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  • Key Policies Shaping U.S. Governance in 2025

    by Greg Margason | Jan 14, 2025

    Extending Federal Funding Through March 14, 2025

    On Dec. 20, 2024, the U.S. Congress passed a Continuing Resolution (CR), H.R. 10545, to extend federal funding and avert a government shutdown through March 14, 2025. The bipartisan measure maintains government operations at current funding levels and includes several key provisions:  

    • Disaster assistance. Allocates over $110 billion for disaster relief efforts across various states, including North Carolina, Georgia, Florida, Oklahoma and regions in the Western United States.   

    • Farm Bill extension. Provides a one-year extension of the Farm Bill, ensuring continued support for agriculture and food policy programs.   

    • Medicaid funding. Allocates $27.1 million to address Medicaid funding shortfalls for the Commonwealth of the Northern Mariana Islands (CNMI).   

    The CR also upholds existing policy provisions, including pro-life and Second Amendment protections. The House approved the resolution with a 366-34 vote, and the Senate followed with an 85-11 vote. President Biden signed the bill into law on Dec. 21, 2024, ensuring the continuation of federal government operations into the new year.   

    House Budget Committee 10-Year Plan

    On Jan. 10, 2025, the House Budget Committee unveiled a 10-year fiscal plan focused on balancing the federal budget, reducing deficits and enhancing economic stability. The blueprint aims to achieve a balanced budget within a decade by cutting deficits by $14.2 trillion and lowering the debt-to-GDP ratio by over 40 percentage points compared to current forecasts. Key to this plan is a reduction in discretionary spending, expected to save $2.5 trillion over the next 10 years. 

    A major portion of the savings comes from health-related reforms, with $8.7 trillion in mandatory spending reductions planned. For Medicare, the proposal targets $486 billion in savings by enhancing efficiency, primarily through site-neutral payments that standardize government reimbursement rates regardless of the health care setting. The plan also addresses hospital uncompensated care payments, bad debt and graduate medical education (GME) funding. Additionally, it proposes dismantling the Inflation Reduction Act (IRA) and scaling back enhanced Affordable Care Act (ACA) subsidies. 

    In Medicaid, the Committee seeks $2.2 trillion in savings by offering states more flexibility and implementing per-capita caps to control federal spending based on the number of enrollees. The plan introduces work requirements for able-bodied adults and aims to standardize the Federal Medical Assistance Percentage (FMAP) for Medicaid expansion, ending the higher federal reimbursement rates for states that expanded Medicaid. It also proposes blocking certain eligibility rule changes and eliminating special FMAP treatment for Washington, D.C. 

    Beyond health care, the plan includes measures to reduce waste and fraud, and to promote economic growth. It targets a 50% reduction in improper payments, anticipated to save $1 trillion over the next decade, through improved data sharing and stricter eligibility verification. Additionally, welfare reforms are expected to save $800 billion by tightening work requirements for Medicaid and food assistance programs and revising the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF). 

    Expected Changes from the Senate Finance Committee

    On Jan. 7, 2025, Senator Mike Crapo (R-ID) was appointed chairman of the Senate Finance Committee for the 119th Congress, a pivotal role overseeing over half of the federal budget. The Committee’s jurisdiction includes federal tax policy; social safety net programs; and health care initiatives such as Social Security, Medicare, and Medicaid, as well as the implementation of foreign trade agreements. In a press release, Chairman Crapo outlined his priorities, focusing on expanding access to affordable health care, promoting pro-growth tax policies and enhancing U.S. competitiveness in global trade. 

    Key health care initiatives include improving primary and chronic care management by stabilizing and streamlining clinician payments, encouraging alternative payment models and expanding chronic care benefits under Medicare. Chairman Crapo highlighted efforts to improve rural health care access, enhance telehealth and mental health services, and prevent rural hospital closures. He also called for reforms in the pharmacy benefit management (PBM) system to lower consumer costs and support financial stability for pharmacies. 

