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S. HRG. 108–42

FITNESS AND NUTRITION:

THE PRESCRIPTION FOR HEALTHY AGING

HEARING

BEFORE THE

SPECIAL COMMITTEE ON AGING

UNITED STATES SENATE

ONE HUNDRED EIGHTH CONGRESS

FIRST SESSION

WASHINGTON, DC

MARCH 11, 2003

Serial No. 108–6

Printed for the use of the Special Committee on Aging

(

SPECIAL COMMITTEE ON AGING

LARRY CRAIG, Idaho, Chairman

RICHARD SHELBY, Alabama

SUSAN COLLINS, Maine

MIKE ENZI, Wyoming

GORDON SMITH, Oregon

JAMES M. TALENT, Missouri

PETER G. FITZGERALD, Illinois

ORRIN G. HATCH, Utah

ELIZABETH DOLE, North Carolina

TED STEVENS, Pennsylvania

RICK SANTORUM, Pennsylvania

JOHN B. BREAUX, Louisiana, Ranking

Member

HARRY REID, Nevada

HERB KOHL, Wisconsin

JAMES M. JEFFORDS, Vermont

RUSSELL D. FEINGOLD, Wisconsin

RON WYDEN, Oregon

BLANCHE L. LINCOLN, Arkansas

EVAN BAYH, Indiana

THOMAS R. CARPER, Delaware

DEBBIE STABENOW, Michigan

LUPE WISSEL, Staff Director

MICHELLE EASTON, Ranking Member Staff Director

(II)

C O N T E N T S

Page

Opening Statement of Senator Larry E. Craig ..................................................... 1

Statement of Senator John Breaux ........................................................................ 18

Statement of Senator Thomas Carper ................................................................... 20

PANEL I

Judith A. Salerno, M.D., Deputy Director, National Institute on Aging,

Bethesda, MD ....................................................................................................... 2

Alfred Maguire, National Senior Games Association, Twin Falls, ID ................. 10

Sam Ulano, Jazz Musician and Author, New York, NY ....................................... 14

PANEL II

Linda Netterville, President, Meals on Wheels Association of America, Lee’s

Summit, MO ......................................................................................................... 25

Jane V. White, Professor, Department of Family Medicine and Graduate

School of Medicine, University of Tennessee-Knoxville, Knoxville, TN .......... 35

Lynn C. Swann, Chairman, President’s Council on Physical Fitness and

Sports, Sewickley, PA .......................................................................................... 43

(III)

(1)

FITNESS AND NUTRITION: THE

PRESCRIPTION FOR HEALTHY AGING

TUESDAY, MARCH 11, 2003

U.S. SENATE,

SPECIAL COMMITTEE ON AGING,

Washington, DC.

The committee convened, pursuant to notice, at 10 a.m., in room

SD–628, Dirksen Senate Office Building, Hon. Larry Craig (chairman of the committee) presiding.

Present: Senators Craig, Stevens, Breaux, Talent, and Carper.

OPENING STATEMENT OF SENATOR LARRY E. CRAIG,

CHAIRMAN

The CHAIRMAN. If we could have your attention, thank you very

much. The U.S. Senate Special Committee on Aging will be convened. We want to thank all of you for coming this morning.

Today’s hearing will explore the importance of fitness and nutrition for older Americans. We are holding this hearing to highlight

the need for all Americans over the age of 50 to be active, to focus

on a nutritional diet, and to take advantage of a routine nutrition

screening. Most importantly, all of these activities can be started

at any age.

This is a timely hearing because March marks the Meals on

Wheels Association’s March for Meals campaign. This is a national

initiative carried out by local senior meals programs throughout

the month of March. I have had the opportunity to travel with the

Meals on Wheels program in my State and have not only seen the

value of the food delivered, but the tremendous value of the outreach and the contact that goes on between the deliverer and the

senior.

I would like to welcome the members of the Meals on Wheels Association who are here today. How many of you are with that association and are in the audience?

Thank you. Thank you for your work and thank you for being

here.

Many people think that physical decline is an inevitable consequence of aging. Today, we have assembled a panel of witnesses

who will speak to the contrary. We will hear from witnesses who

will talk about how becoming active at any age can actually help

extend our lives and improve the quality of life. Today’s witnesses

will demonstrate that fact by living very active lifestyles well into

their 70’s and 80’s.

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We also have nutrition experts who will discuss how simple eating habits and nutritional screening can help us live healthier lives

and may also help reduce overall health care costs to this country.

As Chairman of the Senate Special Committee on Aging, I welcome the opportunity to encourage all seniors to take better care

of themselves. Our testimony will show that it is possible to live

healthier, and have active lifestyles at any age.

I will have to tell you a little story. I was filming a clip yesterday

that will go on our website about the committee. The staff had

written in my talking points that my father was in his 80’s and

played golf every day. My father is in his 80’s. He is 85. He doesn’t

play golf. We had to correct the script. He works 8 to 5 every day

and hasn’t missed work in his life except for a cold. He is fit and

trim at 85 and can’t understand why everybody is just sitting

around. So I chuckled a bit, but it is a true statement and story

and I think that it witnesses for me, at least, the active lifestyle

that my parents have led well into their 80’s because they eat well

and they have remained very active and physically fit.

We had planned our first witness to be Lynn Swann, who, as we

know, was a famous Pittsburgh Steeler player, an ABC Sports

broadcaster. He will be here. He is en route. Weather has held him

out, so he will be here as one of our later panels.

So we will feature a different panel at the first of our program,

and that panel today is made up of Dr. Judith Salerno, Deputy Director of the National Institute on Aging; Alfred Maguire, a 77-

year-old swimmer from Twin Falls, ID, with a remarkable story to

tell you about, who competes in the Idaho Senior Games; and Sam

Ulano, 82-years old, a jazz musician and author and still very active.

In our third panel, we will have Linda Netterville, President of

the Meals on Wheels for America, and Dr. Jane White, Professor

of Family Medicine at the University of Tennessee-Knoxville.

So we welcome all of you once again, and Doctor, why don’t we

start with your testimony this morning. Please pull the microphone

as close as you can and have it comfortable and that way we can

hear you all well. Again, welcome.

STATEMENT OF JUDITH A. SALERNO, M.D., DEPUTY

DIRECTOR, NATIONAL INSTITUTE ON AGING, BETHESDA, MD

Dr. SALERNO. Thank you. Thank you, Senator Craig, for inviting

me to appear before you today to discuss fitness for people over 50,

an issue of importance to us all. I am Judy Salerno, Deputy Director of the National Institute on Aging. I am delighted to be here

this morning to tell you about our commitment to promoting exercise and healthy lifestyles across the lifespan.

One year ago, I took up running and ran my first race, a half

marathon, to honor the memory of my father, who had died of a

stroke due to high blood pressure. I also ran the race to celebrate

my 50th birthday. I had the good fortune to find a coach, running

partner, and role model named Dixon Hemphill, who at 78 remains

fit and active. I felt like Rocky Balboa when I crossed the finish

line with my family and my coach cheering on the sidelines.

The fact is, exercise and lifestyle changes are long-distance goals

which everyone over 50 can achieve. It is a matter of making a

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commitment. Exercise helps maintain healthy bones and joints. It

also helps control weight and improves our mood and sense of wellbeing. It can strengthen all of our muscles, especially the very important one, the heart.

NIA research continues to demonstrate the phenomenal benefits

of physical activity. I would like to give you a few examples.

Compared to their sedentary counterparts, older exercisers are

not only more likely to live to an advanced age, but are more likely

than non-exercisers to remain independent right up to the end of

their life.

A recent study showed that exercise and diet are effective in reducing the risk of Type II diabetes in high-risk older individuals by

over 70 percent. This is important, since over seven million older

Americans have diabetes, a serious and costly illness.

Moderate exercise has been demonstrated to be an effective way

to reduce stress, high blood pressure, and improve sleep among

older women caring for family members with Alzheimer’s disease.

We have also found that older exercisers are able to fall asleep

quickly, sleep for longer periods, and have better sleep quality after

moderate exercise.

Finally, exercise in conjunction with other common sense interventions was able to reduce falls in older people by 44 percent. The

intervention strategies cut health care costs for each of these highrisk individuals by $3,700, thus potentially saving millions of dollars in health care costs.

Several years ago, NIA launched an exercise campaign to promote physical activity for the over–50 crowd. The message is simple. Through regular exercise, older adults can stay healthy and

maintain independence. Our campaign addresses the four necessary types of exercise in a book called Exercise: The Guide from

the National Institute on Aging, and in a companion video based

on the book.

First, endurance exercises, like walking rapidly, raise the heart

rate and get the heart, lungs, and circulatory system working optimally.

Strength exercises, such as leg lifts and arm raises, build muscles. Just a small increase muscle mass can reduce frailty, even in

90-year-olds.

Balance exercises that build leg muscles can prevent falls, a

major cause of broken hips and other injuries that often lead to significant disability.

Flexibility or stretching exercises keep the whole body limber

and improve range of motion.

The NIA’s exercise guide tells people over 50 how to begin a safe,

effective exercise program. All the recommended exercises are

based on evidence from research. To date, the NIA has distributed

over half-a-million copies of the free guide, which is available in

both Spanish and English. A free copy can be obtained by contacting the NIA Information Center through our website or by calling

1–800–222–2225.

The bottom line is that exercise and good genes may ultimately

be the wellspring of healthy older age. Even the oldest and frailest

among us can improve health and independence by making physical activity a part of our everyday lives. The message for older

4

Americans is clear. You are never too old and it is never too late

to be fit for life.

I would like to now share with you our television public service

announcement which has been airing throughout the country which

promotes exercises.

[A videotape was shown.]

It really makes you want to get up and move.

The CHAIRMAN. Is that Sam’s music? [Laughter.]

Dr. SALERNO. Our next one will be.

The CHAIRMAN. All right.

Dr. SALERNO. Thank you very much, Senator.

The CHAIRMAN. Judy, thank you very much for your testimony.

I will find this book fascinating. I think it has the simple kinds of

directions and guides that are understandable, usable, and appreciated.

