of Providers, and
as I will outline, sports medicine is truly a "Team Effort".
The modern Sports medicine Team includes Certified Athletic
Trainers (who are generally the primary point of contact for
the athlete), Physical Therapists, Dietitians, Primary Care
Physicians, Orthopedic surgeons, Psychologists, Chiropractors,
Sports Performance Specialists, Certified strength and
conditioning coaches, and many others.
Our relationship with the athlete generally begins when we
perform a pre-participation physical examination to assess
their health and physical readiness to play. This is a crucial
step and allows the physician and athletic trainer to identify
issues that may predispose the athlete to future injury. We
obtain a health history, do a thorough examination, and often
perform additional testing (such as cardiac testing with
echocardiogram) to develop an individual risk profile for each
athlete. In the aging population, the annual examination with
your primary care physician can provide this level of risk
assessment; but the reality is that issues that put the senior
adult at significant risk, such as balance loss, muscle loss
(sarcopenia), cardiovascular fitness and endurance, and fall
risk are generally not evaluated. Employing athletic trainers,
physical therapists and other health care personnel to assist
in annual risk assessment could likely prevent future falls and
the associated health compromise in the older population. In my
own family's experience, my wife's 90 year-old father has seen
tremendous results and better balance by participating in a
local fall prevention program provided by physical therapists.
Why is fall prevention so important? Falls are the #1 cause
of injury-related death in adults over 65. Up to 30% of adults
die within one year of a hip fracture sustained from a fall,
and many patients that survive past the first year never regain
independence, requiring expensive care from rehabilitation or
long-term care facilities. It is estimated that falls alone add
$50 billion annually to the US healthcare system costs. The old
orthopeadic adage wisely states "we are brought into this world
through the brim of the pelvis, and often leave through a
fracture of the neck of the femur", emphasizing the risk of
mortality from hip fractures in the older patient. Many of
these falls are preventable with risk assessment, regular
physical activity including resistance training and fall
prevention programs.
How do we implement this program? It definitely takes a
Team. The medical team should be empowered to treat the aging
patient with individual risk evaluation, medical optimization,
fitness and performance improvement just like we treat our
athletes. Primary care physicians are often the healthcare
"gate keeper", so we must train these doctors in
musculoskeletal medicine. The American Sports Medicine
Institute, and many programs like it, train primary care
physicians in non-surgical care of the active person, but this
requires an extra year of post-graduate training. Certified
athletic trainers are a valuable part of the team, but we are
seeing a critical shortage of young people entering the field
due to the time commitment in training (now requiring a Masters
level degree), long work hours, and relatively low pay.
Physical therapy visits are generally limited by insurance
plans, and many do not include fall prevention coverage. We
must continue to advance programs that educate the aging
population on the benefits of exercise, muscle mass
improvement, and fall prevention. NIH funding is also critical,
especially in my home State of Alabama. In fact, just two weeks
ago, the American College of Sports Medicine (ACSM) Exercise is
Medicine program launched the Active Aging Initiative for Older
Adults with a mission to integrate physical activity into
routine healthcare by enhancing collaboration between
healthcare providers and exercise professionals and expanding
access to evidence-based exercise opportunities. Wearable
Technology, such as fitness trackers and Apple watches, can
provide feedback concerning individual performance progress and
gains.
In closing, we give our athletes the best care possible to
prevent injury and optimize performance. We should do the same
for our senior citizens.
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Prepared Witness Statements
Paul S. Legg, M.D.
Chairman Scott, Ranking Member Gillibrand, and Honorable
Members of the Committee,
Thank you for this opportunity to offer testimony to the
Senate Special Committee on Aging. The opinions expressed
herein are my own and do not reflect the view or position of my
employer.
My name is Dr. Paul Legg. I am a practicing orthopaedic
surgeon in Charleston, West Virginia, having spent 27 years in
private group practice and the past two years as a hospital-
employed surgeon for Vandalia Health. I am board certified by
the American Board of Orthopaedic Surgery with a certificate of
additional qualification in sports medicine. I am also the
orthopaedic surgeon for the University of Charleson, an NCAA
Division II school with approximately 620 athletes.
Sports medicine encompasses the prevention and care of
musculoskeletal injuries and medical conditions encountered in
sports. Lessons from the field, operating room, and research
are applicable to maintain the physical function and
performance in competitive athletes at any age. The health
outcomes of seniors improve by keeping them healthy, active,
and injury-free as they age. Surgical techniques designed to
return competitive athletes to the field of play can also
benefit seniors with similar injuries. For example, small
incision or percutaneous repair of Achilles tendons is such a
technique. Using this percutaneous technique in patients
decreases operative time, wound complications, scarring, and
infection.\1\ Patients also return earlier to pre-injury
activity. However, surgical techniques are only a small part of
sports medicine s influence on senior health. The manner in
which our athletes train and prepare offer many more lessons on
improving the health outcomes of seniors.
---------------------------------------------------------------------------
\1\ Hsu AR, Jones CP, Cohen BE, and others. Clinical Outcomes and
Complications of Percutaneous Achilles Repair System Versus Open
Technique for Acute Achilles Tendon Ruptures [Internet]. Foot Ankle
Int. 2015 Nov;36(11);1279-86. Available from: https://
pubmed.ncbi.nlm.nih.gov/26055259/. doi: https://doi.org/10.1177/
1071100715589632.
---------------------------------------------------------------------------
According to the 2022 report by the National Health
Statistics, only 13.9 percent of adults aged 65 and older met
the federal activity guidelines.\2\ The environmental factors
related to low physical activity rates include automobiles,
television, computers, mobile devices, remote controls,
elevators, suburban roads with no sidewalks, sedentary jobs,
and eating out/fast food. Since very few people get adequate
exercise at work or throughout their days, exercise needs to be
added as a purposeful activity. Fitness is partly genetic and
is measured by how far you go on an exercise test. Physical
activity is behavioral and requires motivation and commitment.
Increasing your physical activity will increase your fitness.
