Okay, it is 1210. So to stay on time, we will get started. My name is Tom Gilliam. This is Paul Terpilek. The one thing we have in common is we're both retired. So we're not affiliated with anyone. So I want to meet, I want to introduce one of our associates, Phil Stoddard over here. He's with DataFit. And today we're going to talk about muscle health, the implications of muscle health on workforce performance and safety. We thank you for attending our presentation here today. Here's the agenda. We're going to go through this as quickly as we can. And we used a number of different references for this in preparing for this presentation. This is only a few of them. If anyone wants some of these references, I'd be happy to send them to you. Just let me know. And our focus, even though we're talking about muscle health across all age groups, but the focus today, or one of our focuses, is the aging worker. And we do have an aging workforce. In fact, the World Health Organization and several others predict by the year 2050, 22050, there's going to be 2 billion people in the world age 60 and above. And sadly, about 25% of those people will have sarcopenia, low muscle mass. Which leads to a lot of chronic diseases, slips, falls, disability, and a lot of low functionality. It doesn't mean that's going to be here in the United States, a 25% sarcopenia rate. But you'll see some of the data that we're going to present here today that the loss of muscle and strength, that's the critical thing, is occurring across our workforce. We go back and we look at 10 years worth of data and how has muscular strength changed from 2013 to 2022. And sadly, it has changed. And the worker is getting weaker every year, and plain and simply, getting fatter. And that combination is not good for those in the occupational health arena because that just leads to more musculoskeletal injuries, chronic diseases, and the inability to deal with those kinds of things. So, some of the issues we want to focus on is not only that aging worker, but the loss of muscle is real, sarcopenia is real. Normally, it starts around age, sarcopenia, that is, around age 60. It can occur in the 40s and 50s. But if you have a morbidly obese person and loss of muscle in the 40s and 50s, the probability of having sarcopenia is very high. Now, the problem with sarcopenia, and there's a ton of research coming out on this right now, is how do you measure it? Some of the European groups are trying to come up with standardization for what is low muscle mass, therefore, sarcopenia. And so, maybe eventually, over the next four or five years, there will be a standard way and a simple way to assess a worker as to whether or not he or she has low muscle mass. And if they have low muscle mass, then can we intervene? Can we do something to correct the problem? And it is correctable. Muscular strength testing, resistance exercises is one of the primary ways to deal with enhancing muscle. Obviously, nutrition. The more older people, when they get in their 60s and 70s, many times don't consume enough protein in their diet, and that also contributes to the loss of muscle. And what's interesting, too, is that as they study muscle, the research is now claiming muscle to be an intricate organ, the largest intricate organ in the body. Why? Because it will has cytokines, peptides, and hormones, all contributing to what they call myokines. And that allows for crosstalk between muscle, brain tissue, lung tissue, heart tissue, all kinds of tissues in our body, and therefore, what's happening with the muscle is going to have an impact on what's happening to the rest of the body. So in my opinion, we have a serious problem on hand. It's a correctable problem, and that's one of the things we want to talk about. Now, obviously, one of the things here is sarco—whoop, whoop, whoop, whoa, that's way too fast. I told you I'd get through this quickly, but not that quickly. Obviously, what the research has shown, too, is that if you have sarcopenia, you have certain problems with chronic disease and so forth, musculoskeletal injuries. If you have obesity, you have issues with chronic disease and musculoskeletal injuries and so forth. But the combination, if you are sarco-obese, the combination is even worse than sarcopenia by itself or obesity by itself. All right, so let's be on the positive side here. What does a strong, healthy muscle mass do for us? Well, it's wonderful what it does. We've always given credit to the prevention of musculoskeletal injuries. If you have a healthier, stronger work mass or muscle mass, the probability of getting injured is less. And then if you do get injured, the probability of recovery is that much faster. That's a drawback with the older worker who has low muscle mass. When they're 60 and 70 and they have a slip or a fall or they have a musculoskeletal injury, the probability of them recovering is much longer and it may not even recover at all. It may be the last thing they do because the lack of muscle prevents them from recovering from that injury. So we know you have, if you have a strong, healthy muscle mass, you get fewer musculoskeletal injuries. You have better productivity, less