The global demographic shift toward an aging population underscores the urgent need for strategies that promote functional longevity and reduce age-related disease. Physical activity (PA) confers well-established benefits across cardiovascular, metabolic, musculoskeletal, cognitive, and psychosocial domains in older adults. However, PA participation remains suboptimal owing to social, environmental, and policy barriers. The Exercise is Medicine® Active Aging initiative seeks to address PA promotion through its integration into clinical care, connecting older adult patients to community-based PA programming. Developed by a multidisciplinary team of experts, the Exercise is Medicine® Active Aging initiative consists of three priority goals, underpinned by three cross-cutting themes, with the aim of increasing older adult engagement in PA through a community-based extension of healthcare. This article supports embedding PA into aging care models to foster a sustainable culture of active aging by synthesizing current evidence, discussing implementation barriers, and identifying future research priorities.
Artificial intelligence has the potential to rapidly transform exercise prescription and coaching through machine learning, deep learning, and large language models. However, there is a disconnect between peer-reviewed evidence and real-world deployment in commercial platforms. This narrative review evaluated recent literature (2023-2025) assessing data-driven programming approaches for exercise prescription. Articles were identified across four themes in exercise programming: data integration on wearables and sensors, predictive modeling, chatbots and virtual coaches, and general-use large language models. Current evidence demonstrates the feasibility of artificial intelligence for activity recognition, workload estimation, and short-term performance prediction. However, significant gaps remain in evaluating closed-loop adaptive programming, downstream behavioral outcomes, and long-term effectiveness. Industry systems integrate multimodal data and continuously evolve, operating largely without formal validation. Advancement requires translational research models that bridge academic rigor with industry implementation timelines, prioritize transparency and human-in-the-loop frameworks, and evaluate artificial intelligence as a tool to augment rather than replace professional exercise prescription.
Metabolic equivalents (METs) are a long-standing physiological concept used to express the physical intensity and energy cost of human behavior. METs underpin many research methods, mostly employed in epidemiological studies, and they also are implemented in real‑life settings by health and sports professionals to guide individual lifestyle recommendations, exercise testing, and prescription. Therefore, METs can be conceived as a foundational physical activity metric supporting strategies to improve health and exercise performance. However, the origins and evolution of METs remain scarcely documented, and despite growing evidence questioning their validity across demographics, discussion of the challenges associated with their application remains limited. Given these concerns, this review aims to trace the origins and evolution of METs, interpret existing evidence regarding their validity, and discuss some of the challenges of their use in research, health, and training practice.
Supplementation use in athletes is common and increasing in popularity, especially for adults seeking improvements in athletic performance. However, the effects of supplementation for older adults or Masters athletes in improving athletic performance or musculoskeletal health are less well explored. The aim of this narrative review is to explore common supplements, namely protein, caffeine, creatine, beta-alanine, nitrates, and peptides, including collagen, body protection compound-157, and thymosin-beta 4 and 500, in improving performance or musculoskeletal health in Masters athletes and adults over 55 years of age.
As the population of aging athletes continues to grow, the number of older individuals presenting to sports medicine clinics seeking musculoskeletal care is expected to increase. Common conditions treated in the older athlete include osteoarthritis and overuse soft tissue injuries such as tendinopathy and fasciopathy. Initial treatment for such conditions is conservative. However, there is a significant knowledge gap on the next best steps in management when the older athlete becomes refractory to conservative treatments or if medications and surgery are contraindicated. In such circumstances, interventional treatment options may be considered for those seeking alternative nonsurgical interventions. The use of injections, orthobiologics, needle tenotomy, and extracorporeal shockwave therapy to treat musculoskeletal injuries in the aging athlete will be discussed. Interventional treatment options may be a viable option for the aging athlete, but until more well-designed clinical trials become available, extrapolation of the current available data should be used with reasonable caution.
Syndesmotic injuries are complex and often require a longer return to play as compared with lateral ankle sprains. As common as they are, they can be difficult to diagnose owing to the complex biomechanics of the ankle joint as well as their varying degrees of stability. A careful physical examination and dedicated imaging can assist with the diagnosis. Weightbearing ankle X-rays should be obtained to assess for fractures or gross instability with anteroposterior, lateral, and mortise views. If these are inconclusive but there is high clinical suspicion, stress views can be added. Advanced imaging also plays a role. Classification systems attempt to distinguish a stable, dynamically unstable, and unstable injury, as this guides management. Stable injuries can be treated conservatively and unstable injuries warrant surgical intervention. It is the diagnosis and treatment of unstable injuries that can be particularly challenging.
Cyclists present with a broad range of musculoskeletal and neurologic injuries, both traumatic and overuse. The Spaulding Cycling Medicine Clinic is a cycling-specific multidisciplinary sports medicine clinic, employing a collaborative approach to management of cycling injury. This paper outlines the clinic structure and the demographics, training habits, injuries, and biomechanics of 323 adult patients across the first 9 years. The most common areas of chronic discomfort in this group were the knee, hip, and lumbar spine, and knee pain was the most frequent complaint that motivated patients to seek care. Neck pain was noted as an area of discomfort more frequently than as a chief complaint. Patients with a chief complaint of low back pain were more likely to demonstrate posterior pelvic tilt and lumbopelvic asymmetry on the bicycle. This is the first work we know of to comprehensively evaluate demographics, clinical presentation, and bicycle fit for a large sample of cyclists.
Anterior cruciate ligament injuries commonly affect athletes and nonathletes. In the United States, about 200,000 injuries and 100,000 reconstructions are reported annually. While anterior cruciate ligament reconstruction is the standard treatment, nonsurgical options can yield similar short- and long-term results for selected patients with a structured rehabilitation program. Also, anterior cruciate ligament reconstruction has risks, including reinjury, contralateral injuries, and postoperative osteoarthritis. Early rehabilitation, or prehabilitation, accelerates recovery of symptoms, strength, and knee function. It serves two main purposes: identifying whether a patient is a coper and suitable for continued nonsurgical management or preparing them for surgery if needed. Nonsurgical treatment may be appropriate for selected patients. This review provides a practical guide to nonsurgical management, emphasizing the importance of patient selection, early individualized rehabilitation, and patient education to optimize outcomes.
The rapid growth of climbing has led to an increase in climbing-related injuries, particularly finger pulley injuries, which account for up to 20% of all climbing injuries. These injuries result from sport-specific gripping techniques that place supra-maximal loads on the flexor tendon-pulley system, most notably during crimp gripping. This review summarizes the anatomy and biomechanics of the finger pulley system, common mechanisms of injury, and associated risk factors. Clinical evaluation, including key physical examination findings and the role of imaging-especially dynamic ultrasound-is discussed. Injury grading guides management, with most pulley injuries treated conservatively through immobilization, taping or splinting, and structured rehabilitation, while severe injuries may require surgical intervention. Evidence-based recommendations for rehabilitation, prevention strategies, and graded return-to-sport protocols are presented to assist clinicians, therapists, and coaches in optimizing recovery and minimizing reinjury risk in climbers.