---------------------------------------------------------------------------
\2\ Elgaddai N, Kramarow E. Characteristics of Older Adults Who Met
Federal Physical Activity Guidelines for Americans: United States, 2022
[Internet]. U.S. Centers for Disease Control and Prevention; 2022 Nov
25 [cited 2025 June]. Available from: https://www.cdc.gov/nchs/data/
nhsr/nhsr215.pdf. Aerobic physical activity guidelines for adults
recommend at least 150 to 300 minutes a week of moderate-intensity
aerobic activity or 75 to 150 minutes of vigorous activity a week.
---------------------------------------------------------------------------
Poor physical activity and nutrition top the list of most
common health issues encountered by seniors.\3\ Dr. Jerome Fleg
tested healthy patients over 20 years and found that we get
less fit as we get older and fitness sharply declines after age
75.\4\ In 1975, Dr. Robert Bruce demonstrated that physical
fitness as measured by VO2 max decreases as we age, even in
healthy individuals.\5\ VO2 max is a measure of your body s
maximal rate of oxygen consumption. When we re exercising or
just sitting down our body takes in air from the lungs,
distributes it throughout the body via the heart and blood
vessels, and then pulls oxygen from that blood into our
muscles, tissues, and cells. In the cells, mitochondira use
oxygen to produce energy in the form of adenosine triphosphate
(ATP). VO2 max declines with age. This occurs in part due to
decreased cardiac output and decline in mitrochondrial number
and quality. These changes mean that either less oxygen is
taken up by the muscle or the oxygen that is taken up isn t
utilized to the same extent, which can limit our aerobic energy
production and exercise capacity. While VO2 max declines with
age, we can prevent some decline in patients. Continuing to
exercise can boost mitochondrial capacity, preserve cardiac
function, and may even prevent some of the age-related declines
in heart rate and strength with age.
---------------------------------------------------------------------------
\3\ McNaughton SA, Crawford D, Ball K, and others. Understanding
Determinants of Nutrition, Physical Activity and Quality of Life Among
Older Adults: The Wellbeing, Eating and Exercise for a Long Life (WELL)
Study [Internet]. Health Qual Life Outcomes; 2012 Sep 12;10:109.
Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3479030/. doi:
https://doi.org/10.1186/1477-7525-10-109.
\4\ Fleg JL, Morrell CH, Bos AG, and others. Accelerated
Longitudinal Decline of Aerobic Capacity in Healthy Older Adults.
Circulation [Internet]. 2005 Aug;112(5):674-82. Available from: https:/
/pubmed.ncbi.nlm.nih.gov/16043637/. doi: https://doi.org/10.1161/
circulationaha.105.545459.
\5\ See Quinn E. The Bruce Protocol Treadmill Test [Internet].
VerywellFit; 2024 July [cited 2025 June]. Available from: https://
www.verywellfit.com/the-bruce-treadmill-test-protocol-3120269.
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Seniors need aerobic fitness, but they also need strength
training. Loss of strength and loss of muscle mass (sarcopenia)
begins roughly at age 40. Muscle mass declines five percent per
decade starting at age 40. Strength-trained men and women start
with higher peak strength and loose strength at a slower rate.
Muscle mass increases only with intensive and prolonged
resistance training. The established benefits of regular
strength (resistance) exercise include increased strength and
endurance, increased/maintained muscle mass, increased resting
metabolic rate, and preventing disability.
Both research and clinical experience indicate that
resistance training is safe for health older adults, frail
older adults, and individuals with disease. Muscle disuse is a
preventable and reversible factor. Resistance exercise training
has been consistently shown as a feasible and effective means
of counteracting muscle weakness and physical frailty;
improving physical performance; increasing muscle, fiber, area;
improving muscle quality; improving bone density; improving
metabolic health and insulin sensitivity; improving
psychological well-being; and reducing risk for falls and
fractures and older adults.
What behaviors can we encourage in senior adults to help
start and maintain an exercise program? The first step is
making a commitment to increase physical activity. Established
protected time to exercise and forgo other activities that may
encroach on this scheduled time. Develop a habit. Set small and
realizable goals for exercise as you begin but also think about
and establish long-term goals for overall fitness. Barriers to
exercise must also be addressed, which include lack of
understanding, lack of awareness, lack of funds, and lack of a
plan.
What can we learn from sports medicine and athletes?
Athletes train and prepare for competition. Their training
includes aerobic exercise and strength training. Their exercise
is planned and purposeful. We need to view exercise like
personal hygiene regular and routine practices that improve
overall health.
Sports medicine has also introduced specific training
techniques that improve fitness. These techniques were designed
to improve performance of competitive athletes. Yet, these
principles can be used by all ages, including senior adults.
The Norwegian 4x4 protocol is a high intensity interval
training method that involves four minutes of near maximum
intensity exercise followed by three minutes of light activity
repeated four times. A study in 2020 demonstrated a lower all-
cause mortality trend with 4x4 interval training, compared with
controls and moderate intensity continuous training.\6\ Fartlek
is another type of interval training that is based on even
shorter intervals of increased activity with intermittent light
activity or rest. Fartlek, which is Swedish for speed play,
tends to be less structured than other interval techniques.
These high intensity interval training techniques can be used
with a variety of exercises including walking, running,
cycling, elliptical, and rowing.\7\
---------------------------------------------------------------------------
\6\ Acala JJ, Roche-Willis D, Astorino TA. Characterizing the Heart
Rate Response to the 4x4 Interval Exercise Protocol. Int J Environ Res
Public Health [Internet]. 2020 Jul 15;17(14):5103. Available from:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7399937/. doi: https://
doi.org/10.3390/ijerph17145103.
\7\ See Zickl D, Latter, P. What Is a Fartlek Run and How Can It
Help You Get Faster? [Internet]. Runner s World; 2020 Dec 8 [cited 2025
June]. Available from: https://www.runnersworld.com/training/a34824872/
fartlek-run/.
---------------------------------------------------------------------------
Health outcomes in seniors can be improved with lessons
learned from sports medicine and sports science. Surgical
techniques and rehab protocols help return seniors to pre-
injury function and activity. Planned and purposeful exercise
and strength training used in preparation for competitive
athletic events provide a structure for exercise and senior
adults. Advanced training techniques can move senior adults
beyond just physical activity and into increasing levels of
fitness.
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Prepared Witness Statements
Matt Hasselbeck
My name is Matt Hasselbeck, and I am here to share my
insights on the significant role Sports Medicine has played
throughout my athletic career and its ongoing influence in my
life.