asymptotism. The data is pretty clear on that. Also what's beautiful about keeping a healthy muscle mass, and that is assuming you do enough resistance exercise to stimulate the muscle that enhances calcium uptake into the bone and prevents calcium loss from the bone. Very positive as far as bone health is concerned, again, because the bone gets weaker as you lose muscle. We know that as well. And then also less probability and better management of certain diseases. This was unimportant. All through the 80s and 90s, Paul and I are very old, so we can talk about 80s, 90s, and 70s, and we did last night quite a bit. But anyway, I even forgot what I was going to say, but that's okay. The focus is always on musculoskeletal injuries, but in about 2000, you started seeing research coming out saying, hey, if you have a healthy muscle mass, you have less risk for certain chronic diseases, you have a better probability of maintaining your cognition, and so forth. And we're going to talk about that in just a moment. So strong, healthy muscle is not just tied to musculoskeletal injuries, but a lot of diseases as well. If it wasn't for COVID, we probably wouldn't even talk about the immune system. But COVID brought to everyone's attention the importance of the immune system. And what we know, people who are physically active have a healthier immune system. And the research in the last five years, or excuse me, three years since COVID, has shown that those people who are physically active, if in fact they got COVID, the probability of them being hospitalized or even dying was dramatically less. And many people who are physically active never got COVID at all. So one of the reasons is that people who are physically active, healthy muscle, also have a healthier immune system, better prepared to fight infections and diseases. We also know that a healthy muscle mass leads to better control and management of hypertension. It also helps to prevent hypertension if you don't have it today, if you keep those muscles healthy and strong. Same thing with diabetes, and what's critical there is muscle takes up glucose. And if you have a healthy muscle mass taking up glucose, you have less insulin resistance, which is also help in terms of managing your diabetes. Same with cardiovascular disease, the American College of Sports Medicine keeps track of all the various cancers related to muscle health itself. And today, they're tied into 13 different cancers. And what they've seen is that if you have a healthy muscle mass, first of all, there's a greater probability that you have the less probability of getting certain cancers. But if you get the cancer, you have a greater probability of surviving. You know, when you hear all this, you wonder why don't people want to take better care of their muscle, but they don't. Obesity is another area that has a positive impact by keeping a healthy muscle mass, bone and health joint, which we talked about. And then the research that's coming out now is about brain health. And we certainly know that a healthy muscle mass slows the onset of dementia. Doesn't prevent dementia necessarily, but it slows it. What we also know is that in some studies now, and some clinicians are using physical activity and strength training as a means to manage anxiety and depression instead of giving medications. So there's a lot of good positive information coming out on the benefit of muscle. This is our own data. Looking at about 31,000 strength tests in 2013 versus about 29,000 in 2022, and we can see this is looking at the absolute strength of the shoulder joint and the knee, the quadriceps and hamstrings. The shoulder is the worst joint in the body today in terms of strength. Many companies tell us they have more shoulder injuries now than ever before. More than low back. And they're more costly than low back. And one of the reasons is this. When you look, let's see if I can find the pointer, there it is. The blue line is 2013, this is 22. This happens to be shoulder data, and this happens to be knee data. And we show it here by decades. And you can see there's a big difference, about a 13, 14 percent difference between the two time factors in terms of the worker is weaker today than ever before. And more importantly, the biggest problem is with this age group of 20 to 29. The differential here between 13 and 22 is greater here and here than anyplace else. But you can also see a rapid decrease in strength occurring after the age of 40, and particularly age 50, because we know that unless you do something about it, you're going to lose about two to three percent of your muscle mass every decade during the third decade and fourth decade, and you're going to lose up to 15 percent of your muscle mass during your fifth decade and sixth decade, and perhaps the seventh. And if you make it to the eighth, like I have, you're going to lose even more during the eighth decade of your life. And we confirm this. Now here's the good news, is that these types of lines you see here with this rapid decrease in strength in the industrial worker doesn't have to happen. If you maintain resistance exercises throughout your lifespan, you know, that's easy