    The committee aims to modernize Medicare’s prescription drug benefits to achieve savings for both patients and taxpayers. Additionally, Chairman Crapo emphasized the importance of maintaining U.S. leadership in biopharmaceutical innovation, particularly in the face of growing competition from countries like China. He also stated that the committee will closely review the Inflation Reduction Act (IRA) and work to mitigate its potential adverse effects on patients, innovators and taxpayers. 

    ACSM’s Moving Through Cancer Recognized by White House 

    With a vision to bring renewed leadership to the fight against cancer, a White House initiative called the Cancer Moonshot facilitates new collaborations that drive progress across the cancer journey using all facets of the oncology community. One strategy is mobilizing the scientific community, and ACSM is answering the call. 

    ACSM’s Moving Through Cancer Program, part of the Exercise is Medicine® initiative, was recognized by the White House Cancer Moonshot for its notable work mapping exercise oncology program availability in the U.S., identifying disparities and publishing clinical guidelines recommending exercise to improve symptoms and treatment outcomes for people living with cancer. The White House also highlighted Moving Through Cancer efforts to develop a toolkit and course to integrate exercise programming at the University of Pittsburgh Center for Teaching and Learning. 

    Read the White House statement

  • Active Voice | Symptoms and Cognition in Female Collision Sport Athletes

    by Greg Margason | Jan 07, 2025
    Symptoms and Cognition in Female Collision Sport Athletes

    Since the enactment of Title IX in 1972, the number of girls participating in high school athletics has tripled, with the greatest increases appearing in contact and collision sports. Despite this increase in sports participation, female athletes remain underrepresented in studies of sport-related brain trauma. With fewer true collision sports available for female athletes, previous research has focused heavily on male athletes. However, in sex-comparable sports, female athletes are often found to be at greater risk for certain injuries than their male counterparts — particularly non-contact ACL tears, ankle injuries and concussions — so there is a critical need to assess sex differences in the vastly understudied population of female collision sport athletes.

    Data from the Massachusetts Concussion Management Coalition (MCMC) allowed for the examination of thousands of computerized neurocognitive tests in a cohort of adolescent athletes across a variety of sports, including a unique subsample of female collision sport athletes. As presented in the January 2025 issue of Medicine & Science in Sports & Exercise®, our cross-sectional study included 75,128 female high school athletes: 24,448 in noncontact sports, 50,407 in contact sports, and 273 in collision sports. Collision sport athletes reported significantly more concussion symptoms at baseline (9.81 ± 12.63) compared to those in contact and noncontact sports (5.78 ± 9.25 and 6.39 ± 9.74, respectively). Conversely, female collision sport athletes had similar neurocognitive performance to those participating in noncontact sports in all composite scores.

    Collision sports in our study consisted of football, boxing, other martial arts and rugby. We were cognizant that rugby, with essentially the same rules for both sexes, may be the only true collision team sport in our cohort as female football players in our cohort may have played lower contact positions (e.g., kicker) and that females pursuing martial arts may do so without sparring or competing. Therefore, we ran a secondary analysis using only rugby players in the collision sport group, which confirmed our original findings of increased baseline symptoms and similar neurocognitive performance of collision sport athletes compared to noncontact sport athletes.

    Though our study found no indication of clinically significant cognitive impairments in adolescent female collision sport athletes compared to noncontact sport athletes, future longitudinal studies are necessary to examine the ramifications of collision sports participation on the female brain over time. The potential long-term effects of sport-related brain trauma (e.g., risk of chronic traumatic encephalopathy, or “CTE”) are a significant concern for athletes at all levels, but the current literature is developing and remains mixed. Regardless of the inconclusive findings surrounding long-term damage, these studies have been conducted mostly in male athletes, once again highlighting the need to study female athletes separately.

    As the number of female athletes participating in collision and combat sports increases, our study is reassuring, suggesting that in the short term at least, it appears that participating in these sports seems to have no significant effect on cognition.  