[The prepared statement of Dr. Salerno follows:]

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6

7

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The CHAIRMAN. I dare not call the gentleman who has just entered one of our senior Senators, although he is—— [Laughter.]

Senator Ted Stevens of Alaska, who lives a very active lifestyle.

Ted, do you have any opening comment before we continue with

our witnesses?

Senator Stevens. No. I just told a group, though, this is one committee I am a natural member of. [Laughter.]

The CHAIRMAN. Well, that he is, and a very active one at that.

Alfred, we will turn to you, Alfred Maguire of Twin Falls, ID,

who has a remarkable story to tell us about aging and exercise.

STATEMENT OF ALFRED MAGUIRE, NATIONAL SENIOR GAMES

ASSOCIATION, TWIN FALLS, ID

Mr. MAGUIRE. Senator Craig, panel members, distinguished visitors, ladies and gentlemen, I wish to thank you for the invitation

to speak to you today. I am Al Maguire, a senior swimming athlete

from Twin Falls, ID, who has participated in five National Senior

Games, numerous State Senior Games, and many California Regional Games.

I have a book written by a nutritionist, Dr. Michael Colgan, who

relates that our bodies have muscles which are, in essence, the machines which move us anatomically. Protein is the food that builds

these muscles around our limbs, but our muscle machines can’t

work without fuel. Carbohydrates are that fuel. The bigger the

muscle is, the more the available fuel capacity.

There is another kind of food called fat. There are good fats and

bad fats. An athlete needs only the essential fatty acids. Saturated

fats should be eliminated from your diet.

Make a clear distinction between nutrients that are building materials and nutrients that are fuel. Proteins, vitamins, minerals,

and essential fats are predominately building materials. They are

used long-term to grow a better body. All carbohydrates are predominately fuel and are critical for any particular performance to

succeed.

Then comes exercise, you know, that which moves those muscle

machines, that moves those lubricated limbs, that keeps all those

neurotransmitters electrically and biochemically connected, and

that facilitates the removal of waste toxins and the input of good

nutrition for maintenance and continuance of energy.

During one of the National Senior Games, I became impressed

with some of the 90-year-old senior athletes who were still doing

whatever they could to be active. There was even a 98-year-old

blind athlete who swam long distances.

In the Twin Falls area, there are over 800 people 60 to 94 years

of age within the city and in isolated locations who exercise three

times a week for an hour by walking, resistance training, stretching, and who have in a 10-week period achieved dramatic results

when put through the Fullerton, CA, Senior Fitness Test. These

participants were tested for balance, lower body strength, upper

body strength, flexibility, and cardiovascular endurance. The College of Southern Idaho and the city of Twin Falls provides these

events which have great social interactivity under the personal

care of the event’s pioneer, Jan Mittleider.

11

Now, according to William Evans, who wrote ‘‘Bio Markers,’’ seniors who remain independent and are able to care for themselves

at home just 1 month longer save the government millions. It

would seem reasonable to conclude that prevention, therefore, is

less costly than disability treatment.

Fortunately for me, the existence of the Idaho State Senior

Games and its sponsors, along with the National Senior Games

Association, the NSGA, have helped me with the availability of accessible competition. I do remember back in 1948 when the World

Olympics were activated again after World War II that it was very

difficult for myself as an individual to even try out in any preliminaries. In 1993, because there was Senior Game help, when I

began my first Senior Game competition, opportunity was made

very accessible and I was helped to overcome my fears and to continue with hope and courage.

The National Senior Game Association now, fortunately, has

made available quantities of opportunities for all of the 10,000 men

and women so that they may select any one of 18 different sport

venues in which they are able to exercise, train, and finally compete according to their own age group, with peers who travel from

all the 50 States of the U.S., from archery to volleyball. I now personally thank them.

I also thank you, Senator Craig, for giving me this opportunity

to give my modest testimony. Thank you. I invite all committee

members to attend the National Senior Games in Hampton Roads,

VA, May 26 through June 9, and I do now also encourage all the

committee members to get involved and support the National Senior Game Association, the NSGA, including the State Senior Games

in Idaho. I would like to thank the Idaho Senior Games and the

Special Committee on Aging for providing the transportation so

that I might be with you today. Thank you.

The CHAIRMAN. Well, I will thank you very much. Your testimony is marvelous and your presence here is living testimony. I

see, looking at your resume, 43 gold medals, three national ribbons.

That is an outstanding record. Congratulations.

Mr. MAGUIRE. Thank you.

[The prepared statement of Mr. Maguire follows:]

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The CHAIRMAN. Now, the committee turns to Sam Ulano. Sam,

I am looking at your resume and I find out that for 56 years, you

have been a music professional, instructor, educator, author, and I

see those drumsticks there. I assume that means you are a drummer of the first order.

STATEMENT OF SAM ULANO, JAZZ MUSICIAN AND AUTHOR,

NEW YORK, NY

Mr. ULANO. I have been a drummer for 70 years, Senator, and

I want to thank you for inviting me here to this interesting——

The CHAIRMAN. Well, start pounding on the table. We are anxious to hear you. Thank you.

Mr. ULANO. I brought this along to demonstrate a very interesting idea about staying in condition. I have been drumming with

metal drumsticks for many years, which was considered a no-no by

most of the people in the drum community for many, many years.

They were saying you are going to get muscle bound, and there is

no such thing as being muscle bound. What they are really saying

is that you overtrain and you tire your muscles out and they have

given it that name called muscle bound.

But I have been practicing since I was 13 and I have found that

by staying in shape [playing drumsticks and humming]—so these

sticks, by the way, were made by my twin brother in 1946, but

Louis Belson, the very famous drummer who was married to Pearl

Bailey for many years, was the originator of inventing or creating

the metal sticks. So the principle is that when you go to the lighter

drumstick, your hands don’t get faster, but they got stronger.

So in 1960, I weighed 320 pounds. I think that was pretty heavy,

I would say.

The CHAIRMAN. How tall are you?

Mr. ULANO. I am five-foot-seven.

The CHAIRMAN. I would say you were pretty heavy. [Laughter.]

Mr. ULANO. I wore a size 54 jacket and a 52 waist belt, and a

student of mine brought me over to a gentleman who was Mr.

America in 1936, had a little gymnasium near where I teach

drums, by the name of Sigmond Klein, and Sigmond Klein said

something that was very interesting. He said ‘‘Boy, you are a

mess.’’ I said, ‘‘Well, what are we going to do about it?’’ He says,

‘‘What are we going to do about it?’’ he says, ‘‘What are you going

to do about it?’’ He says, ‘‘I don’t have to worry about it.’’ He was

in incredible condition.

He said, ‘‘How long did it take you to get out of shape?’’ I said,

‘‘About 25 years, after I got out of the Army.’’ I was in the Army

band, the 98th Division. We wound up in Hawaii and then ended

up in Japan and came home. He said, ‘‘Well, it took you 25 years

to get out of shape, it’s going to take you 25 years to get back in

shape.’’ You know what? He was right.

But his principle was weights, using light weights, 5-pound, 10-

pound, 20-pound weights, and doing a short routine of exercise

every morning and at night before you go to bed, roughly 10 minutes a day, not this business about doing 2, 3 hours. A lot of the

reason people go to the gym—I am not knocking gyms, by the

way—they like to be seen getting macho and maybe they are going

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to go on a beach. I am not going to go on a beach. I am going to

be 83 on August 12 of this year.

So what I am trying to say is that we have got to find a system.

I tell all my students—I do some drum instruction—I say, ‘‘What

do you do in the beginning of the day?’’ ‘‘Well, I make coffee and

then I’’—I said, ‘‘Well, I have a system.’’ I get up, go to the bathroom, take a shower, put on some clothes, and then the day starts,

and that is the system that happens Monday, Tuesday, Wednesday,

Thursday, Friday, Saturday, Sunday, Monday, Tuesday, Wednesday. The whole year goes that way, and I have been doing that

kind of a routine using light weights which I keep on my bed right

next to me.

When I wake up in the morning, I do my stretching exercise and

I work on three parts of my body, my legs, my midriff, and my

shoulders. Your arms are attached to your body. Your legs are attached to your body. You can’t make your feet stronger. If you

make your hips and your thighs stronger, everything down the line

on to your feet are going to get stronger. On my arms, in order to

play my instrument, I have to have strength in the shoulder [playing drumsticks and humming]. I still practice 3, 4, 5 hours a day.

It is like an athlete, if you don’t stay in condition.

So what I say to most people when we talk about this thing, you

have got to do two things. One is find a system of lightweight exercise, not once every other day but 5 minutes a day, maybe in the

mid-afternoon a day. Some people say, ‘‘I don’t have time to do it.’’ Keep a set of weights under your desk. Your boss won’t see you

doing that. You pick them up while he is turning around, you do

some exercise with them, put the weights back. Or you bring them

into your bathroom and you have them there and you do some

squats.

I work on keeping my legs strong, because without your legs, you

are nobody. Think about it. You can’t go shopping, you can’t go

dancing, you can’t play football. I don’t care if you are young, old,

or I don’t think there is anything as getting old. I am going to be

83 and I don’t consider myself old.

The other part is learning how to eat. I love to eat a lot of things,

but I have learned how to eat a pizza once a month, have a steak

maybe once a month, eat some bread maybe once every 2, 3, 4

days, cut down on some of my excessive dairy food, and I wound

up weighing 168 pounds.

So I think the theory works. The resistance of putting the

weights against your arms and your shoulders and your legs will

make you stronger and people who—I live, by the way, in the senior citizen building and nobody does any exercise. They are lucky

if they walk into the cafeteria to have breakfast.

So that is what I have got to say about this and I think it is important that we find a system, how to stay in condition. And the

condition that I use is with light weights. They are very inexpensive. I have got 5-pound, 10-pound, 15-pound weights, and I just

went and got a set of 20-pound after 43 years of doing this conditioning. I want to thank you for inviting me here to say my little

piece about this. I think it is very important.

