EXPLORE ACT

In a significant milestone for outdoor enthusiasts nationwide, the House of Representatives has passed the groundbreaking EXPLORE Act by a resounding voice vote. This innovative policy package represents a monumental step forward in enhancing outdoor recreation experiences on public lands and waters across the United States. 

Crafted as a bipartisan effort, the EXPLORE Act, championed by Congressman Westerman (R-AR) and Congressman Grijalva (D-AZ), Chair and Ranking Member of the House Natural Resources Committee, sets a precedent in prioritizing the management and utilization of public lands and waters for recreational purposes. It offers a comprehensive framework for maximizing the potential of these spaces to enrich outdoor experiences. 

Key Highlights of the EXPLORE Act: 

• Biking on Long Distance Trails Act (BOLT): A pivotal initiative aimed at fostering sustainable long-distance mountain biking trails, facilitating collaboration between land management agencies, mountain bikers, and stakeholders to promote trail development. 

• Protecting America’s Rock Climbing Act (PARC): Recognizing the historical significance of rock climbing in the U.S., this act safeguards climbing in Wilderness areas, providing clarity and guidance on fixed anchor placements to preserve access for climbers. 

• Simplifying Outdoor Access for Recreation Act (SOAR): Addressing long-standing challenges in recreational permitting, the SOAR Act modernizes and streamlines the permitting process for outfitters and guides, enhancing accessibility to outdoor adventures. 

• Permanence of FICOR: The EXPLORE Act enshrines the Federal Interagency Council on Outdoor Recreation (FICOR) as a permanent entity, facilitating coordination among land managers and prioritizing initiatives to expand outdoor recreation opportunities. 

The passage of the EXPLORE Act heralds a new era of collaboration and innovation in outdoor recreation policy. It is expected that the Senate will take up a similar piece of legislation in the coming weeks. 

PRESIDENT’S FY 2025 BUDGET 

President Biden unveiled his proposed budget for the fiscal year 2025 to Congress on March 11, 2024. 

Among the highlights, the National Institutes of Health (NIH) would receive a program level of $50.1 billion, with an additional $1.5 billion designated for the Advanced Research Projects Agency for Health (ARPA-H), bringing the total program level to $51.6 billion. This allocation aims to support NIH's mission of translating biomedical research discoveries into tangible health benefits for all. 

The budget request includes discretionary budget authority of $46.4 billion, with an additional $83 million earmarked for Superfund research activities. Notably, nearly $2.02 billion of the NIH's total request stems from Program Evaluation financing, while an additional $1.71 billion is allocated as mandatory resources for special initiatives such as type 1 Diabetes and Cancer Moonshot research. The NIH seeks to bridge the gap between laboratories, clinics, and communities, ensuring that collected data is utilized ethically and effectively to enhance public health. 

The National Science Foundation (NSF) is allocated $10.183 billion in the proposed budget, significantly lower than the FY 2025 authorization level of $16.7 billion outlined in the CHIPS and Science Act, 2022. Meanwhile, the Department of Energy Office of Science is allocated $8.583 billion. 

Congress has initiated hearings with agency officials to review the proposed budget, with further discussions scheduled throughout April and May. These deliberations will culminate in House and Senate Appropriations Committee consideration of FY 2025 spending bills, ultimately determining funding levels for each agency and program. 

ATIIP FY25 BUDGET 

ACSM recently signed onto this letter, sponsored by Rails to Trails. The letter will be sent to the House and Senate Appropriations Committee Chairs and Ranking Members. 

Dear Chair and Ranking Member: 

The undersigned organizations respectfully request your support for the Active Transportation Infrastructure Investment Program (ATIIP) in the FY25 budget at the $200 million level as authorized in the Infrastructure Investment and Jobs Act (IIJA). 

IIJA established policies and programs aimed at developing a transportation system that is safer, more sustainable and equitable, providing broader access to economic opportunities. To realize these goals, a key piece of unfinished business for IIJA has been the failure to fully fund ATIIP. ATIIP is a unique and essential new program designed to leverage existing infrastructure to connect people to the places they need to go, by foot and bicycle. The novel approach maximizes return on investment and ensures that the mobility and economic needs of urban, suburban and rural areas are each addressed by investing in facilities connecting within and between communities. 