     


    Jessie R. Oldham, PhD, is an assistant professor in the Department of Physical Medicine and Rehabilitation at the Virginia Commonwealth University (VCU) School of Medicine and co-director of the Research in Athlete & Military Health Science (RAMHS) Lab. She is also affiliate faculty in the VCU Institute for Women’s Health and co-director of the Female Athlete Research Development Group. She is a National Institutes of Health Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) scholar with her K12 proposal, titled “Sex Differences in Post-Concussion Psychophysiological Dysfunction and Subsequent Musculoskeletal Injury.” She has been a member of the American College of Sports Medicine® (ACSM) for 12 years.  

     

    William P. Meehan III, MD, is a professor of pediatrics and orthopedics at Harvard Medical School and director of research for the Brain Injury Center at Boston Children’s Hospital. He also serves as director of The Micheli Center for Sports Injury Prevention and is principal investigator of the Neurologic Function across the Lifespan: A LONGitudinal, Translational Study for Former National Football League Players (NFL-LONG) study. He is an active member of ACSM.   

  • Hot Topic | Personalized Fitness Plans via Mobile Health Technology

    by Greg Margason | Dec 18, 2024

    As you look around your home, you may spot devices like smartphones, tablets, smart TVs or even fitness tools like a smart gym, a smart soccer ball, or a virtual reality exercise bike. These devices not only keep us connected or entertained but also transform how we approach health and fitness. Moreover, these fall under mobile health (mHealth), defined as the integration of mobile health technologies with advancements in smart sensors, 5G communication systems, Web 2.0 functionalities, cloud computing and social networking technologies, all aimed at delivering personalized, client-centered health care services. mHealth has made integrating healthy habits into daily life easier and more accessible than ever before. 

    Wearable Technologies 

    In the United Sates, most adults don’t meet the recommended 150 minutes of moderate-to-vigorous physical activity per week. Studies often highlight the potential of wearables and apps for promoting physical activity. Wearables like Apple or Garmin watches and associated apps can help track physical activity, sleep and calories burned in real time, which could be foundational to motivate users to set and achieve health goals. Fitness trackers and apps, for example, can help users stay engaged with their goals, optimize health outcomes by motivating sustainable behavior changes, and offer scalable, cost-effective solutions. 

    Artificial Intelligence (AI) 

    mHealth and wearable technologies are increasingly leveraging AI and big data to create personalized fitness plans tailored to individual needs, such as daily activity levels, sleep, mood and body weight. By the end of this decade, the AI market is expected to grow exponentially, influencing everything from medical diagnoses to fitness tracking. Fitness apparatuses such as Tonal and smart mirrors are AI-driven devices that offer personalized fitness plans for home use. Fitness apps integrated with wearables like Fitbit use AI to personalize exercise prescriptions. For example, certain apps combine real-time activity data, physical condition and user preferences to create tailored workout plans. By leveraging reinforcement learning or deep learning, AI-driven technologies can provide dynamic feedback, helping users stay motivated and consistent.

    Virtual and Augmented Reality 

    Virtual reality (VR) and augmented reality (AR) are among the most exciting technologies in health promotion. VR creates fully immersive digital environments, whereas AR overlays virtual elements onto the real world. Games like FitXR, Supernatural Fitness, Pokémon Go and Zombies Run have shown how these tools can encourage physical activity through fun, engaging experiences. While still in their early stages, VR and AR, with their interactive features and components, are set to revolutionize fitness and health promotion, blending entertainment with movement to help people stay active. 

    Health Hubs 

    Health promotion, however, isn’t limited to individual devices. Digital health hubs are emerging as a complement to traditional fitness clubs. These encompass key components such as designing and implementing training programs, tracking client progress, managing nutrition, enabling in-app payments, engaging clients and offering rewards. Apps like BetterYou and Virgin Pulse exemplify this approach by creating comprehensive platforms where users can set health goals, track progress, participate in group challenges and receive incentives for achieving wellness milestones. 