The CHAIRMAN. Sam, thank you. That is outstanding testimony,

and as I say, ‘‘You are living proof, to come from 300 pounds down

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to your current weight, and your health condition by all appearances is excellent, and I congratulate you for that.’’ As I said to Al,

I say to you, your testimony is living testimony that you can age

well and—— Mr. ULANO. Do you remember Packard Auto, Senator? I didn’t

mean to interrupt you. They used to have this slogan, Packard

cars. ‘‘Ask a man who owns one and he will tell you.’’ That was

their slogan and it is a very true slogan.

The CHAIRMAN. All right.

Mr. ULANO. If you want to find out how to do this, you have got

to find somebody who can teach you how to do it.

The CHAIRMAN. Well, that is true.

Mr. ULANO. You go and pick up a 100-pound weight and you

didn’t stay in condition, you are going to bang your back out. You

are out of condition.

The CHAIRMAN. Sam, thank you.

[The prepared statement of Mr. Ulano follows:]

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The CHAIRMAN. We have been joined by the ranking member of

the committee, John Breaux. John, do you have any comments or

questions?

STATEMENT OF SENATOR JOHN BREAUX

Senator BREAUX. Just briefly to thank you, Mr. Chairman, for

calling this hearing today. It is very, very clear that exercise among

all Americans is really the key to a healthy society. Five percent

of all of our Medicare beneficiaries consume about 50 percent of the

total amount of money spent in the Medicare program. It is being

spent by 5 percent of our citizens.

I think, clearly, exercise and proper nutrition are the major ingredients in preventative medicine which will allow people to live

not only longer lives, but certainly better lives, and I am very glad

that we are using this hearing to emphasize the importance of rational and balanced exercise as part of our regular health programs

in this country.

Thank you, Mr. Chairman.

The CHAIRMAN. John, thank you very much.

Let me turn to our colleague from Missouri, Jim Talent. Senator

Talent, do you have any opening comments?

Senator Talent. I think I will reserve, Mr. Chairman, for the next

panel.

The CHAIRMAN. Well, thank you.

Doctor, in your testimony, you mentioned that family caregivers

are at a risk of increased rates of depression, serious illness, and

mortality. Are you aware of any outreach efforts for family caregivers to provide some type of respite?

Dr. SALERNO. Well, NIA is a research organization and we don’t

provide direct care. We make a considerable effort to provide information with particular emphasis through our Alzheimer’s disease

education and research and referral centers to family caregivers.

We have a caregiver kit which provides a lot of resources and also

gives information on exercise, because exercise has been demonstrated to improve the health and well-being of caregivers. We

have lots of connections to other organizations through our website,

lots of links which help caregivers get the support they need in

their local communities. We get thousands of calls each month to

our hotline, and mostly from family caregivers.

The CHAIRMAN. Al, you became active again at, what, age 60?

Mr. MAGUIRE. Sixty-four.

The CHAIRMAN. With that experience, the obvious experience you

have had now into your 70’s, can you offer any suggestions of how

we better inform seniors of the health benefits of becoming active,

physically active, I guess is the question?

Mr. MAGUIRE. One of the things that I discovered was that every

7 years, the body changes. Almost every molecule in the body just

revolves around and it is brand new. In about 1991—when I was

64 years of age, I determined that this body that you see before you

right now is going to be a new body and it has taken me some time

to do it, but it was a slow process. I had to learn how to eat

correctly and to sleep correctly and to exercise moderately to get

everything going.

19

One of the things that you mentioned now was how to get other

people to do it, and that is that if you have accessibility, if they

are able to get out amongst themselves, to get out amongst a group

and walk. As an example, in Twin Falls, we have 200 people that

walk around a gym three times a week, Monday, Wednesday, and

Friday, and during that time, they exercise and do all sorts of

things. Since they are doing it together, they enjoy it, and by the

time 10 weeks goes by, they have increased their—everything

about their body.

The CHAIRMAN. In other words, involving yourself in a group or

getting somebody involved in an active group.

Mr. MAGUIRE. Right. Right.

The CHAIRMAN. Is a greater motivator.

Mr. MAGUIRE. Right, and the more that you do that, the more

the body feels great. In fact, as you are feeling better, your body

says, ‘‘Gee, I like this and I want to do more.’’

Since I am speaking right now, I want to say hello to Senator

Breaux. I did hear you in 1993 at the Senior Games and I was very

impressed with your thoughts.

The CHAIRMAN. Thank you, Al.

Sam, you are 82. You have obviously continued to teach music.

You play in your band. You have stayed active. You live in a senior

community or a senior environment where there is inactiveness.

How do you stay motivated to be active?

Mr. ULANO. Well, that is a good question. I am a big believer

that we have to learn how to motivate ourselves, Senator. If you

don’t do that yourself, you could be told all day long how to stay

in shape, you can go and watch people do it, but somewhere inside

yourself, you have got to say, ‘‘Hey, I am a mess.’’ I am getting

older and I had better find some way that I can get my legs

stronger because eventually I won’t be able to go out dancing and

I won’t be able to play with my grandchildren and I will wind up

in a wheelchair if I don’t find some way to put some resistance

against these muscles.

I found a very inexpensive way to do it, and I was taught that

by Sigmond Klein. He was a very dear friend of mine. He says, go

out and buy a 5-pound set of weights, 10-pound, 20-pound, and

they are very inexpensive. I keep them under my bed. I have a set

in my practice studio. I will come in and I will do maybe ten lifts,

I will do ten stretching. I do a bicycle ride by laying flat on my

back. I do 20 squats. I go to the men’s room. I grab hold of the sink

and do another 10, 15. So I am always constantly putting a resistance against the muscles.

So now when I want to play my instrument, I can get up at any

time of the night. I was up this morning at 3:30 to get ready to

come here from New York and I did about 20 minutes of what I

call drum exercise, lifted the weights for about another 5 minutes.

I didn’t have to do an hour. I didn’t have to do 2 hours. People

think you have to do a lot of it.

You can do it right in your home. It is nice if you can do it with

groups, but a lot of us don’t have the time to go with a group. We

have a day job. We have got maybe children or grandchildren or

family or whatever. We have other things that have to be done. So

you have them in your apartment. I hold on to my door and I kick

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my legs for about 50 counts, making my knees and my thighs and

my hips and I stay strong, and it can be done. So I think we have

to motivate ourselves with moderation.

The CHAIRMAN. That is well spoken. Thank you.

Mr. ULANO. Yes.

The CHAIRMAN. We have been joined by another one of our colleagues, Senator Tom Carper. Do you have an opening comment?

STATEMENT OF SENATOR THOMAS CARPER

Senator CARPER. I am really tempted to just jump in, because I

am a guy who believes in fitness. I work out almost every day. I

ran five miles this morning about 5:30 in Delaware. On Sunday, I

was visiting my mom—— The CHAIRMAN. You ran from Delaware to here?

Senator CARPER. I could have. [Laughter.]

The CHAIRMAN. It is faster than the Metroliner, yes.

Senator CARPER. Last night, it would have been. [Laughter.]

I am getting ready to run my 21st Caesar Rodney half marathon

this Sunday for 13.1 miles. I am one of those people who believes

that we run or we exercise daily and it not only is good for our

body, it is good for our mind. People used to talk about runner’s

high, and there is really something that happens physiologically in

our brains when we exercise rigorously and it helps us in so many

different ways. You are all an inspiration. We welcome you coming

here today, setting a good example.

I just wonder, Mr. Ulano, what your neighbors thought at 3:30

this morning when you started your drum exercise. [Laughter.]

Mr. ULANO. I have a question. Can I ask a question?

The CHAIRMAN. Can you ask a question?

Mr. ULANO. Can I ask a question?

The CHAIRMAN. Sure.

Mr. ULANO. I saw an article in the local newspaper in New York

that some doctor said that if the mind is kept active, you stand less

of a chance of getting Alzheimer’s, so I am wondering, is there any

kind of a survey they have done on that, some kind of way that

they came to that conclusion?

The CHAIRMAN. I have heard that said on numerous occasions

and there is research being done now. I don’t know of a survey per

se that indicates that, but I understand, Sam, there is considerable

research now that the more active you keep the mind, the less likely the onset of Alzheimer’s.

Senator CARPER. Can I take a quick shot at that?

The CHAIRMAN. Yes.

Senator STEVENS. There is a book, Sam, written by David

Mahoney, ‘‘How to Live to Be 100.’’ He was a resident of your city.

You ought to get David Mahoney’s book. He is part of the group

of the Decade of the Brain, and there is a lot of information about

what you asked. It is available.

Mr. ULANO. I have a sister, Ida, who was 95 3 weeks ago. We

went to her 95th birthday party. She just finished writing her

memoirs, typed it all out, and it is amazing what she does. She

goes shopping, cleans her own apartment. She says, ‘‘Don’t bother

me. Leave me alone. I do my own thing.’’ Ninety-five years old.

The CHAIRMAN. Senator Carper.

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Senator CARPER. This is subtitled, ‘‘The First Part’’? Is this just

the first part of her memoirs? Has she got some more to go?

You asked a question about Alzheimer’s. There was an interesting study done in Europe, fairly large scale, about a year ago. The

results were released about a year ago, and the study was not on

Alzheimer’s but it was on depression. They took a large group of

people, divided them into three categories. A third of the folks exercised strenuously regularly about 30 minutes a day, I think 5 days

a week. The second group took a medicine that is designed to control depression. The third group was given a placebo, sugar pill, or

something like that.

Then after an extended period of time, they measured and kept

track of whose depression was reduced the most. The people who

took the placebo, no. The people who took the medicine for depression, no. The people who exercised regularly had the most improvement on their depression.

The CHAIRMAN. Thank you. Any further questions of this panel?

Yes, Senator Breaux?

Senator BREAUX. Just briefly. Mr. Maguire, I am sorry I missed

your testimony, but I am very pleased to see that you reference

your participation, I think as a swimmer, in the National Senior

Games.

Mr. MAGUIRE. Correct.

Senator BREAUX. I have attended the Games in Orlando and

Baton Rouge, and I hope to go to the Games this May in Virginia.

I think the Games are an incredible opportunity for the Nation to

witness the activity of seniors participating in competitive sports.