I played quarterback for five years at Boston College
followed by a lengthy NFL career. The NFL, if you don't know,
is commonly referred to by players and coaches as "Not For
Long", but, with the help of great sports medicine teams I was
fortunate to play for 18 years with the Green Bay Packers,
Seattle Seahawks, Tennessee Titans, and Indianapolis Colts. I
grew up as the son of a football player. After an All-American
career at the University of Colorado, my dad played tight end
in the NFL for nine seasons. He played primarily with the New
England Patriots, but also with the Minnesota Vikings, the New
York Giants, and the Los Angeles Raiders, where he and his
teammates won Super Bowl XVIII. My brothers and I all earned
full scholarships to play college football, and my brother Tim
followed me as a longtime quarterback in the NFL. Most of our
wives were prominent Division one athletes as well, and my wife
was no doubt a better athlete in college than I was.
In the decade since my NFL career ended, I have primarily
worked in the sports media space. After spending eight years at
ESPN on shows like Sunday NFL Countdown, Monday Night
Countdown, and SportsCenter, I now work as an NFL analyst for
Fox Sports on the Colin Cowherd Show. I've also been serving as
a high school football coach the past four years. After winning
a state championship in Massachusetts coaching my son, last
year we moved to Tennessee so I could coach on a staff with my
father and brother, where we coached two of my quarterback
nephews Taylor and Isaiah. Taylor is currently committed to
play college football at the University of Wyoming.
Raising our own three kids and supporting their athletic
journeys has been the other major career for my wife and me.
Our two daughters are National Champion lacrosse players from
Boston College; the younger one is preparing for a fifth year
after three knee surgeries earned her a medical redshirt. Our
son is a redshirt freshman quarterback at UCLA and is battling
for his own opportunity much like I did at his age.
During my 23 years of college and professional football, I
only had one surgery. This is unheard of! I attribute this to
many factors, one of which is the help of skilled athletic
trainers and sports medicine teams. Many of my teammates took a
"react and survive" approach to their health, while a
"proactive and thrive" approach is a mindset that helped me. I
attribute this mindset to the advice, care, and expertise of
the athletic training staffs of my teams. Not only did they
help me prevent injuries, but they also contributed to helping
me heal faster and return to play. Staying healthy is priority
#1 for an NFL quarterback. Injury prevention, recovery, and
prioritizing wellness were equally important to me as throwing
touchdown passes. My coaches would often tell us, "Your
greatest ability is your availability".
Both during and after my NFL career, I have been dedicated
to making the game safer for future generations. I actively
participated in the NFLPA's Mackey-White Health and Safety
Committee and proudly served as a Vice-President of the NFLPA's
Executive Committee for six years. Our work successfully
fostered a significant culture change regarding brain injuries
and return-to-play protocols in football. In commitment to this
cause, upon my death I have pledged my brain to science through
the Concussion Legacy Foundation. I currently serve as the
ambassador for the DiagnoseCTE.org study for men over 50 which
aims to develop a method to diagnose and differentiate brain
trauma while patients are still alive.
In this new empty nester era of our lives, my wife and I
have experienced the challenges of caring for our aging
grandparents and parents. We have leaned on the lessons learned
through athletics to help replicate the best outcomes for them
as they get older. For example, helping my mom set goals for
the activities hopes to participate in with her grandkids when
she is older means that we have to start prepping for that now,
much like you would do as an athlete. My mom would love to be
able to play pickleball and ride bikes with her grandkids when
she is 75.
Sometimes it's not as simple. Following a painful knee
replacement surgery, my dad was waiting to get healthy enough
for the next one, when he tragically suffered a cardiac event
this April, which he did not survive. This heartbreaking event
has left my mom a widow after 50 years of marriage and she now
faces new challenges, some of which are loneliness and
isolation, that she must overcome. Sadly, as a family, we are
also dealing with the significant challenge of my mother-in-
law's Alzheimer's disease. This illness has placed immense
hardship on our family, particularly affecting my father-in-law
who sacrificed his profession to become her full-time
caretaker.
In conclusion, that's a glimpse into who I am, and I'm
truly honored to be here today. The last time I visited this
building was during my 8th-grade class trip, and I had a
wonderful time. I always hoped I'd get to come back again. I
look forward to answering your questions.
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Prepared Witness Statements
Jennifer Raymond
Chairman Scott, Ranking Member Gillibrand, and members of
the Committee, thank you for the opportunity to speak before
you today. My name is Jennifer Raymond, and I am honored to
serve as the Chief Strategy Officer for AgeSpan, an Area Agency
on Aging located in Lawrence, Massachusetts. We are one of 614
AAAs across the country, helping our older adults stay
independent. On behalf of these agencies, as well as the older
adults and family caregivers they serve, I want to first thank
you for your ongoing efforts to meet the needs of our aging
population through the Older Americans Act.
Thank you for your attention on the importance of physical
wellness for older adults. The consequences of physical
inactivity among older adults are catastrophic. They include a
decline in overall function, increased risk for chronic
diseases, increased frailty and a heightened risk for
depression and cognitive decline. Despite these consequences,
more than one in four older Americans are physically
inactive.\1\ The reasons for inactivity are many and varied: a
fear of injury, lack of confidence in their ability to exercise
safely, and even a lack of motivation to begin exercise.
---------------------------------------------------------------------------
\1\ Watson KB, Carlson SA, Gunn JP, et all. Physical Inactivity
Among Adults Aged 50 and Older-United States, 2014. MMWH Mor Mortal
Wkly Rep 2016;65:954-958. DOI:http://dx.doi.org/10.15585/mmwr.mm6536a3.
---------------------------------------------------------------------------
Across Massachusetts and throughout this country, Area
Agencies on Aging (AAAs) and their partners offer effective
physical activity programs that both promote exercise and help
individuals overcome the motivational and behavioral barriers
that contribute to inactivity. For example, May C. from Quincy,
who was able to safely abandon her walker after improving her
balance through an evidence-based program called A Matter of
Balance, and Maria A, who, despite her frailty, now
participates in virtual physical activity classes, from the
comfort of her own home thanks to our AAA's digital access
program.
One of the most important benefits of increased physical
activity for older adults relates to the prevention of falls.