to say, but it's hard to do. Because you just can't, to stimulate muscle, your muscle's made to work. Put a cast on this arm, and six weeks from now you take that cast off, and you don't like what you see. It's ugly. You've atrophied. Your muscle's gone. Well, that's what happens to your body when you sit and watch TV for hour after hour after hour. You just basically put in a cast on your body. So we want to be able to keep this strong. And people who do physical strengthening exercise, resistance exercises, whether it be weights, whether it be bands, whether it be kettlebells, whatever it might be, your own body weight, the old standby from 50, 60, 80 years ago, pushups, really works. So anyways, you can delay that. You can slow this rate of loss of strength in your fifth decade and sixth decade by maintaining a resistance training program throughout your entire lifespan. And that's the challenge. How do you get your worker to turn around and say, hey, you know, I want to get a healthier muscle mass. I'm going to work 8, 10, 12 hours a day, 5, 4 days a week, and I'm going to go take care of my muscle at the same time. They're not going to do it. We've known for 60 years of the American College of Sports Medicine, people who are physically active are healthier. But 10% of the American people today only complete or fulfill the requirement for strength training. And some studies show up to 30%. But only 10% mostly refill their strength requirement, which is two times a week for about one hour per session or 30 minutes per session. That's all. To get resistance exercises done and to keep muscle or to gain muscle. That's all they're requiring. And when the American College of Sports Medicine came out with this in 2007, they only took it through the age 65. What's wrong with the people who are 60s, 70s, 80s, and 90 years old? They're alive. They have muscle. And they've extended it. Now they're saying a lifetime. The World Health Organization jumped on the bandwagon around 2010. But they also now went down to the other end of the spectrum. Yes. What about our children? You know, we have problems. See, this shows right here. We have problems. The kids coming into the workforce at 20 years of age are in bad shape. They're weak. And they're obese. And you have to deal with them. You have to deal with their injuries. You have to deal with their diseases at that very young age. So, yeah, we can delay that rapid drop off in strength through resistance training programs. And we'll talk a little bit about that in a moment or two. Now, we do some isokinetic testing. Well, we don't do some. We used to do a lot. This is isokinetic testing. The Cleveland Clinic did that. Paul's going to talk about that in just a moment. But what this is, in case you don't know what it is, we're not asking someone to pick up 10 pounds, 15 pounds, 150 pounds. But we're looking at their ability to generate force in a working muscle. You do a physical demands analysis and say, hey, we know you're pushing, you're pulling, you're bending, you're stooping, you're climbing, whatever you're doing. We want to assess the muscles that are critical to those task analyses completed. And so this machine will accommodate strength. The stronger you are, the more resistance you get. The weaker you are, the less resistance you get. And the beautiful thing about it, you get a force curve pattern. We can see if someone is coming through your workforce that has a bad shoulder. Doesn't mean you don't necessarily have to hire them. You don't have to hire them to keep it straight. But in today's society, where you can't find workers to begin with, you hire them. But you don't put them into that physically demanding job, unless that's the only thing you have. And if that's the only thing you have, then you don't hire them. Because what I can tell you, you hire a person with a shoulder like this. This is shoulder flexion. This is taking your arm from here to here. You're reaching. You're working overhead. Critical movement. Particularly in a warehouse or a distribution or pushing, pulling, something like that. Critical movement. That shoulder flexion shouldn't look like that. That's normal. This is a natural test. This is one side, the other side. That shoulder right there, if you hired that person, and he or she had to do that kind of work, they're going to get injured. Now you have yourself a worker's conflict, but you could have prevented it by doing an objective type of evaluation to look at what his or her physical capability are. So isokinetically, you get a force curve pattern on this, happens to be shoulders. You get the same thing with the knees. We have over 600,000, I should say we, Phil does, I don't, in the database of 600,000 strength evaluations we'll look at. So we also look at muscle symmetry. We've known in athletics for years, I was a tenured faculty member way back at the university and then you get revulsion, but anyway, when they, when you, we know that if you have muscle asymmetry, you're going to get injured. And then muscle asymmetry doesn't mean you have to be perfect, but it's usually plus or minus about 14, 15%. So we look at nine different muscle symmetries, we