I think they are absolutely wonderful. I just wish we could entice

some of the major corporations in the country to participate as

sponsors since the Games struggle financially.

I met with AARP just this past week and they are getting ready

to engage in a massive new effort to try and get seniors to be more

active through exercise. There is no better example of seniors doing

that than their participating in the National Senior Games. If

there is anyone out there who is interested in seniors and selling

products to seniors and encouraging seniors’ exercise programs, the

National Senior Games, I think, is a wonderful venue to get that

message out.

I realize, everybody cannot run the 100-meter dash, but maybe

they can walk the 100 meters, and they can’t throw a 16-pound

shot put but they can throw a baseball. But they are active, they

are competing with people in their own age category and I just

think it is a wonderful signal to other seniors.

We talk about our youngsters sitting in front of televisions and

computers and not getting off their you know what. Well, it is also

important for seniors to get out of the recliner and to do whatever

they can, because it is going to mean a lot to them and their children and their grandchildren as they get older, and the National

Senior Games is incredibly important as an inspirational message

to seniors and to all Americans to participate in exercise. So I just

congratulate you for being here and telling us that story.

Ms. Salerno, on the question of the importance of exercise, I

mean, this is real. This is real in terms of health care spending,

quality of life, the last 6 months of a person’s life. People who have

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chronic diseases in this country like diabetes, I mean, all of that

is brought on to a greater extent because of lack of exercise, being

overweight, living a sedate lifestyle as opposed to an active lifestyle

is all very, very important.

I think it is also important to tell seniors that if you have never

done anything in your life in terms of exercise, you can’t just jump

into this when you are 80 years old and all of a sudden I am going

to start working out five times a week or running with Senator

Carper five miles a day every day. I mean, they have to take this

upon themselves gradually and not try to do it all at one time and

I think that is very, very important, as well.

I can’t think of anything else I would like to say about it. I don’t

have any questions. I agree with what you are saying. This is important from a health standpoint. This is just as important as anything else we recommend Americans to do in terms of managing

their health care. Managing your health care is much more than

taking prescription drugs. It is much more than a yearly checkup

at your doctor. I mean, you go to the doctor once a year and they

tell you what you should have been doing for the previous year,

whereas a regular exercise program saves money and it makes the

lifestyle of our seniors much better as well as much longer. So I

thank all of you for what you are doing.

Mr. MAGUIRE. Could I add one little thing? One of the things

that I mentioned before, Senator Breaux, you came in was that

there are 18 opportunities for seniors to be involved, 18 different

types of things, from volleyball, anything that you can think of. In

fact, in 1993, when I was in Baton Rouge, there was a man who

was in his middle–90’s and he was so happy because he threw

horseshoes or something like that and he was beaming all over.

I also would like to add something that was sort of mentioned

in here, was by exercising, you actually get rid of the toxins in your

body, all sorts of toxins which can cause all sorts of disabilities,

and it also then increases things so that you can also continue on

and get new nutrients in.

Senator BREAUX. I remember meeting one of the gentlemen in

Baton Rouge who was in his upper 90’s who won the javelin throwing context who was from the State of Hawaii and he was just a

remarkable athlete. I would just mention, I probably shouldn’t, but

both in the Orlando Games and the Baton Rouge Senior Games,

Ted, I challenged the winner of the Senior tennis event to play because I thought it would be a lot of fun and also to bring about

more attention to the program, and I can report that both in

Orlando and in Louisiana at the Senior Games, I lost both times

to the person who had won the tennis event. [Laughter.]

But it just shows you how competitive they can be, but also, I

mean, just being with your colleagues in your same age division

doing this, it is just a wonderful social outlet that is very, very important, as well. So thank you.

The CHAIRMAN. John, thank you for those questions and that testimony.

Senator STEVENS. Mr. Chairman.

The CHAIRMAN. Yes, Senator Stevens?

Senator STEVENS. Sam, you give me a copy of your book and I

will mail you a copy of David’s book, OK?

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The CHAIRMAN. Did you hear that, Sam? Senator Stevens would

like a copy of your book and then he will mail you a copy of David’s

book.

Mr. ULANO. Here it is.

The CHAIRMAN. Here it comes. You have got to sign it, though.

Mr. ULANO. I will sign it.

The CHAIRMAN. Senator Talent.

Senator TALENT. I didn’t have an opening statement, but I did

have a question I wanted to ask. Maybe I ought to direct this at

Ms. Salerno. My father just passed away last November at 91 years

of age and one thing I learned as Dad grew older was it was harder

and harder to make him do anything he didn’t want to do, and we

can’t make seniors exercise and probably wouldn’t want our government to try actually to do that.

But what I do think works is if we send the message from all

different directions to them, and a key, it seems to me, is through

the various programs that seniors are already participating in.

Now, there is this huge network. Some of these are public and

some of them are private out there. We are going to have testimony

on the next panel from the lady who is the President of the Meals

on Wheels Association. There are senior centers, day care centers,

and the whole spectrum of independent living centers, retirement

centers, et cetera.

I am wondering, is there some way that we could encourage all

those groups to send a message for a concentrated period of time

about the importance of exercise? Do you see what I am getting at,

so that the seniors around the country are hearing this from a lot

of different places for several weeks at a time.

I remember when I was in the legislature and we first started

passing the mandatory seat belt laws, I always thought that the

publicity attendant to the passage of the law helped as much as the

law did, in convincing people. Do you have any suggestions along

those lines?

Dr. SALERNO. Yes. I think that you are absolutely right. It has

to be a multi-pronged approach. That is why we are on radio, we

are on TV. We are trying to get our exercise materials into public

libraries. We are distributing to 250 community health centers

around the country so that the message gets out there.

But also, I think that it is important to have an exercise buddy,

and that really makes a difference for most people, because some

mornings I know I get up and I really don’t feel like putting on my

running clothes and getting out there and doing a few miles. But

when I get my son to go with me, who is sitting behind me, he motivates me. We motivate each other. So it is that kind of thing that

I think is very important, and there is a natural group in senior

centers, through all kinds of networks, assisted living facilities,

where people can do that.

We are also interested in having our materials be part of the program that we can provide as a public service to groups such as

those who run activities in senior facilities.

Senator TALENT. Thank you, Mr. Chairman.

The CHAIRMAN. Thank you. We thank all of the panelists.

Judy, I saw that young man wave back there. You brought some

of your family with you?

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Dr. SALERNO. Yes, my three children.

The CHAIRMAN. Why don’t you introduce them.

Dr. SALERNO. Lauren Guberman, Alyssa Guberman, and Michael

Guberman, and please don’t tell their teachers they are here.

[Laughter.]

The CHAIRMAN. No, quite the opposite. They should go back and

tell their teachers that they attended a Congressional hearing

today.

Dr. SALERNO. Absolutely.

The CHAIRMAN. They can get credit for it.

Dr. SALERNO. Absolutely.

Senator TALENT. Judy, this is on C-SPAN. I am afraid it is a little bit too late. [Laughter.]

The CHAIRMAN. Prior to you coming in, Senator Talent, Judy did

talk about this document and also showed a public service announcement encouraging access to this, so that is a part of the outreach that the Institute is undertaking.

Thank you very much, all of you. We appreciate you being here.

Thank you.

The CHAIRMAN. Let us turn to our second panel. We would excuse you. Thank you. We trust that Mr. Swann is still en route.

Do we have any report on Lynn yet?

We have two in our next panel, and I think that Senator Talent

had already mentioned one of them, so I will allow the Senator to

introduce that panelist when we get them seated.

As I mentioned, March marks the Meals on Wheels Association’s

‘‘March for Meals’’ campaign, and so this next panel in part will be

discussing nutrition and certainly Meals on Wheels. Senator, would

you introduce our first panelist, please?

Senator TALENT. That would be a privilege, Mr. Chairman. We

are honored in Missouri to have living in Lee’s Summit, MO, the

President of the Board of Directors of the Meals on Wheels Association. She is Linda Netterville. That is the oldest and largest national association representing senior meal programs. Linda serves

not only in that capacity, but as the Nutrition Program Manager

with the Johnson County Nutrition Program in Olathe, KS.

She has enjoyed a number of professional appointments through

her career. She really has a long and distinguished career in

helping seniors, Mr. Chairman. I am not going to mention them all,

but among them are the National USDA Commodity Food Distribution Advisory Council and she has been on the National Elder Care

Institute on Nutrition, the Advisory Committee. Above and beyond

all that, she is a graduate of the University of Missouri, and so I

thank you for the opportunity to introduce her today, Mr. Chairman. Thank you for being with us, Linda.

Ms. NETTERVILLE. Thank you, Senator.

The CHAIRMAN. Well, Linda, we thank you very much for being

with us.

Our second panelist will be Jane White, Professor, Department

of Family Medicine, Graduate School of Medicine, University of

Tennessee-Knoxville, in Knoxville, TN, so we welcome this panel.

Thank you very much, Doctor.

Linda, if you would start, please.

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STATEMENT OF LINDA NETTERVILLE, PRESIDENT, MEALS ON

WHEELS ASSOCIATION OF AMERICA, LEE’S SUMMIT, MO

Ms. NETTERVILLE. Thank you. Chairman Craig, Senator Breaux,

and members of the committee, I am Linda Netterville, President

of the Meals On Wheels Association of America for whom I am

testifying today.

The Meals On Wheels Association of America, or MOWAA, as we

call our organization, represents senior meal programs from every

State. Our members provide nutrition services to older Americans

to improve their dietary intakes, nutrition and health education;

links to informal and formal community support; and opportunities

for active living. I am joined here in the audience by the Board of

Directors of MOWAA. We, on behalf of MOWAA member programs

from across the country, thank you for holding this hearing and

giving us the opportunity to testify.

Before I begin to address the issue of the role of nutrition in

healthy aging, I want to briefly note a couple of important milestones. Later this month, we will commemorate the 31st anniversary of the inclusion of senior meal programs in the Older Americans Act, a Congressional action that has literally changed the

lives for the better of millions of Americans over the years. To date,

over six billion meals have been served through the Act and senior

meal programs are adding to that total every day.