Falls can be detrimental to a senior's life. They can result in
hip fractures, head trauma, other serious injury, and even
death. They often reduce mobility, take away a senior's ability
to live independently and can make people afraid to leave their
home, increasing loneliness and isolation.
Every year in this country, more than 14 million Americans
65 or older (or one out of every four) suffer a fall.\2\ In
2021, emergency room departments reported three million visits
due to older adult falls.\3\ The total health care costs for
these falls are over $80 billion per year.\4\ Of these costs,
67% is paid for by Medicare, 4% by Medicaid, and 29% by older
adults and their families.\5\
---------------------------------------------------------------------------
\2\ Kakara R, Bergen G, Burns E, Stevens M. Nonfatal and Fatal
Falls Among Adults Aged =65 Years-United States, 2020-2021. MMWR
Morbidity and Mortality Weekly Report. 2023;72:938-943. DOI: 10.15585/
mmwr.mm7235a1.
\3\ Centers for Disease Control and Prevention, National Center for
Injury Prevention and Control. Web-based Injury Statistics Query and
Reporting System (WISQARS) [online]. Accessed March 11, 2024.
\4\ Haddad YK, Miller GF, Kakara R, et al. Healthcare spending for
non-fatal falls among older adults, USA Injury Prevention 2024;30:272-
276.
\5\ Haddad YK, Miller GF, Kakara R, et al. Healthcare spending for
non-fatal falls among older adults, USA Injury Prevention 2024;30:272-
276.
---------------------------------------------------------------------------
Today, many AAAs partner with family health centers,
primary care providers, and managed care to reduce falls risks.
First, our health care partners screen and identify older
adults at risk for falls. Then, they refer those individuals to
networks of AAAs for falls intervention. This might include a
physical activity program, assistance with home modifications
to address falls hazards, and even the provision of medically
tailored meals to make them more ready for physical activity.
These referrals allow us to take a more holistic approach to
addressing the needs of the individual and create a shared care
plan to improve outcomes.
There is much we can do to support older adults in their
desire to age in place, stay physically active, and avoid
falls. To further these goals, we must:
1. Support robust funding for community-based physical
activity and falls prevention through the Older Americans Act,
specifically Titles IIID Evidence-Based Health Promotion and
Disease Prevention and Title IIIB Supportive Services.
2. Educate health care providers about falls prevention
through tools like the STEADI program, which assists providers
in integrating falls prevention to their clinical practices.
3. Encourage prescription for physical activity and falls
prevention by health care providers and allowing for
appropriate reimbursement for effective interventions offered
in the community.
4. Continue investment in research related to physical
activity and falls prevention for all older adults, including
those with physical frailty, those with disability, and those
with cognitive decline.
If we are serious about a healthy America, we cannot ignore
the impact of physical inactivity and falls among older adults.
Area Agencies on Aging stand ready to partner with health care,
older adults, and family caregivers to address this challenge.
Investments today will not only allow older adults to thrive
independently but will also help stem the costs for our health
care system for years to come.
Thank you again for the opportunity to speak with you today
and for your support on this issue. I look forward to your
questions and working together to support our country's older
adults.
=======================================================================
Questions for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Questions for the Record
Dr. E. Lyle Cain, Jr.
Ranking Member Kirsten Gillibrand
Question:
Your online biography notes that you have an interest in
"the emerging field of biological treatment options" for
healing injuries. Our country has made remarkable strides with
developing new treatments and medical procedures. The National
Institutes of Health has played a significant role - in fact,
NIH is responsible for more than 80% of the world's grant
investment in biomedical research.
Can you discuss some of the emerging biological treatment
options for injuries, and the potential those options hold for
patients - including older adults?
Response:
Thank you Senator Gillibrand. Most of the emerging biologic
treatment options involve isolating specific growth factors to
treat individual diseases. Our current options include Platelet
Rich Plasma (isolated from the patient's own blood) and Bone
Marrow or Fat-derived Mesenchymal Stem Cells (isolated for the
patient's bone marrow or fat). These biologic treatments are
full of many chemical factors and enzymes secreted by the cells
that can be both helpful and sometimes harmful. Scientists are
currently running trials supported by the NIH to better
determine which specific factors and cells are best for each
specific condition or disease.
Question:
What will it mean for your patients if the development of
new treatment options slows, or ends all together?
Response:
The loss of research support to improve the treatment
options will have a negative effect on my patients, leading to
less medical breakthroughs that may save lives.
Senator Raphael Warnock
Question:
Falls are the leading cause of injury-related death amongst
older adults, resulting in roughly $80 billion in medical costs
every year\1\ and contributing to three million emergency
department visits annually.\2\ The Centers for Disease Control
and Prevention (CDC) Stopping Elderly Accidents, Deaths &
Injuries (STEADI) Initiative collaborates with healthcare
providers to provide clinical resources for falls screening,
assessments, and interventions.\3\ Georgia, alongside 22 other
states, also receives funding through the CDC Core State Injury
Prevention Program (Core SIPP) to address fall prevention.\4\
However, these programs are at risk due to significant proposed
Fiscal Year 2026 budget cuts to the CDC.\5\
---------------------------------------------------------------------------
\1\ Older Adult Falls Data, Centers for Disease Control and
Prevention (October 28, 2024), https://www.cdc.gov/falls/data-research/
index.html.
\2\ Facts about Falls, Centers for Disease Control and Prevention
(May 9, 2024), https://www.cdc.gov/falls/data-research/facts-stats/
index.html.
\3\ STEADI - Older Adult Fall Prevention, Centers for Disease
Control and Prevention, https://www.cdc.gov/steadi/index.html.
\4\ CDC Core, Georgia Department of Public Health, https://
dph.georgia.gov/health-topics/injury-prevention-program/cdc-core.
\5\ Fiscal Year 2026 Centers for Disease Control and Prevention
Justification of Estimates for Appropriation Committees, Department of
Health and Human Services, https://www.cdc.gov/budget/documents/fy2026/
fy-2026-cdc-cj.pdf.
---------------------------------------------------------------------------
What unique challenges might older adults in rural areas
face regarding access to falls prevention resources in a
primary care setting?
Response:
Many older adults in rural communities are not able to
access these programs because of the distance needed to find
appropriate resources. Online and web-based models are helpful,
but can never really replace personal, hands-on expertise.
