Let's see if we can. I have no conflicts of interest in this area. So, these are pictures of the athletes that I like to take care of. You know, in this country, since the turn of the 19th century, when the median life expectancy was 40 for men, was 39 for African American men. And there's no record of how long women live. We have more than doubled our lifespan. And in the United States right now, the life expectancy is 78.9. If you live in Canada, any Canadians, it's 80. And in Japan, it's 82. But the point being is that as I look around the room, many of us are squarely in mid-age. And what that means is that we have 40 more years to be healthy, vital, active, joyful. And so, sports medicine is often focused on the youth athlete, which is amazing, right? There's 60 million youth athletes who need the care we give them. But my contention to you is that a focus on the last 40 years of sporting life is what today is about and what I hope we will do more in the future. And these are real people that we take care of. And if you look up in the upper right-hand corner, that is Robin West, who in Pittsburgh, when we were together, she and our two attendings won the Pittsburgh Triathlon Group, not in the age division, but the whole thing. So it just shows you, even people you know can be a lead at sports at this point. So today, my brief talk is going to try to estimate how many aging athletes are there in this country, how many of them get injured, how many of them need surgery, and then finally, why do we need to care, right? Why do we need to care more? When I present these data to you, I want you to know that there's a paucity of data. It is actually pretty hard to find out these numbers, so I've done some estimations. So in this country, when you look at generations, there are approximately 141 million people in this country who are less than 35. And sometimes we think of millennials as very young people, but the fact of the matter is that the oldest millennials are turning 42. So they are in the group that we are talking about. So we're going to take the number, 141 million over 35, and then we're going to estimate, well, how many of them are really active? We know that two-thirds of our country really don't move at all, except from couch to car, etc., sitting at a desk. But these data estimate, in the three age groups that we're talking about, that about 37% of people are very active with high-calorie expenditure. So 141 million, 37% of them expend a lot of energy and mobility. So in 2005, when I returned from my fellowship to the University of Pittsburgh, we formed a little group called PRIMA, the Performance and Research Initiative for Masters Athletes. And we collaborated with the Huard group, Brett Goodpasture, with Jay Eargang, and a variety of my research assistants to study master and senior athletes who maintain high levels of functional capacity and quality of life throughout their entire lifespan. So the first study we did was, oh, here's the scope of our studies. It spanned 15 years. There's lots of them. I promise I'm not really talking about any of them, but they're out there if you're interested. But the first study we did, Dr. Ryder was great to include it in our journal that really talked about physical performance as a biomarker of aging, looking at when we really do slow down. And you would be surprised to know it's not statistically significant until we're in our 70s. So we say, and I'll show you more data on triathletes, but we say that if we significantly slow down, it's because of injury or because we just don't want to work that hard anymore or life keeps up. So from that same study of more than 3,000 participants in the National Senior Games, we found these data about injury, that 89% had at least one injury and 50% had greater than five. Not really that surprising, but it means that they really need our help. Interestingly, only a third of those people sought medical care from an MD and 12% required surgery. Some of the reasons that performance declines over time is definitely due to orthopedic injury. Overuse is the number one reason these people reported, and old literature shows that they stopped exercising. And not surprisingly, exercise physiologists find that the attenuated mechanical properties and lower healing capacity of aging muscle and tendon were some of the reasons that these injuries occurred at such high level. Then we pulled data from emergency room visits. This is insurance data. So they estimate that 3.2 million people within the age group we're talking about, or 3.2 million people visit the ED and report that their injuries are due to sports and recreational injury. But when you pull it out by age group, a significant amount are in the demographic we're talking about today. And then because we're going to be joined up here shortly by Dr. Karen Sutton from HSS, who is an elite Ironman triathlete. I had my research assistant pull data on 50,000 Ironman athletes. The average age of Ironman is 44, right? It's an endurance sport, so that makes sense. But 44, 20% are female. Their data on performance decline really reflects the data that we published in the AJSM so long ago that there is slow decline until about 60. But then in a paper by Rind et al., they estimated the injury rates in Ironman triathletes. And overuse is not surprising, 31 to 91%, but about 25% are acute injuries that could use our help. So let's put all these data that we're estimating together. 141 million people in the age demographic, 37% of whom are active. That's about 52 million people, right? So we have 60 million youth. We have about 50 million master's age athletes. How many of these people are injured? Well, if you take my senior Olympic data, 50% have a lot of injury. In triathletes, 25%. But if you take my 12%, again, remember, we need to do more work, right? I'm estimating these. 12%, it's about 6.2 million master's athletes who actually need surgery in addition to our non-operative care. So the last question I'm going to answer in the next minute is why should we care, right? We're doing just fine taking care of the youth and the elite athletes, pro-athletes, but I have several reasons. Number one, we're dying in this country of sedentary death syndrome. This is no joke. You just look around where you live, if you're where I live, there are lots and lots of people who are dying from diseases that we control, mobility-controlled diseases. That's number one. Number two, there's a myth in this country that aging is an inevitable decline from vitality to frailty and that there's nothing we can do about it and that you decline like this. The fact of the matter is, with the interventions we give, more and more people can be healthy, vital, active, joyful, and condense morbidity. The data is clear and we have examples of that within our own groups. The next reason we should care about it is when we look at all the data we produce from PRIMA at the University of Pittsburgh, the factors affecting physical performance, including loss of exercise economy, loss of endurance capacity, and muscle strength, are things that fall within our musculoskeletal basket. We are the gatekeepers of mobility. This is our field. And there are things we can do, right? This is a study from the PRIMA group and it shows what happens over time to the lean muscle mass of these are triathletes, right? The first picture is a 40-year-old triathlete taken with an MRI measured with some—we do not have time to go into this, but it's fascinating—NIH software looking at intramuscular adipose tissue. The last picture is one of my 70-year-old triathletes who you would think I took just the next slice on the same MRI of the 40-year-old, but the control group in the middle shows us what we do when we say things to our patients like, if it hurts, just stop, or act your age, because if we are investing every day in our mobility, we can structurally maintain our bodies. And this isn't just from an organism level, but from a stem cell level. This is from data collaborated with Dr. Fabricio Ambrosio and Johnny Huard, showing that even at a stem cell level—we work with muscle-derived stem cells in that lab—that we can put old mice on treadmills and really flip their stem cells into a younger behavior. So this slide is just to encourage us to rethink when we tell our patients to act their age or just stop doing it, because this woman is a master's athlete, and she just completed this race in Pittsburgh in 445. So I believe, obviously, that our job in saving mobility is actually saving people from the ravages of chronic disease, and I am so thrilled that all of you are here today, because we have a lot of great research to do.

aging athletes

youth athletes

importance of focusing

musculoskeletal health

sedentary death syndrome