As part of their commemoration of this, senior meal programs in

communities throughout the country will be participating in

MOWAA’s ‘‘March For Meals’’ campaign, as you mentioned. ‘‘March

For Meals’’ is a national initiative carried out individually by local

senior meal programs throughout the month of March. The campaign is designed to raise public awareness about our senior programs and the need for meals, to raise funds to enable the provision of services locally to meet those needs, and then most important, to recruit volunteers to assist in the delivery of services so

that no senior goes hungry.

I know that this is quite familiar to you, Senator Craig and Senator Breaux, as Chairmen of the Honorary Congressional Advisory

Committee and as Senators who helped kick this off last year here

in Washington at a press conference with race car drivers A.J. and

Larry Foyt. But some of your colleagues, particularly those new to

the Senate, might not be aware of your leadership and involvement

in the Meals on Wheels behalf. So remembering that anniversary,

we want to thank you again publicly and encourage your colleagues

to get involved, as well. ‘‘March For Meals’’ is just another way that MOWAA is helping

individual meal programs enhance public-private partnerships that

are essential to their past and current success, as well as to the

future growth of the senior meal program.

Senior meal programs, some over 4,000 across America, are as

diverse as the communities in which they operate and the seniors

that they serve. They are urban and suburban and rural. They furnish congregate meals in places like senior centers and community

centers. Others provide home-delivered meals, and still others provide both the congregate and the home-delivered meals. Some programs are small serving 30 meals a day, while others serve as

many as 3,000 meals a day.

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But all programs share one commitment, and that commitment

is the regular provision of healthy, nutritious meals to America’s

seniors who need them. By doing so, all of these programs are important partners, ‘‘senior partners’’ as we call them with President

Bush and Lynn Swann in their efforts to promote a healthier lifestyle in the Healthier U.S. Initiative: The Healthier U.S. Initiative

identifies four components, first of all, being physically active every

day; eating a nutritious diet; getting preventive screening; and

making healthy choices and avoiding risky behaviors.

It will not surprise you when I tell you that MOWAA would like

to reverse that order and put a nutritious diet first. That is precisely what our programs endeavor to do to put healthy nutrition

first in the lives of seniors. There is no question that scientific evidence supports the relationship between good nutrition, health, and

functionality among our older adults.

The majority of our MOWAA member organizations provide nutrition services under the Older Americans Act. Under the Act,

meals served must provide one-third of the recommended dietary

allowances, or the RDA, established by the Food and Nutrition

Board of the National Academy of Sciences National Research

Council. The meal must also follow the dietary guidelines for Americans, which encourage healthy eating habits and physical activity

as a part of life.

Although one-third of the RDA is the minimum requirement for

our meals, most of our meals contain 40 to 50 percent of the daily

nutrients needed by older adults. In addition, the meals provide

more than half of many recipients’ total meal intake for the day.

So our outcome is two-fold. By providing a nutritious meal, we address both malnutrition and hunger.

Our programs also encourage physical activity. Congregate programs provide important opportunities to engage in community life.

They offer—in addition to the meal—a variety of other programs,

including exercise. Home-delivered meal programs make it possible

for many home-bound older adults to continue to live in their

homes and thereby maintain some level of physical activity. I am

referring to just moving from room to room, interacting with their

pets, eight gardening, watering plants, caring for their home, and

remaining active in their community. I believe that all panelists

would agree to me that every movement counts.

Meal programs also direct seniors to other key recommendations

of the Healthier U.S. Initiative, namely the preventative screening

and making healthy choices. Meals are not the only thing provided

by senior meal programs. Programs conduct a nutrition screening

at the intake. A simple ‘‘determine your nutritional health’’ checklist identifies warning signs of poor nutritional health and assigns

appropriate nutrition interventions. Nutrition programs also provide nutrition education, which stresses the importance of nutrition

and health. It equips older adults with the knowledge they need to

make healthy food choices on their own.

For some older adults, general nutrition education may not be

enough, and for then, many programs employ a dietitian to provide

individual nutrition counseling to translate a person’s nutritional

needs into better personalized food choices. These healthy choices

can have a measurable effect on health status.

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I would also like to elaborate on just two benefits from the homedelivered meal program. Home-delivered meal programs address

two distinct populations: the frail in need of long-term support and

also those in need of short-term intervention.

The first group I believe most generally comes to mind when we

talk about home-delivered meals, because the Older Americans Act

targets its limited services to those in greatest economic and greatest social need with an emphasis on low-income population. This

long-term needs group is the one that is most likely to be served

by our programs, and that is the way it should be.

But the other group, those with short-term needs, merit attention, as well. The last national survey, conducted almost a decade

ago, found that 41 percent of all home-delivered meal programs

have waiting lists. The median time on these waiting lists is 1

month, with some programs having wait times as long as 3

months. As a result, particularly in some areas, those in need of

short-term intervention may go unserved. The group may be comprised of individuals who are recently hospital discharged, for example, or recovering from an acute illness, or have a short-term

mobility impairment, say from a broken bone. Without access to

community-based services, they may have to be institutionalized

further or return home to fend for themselves. Regrettably, that

can result in deterioration of nutrition and health status and, in

turn, can result in re-hospitalization.

MOWAA believes that this is an unnecessary cost in both human

and financial terms. Our programs can feed an individual for a

year for the approximate cost of a one-day Medicare hospital stay.

Whether or not the worst-case scenario occurs, the lack of service

does not contribute positively to our shared goal of promoting

healthy aging.

The CHAIRMAN. Linda, if we could have you start wrapping up

now, please.

Ms. NETTERVILLE. OK.

The CHAIRMAN. Your full statement will be a part of the record.

Ms. NETTERVILLE. OK. Actually, we are almost done.

The CHAIRMAN. All right.

Ms. NETTERVILLE. We come before you to show how important

nutrition is to the nation’s elderly and to our seniors, and the fact

that you have convened these witnesses here today demonstrates

once again your concern and support of America’s seniors. We

thank you for focusing on these important issues. Senior nutrition

programs are a lifeline for millions of Americans.

Thank you very much. This concludes my oral testimony and the

written testimony is submitted.

The CHAIRMAN. Linda, thank you very much for that very valuable testimony on the importance of senior nutrition.

[The prepared statement of Ms. Netterville follows:]

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The CHAIRMAN. Now, I am turning to Dr. White. I would be remiss for two reasons if I did not mention not only is she a tenured

professor at the Department of Family Medicine at the University

of Tennessee, but as Jane knows, I am married to a dietitian. Dr.

White is the recent Past President of the American Dietetic

Association and currently serves on ADA’s Foundation Board of Directors. So, Jane, welcome before the committee.

STATEMENT OF JANE V. WHITE, PROFESSOR, DEPARTMENT

OF FAMILY MEDICINE AND GRADUATE SCHOOL OF

MEDICINE, UNIVERSITY OF TENNESSEE-KNOXVILLE,

KNOXVILLE, TN

Ms. WHITE. Thank you so much, Chairman Craig, Senator

Breaux, and distinguished committee members. I appreciate the

opportunity to discuss nutrition and its relationship to healthy

aging.

America is getting older. More than 35 million Americans will

turn 65 during the next 30 years. Older Americans are increasingly

seeking lifestyle improvements to maintain health. Eight out of ten

older Americans have one chronic disease, and half of them have

two or more. Eighty-eight percent of Medicare spending is for beneficiaries with three or more chronic conditions.

I am a professor of family medicine at the University of Tennessee in Knoxville and a registered dietitian. I am technical advisor to the Nutrition Screening Initiative, or NSI, a health care coalition led by the American Dietetic Association and the American

Academy of Family Physicians. NSI promotes routine nutrition

care for older adults to prevent and manage chronic disease. Mr.

Chairman, NSI was founded because the efficacy of nutrition intervention is one of the best-kept secrets in town.

Chronic disease affects people of all ages. I expect many otherwise healthy members of the Senate and many of your constituents

at home have a condition, a diet-related condition that they are

working to manage, such as high cholesterol or high blood pressure. Hypertension affects one out of three people aged 70 years

and older, while roughly one in ten have diabetes and one in four

has coronary heart disease.

Nine out of ten people with a chronic disease have a condition

that could be improved with nutrition intervention. Through my

work with older adults and physicians, I have seen the critical role

nutrition plays in maintaining the health of adults as they age. I

have submitted a patient case study attached to my testimony.

Nutrition intervention is supported by substantial scientific evidence. The Institute of Medicine reported that there are proven nutrition strategies for managing cardiovascular disease, diabetes,

and renal failure. These measures are cost-effective, leading to a

reduced number of hospitalizations, reduced length of hospital stay,

and fewer physician office visits.

Medical nutrition therapy, or MNT, offers economic advantage to

individuals as well as to the nation’s health care industry and to

our economy in general. Chronic disease costs our country $300

billion annually, one-third of the U.S. health care expenditures.

Ninety-nine percent of all Medicare spending is being used to treat

chronic illness. Prescription drug costs are rising and patient drug

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use is skyrocketing. The number of older adults taking eight or

more drugs per day has increased 50 percent in the last 3 years.

The American Diabetes Association reported recently that costs

associated with diabetes have doubled in the last 5 years. The

annual cost per patient with diabetes is more than $13,000, compared to $2,500 for individuals without this disease. Changes in

diet and regular exercise can reduce the risk of developing diabetes

in older people by up to 71 percent.

Further, nutrition strategies offer a cost-effective treatment

alternative to prescription drug therapy. For example, it is estimated that nutrition intervention could save anywhere from $52 to

$168 million for older adults with high blood pressure and $132 to

$330 million for those with diabetes.

However, physicians seldom discuss nutrition with patients. Doctors say they lack the time, knowledge, and tools to provide this

information. At the same time, 85 percent of older patients want

nutrition information from their physicians, but only 36 percent

report that their doctor emphasizes nutrition during office visits.

The clear need for practical tools for both physicians and

consumers led NSI to develop the ‘‘Physician’s Nutrition Guide to

Chronic Disease Management for Older Adults.’’ This brief synopsis

includes specific nutrition information on eight chronic diseases.