    For example, BetterYou collaborates with institutions like the University of Tennessee, Knoxville, to integrate with other apps, engage employees and provide a centralized platform for tracking wellness habits. Similarly, Virgin Pulse partners with organizations and universities like the University of Minnesota and Arizona State University to access to employer-provided fitness and wellness resources, offer features such as fitness and wellness tracking, and facilitate personalized health consultations (e.g., health coaching, nutrition coaching). It also provides monetary rewards for completing a specific number of gym visits per month and compensation in health care credits for achieving annual points-based goals provided by health insurance companies. These platforms not only enhance accountability but also motivate users through personalized health management and tangible rewards. 

    Building a Healthier Future 

    While emerging technology offers new ways to promote physical activity and health, challenges remain. Hundreds of wearables and apps are available, but their long-term effectiveness is still under study. Questions linger about how well these mHealth programs help users increase physical activity, lose weight or sustain fitness goals over time. Scalability may be limited and driven by large corporations, and safety and cybersecurity are critical issues that must still be resolved. Importantly, technology alone cannot drive behavior change. Successful implementation depends on thoughtful program design, collaboration among health professionals with end users and removal of barriers like cost and accessibility. 

    mHealth and its innovations align with a broader shift in health care from reactive treatment to preventive care. By leveraging the “Internet of Health Things” like wearables, apps, AI and VR/AR, health professionals can proactively monitor and optimize clients’ physical activity and overall well-being. Real-time data allow for personalized fitness plans and early interventions, potentially preventing the onset of chronic disease or slowing their progression. 

    The integration of emerging technologies in fitness and health holds immense promise. By combining fitness wearables, mobile apps, AI and VR/AR, we can create mHealth programs that encourage more active lifestyles, reduce sedentary behavior and improve long-term health outcomes. However, to fully harness their potential, these tools must be thoughtfully designed, accessible and supported by strong partnerships across industries, researchers and end user communities. 

    As technology continues to advance, it offers unprecedented opportunities to transform physical activity promotion. When implemented effectively, the mHealth programs can empower individuals to lead more active lives, creating a healthier and more connected global population. 

    Zang Gao

     

    Zan Gao, PhD, FACSM, is the department head and professor in the Department of Kinesiology, Recreation, and Sport Studies at the University of Tennessee, Knoxville, where he also directs the Physical Activity Epidemiology Laboratory. He is a member of the ACSM’s Diversity Action Committee and an internationally recognized expert on lifestyle behavior interventions using emerging technologies, including VR, fitness wearables and mobile apps. Dr. Gao has authored or co-authored over 200 peer-reviewed journal articles and book chapters and published an edited book titled Technology in Promoting Physical Activity and Health. He is a fellow of the National Academy of Kinesiology and the co-founder of a mobile technology company developing the precision exercise prescription app sFitRx. 

    Fang Yu

     

    Fang Yu, PhD, is a professor, Edson Chair in Dementia Translational Nursing Science, and director of the Roybal Center for Older Adults Living Alone with Cognitive Decline at Arizona State University’s Edson College of Nursing and Health Innovation. Her research focuses on exercise and lifestyle interventions to prevent and treat Alzheimer’s disease and fosters the training and education of students, postdocs and faculty. Her research findings have been broadly disseminated via journals and a book titled Alzheimer’s Rx: Aerobic Exercise. Dr. Yu is a fellow of the Gerontological Society of the America and the American Academy of Nursing. 

  • Policy Corner: Trump Nominees & Congress’s Lame Duck Session

    by Greg Margason | Dec 17, 2024

    The recent elections underscored the nation’s ongoing political divisions while highlighting key trends and shifts in voter priorities. Across the country, voters turned out to decide pivotal races for Congress, state legislatures and local offices, as well as ballot measures addressing issues like abortion rights, economic policy and voting access. 