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Questions for the Record
Dr. Paul S. Legg
Ranking Member Kirsten Gillibrand
Question:
America's population is rapidly aging. I understand that
you have seen some of the consequences of that aging, as a
large share of your patients are now over 60 years old.
However, new doctors may not be completely prepared to provide
patient care tailored to the needs of older patients. For
example, medical schools typically offer rotations in
specialties like pediatrics, cardiology, surgery, and emergency
medicine - but often leave geriatrics off the list.
As someone who has experience treating patients over the
age of 60, what advice do you have for new doctors who are
about to serve an aging population?
Response:
Treating senior adults should include the ability to
recommend and /or prescribe exercise programs for patients. New
physicians should be prepared to inform patients on the
importance of exercise to maintain health and to help prevent
certain diseases. New physicians can provide simple exercise
programs to their patients and use local resources that
patients can access for physical activity. I often recommend
Dr. Ben Levine's Exercise Prescription for Life as a simple and
easily adaptable program for exercise. New physicians must be
prepared to motivate patients to exercise. The most difficult
task is convincing patients that exercise is essential to good
health, and motivating them to develop and maintain a
consistent program.
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Questions for the Record
Jennifer Raymond
Ranking Member Kirsten Gillibrand
Question:
Health care expenditure for non-fatal falls in 2020 was 80
billion dollars. Instead of treating falls, we should be
preventing them. A preventive approach would save the health
care system billions of dollars and prevent needless suffering
for many seniors. Many of the programs funded by the Older
Americans Act, including those provided in your agency, focus
on health promotion and disease prevention.
Why is it so important to take an upstream approach to
health and aging? Could you give us some examples?
Response:
Thank you for this question. Taking an upstream approach to
both health and aging is critical if we want to both improve
health outcomes and contain the rising costs of poor health.
Taking an upstream approach also more proactively looks that
the root causes of poor health outcomes, and the drivers of
positive health outcomes and allows us to tackle potential
problems before they manifest into costly and chronic health
conditions. This might mean enhanced investment in physical
activity programs (and safe places for people to access
physical activity), increased access to affordable nutrients
that improve physical health, and transportation and access to
community wide physical activity centers. It also means that
this access is accompanied by education and training related to
health care and the ability to make incremental behavior change
to adapt healthy behaviors at all ages.
Senator Raphael Warnock
Question:
Falls are the leading cause of injury-related death amongst
older adults, resulting in roughly $80 billion in medical costs
every year\1\ and contributing to three million emergency
department visits annually.\2\ The Centers for Disease Control
and Prevention (CDC) Stopping Elderly Accidents, Deaths &
Injuries (STEADI) Initiative collaborates with healthcare
providers to provide clinical resources for falls screening,
assessments, and interventions.\3\ Georgia, alongside 22 other
states, also receives funding through the CDC Core State Injury
Prevention Program (Core SIPP) to address fall prevention.\4\
However, these programs are at risk due to significant proposed
Fiscal Year 2026 budget cuts to the CDC.\5\
---------------------------------------------------------------------------
\1\ Older Adult Falls Data, Centers for Disease Control and
Prevention (October 28, 2024), https://www.cdc.gov/falls/data-research/
index.html.
\2\ Facts about Falls, Centers for Disease Control and Prevention
(May 9, 2024), https://www.cdc.gov/falls/data-research/facts-stats/
index.html.
\3\ STEADI - Older Adult Fall Prevention, Centers for Disease
Control and Prevention, https://www.cdc.gov/steadi/index.html.
\4\ CDC Core, Georgia Department of Public Health, https://
dph.georgia.gov/health-topics/injury-prevention-program/cdc-core.
\5\ Fiscal Year 2026 Centers for Disease Control and Prevention
Justification of Estimates for Appropriation Committees, Department of
Health and Human Services, https://www.cdc.gov/budget/documents/fy2026/
fy-2026-cdc-cj.pdf.
---------------------------------------------------------------------------
What steps can Congress take to protect and strengthen
community-based partnerships, like the STEADI Initiative and
Core SIPP, to ensure that evidence-based fall prevention
resources are adequately accessible to older adults?
Response:
Thank you for this question. The integration of the social
care provided by community-based organizations with the
clinical care provided by health care practitioners has proven
in many cased to both improve health outcomes and advance cost
containment. The STEADI Initiative and Core SIPP are just two
such examples. To better support these and similar
partnerships, Congress should:
1. Support robust funding for community-based physical
activity and falls prevention activities through the Older
Americans Act, specifically Titles III D Evidence-Based Health
Promotion and Disease Prevention and Title III B Supportive
Services.
2. Invest in an educated health care provider workforce
that advances falls and falls prevention activities in their
community through tools like the STEADI program, which was
created by the Centers for Disease Control and Prevention to
assist health care providers in integrating falls prevention in
their clinical practices.
3. Incentivize prescription for physical activity and
falls prevention by health care providers and allowing for
appropriate reimbursement for effective interventions offered
in the community.
4. Continue investment in research related to physical
activity and falls prevention activities for all older adults:
those who have the capacity to be more active, those with
physical frailty, those with disability, and those with
cognitive decline include Alzheimer's Disease and Related
Dementia.
=======================================================================
Statements for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Statements for the Record
American Physical Therapy Association and the Academy of Geriatric
Physcal Therapy (APTA Geriatrics) Statement
On behalf of the 100,000 member physical therapists,
physical therapist assistants, and students of physical
therapy, the American Physical Therapy Association and the
Academy of Geriatric Physcal Therapy (APTA Geriatrics), an
Academy of the American Physical Therapy Association, submit
the following comments in response to the Senate Special
Committee on Aging hearing, "Lessons from the Field: How Sports
Medicine Can Improve Health Outcomes for Seniors"
APTA is dedicated to building a community that advances the
physical therapy profession to improve the health of society.
As experts in rehabilitation, prehabilitation, and
habilitation, physical therapists play a unique role in society
in prevention, wellness, fitness, health promotion, and
management of disease and disability for individuals across the
age span, helping individuals improve overall health and
prevent the need for avoidable health care services. APTA
Geriatrics supports PTs, assistants and student with their
mission to optimize the experience of aging by 1) promoting
value, quaity, and accessiblity of geriatric care. 2) Prpviding
life-long learning and mentorship that promotes innovative
person-centered care. 3) Buidling a passionate community for
those call end committed to improving the human experience.