The patient education materials include nutrition tips on each disease that can be tailored for the individual in the physician’s office,

with referral to a registered dietitian mentioned for complex cases.

We want to underscore the need for updates to Medicare that

keep pace with the current state of knowledge and best practices,

including nutrition care. Older Americans want to be as healthy

and independent as possible. Nutrition and fitness within individual limits can contribute to successful aging, but more can and

must be done to make basic nutrition services available to every

older American.

I urge you to support programs that provide nutrition services

for older adults, to enable nutrition research through adequate

funding, and to support graduate medical education in nutrition for

residents and fellows in the primary care specialties.

Senator Craig, the public wants this. Our nation needs it. The

economics of health care mandate it. Nutrition is essential to

healthy aging.

Thank you for allowing me to be here today, and I would be

pleased to answer any questions you might have.

The CHAIRMAN. Well, Jane, thank you very much for that

valuable testimony. That, as you know, is an area we have worked

collectively on as it relates to Medicare and Medicare reimbursement, to allow nutritional experts to be reimbursed for obviously

the advice and the programs they develop instead of having it

screened through a primary care provider, or at least to be able to

be billed directly for those services and that information.

[The prepared statement of Ms. White follows:]

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The CHAIRMAN. Linda, in your testimony, you mentioned that the

senior meals program conducts nutritional screening. Can you

elaborate on how this program works and what you do with the

outcome of the information?

Ms. NETTERVILLE. As part of the requirements through the Older

Americans Act and through the national NAPAS requiring, we use

the determine check list, which is about ten questions which are

simple questions and gives us some kind of an idea of what appropriate nutrition interventions might be appropriate for those individuals. Depending on the staff and skills at each of the nutrition

programs, it depends on how far we go with that information and

what we do with that information.

It does help an individual and nutrition education materials that

are appropriate that are provided that go along with that screening

that we do, so an individual knows how many fruits and vegetables

they should eat and so on.

The CHAIRMAN. So screening includes also, obviously, the advice

that follows then?

Ms. NETTERVILLE. Right. That is a big part of it.

The CHAIRMAN. Is there then the opportunity to follow up to see

if down the road some weeks or months that advice is still being

taken?

Ms. NETTERVILLE. There is the opportunity every time we reassess. At an annual reassessment of any of our individuals, we follow that same procedure and do a screening so we can see changes

in health care, in healthy status. It is part of our outcomes that

we document.

The CHAIRMAN. Thank you.

Jane, you referred to the disease management hearing that I

chaired last September. In general, can you elaborate on how the

private insurance companies currently integrate nutrition care into

disease management programs?

Ms. WHITE. Certainly. It is extremely variable from State to

State. Many of the programs follow national Medicare and Medicaid guidelines, and so reinforcing the need for nutrition services

and paying for services through these programs would help to ensure that the private insurers follow suit and provide appropriate

nutrition services for patients.

In Tennessee, with TennCare, TennCare does provide chronic

disease management services and nutrition counseling for patients

with specific chronic diseases. This has been a big boon to the older

population in Tennessee.

The CHAIRMAN. What would a state-of-the-art nutrition care program look like for the Medicare program?

Ms. WHITE. I think the state-of-the-art program would have to

incorporate routine nutrition screening and assessment with the

caveat that appropriate intervention be provided, and this intervention might include referral to social services and programs such

as Meals on Wheels congregate feeding sites, et cetera. It would be

a review of prescription drugs, because, you know, many drugs,

such as the ACE inhibitors and beta blockers and diuretics are

very dependent on a low-sodium intake for efficacy. So, again, advice related to diet and exercise in terms of chronic disease management.

41

So I think it is two components, nutrition assessment and then

appropriate nutrition intervention, and, of course, reimbursement

for services provided.

The CHAIRMAN. Thank you. Senator Breaux.

Senator BREAUX. Thank you, Mr. Chairman. I thank both of our

witnesses. It is clear that diet and exercise together play an incredibly important role in the aging process and guaranteeing that people live, again, not just longer lives, but better lives and less costly

in terms of the medical care they need, particularly in their last

months of life. Also, obviously, it brings about a quality of life that

is a big improvement, so they both go together. If you have a great

exercise program and horrible nutrition, you are not going to get

the job done. If you have great nutrition and no exercise, you are

not going to get the job done. So the two are very directly interrelated and very necessary.

The Meals on Wheels program provides so much in terms of

meals and nutritional programs to help seniors. It is a wonderful

program. I have delivered them on numerous occasions and you see

the joy they bring. It is also a point of social contact for many of

the people and a connection with the outside world that many of

them might not have. It is hard to believe that may be the only

person that visits that senior sometimes is the person delivering

the Meals on Wheels. So in addition to delivering the nutritional

food, they also deliver friendship and a contact with that senior

which is incredibly important.

I get, Ms. White, from your testimony that you would support

that the Medicare program has as one of its reimbursable things

that are covered, what, nutrition?

Ms. WHITE. Yes. Medicare covers currently treatment for diabetes and renal disease, but we really need to expand coverage certainly to include the cardiovascular diseases and other diseases

where there is a clear indication that nutrition care and nutrition

intervention work improve quality of life, and lower health care

costs.

Senator BREAUX. Would you know whether private health plans

in the country that are not for Medicare individuals have that type

of provision?

Ms. WHITE. It is very variable from State to State. Some of the

private plans do cover nutrition intervention. Some of the State

programs cover nutrition intervention. But it is not universal

across our health care system and we really need to institute these

services for all Americans.

Senator BREAUX. Does Medicaid cover it, do you know? Some

States maybe and some States not?

Ms. WHITE. Some States. Maybe TennCare does, but other States

not. So again, we need to institute early intervention for the Medicaid population, and continued intervention for our seniors because

we know that nutrition and physical fitness implemented at any

age improve health.

Senator BREAUX. Do you have any kind of a ballpark estimate of

how much including this type of service under Medicare would

cost?

Ms. WHITE. I don’t have the specific figures, but it was included

in the Institute of Medicine report on the benefits of nutrition care

42

for older Americans. Again, it would depend on how often the services are prescribed, because for chronic disease management, we

really don’t diagnose disease. It is up to the referring primary care

provider to diagnose a problem and refer. So again, it would depend on how many of our physician colleagues were involved in

screening and assessment, and then how many of our older Americans recognize that this benefit is available and choose to avail

themselves of the services.

But certainly in the long run, as I mentioned with the figures on

hypertension and diabetes, we have similar cost saving estimates

for the dislipidemias, osteoporosis. The funds that you would expend to provide nutrition services would be more than covered by

the cost savings in medications, in hospital admissions, readmissions, length of stay, and so forth.

Senator BREAUX. Well, unfortunately, the way we score things in

Washington, we don’t consider the positive effects. We only consider the expenditures of how much it costs. I think that is patently unrealistic. I mean, obviously, if you have better preventative

care, you are going to reduce the cost in the long term, but the only

thing we look at is the up-front costs, which is one of the problems.

I think that we have a Medicare program that today spends more

money than we take in, and just as I said, ‘‘Unless we reform the

program, I am going to strongly resist adding things to a program

which is already financially in very serious trouble, and with the

77 million baby-boomers getting ready to come eligible for the

Medicare benefits, we cannot add benefits without reforming the

system and bringing it into the 21st century.’’

The micromanagement of health care in this country for seniors

is unlike any other health program that I have been able to find

anywhere in this country and we really have to reform it as well

as allow for new and innovative ideas. We shouldn’t have to come

to Congress and ask that this type of process be covered. It should

be covered because it is the right thing to do in the private world.

So I thank you for your suggestions and for the good work that

Meals on Wheels does. Congratulations and continue the good

work.

The CHAIRMAN. To both of you, thank you very much. I agree

with John. Our difficulty without reforming is to add more to an

already overburdened cost in a system that does provide critical

care access or care access that is so critical. But at the same time,

we are also recognizing now in the heightened awareness of nutrition and exercise, and I think there is a heightened awareness that

we shouldn’t allow the doctors, or if you will, the primary care

practitioner to be the sole screener of that service and I think that

is a concern that we all have.

I thank this panel. I thank both of you very much for being here

today.

The CHAIRMAN. I understand our first/last panelist has arrived.

Would you please come forward? Lynn Swann, let me thank you for

being here today, and most importantly, let me thank you for being

the Chairman of the President’s Council on Physical Fitness and

Sports.

I must tell you that probably everyone in this audience knows

about you and your marvelous athletic career and record, now

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being in the Hall of Fame, of course, being that marvelous wide receiver for the Pittsburgh Steelers. I have a former son-in-law—you

know how that can happen on occasion.

Mr. Swann. Yes, I do, sir.

The CHAIRMAN. Who is from Pittsburgh who would give his eye

teeth to be in the audience today and to meet you. He is also

a father of a marvelous grandchild, so he is still a very close personal friend of mine and will always be. He is a delightful gentleman.

But as an Idahoan, I never grew up with pro ball and I never

realized how addictive it is until I came to Washington, and then

I really didn’t realize how addictive it was until I had in my family

a Pittsburgh Steeler fan. It is obsessive in that crowd. [Laughter.]

But probably it is because of the marvelous game that you played

and obviously the record you delivered and the support you built

with your fans throughout the years, so we thank you so much for

being here.

But now we thank you for heading up the President’s Council on

Physical Fitness and Sports. Senator Breaux and I have mentioned, our growing concern about the absence of physical activity

in our population and now we have what some would term an epidemic of obesity in our society that is of great concern and brings

on the kinds of chronic illnesses that continue to cost this society

a great deal of money and cost the individual a great deal of life,

and so, clearly, physical fitness is important.

We thank you for being here. Please proceed with your testimony.

STATEMENT OF LYNN C. SWANN, CHAIRMAN, PRESIDENT’S

COUNCIL ON PHYSICAL FITNESS AND SPORTS, SEWICKLEY, PA

Mr. SWANN. Senator Craig, thank you very much, Senator

Breaux. Thank you for holding this hearing.

Indeed, Senator Craig, there are some obsessions worth having,

and for all those Pittsburgh Steeler fans, I understand how they

feel about their obsessions.