    Trump nominees

    President-Elect Donald Trump has continued to announce nominations for his incoming administration — including his picks for HHS secretary, CDC director, NIH director, FDA commissioner and surgeon general: 

    • HHS secretary nominee Robert Kennedy Jr. is an American environmental attorney, author and political activist known for his work on environmental and public health issues. Kennedy has become a controversial figure due to his opposition to vaccines and public health mandates, citing concerns about safety and government overreach. 
    • CDC director nominee Dr. David Weldon, a practicing internist and former U.S. representative from Florida, has previously sponsored legislation aimed at expanding vaccine safety research and has been a vocal advocate for transparency in public health policy. His nomination aligns with the administration’s focus on reforming federal health agencies.
    • NIH director nominee Dr. Jay Bhattacharya, a professor of medicine and economics at Stanford University, gained prominence during the COVID-19 pandemic for advocating focused protection strategies and co-authoring the Great Barrington Declaration, which called for fewer lockdowns and a pandemic strategy centered on focused herd immunity. His research spans public health policy, the economics of aging and global health.
    • FDA commissioner nominee Dr. Marty Makary, a Johns Hopkins surgeon and public health researcher, has called for greater transparency in regulatory decisions and has expressed concerns about vaccine mandates, emphasizing a data-driven approach to public health. His focus includes reducing regulatory burdens and encouraging innovation in health care.
    • Surgeon general nominee Dr. Janette Nesheiwat, medical director at CityMD and a regular media commentator on Fox News, has been an advocate for preventive care and patient education, supporting COVID-19 vaccines while opposing mandates. Her experience in urgent care and public health communication is expected to shape her approach to the role. 

    Lame Duck Congress

    Congressional leaders in the House and Senate are working to negotiate a funding agreement to prevent a government shutdown as Fiscal Year (FY) 2025; funding is set to expire on Dec. 20, 2024. With the deadline fast approaching, a temporary funding measure known as a continuing resolution (CR) appears increasingly likely. This CR would likely extend federal funding into February or March 2025. 

    Additionally, the CR is expected to include a supplemental disaster aid package. While the Biden administration has requested $98.6 billion for disaster relief, Speaker Mike Johnson (R-LA) faces pressure from some members of his party to either reduce this amount or include cost-offsetting policy changes, leaving the final funding level uncertain.  

    Several key health programs are also set to expire by the end of the year if not addressed in the funding package. These include: 

    • Medicare telehealth flexibilities, 
    • The Medicare Acute Hospital Care at Home (AHCAH) program,
    • The Medicare Dependent Hospital (MDH) and Low Volume Hospital (LVH) programs,
    • The Teaching Health Center Graduate Medical Education (THCGME) program,
    • The National Health Service Corps (NHSC),
    • The Pandemic and All-Hazards Preparedness Act (PAHPA) programs, and
    • The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) programs.

    In addition, unless Congress acts, a 2.83% cut to the Medicare Physician Fee Schedule (PFS) conversion factor is set to take effect in 2025. Bipartisan and bicameral efforts are underway to urge leadership to address these program expirations and the looming PFS cut as part of any year-end legislative package.  

     

    New CMS Framework on Care  

     

    On Dec. 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released a new health care delivery framework entitled Optimizing Care Delivery: A Framework for Improving the Health Care Experience. The report outlines CMS’s five-year strategy to address administrative burdens and other frictions in the health care system with the goal of improving the care experience for patients, clinicians and other stakeholders. According to the report, these burdens limit timely access to quality care, contribute to workforce challenges and exacerbate health disparities.  

    The framework introduces a set of seven strategic priorities to guide CMS’s efforts in enhancing the delivery of care and the overall health care experience. 