Physical therapists are doctorally trained movement experts
who help to optimize people's physical function, movement,
performance, health, quality of life, and well-being. Physical
therapists evaluate, diagnose, and manage movement conditions
for individuals, and they also provide contributions to public
health services aimed at improving population health and the
human experience. Physical therapists have a designated
specialy certification in geriatrics that demonstrated advanced
practice in providing services for older adults complex needs
across the care spectrum from skilled nursing facilities to
senior games and fitness/wellness. Physical therapists working
with older adults address the 5M's of geriatric care: Mobiltiy,
Mind, Medications, Multi-complexity and What Matters Most.
Physical therapist assistants (PTAs) are educated and licensed
or certified clinicians who provide care under the direction
and supervision of a licensed physical therapist. PTAs also
have an advanced proficieny program for geriatrics. PTs and
PTAs care for people of all ages and abilities.
The Role of Physical Therapy in Building Strength and Improving
Balance
Older Americans are most at risk for experiencing a fall
and suffering from debilitating conditions that may result from
such incidences. In fact, according to the Centers for Disease
Control and Prevention, more than one out of four older
Americans fall each year. Falling once doubles the chance of
falling again. Every 19 minutes, an older adult will die
because of a fall. A fall can result in serious injuries,
potentially leading to loss of independence, misuse of opioids,
and decreased ability to do meaningful activities. All told,
accidental falls among older adults result in three million
emergency room visits and one million hospital stays annually.
The average falls-related hospitalization costs $30,000 and
falls rank fifth in terms of the highest personal health care
spending. Older adult falls cost $50 billion in medical costs
annually, with 75% paid by Medicare and Medicaid.
Physical therapists have a critical role in preventing
falls, especially among older segments of the population.
Through PT care, patients can significantly reduce the risk of
a fall and potentially avoid serious injuries that could likely
be difficult and costly to treat. Physical therapists are
movement experts with knowledge and skills in identifying,
measuring, and improving balance system deficits, functional
limitations, and strength and flexibility deficits that have
been shown to contribute to falls.
The physical therapist's role in falls prevention includes,
but is not limited to:
Assessing the multifactorial risk for falling:
Designing an individualized plan for a patient's fall-
prevention needs;
Providing home safety assessments and modifications to
make a patient's home as safe from fall hazards as possible;
Educating about the risk factors associated with falls;
Providing appropriate exercises and balance training;
Working with other health care professionals to address
any underlying medical conditions that could increase the risk
of falling; and
Providing recommendations on evidence-based community
programs.
Physical therapists also address the identified deficits
following physical examination and objective tests of movement
patterns. Physical therapists are a vital component of
multifactorial interventions that address modifiable risk
factors for falls including medications, environment and
personal factors. Interventions provided by physical therapists
are targeted and dosed to provide the ability of the nervous
system to adapt to changing situations and environments since
balance requires both anticipated actions and reaction
responses. . Improvements in the interactions between
components of the balance systems through physical therapist
management leads to enhanced effectiveness of the activities
and participation that support what matters most to each
person. .
Physical therapy may also reduce long-term opioid
medication as an effective means to decrease preventable falls
in community-dwelling older adults. Physical therapists provide
tailored patient teach-back methods and motivational
interviewing to assess readiness and intervene to improve gaps
in client understanding of falls risk factors to mitigate their
falls risk.
The Economic Value of Physical Therapy
"The Economic Value of Physical Therapy in the United
States," a recently released APTA report, showcases the cost-
effectiveness and economic value of physical therapist services
for a broad range of common conditions. The report compares
physical therapy with alternative care across a suite of health
conditions commonly seen within the U.S. health care system.
The report underscores and reinforces the importance of
including physical therapists and physical therapist assistants
as part of multidisciplinary teams focused on improving
outcomes for seniors and decreasing downstream costs. We urge
the Committee to consider the insights provided in this report
to support access to, coverage of, and payment for physical
therapist services, and to support policies that position
physical therapists as entry-point providers for seniors to
ensure beneficiaries have timely access to proven, cost-
effective care.
Policy Recommendations
Preventing falls is critical; however, access to falls
screening and prevention services is often limited. The APTA
endorses the following policy recommendations to increase
patient access to physical therapy that can significantly
reduce the risk of falls in the older adult population.
Recommendation #1: APTA urges Congress to pass H.R. 1171
- the Stopping Addiction and Falls for the Elderly (SAFE) Act.
This bipartisan legislation introduced in the U.S. House by
Reps. Carol Miller, R-W.Va., and Melanie Stansbury, D-N.M.
would ensure that Medicare beneficiaries, identified by their
physicians as having experienced a fall the year before their
Initial Preventive Physical Examination (known as the "Welcome
to Medicare" visit), would be referred to a physical therapist
for falls screening and preventive services. This bill also
enables beneficiaries who've been enrolled in Medicare for at
least a year and who choose to participate in an annual
wellness visit (different from an annual physical) to be
referred for a separate falls risk assessment and potential
additional PT services if the annual wellness visit reveals
that they've fallen within the previous year.
Recommendation #2: APTA urges Congress to pass S.668/
H.R. 3183 - the SAFE STEPS for Veterans Act introduced Sens.
Angus King, I-Maine, and Mike Rounds, R-S.D., and in the House
by Reps. Nikki Budzinski, D-Ill., Lois Frankel, D-Fla., Jen
Kiggans, R-Va., Jack Bergman, R-Mich., and Gus Bilirakis, R-
Fla. This bipartisan legislation introduced by addresses
preventing falls among older veterans and would require annual
falls risk assessments to be carried out by a licensed physical
therapist for veterans receiving extended care services
throughout the Department of Veterans Affairs (VA). It would
also establish an Office of Falls Prevention and create a falls
prevention coordinator within the Veterans Health
Administration to serve as a point person on federal panels
focused on falls prevention.
Recommendation #3: APTA recommends Congress reauthorize
and fully fund programs under the Older Americans Act (OAA).