The CHAIRMAN. You have got it.

Mr. SWANN. But certainly an obsession of mine is also being fit

and maintaining a great quality of life.

You have the statement that we prepared obviously for this day

and I don’t want to go over that word for word. But certainly, we

have to set better examples for young people in America and our

elderly in terms of what we expect and what they can do.

The President of the United States believes in this and he is

physically fit. The Secretary of Health and Human Services,

Tommy Thompson, has lost 15 pounds since he took that office in

an effort to walk the walk and not just talk the talk, and we all

have to do——

The CHAIRMAN. It has nothing to do with the stress of the job?

[Laughter.]

Mr. SWANN. Well, his level of physical fitness probably allows

him to deal with that stress in a better way.

We have to look at our aging population, and sometimes we have

to ask a question before we get to the answer in terms of being able

to help them and the question is, Why are our elderly people in

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such a poor state of physical health? For many reasons, one of

which is because for many of our older citizens, they never have

worked out. It was not a part of their lifestyle.

We have shown that a healthier lifestyle is far more important

than we used to think of it. It is not just a matter of running

around and trying to look good in a bathing suit in the summertime. It is not a matter of trying to fit into that tuxedo you bought

10 or 15 years ago for a special event. It means a higher quality

of life.

Our senior citizens can have a higher quality of life even if they

have never worked out before, and so they can start now. It is

never too late to start working out and you can derive the benefits.

There are more than, I think the number is about 300,000 hip

injuries to senior citizens a year, and unfortunately for our senior

citizens who are in poor health, that one injury can also lead to

death. A lot of us like to think that weight loss is an important

thing, is a positive sign. But when the elderly start to lose weight

rapidly and for no apparent reason, it is a very poor sign that they

may never recover.

If an older person is more physically fit, their bone density is

going to be stronger. Their muscles are going to be stronger. Their

reactions are going to be stronger. So in an inadvertent fall, a hand

can go down that prevents that fall from being a broken hip and

prevents that particular injury that could lead to their death, to

mortality.

So we can start our elderly on programs that give them great

benefits today, but I think it is equally important that while we attack that front, we also attack a larger front in terms of our children and our adults. The President’s Council on Physical Fitness

and Sports has an adult lifestyle program that we have enacted

this year that is different than the Challenge program for the children that we have had for many, many decades and we are trying

to encourage adults and families and senior citizens to work out to

derive all the health benefits of good, balanced physical fitness.

We are not asking people to become professional athletes. I am

not asking that everybody go out and try to run the marathon or

become a triathlete or become a part of the extreme sports that we

have in our society today, but that we do a little bit of something.

Thirty minutes a day, moderate exercise, can derive all the benefits

for our senior citizens. We have over 60 million people who don’t

really work out at all, don’t do anything. Ten minutes a day of

moderate exercise, they can derive those benefits.

What is the cost of that? Senator Breaux, you had mentioned beforehand that the expectation of putting a lot of money up front is

not warranted. You can’t expect to have those kinds of outlays of

cash. But we are spending over $250 billion a year—$250 billion—

on obesity-related diseases that are preventable. Diabetes are preventable. Where will we spend that $250 billion if we didn’t have

to spend it there, and wouldn’t we need to get that $250 billion

back into other parts of our economy, to other areas? We need people just to be more active.

We are instituting sometime this year, late spring, early summer, a new President’s Challenge website that will be able to track

citizens for the rest of their lives, to give them information they

45

need to be healthier and to stay fit—young kids, adults, senior citizens. It will track them and give them the kind of information they

need to maintain or to gain an active physical lifestyle so they can

derive those benefits, and that cost is minimal.

We just need to get people to be active and to start doing something, and there are many ways we can get that going, but the key

here is to take that one step, and then the next step and the next

step.

So I am sure, Senator Breaux and Senator Craig, with your help

and your emphasis on this problem, we as a nation will continue

to move forward and get stronger. Thank you.

The CHAIRMAN. Lynn, thank you very much for your testimony

and your commitment and your involvement.

[The prepared statement of Mr. Swann follows:]

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50

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The CHAIRMAN. In what ways is the President’s Council promoting the President’s Challenge? You mentioned the website. Beyond

that, is there an incorporated effort?

Mr. SWANN. There are several partnerships that we have with

various companies in corporate America to get people in the workplace to continue to work out and derive those benefits. We have

programs in place with the YMCA to engage people to continue to

work out and tracking them. We certainly want to get them all

signed up on our website, but to motivate them. I think it is important to motivate, to incent, and to encourage people to work out in

a variety of ways.

The President’s Council is about 20 members strong and we have

been out speaking to groups, large groups across this country. We

will continue to do that and continue to seek forums to express the

President’s position on a healthier us, that is, 30 minutes of exercise every day, 5 days a week. It is a balanced diet, getting the

proper testing to see what our state and physical condition really

is and make sure we are medically OK, and to avoid risky behavior, things like if you don’t smoke, don’t start, and if you do, don’t

smoke around children, wear your seat belt, wear a bicycle helmet,

those kinds of things.

The CHAIRMAN. In addition to holding this hearing, what can the

Special Committee on Aging do to help you and the President’s

Council on Physical Fitness and Sports promote physical fitness for

seniors, because you said something in your opening comments

that really is a reality to me in talking with older Americans about

exercising and they will say, ‘‘Well, I never have.’’ Why should I

start? I never did play any sports. I never have done anything of

that nature. I think there is quite a bit of truth to that. When you

talk about these 60 million out there who are not, part of it is because they never have.

Mr. SWANN. Correct. It is very much like that student that was

in your school probably, that guy, that girl that never had to really

open the book very long and they just kind of got it.

The CHAIRMAN. Oh, I really resented them.

Mr. SWANN. Oh, didn’t you? You resented them. They were so

bright and so smart, they just got it like that, As and Bs just up

and down the report card. [Laughter.]

But as soon as they went to college, they found themselves in a

bit of trouble. It didn’t come that easy and they couldn’t compete.

Why? Because they didn’t have the tools. They didn’t know how to

study. When the other bright minds came to that university, they

were bright and they had the tools. They did know how to study

and so they competed better. Many of those bright kids got lost and

didn’t have the results they were looking for.

There is also that guy and that girl you grew up with, they could

eat anything in the world and they never gained an ounce and they

looked great in their clothes, and they ate the desserts, they ate

the pies, they ate everything they wanted to, never gained a pound.

Then all of a sudden, 35 and 40 hit and the belly started getting

out there. There was one guy, if you asked him for $5, he could

reach into his wallet this way because it just grew that big out the

other end. They never had the tools to start working out. They

never understood it.

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We can give senior citizens those tools. As a matter of fact, later

this week, we are meeting with the American Association of

Retired Persons to talk about a plan to get more senior citizens activated and working out, light weights, moderate exercise to derive

the benefits. They can increase their muscle mass at age 60 and

they can gain more flexibility. They can increase the density of

their bones so they are not quite as frail. They can derive all the

benefits of moderate exercise.

Again, we are not talking about anything substantial. It could be

10 minutes here, 10 minutes there, another 10 minutes vacuuming,

gardening, walking their grandchildren, walking the dog, exercising with other senior citizens, and that is enough to derive the benefits.

The CHAIRMAN. My last question to you, Lynn, would be—and

this is going to put you on the spot, but I suspect you can handle

it well. You have been an athlete all your life. How often do you

exercise?

Mr. SWANN. I exercise about 5 to 7 days a week.

The CHAIRMAN. What is your routine?

Mr. SWANN. Just last weekend, I celebrated my 51st birthday,

and I get up at about 5 in the morning because that is my routine.

I will do anywhere from 45 minutes to an hour of cardio, treadmill,

bicycle, elliptical machine. I will do a minimum of 300 sit-ups a

day, and then 3 or 4 days a week, I will lift weights for about an

hour.

The CHAIRMAN. You can stop. [Laughter.]

Mr. SWANN. But it is important, sir. Certainly, I am not asking

people to do what I do, but I am asking America to be a little more

fit. I am asking all the organizations who need to have America be

more fit because their dollars and cents can be spent elsewhere.

The American Diabetes Association, the American Heart Association, all of these organizations are doing great work and research

to find cures and prevent diseases and to prevent death.

One of the things we need all of us to do is be more proactive.

If they get their constituents to lose weight, if they promote a

healthier lifestyle and moderate exercise, and it costs nothing to do

that, then they take people off the rolls of diabetics and obese people with other diseases and we get some of that money back looking for a cure.

So we need everybody from all parts of our society to encourage

people to work out and derive those benefits. If we get that, if we

become much more proactive on the preventative side, then that

$250 billion a year we spend can go to other areas where we certainly need that money.

The CHAIRMAN. Lynn, thank you. You are a wonderful example

and it is very obvious why the President has selected you to Chair

the Council.

Let me turn to my colleague, Senator Breaux. John?

Senator BREAUX. Thank you very much, Mr. Swann, Lynn.

Thank you for your participation and your involvement.

I will just ask, if I followed your suggestion, would I be able to

play like Michael Jordan? [Laughter.]

55

Who is a real example, I mean, among others, but an example

of what you can do later in life at the very top of an athletic profession. It is just absolutely amazing.

I do think, sincerely, that what you are doing is very important,

because you are such a recognizable person in the athletic world.

To take this position on behalf of the administration and be able

to use your fame and position to encourage others to do the same

thing is very, very important. You are giving something back.

Although I hate to admit this, there were some in my office, and

I would say that it was some of the females in my office that

thought that Lynn Swann was a female. [Laughter.]

They have been banished for a long time. [Laughter.]

The CHAIRMAN. You should bring them down and introduce

them.

Senator BREAUX. I think they would like to meet him. [Laughter.]

Mr. SWANN. Senator Breaux, I hate to tell you this, but my mother was hoping I would be a girl, too. [Laughter.]

Senator BREAUX. I thank you just for that involvement, because

your being where you are is really giving back to this country and

it is just wonderful to see you doing this.