Localities nationwide have ambitious plans to close gaps in active transportation infrastructure to make it safe and convenient to walk and bike to destinations, an economic imperative for some people and a healthy and sustainable choice for all. Realizing these plans is dependent upon an expanded and reliable financial partnership among federal, state, local and tribal levels of government. A recent poll from Rails to Trails Conservancy found strong support for improved infrastructure for walking and biking with a focus on dedicated rights-of-way for active travel. This sentiment is shared across the political spectrum. 

The demand for dedicated funding to expand active transportation networks far exceeds current allocations under existing federal programs, as evidenced by the high volume of quality active transportation applications to discretionary programs that remain unfunded. A commitment to fully appropriate ATIIP at its $200 million authorized level would signify a decisive step toward achieving IIJA's goals. This view is shared by many organizations and coalitions that have circulated letters requesting funding for this program among others, including Transportation for America, the Transportation Equity Caucus and the National Campaign for Transit Justice. 

As the FY 2025 appropriations process unfolds, we appeal to your leadership to provide additional funding to accommodate the 302b allocation process so that ATIIP can be funded at its intended $200 million level. Such an investment would not only advance the national goals outlined in the IIJA but also reflect a commitment to a future where active transportation is a safe, accessible and equitable option for all Americans. 

Sincerely, 

There is little doubt that our brain changes as we age, with changes in structure that contribute to cognitive decline over time. However, the degree of change is highly variable across individuals in terms of its onset, rate and magnitude. How should we behave, and what should we change to ensure that our brains stay healthy longer? This question of what keeps our brains functioning well is one that should have clear meaning and personal implications for all of us. 

In our recent study of 485 cognitively normal older adults, we explored this question in detail through machine-learning analyses that use MRI to look at hundreds of structural features across the brain to compute a “BrainAge.” This is then compared to the number of years the individual has been alive to determine if the brain is younger than expected based on the chronological age. We found that, compared to a control, a six-month exercise intervention was effective at improving cardiovascular fitness and elicited beneficial changes in body composition, mostly in the form of increased lean tissue. But surprisingly, changes in BrainAge over the course of the study were minimal and not related to increased fitness, higher levels of physical activity or changes in sleep. Our findings suggest you cannot exercise your way to a younger brain. 

It is worth noting that across our entire cohort, there were individuals who had substantial weight loss, including large amounts of visceral fat. Perhaps individuals who enrolled in our study were motivated to change their lives, or maybe our active control group specifically contributed meaningful lifestyle changes. When we evaluated changes in BrainAge independent of group assignment, we found that changes in fatness, particularly visceral fatness, led to meaningful changes in BrainAge. Individuals who lost visceral fat had brains that were aging more slowly — both compared to others with more visceral fat and in terms of the number of months that had passed. Eureka! We have found the solution to the aging brain: Try to get rid of excess weight and keep it off! 

This is of course overly simplistic, as there is no single answer to the challenges of maintaining health over our lifetimes, particularly as we examine something as complex as the brain. However, when our findings are combined with other evidence linking central obesity (in the form of waist circumference) to declines across multiple biological systems, it is clear that being overfat is particularly harmful to health, in both the short and long term. 

Given the many important positive changes that occur with improved fitness and increased physical activity, it is tempting to view these as a “fix-everything” solution. This may be particularly true for those of us promoting Exercise Is Medicine^®. Encouraging exercise and physical activity to promote health is critical, but there should also be a strong focus on maintaining a healthy body composition, particularly for successful aging and long-term health, including the health of the brain. As such, it is worthwhile to consider and promote the role of “Exercise and Food as Medicine” as we seek to better understand health across multiple complex and interconnected systems. 

David Wing, M.S., is the senior manager of the Exercise and Physical Activity Resource Center at the University of California San Diego, where he oversees all aspects of its day-to-day operation. He is also instrumental in design, delivery and dissemination of multiple research studies and educational initiatives. Mr. Wing is completing his Ph.D. at Vrije University Brussels with a focus on the role of fitness, physical activity and body composition on brain health and aging. He is passionate about Exercise Is Medicine® and works with both public health and medical professionals to ensure that physical activity is included as a vital sign and every “patient” is recognized as an athlete. 

Viewpoints presented in ACSM Bulletin commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic must disclose such relationships at the time they accept an invitation to write for the ACSM Bulletin. 