The OAA was enacted in 1965 with the goal of supporting older
Americans to live at home and in the community with dignity and
independence for as long as possible. OAA supports various
programs and services, including information and referral,
congregate and home-delivered meals, health and wellness
programs, in-home care, transportation, elder abuse prevention,
caregiver support, and adult day care. As Congress may consider
ways to improve the efficiency and effectiveness of OAA
services and programs, APTA recommends that federal grants
authorized by OAA be utilized to promote timely assessments of
seniors for the risk of falling that can be performed by
physical therapists. Timely access to such an assessment could
help seniors and their caregivers prevent falls that lead to
devastating outcomes and would help reduce health care costs in
the U.S.
Should you have any questions, please contact APTA
Congressional Affairs Specialist Steve Kline at
[email protected]. Thank you for your time and consideration.
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Statements for the Record
BPR Lab Statement
BPR Lab, a multidisciplinary group of geriatric physicians,
board-certified healthcare architects, and bioethicists,
appreciate the opportunity to submit comments for the Special
Committee's hearing on physical activity in older adults. Our
area of expertise is the impact our built environment has on
the mobility and physical activity of older adults.
It has long been known that architecture shapes the
activities of people within a building. What is new is the
extent to which architecture impacts the health of its
occupants. In some cases, those effects are similar in scale
and scope to that of medications and procedures. The study of
these effects, Evidence-Based Design (EBD), seeks to uncover
these relationships. Our work at BPR Lab focuses on leveraging
EBD to increase the benefits and reduce the harms to people in
healthcare facilities through an understanding of causes and
effects. Fall prevention and promotion of mobility are two such
effects with far reaching personal and financial costs.
Opportunities to improve these effects through architecture
stand as an untapped vector to increase quality of life for
older Americans and stem taxpayer costs. Falls are the leading
cause of injury and among the leading causes of death among
older Americans. In 2020 over 42,000 Americans died due to
falls.\1\ Medical care related to falls of adults over 65 years
old was estimated to be $50 billion annually (2018),\2\ of
which approximately $29 billion and $9 billion came from
Medicare and Medicaid funding, respectively.\3\ In 2020, that
number had risen to $80 billion\4\ and by 2030 the cost is
expected to exceed $100 billion annually.
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\1\ Santos-Lozada AR. Trends in Deaths From Falls Among Adults Aged
65 Years or Older in the US, 1999-2020. JAMA. 2023 May 9;329(18):1605-
1607. doi: 10.1001/jama.2023.3054.
\2\ Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C.
Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriatr
Soc. 2018 Apr;66(4):693-698. doi: 10.1111/jgs.15304. Epub 2018 Mar 7.
PMID: 29512120
\3\ National Center for Injury Prevention and Control (U.S). Cost
of Older Adult Falls. Published 2020 July 9. Accessed 2025 June 22.
https://stacks.cdc.gov/view/cdc/122747
\4\ Haddad YK, Miller GF, Kakara R et al. Healthcare spending for
non-fatal falls among older adults, USA. Injury Prevention. 2023;30(4)
https://doi.org/10.1136/ip-2023-045023
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While the CDC's Stopping Elderly Accidents, Deaths, and
Injuries campaign (STEADI) is a well-known U.S. Government
effort to reduce falls in older adults,\5\ there are lacunas
with which the Special Committee could help. Among the
implemented recommendations made by Geriatric medical societies
is the screening of home environments for elements within that
increase the risk of falls in older adults.\6\ However, a
variety of structural factors continue to limit the practice of
basing long term care facility design decisions on empirical
data. While the knowledge is highly translatable, the
mechanisms that support and promote medical research do not
have a parallel in the architecture and construction of
healthcare facilities. Our work promotes a non-regulatory
mechanism for the incorporation of EBD.
---------------------------------------------------------------------------
\5\ Centers for Disease Control and Prevention (CDC). About STEADI.
Published 2024 April 22. Accessed 2025 June 22. https://www.cdc.gov/
steadi/about/index.html
\6\ Centers for Disease Control and Prevention (CDC). Check for
Safety: A Home Fall Prevention Checklist for Older Adults. Published
2017. Accessed 2025 June 22. https://www.cdc.gov/steadi/pdf/steadi-
brochure-checkforsafety-508.pdf
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As healthcare-built environments are studied more,
physicians and architects are understanding the relationship
between design elements and different health outcomes better.
While the interaction can be complex and much remains to be
known, what we do know demonstrates the personal, ethical, and
financial value of action, considering the frequency of falls
in older adults and their cost to the health system and U.S.
Government. For example, a recent study demonstrated that
simply changing lightbulbs in a long-term care home to increase
short-wavelength light during the day and decrease it overnight
decreased falls by 43% compared to a control site.\7\ As
professionals in this area, we continue to observe preventable
harms and the missed opportunities to reduce falls in older
adults. Whether in hospitals, long-term care facilities, or in
home environments, evidence-based practices for fall reduction
are inconsistently and optionally applied. We also see the
benefits of improving environments, often with additional
expertise from our colleagues in Physical and Occupational
Therapy.
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\7\ Grant LK, St Hilaire MA, Heller JP, Heller RA, Lockley SW,
Rahman SA. Impact of Upgraded Lighting on Falls in Care Home Residents.
J Am Med Dir Assoc. 2022;23(10):1698-1704.e2. doi:10.1016/
j.jamda.2022.06.013
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We applaud the Senate Special Committee on Aging's focus on
fall reduction in older adults. As the US population ages, this
topic will become increasingly germane to many Americans and
their loved ones. The potential cost-savings to the federal
government and for families' out-of-pocket expenses by
implementing evidence-based practices to reduce falls in older
adults is immense, in addition to the basic improvement in
older adults' quality of life.
Recommendations
We urge the following specific actions:
Congress should establish an Advisory Committee to
develop a National Falls Prevention Plan and advise CMS to
address falls prevention through home modifications and
mobility-focused interventions. The evidence base is sufficient
to support the proposed pilot program for Medicare coverage of
home modifications when recommended by a medical professional,
to decrease the rates of falls in the home.
The federal government should support ongoing research
into design-based fall reduction strategies. The federal
government has the capacity to study relationships between
health outcomes and design elements due to its access to large
and inter-related datasets. The federal government should
continue to partner with researchers in both academia and
private industry to publicly disseminate research of high
quality.