Maybe everybody in America needs to do more in this area, but

two populations where it causes the greatest degree of problems is

with the young and the elderly. I mean, we have so many of our

young people who are tied to the television and tied to the Internet

and who don’t do what I think we did growing up. We didn’t really

have access to television like that and certainly didn’t have the

Internet, so we had sports. Boys and girls both were out doing

things. It seems like it is a huge problem now.

Then there is an attitudinal problem, I think, among our elderly.

My father was an outstanding athlete when he was young, but

when he hit a certain age, people in his generation said, ‘‘That is

it, I can’t do anything anymore, and they just retired to the lounge

chair and to the television.’’ Those are two distinct challenges. How do we get to the young

people to tell them to get off their backsides and get out and do

something, and how do we encourage the somewhat elderly in our

society that they, too, need to still be doing this because of what

it means not only to themselves, but also to their children and

their grandchildren who are going to have to participate in helping

to take care of them? I mean, how do we do that?

That is the real challenge, and I think the President’s Council on

Physical Fitness hopefully can come up with some ways to target

that. Certainly, your being a spokesman will help. Do you have any

thoughts about how we get to those two distinct groups, the young

people and the elderly?

Mr. SWANN. Certainly through our school systems. We mail out,

we provide for the school systems the information on the President’s Challenge, a program by where they can earn points and

awards through the Presidential Fitness Program. Any teacher can

put this program in place. They don’t have to be a physical fitness

teacher or a physical education teacher to enact this program and

plan. So we mail out information and make it available to children,

to schools all over America. Our corporate partners make it availVerDate 11-MAY-2000 13:49 Jun 16, 2003 Jkt 000000 PO 00000 Frm 00059 Fmt 6633 Sfmt 6633 C:\DOCS\87354.TXT SAGING1 PsN: SAGING1
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able to many more children, to the Boys and Girls Clubs, through

Big Brothers and Big Sisters of America, and through the YMCAs,

YWCAs, so that the kids can have access to these programs.

We continue to try and reach adults in other sections of our society to reach adults and senior citizens to make these programs

available to them.

Senator BREAUX. But aren’t we finding, for whatever reason, that

more and more schools now are not requiring physical education as

part of their curriculum? It seems like the first thing they drop is

PE, physical education, because it is sort of assumed it is sort of

an extra, when now we know today it is much more a part of an

educational process. It is just as important to teach people to exercise and save their lives as it is how to add in a math class. One

is not more important, I think they are pretty much even. But

aren’t we finding that more and more schools are not even requiring physical education any more?

Mr. SWANN. That has been the case for quite some time. Now

about 10 years ago, the Chairman of the President’s Council on

Physical Fitness and Sports was a gentleman by the name of Arnold Schwarzenegger.

Senator BREAUX. I remember the name.

Mr. SWANN. Arnold spent a great deal of time in his tenure trying to reach out to Governors of all 50 States. As a matter of fact,

my research tells me he visited every Governor at that time to encourage them to have physical education as a mandated portion of

their educational system. At the time, there was only one State,

the State of Illinois, that mandated physical education as a part of

their educational program.

Senator BREAUX. How many do you think today?

Mr. SWANN. Today, Illinois is still the only State that mandates

physical education.

Senator BREAUX. Unbelievable.

Mr. SWANN. It is the only one. The State of California has failed

a physical education test for its young people recently.

Senator BREAUX. I think that you have highlighted in this something that—I mean, if our schools who educate our children do not

recognize that physical education is an important part of the learning process, then we have a challenge that is almost insurmountable.

Mr. SWANN. It is a challenge, not insurmountable, I believe, Senator Breaux. I believe if we just kind of dig our heels in, we can

fight that trend toward obesity.

Senator BREAUX. Well, insurmountable is too tough a word.

Nothing is insurmountable. But, I mean, I tell you, to have to do

it without the schools’ participation is an unnecessary challenge

that we shouldn’t have to face. Schools should recognize that physical education is part of the learning process and a very important

part of it.

Mr. SWANN. We certainly need that balance, and we need to

reach our children to get them more active. But part of that, I also

believe, is because we have been so extraordinary successful as a

nation, our technology. We look at our workforce. We don’t necessarily need as physical a workforce as we had 10 years ago, or

as we had 20 years ago. We have a society that has grown up with

57

a great deal of convenience. I mean, you don’t even have to turn

the handle to open the can. You just press the button.

Senator BREAUX. But that is part of the problem. Not to be argumentative, but we have become such a high-tech society that things

that used to require a degree of physical activity and qualification

to operate a particular piece of machinery or to perform a function

is no longer necessary. You can sit behind a desk and push a button, or you can get on a computer and get the job done. So there

is a lot less physical activity involved in what we used to have. You

used to have to be in better shape in order to perform certain work

tasks.

So I would argue that that is an indication that physical exercise

not connected to your work activities is even more important. We

are going to have a bunch of high-tech people who are as smart as

hell but are obese and fat and sick with diabetes and it is going

to cost us, as the lady said, $250 billion a year. They are going to

be really smart, but they are going to be so fat and obese and sick

that they create a problem for society that outweighs the ability to

be a high-tech society.

Mr. SWANN. In my effort to reach Washington, DC, this morning,

my plane was delayed a bit and I ended up landing in Baltimore.

I was facilitated in getting here by Representative English and Tim

Murphy, and Tim, I have known for many, many years in Pennsylvania, and we were having this conversation and we were discussing physical fitness and how you get the time to exercise in a busy

schedule, the busy schedule of a Congressman, of a Senator, of any

individual, and we came to one of several conclusions.

One is that it has to be a priority, and as a priority, we have to

schedule it. I would prefer to sleep in. I would prefer not to get up

at 4:30 or 5 in the morning. But as my day unfolds, I know that

I may not get the opportunity to get that workout in, and I will

be sitting in my office and I will be reading material getting ready

for the next broadcast or the next project. I will be on the Internet.

I will be on the computer. I will be one of those people sitting

there, not moving around. So I get up at 5 in the morning to schedule that activity.

Senator BREAUX. Well, I don’t—— Mr. SWANN. If it is important to us, we need to figure out how

to schedule it.

Senator BREAUX. I don’t know how to do that, Mr. Chairman. I

mean, I don’t like to mandate to States what they should do. I

would be last to mandate what the curriculum should be in schools.

But we as a nation have an invested financial interest in this.

When they are not teaching young people how to be part of an organized exercise program, it is costing all of society a huge amount

of money. The fact that the schools have moved away from this is

something that—they did it in many cases because they don’t have

the money, so they figure they cut the least important program in

the curriculum and it has always been physical education, which

I think is a huge mistake.

I don’t want to belabor it, but I asked also about seniors. Do you

have any thoughts about how do we get people who think it is time

to retire to the rocking chair to also do more than just rock away

their lives?

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Mr. SWANN. I think if we can engage our senior citizens. I think

certainly the conversations we are going to have with the AARP

this week are going to give us some help in enlightening us in

terms of how we can approach that. But I do believe we need to

engage them.

As a matter of fact, I just met recently a doctor from the University of Pittsburgh who was headed down to Miami for a conference

and her mother had passed away several years ago. Her father was

at home in Massachusetts and he had never lived anywhere other

than Massachusetts, and she convinced him to move to Pittsburgh

with she and her new husband. He came there and he lives in an

area called Squirrel Hill and he spends his time at the community

center with other senior citizens and it has opened up an entirely

new world for him, the exercise programs with other senior citizens. He is taking Tai Chi, and, as a matter of fact, tried to pull

a couple of moves on his daughter so he could take her down if it

was necessary. [Laughter.]

It is not just the physical benefits that seniors get when they engage in these programs, but it is also a psychological benefit. They

feel better. Their attitude is better. They have an air of confidence.

So I think if we can engage them, show them through a variety

of means that the quality of their life is going to improve, that they

will be able to see that little bright light in the eyes of their grandchildren for many more years if they take a little bit of time, it is

well worth it and we can make that effort.

Senator BREAUX. See if you could help, I mean, use the office

that you are in, that you head, to really see what we can do to

maybe help promote the National Senior Games Association. I

mean, it has struggled. It has sort of been the stepchild of athletic

endeavors in this country and I think that it is the only thing that

really encourages seniors to be involved on a national level in

something that emphasizes physical fitness. I have tried, and I

would love to join with you and others to try and find out what we

can do to encourage that as an endeavor that continues. They have

had really tough problems in getting people to recognize this as a

commercial entity.

I mean, if I was an advertiser, I would say, look, you are talking

about a group of people who are some of the largest purchasers in

this country that are seniors, and to try and find ways to get the

private sector involved. It shouldn’t be the government doing it, but

we should be involved in that. So I look forward maybe if you have

any thoughts on that.

Again, congratulations. I know you couldn’t land here because of

the snow storm and you went to Baltimore, and the worst thing

possible, you had to hitch a ride with two politicians. [Laughter.]

Thank you for being here.

Mr. SWANN. It was not the worst thing. I actually enjoyed the

ride. But I certainly look forward to working with you, Senator

Breaux. It would be an honor and a pleasure to work with you on

the Senior Games, to encourage and to motivate our senior citizens

to be more active and give them the goals. We do need to give everyone goals to reach for and to motivate them and it would be a

pleasure personally and through the office to be able to help you

with that project.

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The CHAIRMAN. Lynn, thank you very much for your time and

your struggle in getting here today to be with us. We thought it

was very important that we make an effort to highlight senior nutrition and senior physical fitness by example and certainly by

building a record for our colleagues and for a broader public awareness.

The evidence is there. It is just irrefutable that a healthy lifestyle, certainly exercise and reasonable nutrition extend lifestyle.

Senator Breaux and I had hearings here yesterday, and when we

look at the demographics of aging today, even under current demographics, simply because we are making people healthier longer, it

is a task at hand that requires us to reform institutions of government, and I would like to make them even healthier.

But to see folks living well into their 90’s, being physically fit

and mentally active is absolutely wonderful, not only for themselves, but for their families. You have played and are playing a

role in that kind of information education and we thank you very

much for it and thank you for coming to the committee.

Mr. SWANN. Senator, thank you very much.

The CHAIRMAN. The committee will stand adjourned.

[Whereupon, at 11:43 a.m., the committee was adjourned.]

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