The American College of Sports Medicine (ACSM)’s journal, Exercise and Sport Sciences Reviews (ESSR), awarded the “2023 Paper of the Year” designation to Sex Differences in Athletic Performance: Perspectives on Transgender Athletes (Volume 51, July 2023), collaborated on by authors Natalie J. Nokoff, Jonathan Senefeld, Csilla Krausz, Sandra Hunter, and Michael Joyner.  

The manuscript provides an overview of sex-based differences in individual sports performance that arise at the onset of puberty, primarily because of the hormone testosterone. The authors consider perspectives related to transgender athletes, including facets of medical transition and hormone therapies, and conclude that there is demand for broadened research related to the implications of testosterone on sports performance among cis- and trans-gender individuals. Confused about the terminology? This Perspectives for Progress provides a table of terminologies and their definitions (adapted from the Endocrine Society Guidelines, 2017). The inclusion of Table 1 makes the paper a fair starting place on the topic of sex differences in the context of physiology and motor performance. 

In addition to recognizing that the taxonomy of these topics may not be known or consistent among readers, the authors provide a short overview on the history of policies regulating sex verification in elite sports, cumulating with the International Olympic Committee (IOC)’s most recent recommendations (2021), which are broad and defer regulatory power to the governing bodies of individual sports. No doubt, the policies that are adopted within individual sports may vary and will likely be interpreted differently, which is something I consider as a university educator who may come across a paper like this in my classroom. 

The incorporation of journal club questions can help guide conversations in classrooms, no matter the format in which they are conducted, if at all. Often, they can help guide discussion on a piece of literature as relevant to the basic science the course is likely focused on (e.g., applied human physiology or exercise science). Guiding the thought process through questions like those that can be provided through a journal club is a reasonable solution to not imposing personal beliefs and letting the science direct the conversation, whether internally or aloud. Perhaps needless to state, it is important to provide students with the option to keep their perspectives private (a.k.a., not mandate they share their opinions). Beyond journal club questions, ESSR provides other free supplemental material for certain manuscripts, such as video abstracts and visual abstracts. This year’s honored paper does include journal club questions, which educators can download from the ESSR page to integrate into their classrooms. Integrating research articles, especially review papers, is an excellent mode to teach students curriculum content while developing their professional research skills. 

Again, a big congratulations to the authors for the selection of their article as the ESSR 2023 Paper of the Year! ESSR’s paper of the year will be honored at ACSM’s Annual Meeting held May 28-31, 2024 in Boston, Massachusetts, USA in a session on May 31, 2024 3:45-5:45 PM local time welcoming the organization’s journals and authors of each journal’s featured paper.   

Diba Mani, Ph.D., is an Instructional Associate Professor in the Department of Applied Physiology & Kinesiology at the University of Florida. She serves as the Digital Editor for Exercise and Sport Sciences Reviews. She earned her degrees under the mentorship of Dr. Roger Enoka in the Neurophysiology of Movement Laboratory at the University of Colorado. Her doctoral dissertation focused on evaluating the effects of electrical nerve stimulation on motor unit discharge properties and mobility in young and older adults. Dr. Mani most enjoys the human component of any work she is engaging in, be it research in the field of geriatrics or teaching college students in the classroom. Dr. Mani is an international judo referee and coach, and a regular vinyasa yoga practitioner. She is passionate about internationalization in the STEM courses, as implemented through experiences such as virtual exchange and study abroad. 

The field of exercise and cancer (exercise oncology) has a long history. In 1911, findings were published documenting that being more physically active was associated with lower risk of colon cancer. Throughout the 20th century, animal model experiments repeatedly showed that exercise slowed tumor growth. In the late 1980s, Winningham and MacVicar carried out the first human clinical trials of exercise and cancer, documenting benefits on body composition and quality of life. In 1996, the first review in the field of exercise oncology was conducted by Friedenreich and Courneya, and in 2005, the first meta-analysis was published, by Schmitz et al., that identified 22 high quality randomized controlled trials. The American College of Sports Medicine^® (ACSM) published the first roundtable guidelines for exercise in cancer survivors in 2010, initiating 14 years of exponential growth in the field of exercise oncology. By the time the second roundtable guidelines for exercise in cancer survivors were published in 2019, there had been a 281% increase in the number of published randomized controlled trials in this area. A current search of PubMed indicates there are over 2,600 exercise oncology randomized controlled trials in humans and over 15,000 peer-reviewed scientific publications (including animal model research and observational studies). The American Cancer Society and the American Society of Clinical Oncology both published guidelines in 2022 echoing the advice from ACSM that exercise mitigates common cancer symptoms and treatment side effects, as well as helps to prevent the development and recurrence of cancer. More research is certainly needed to better understand the mechanisms by which exercise may improve cancer-related outcomes. But how should exercise be implemented in oncology settings? 