    • Priority 1: Integrate the voice of the patient and caregiver into opportunities to increase equity in care access and delivery.  
    • Priority 2: Improve patient safety and reduce administrative burden in care transitions. 
    • Priority 3: Address well-being and experience for health care workers across the health care enterprise. 
    • Priority 4: Improve care-approval processes to increase access to care and reduce care delays. 
    • Priority 5: Reduce redundant or outdated data collection, documentation and reporting requirements. 
    • Priority 6: Leverage technology to accelerate innovation and the adoption of best practices. 
    • Priority 7: Convene and support public-private partnerships to advance the health care experience and burden-reduction efforts.  

    View the Framework

  • Active Voice | Diving into Health: Aquatic HIIT for Older Women

    by Greg Margason | Dec 10, 2024

    Aquatic HIIT for older womenRecent public health guidelines emphasize the importance of high-intensity interval training (HIIT) as an effective strategy for improving cardiometabolic health, particularly among older adults. While land-based HIIT (L-HIIT) has gained popularity, it may not be the best fit for everyone, especially elderly individuals struggling with deconditioning and joint issues. This is where aquatic high-intensity interval training (AHIIT) comes into play, leveraging the unique properties of water to provide a safer and more effective exercise option. 

    One of the standout forms of AHIIT is deep-water running (AHIIT-DWR), which uses flotation devices to allow seniors to engage in high-intensity workouts without the stress of weight-bearing exercises. This can significantly enhance exercise compliance among older adults who might otherwise be hesitant to participate in more strenuous physical activities. The buoyancy of water reduces the impact on joints, making it easier for seniors to maintain a consistent exercise routine. As we age, maintaining aerobic capacity becomes crucial for overall health, especially for older women who often face heightened health risks, including cardiovascular disease and metabolic disorders. Engaging in higher-intensity training is essential for mitigating these risks, and incorporating AHIIT into exercise regimens can provide older adults with the necessary intensity to achieve these benefits. 

    Our study, published in the November 2024 issue of Medicine & Science in Sports & Exercise®, sought to address this. We asked 70 inactive elderly women to participate in a randomized controlled trial comparing AHIIT-DWR and LHIIT over eight weeks. Participants were carefully screened and assigned to one of the two groups (AHIIT-DWR and LHIIT, respectively), both engaging in 30-minute sessions twice a week that included warm-ups, HIIT intervals and cool-downs. The AHIIT-DWR group focused on two-minute running intervals at 80% of heart rate reserve (HRR), whereas the LHIIT group utilized treadmill running. 

    Both groups showed significant improvements in cardiorespiratory fitness, with AHIIT-DWR participants experiencing greater enhancements in relative VO2. Furthermore, our results indicate that both groups had reductions in triglyceride levels, underscoring the effectiveness of both training modalities in promoting cardiometabolic health. Interestingly, no significant differences in enjoyment or self-efficacy were reported between the two groups, indicating that both AHIIT-DWR and LHIIT resonate well with participants. It was surprising that equal participation rates were noted for both interventions, highlighting their potential for long-term engagement in physical activity. While preparing to go to a pool may seem more difficult than getting ready for a run, the high adherence could be attributed to the availability of reliable public transportation in the area, making access to the pool more convenient for participants.  

    AHIIT-DWR clearly stands out as a promising alternative to traditional HIIT for improving cardiometabolic health in inactive older individuals. Its unique benefits, combined with high levels of participant satisfaction, make it an invaluable option for health care professionals designing exercise programs. By incorporating AHIIT into fitness regimens, we can help older adults not only improve their physical health but also enhance their quality of life, proving that age need not be a barrier to staying active and healthy. 

    Billy C.L. So


    Billy C.L. So, PhD,
    is an assistant professor in the Department of Rehabilitation Sciences at the Hong Kong Polytechnic University. With a keen focus on aquatic exercises, his research explores their impact on health and biomechanics. He serves as secretary of the International Organisation of Aquatic Physiotherapists (IOAPT) and as chairperson of the Hong Kong Physiotherapy Association Aquatic Physiotherapy Specialty Group. He is committed to enhancing the well-being of individuals through evidence-based practices. 

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