The federal government's potential investment into built
environment modifications should support interventions
recommended by medical and design professionals who demonstrate
evidence to support their ability to reduce falls. As evidence
grows, the federal government should adjust their reimbursement
based on the recommendations of medical and professionals with
relevant professional experience and minimal conflicts of
interest.
Thank you for the opportunity to provide our views on this
important topic. Our views do not represent those of our
employers but are based on the authority of our respective
professions. We look forward to working with you to reduce the
risk of older adults' falls through evidence-based design
interventions.
Sincerely,
David A. Deemer, MD, MA
Geriatric & Palliative Medicine Fellow
Icahn School of Medicine at Mount Sinai
New York, NY
Diana C. Anderson, MD, M.Arch, FACHA
Geriatric Medicine Physician
Boston University School of Medicine
Boston, MA
Stowe L. Teti, MA, HEC-C
Clinical Ethicist
Inova Fairfax Medical Campus
Woodburn, VA
William J. Hercules, FAIA, FACHA, FACHE
CEO
WJH Health
Orlando, FL
U.S. Senate Special Committee on Aging
"Lessons from the Field: How Sports Medicine can Improve Health
Outcomes for Seniors"
June 25, 2025
Statements for the Record
The Watertown YMCA Statement
I am Michelle Graham, Senior Director of Health and
Wellness at the Watertown Family YMCA. I will briefly share our
work locally and at the state and national level to advance the
health and wellbeing of aging adults.
At the Y, we are committed to strengthening communities by
connecting people of all ages, abilities and backgrounds to
their potential, their purpose and each other. Nationally,
YMCAs engage 17 million Americans annually, and nearly four
million are over age 55, including 2.5 million over age 65.
Older adults make up nearly one-quarter of our members.
In New York State, YMCAs operate in all 62 counties through
140 branches, reaching over 890,000 members each year.
Statewide the Y serves 217,562 older adults. This includes over
13,000 adults and seniors who have found safe housing and
community at the Y and 10,000 who participated in evidence-
based programs focused on preventing and managing chronic
diseases like diabetes, hypertension, and arthritis. Programs
at the Y promote longevity beyond building stronger bodies -our
participants reported feeling emotionally supported and more
socially connected through a sense of belonging.
In the greater Watertown NY area, we reach over 21,000
individuals annually, with almost 1400 visits daily and over
3,500 adults throughout the year.
As a nation, we spend 90% of our health care dollars
treating chronic disease and far too little trying to prevent
disease and injury. At the Y, we know from experience that
investing up front in prevention and control of disease and
injury will save lives and reduce health care spending.
The Watertown YMCA is proud of the role we have played in
delivering evidence-based lifestyle health programs to address
falls and chronic disease that our national resource office -
YMCA of the USA - has worked to scale with public health
partners at CDC and with our state and local health
departments.
Our Y just completed year one of a four-year New York State
YMCA Falls Prevention Initiative led by the Alliance of NYS
YMCAs, which is funded through a federal grant by the
Administration for Community Living. According to CDC, $50
billion is spent annually on medical costs related to older
adult falls each year. And, according to the NYS Department of
Health, falls account for $1.7 billion in hospitalization
charges and $145.3 million in annual outpatient emergency
department charges in the state. Fall injuries are increasing
despite the ability to prevent them.
In year one of the falls prevention funding, NY Ys
supported more than 400 older adults across the state, part of
a larger goal to reach over 2,000 by the end of four years.
This includes the launch of a statewide virtual program to
remove barriers to access, especially in rural communities.
Importantly, the program has delivered powerful outcomes,
including:
50% of older adults in the program report changes in
social isolation and loneliness.
96% reported that they plan to continue participating in
exercise.
80% of participants said they feel more comfortable
talking to their family about falls because of this program.
71% felt more comfortable talking with their health care
provider about falls.
83% report being more satisfied with life because of
this program.
63% made safety modifications to their home because of
the program.
Beyond preventing falls, NYS YMCAs are fostering meaningful
connections, encouraging lifelong habits of active living, and
supporting whole-body health for older adults and this is only
the beginning. Continued funding will sustain and expand this
work, the full impact of which we are only just beginning to
see, toward a vision where more Ys in the state and across the
country can make a difference.
Our Y is also working to address one of the leading drivers
of health care costs diabetes. One in four health care dollars
goes to treat diabetes. If we prevent it, we also avoid serious
and costly complications from the disease, including limb loss,
blindness, and kidney disease. The good news is we know that we
can prevent or delay 58% of diabetes in adults and 71% in older
adults with modest weight loss through the National Diabetes
Prevention Program.
The Y is recognized for its diabetes prevention work with
the Centers for Medicare and Medicaid Innovation. During a
national study, the YMCA s delivered the National Diabetes
Prevention Program to 8,000 Medicare recipients and saved
$2,650 per participant while preventing or delaying diabetes
among the majority of recipients.
Our Y also offers evidence-based physical activity,
nutrition and lifestyle health programs for people living with
arthritis, cancer, hypertension, and childhood obesity. I would
be happy to discuss any of these in more detail with the
Committee.
The Y is deeply concerned about proposals that eliminate
funding for chronic disease and injury prevention and control
programs. We urge Congress to continue supporting funding for
falls prevention among older adults and funding for evidence-
based chronic disease prevention and control programs. Loss of
these dollars will cut deeply into state health department
funding and will eliminate support for most of the programs I
have shared with you today.
Every dollar invested in community-based organizations like
YMCAs organizations with trusted relationships and on-the-
ground credibility have a myriad of important results but let
me leave you with a story about Barb. Barb is a valued member
of our YMCA community and lives alone. While she originally
joined the Y for fitness, she quickly discovered that the Y is
so much more than a gym. Barb now regularly takes part in our
Healthy Aging programs, including Enhance Fitness, Tai Chi for
Arthritis, and Silver Sneakers. Before class, she enjoys
walking the track with the new friends she's made at the Y. In
a recent conversation, Barb shared, "I feel supported and
welcome at the Y. I'm getting stronger and have made so many
new friends. The YMCA has truly changed my life. I look forward
to coming every week."
At the Y, it's not just about physical wellness, it's also
about building social connections and reducing loneliness. We
re honored to have Barb, and others like her, as part of our
community and are proud of the meaningful difference the YMCA
continues to make in their lives.
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