ACSM started a new disease-specific initiative in 2019 under the umbrella of Exercise Is Medicine^® called Moving Through Cancer. This initiative has a bold goal of making exercise the standard of care in oncology settings by 2029. Activities to this point include policy proposals (including the submission of a National Coverage Determination application in March 2024), stakeholder awareness resources (including brochure and movie), workforce development resources (including development of the revised ACSM-ACS Cancer Exercise Specialist Course), program development (including registry of exercise oncology programs across the United States and beyond) and research and evaluation activities (including a Medicare pilot study). 

One observation from many in the field of exercise oncology is that there is not an overarching organizational home for those who work in this field. A review of recent sports medicine annual meetings reveals less than 20 hours of exercise oncology-focused programming to be the norm. The small amount of exercise oncology content at such meetings does not reflect the progress in the field, the volume of work ongoing scientifically or the rise in the clinical practice of exercise oncology. There is real concern that this may constrain development of the field. Might it be time for a new scientific organization focused exclusively on exercise oncology? 

A critical preconference planning meeting has been set for May 28, 2024, in advance of the ACSM annual meeting in Boston, to discuss the formation of the International Society of Exercise Oncology. The purpose of this society would be to create a central hub for the growing exercise oncology community, including exercise oncology researchers, clinicians, exercise professionals with specialty training in cancer, trainees, people living with and beyond cancer and potential sponsors. The meeting will feature panel discussions on multidisciplinary and international perspectives regarding the future of exercise oncology and audience insights and opinions will be encouraged. We welcome all to attend and be part of this critical movement in exercise oncology. ACSM annual meeting attendees can register as a supplement to the annual meeting registration. 

Kathryn Schmitz, Ph.D., MPH, FACSM, is a professor of medicine at the University of Pittsburgh School of Medicine. She serves as associate director of population science and co-leader of the Biobehavioral Cancer Control Program for the UPMC Hillman Cancer Center. Dr. Schmitz is the founder of ACSM’s Moving Through Cancer initiative, which has a bold goal of making exercise a standard of care in the setting of oncology by 2029. She is a past president of ACSM and the recipient of the prestigious Citation Award from ACSM, the Distinguished Scientist Award from the Society of Behavioral Medicine, an honorary fellowship from the Faculty of Sport and Exercise Medicine U.K., and the American Cancer Society’s Clinical Research Professorship. 

Allison Betof Warner, M.D., Ph.D., is an assistant professor of medicine (oncology), director of the Melanoma Program, director of Solid Tumor Cellular Therapy, and Mark & Mary Stevens Endowed Scholar in Melanoma at Stanford Cancer Institute. Dr. Betof’s laboratory focuses on modulating tumor microenvironment to overcome resistance to immunotherapy. A large focus of her work is on immunomodulatory effects of exercise, and her lab utilizes preclinical models to study how exercise may enhance anti-tumor immunity. She is the principal investigator of clinical trials exploring novel treatments for immunotherapy-refractory melanoma and is internationally recognized for her expertise in brain/CNS metastasis and the use of novel cellular therapies. 

Karen Wonders, Ph.D., FACSM, is the founder and CEO of Maple Tree Cancer Alliance and professor/program director of exercise physiology at Wright State University. Her passion is to advocate for exercise as part of the national standard of care for cancer. Her nonprofit organization (Maple Tree) provides free exercise training to thousands of cancer survivors every month at 65 clinical locations across the United States. An avid researcher, Dr. Wonders is committed to evidence-based practice in her facilities and leads a robust research program on exercise and cancer recovery. Dr. Wonders has given numerous professional presentations, including a talk at TEDxDayton on Exercising through Cancer Care. 

Viewpoints presented in ACSM Bulletin commentaries reflect opinions of the authors and do not necessarily represent positions or policies of ACSM. Active Voice authors who have received financial or other considerations from a commercial entity associated with their topic must disclose such relationships at the time they accept an invitation to write for the ACSM Bulletin.