look at the four up with the shoulders, four with the legs. Then we look at the upper body versus the lower body. That's critical too. You can be strong as hell up here, but if you're weak down here, you've got a problem. Particularly as you grow older, because these legs get weak, now you are going to fall. So this leg strength is absolutely critical. We also look at strength to body weight ratio. This was unimportant in the 1990s, 1980s, but today it is. Osterby's research at the Duke Medical Center in 2007, there's been a lot of data to reproduce this, said if you have a BMI of 35 or more, which is severe, BMI of 35 or more, and he looked at their healthcare workers that compared to normal weight individuals, that they would get injured two and a half times with soft tissue injuries, seven times the cost, and 13 times more lost work days. Well, when we look at our own data, looked at about 395,000 tests several years back, this is body weight and this is strength, absolute strength, the blue line. As you gain in weight, the good news is up to about a BMI of 35, your strength pretty much parallels your gain in weight. That's a positive. But after the BMI of 35, your strength no longer can keep up with your body weight, which puts your strength to body weight ratio at high risk. And that means that drives your strength to body weight ratio down. The lower that value, the greater the risk you have for soft tissue injury and for disease, which Paul will talk about in just a couple minutes. So this is a critical measure, and in some recent research with hand grip, hand grip is very popular today, and they're talking about hand grip strength measurements relative to body weight, or BMI, excuse me, because they're saying that people who have low hand grip scores relative to BMI have a greater risk for injury and chronic disease, and a greater risk, therefore, for sarcopenia. So that's how we look at the data, and now this is where I be quiet, and Paul comes up and he says a few things. So Paul, it's all yours. I didn't use this. I just waved it around. I'm going to use it. Okay. Okay. Can you hear me? So this is the important part of the lecture. Yeah, yeah. So a couple of things. This is the claims and the cost part, which I'm sure you're very interested in. What Tom just did is he basically told us all about muscles, and at the end of the day, what he basically said was that if you have, if you're weak, you're going to get injured or you're going to be sick, and that's what the data shows. I personally didn't know that when I first got into this analysis with Tom's company at the Cleveland Clinic, but I was at the Cleveland Clinic for about 17 years, and I managed occupational medicine. My span of control there was just not occupational medicine, it was workers' compensation and also the employee health plan. So I was in charge of the data associated with illness, in addition to injury and other things at the clinic. And so we had unusual availability or access to claims and the cost associated with the injuries that I saw and the diseases that we were managing at the clinic. So I'm gonna go over some of those findings, especially on our new hires. So Tom talked about a PCE test, which is a physical capability test. It was a new hire test that we did at the clinic on nurses and patient transport employees. And the idea was to screen out people who are weak, we just don't wanna hire them. Because legally you can do that if you do a job task analysis of the job. It's a Department of Labor standard and you compare it up against what the findings were. So we did a lot of due diligence on whether we should do this because the organization, it's a big organization, we didn't wanna do anything that was legally, put us in a problem area. So what we did is we did the stress testing program from 2011 to 2019 there and tested over almost 20,000 nurses. And then Tom and I did a paper we published a few years ago where we compared those findings on those nurses who were tested against nurses that we did not test for two years prior to. And we compared their first year experience with claims. Just their first year experience, we aggregated their claims for that one year. So we were comparing apples to apples for each of the years that we were testing versus the two years and the 2,000 people, the 2,400 nurses that we hired before we did the testing. And I didn't expect any results that were gonna change my mind. I just thought it made sense that you wouldn't have an injury if you were weak, right? Like most people here probably think, if your muscles are strong, you're not gonna get hurt as often because of the job you have. But what I found, what we found was the fact that the claims data on pharmacy and the claims data on healthcare claims, in addition to workers' comp claims, were just off the charts better for people who were tested. It was phenomenal. So this is the money shot, if you wanna think about it. We have three different costs that we looked at. The medical costs associated with the health plan, yes? That one bar is not, you can't see the yellow bar. Oh, right here, that's right. Except the bars are beige. You see that bar there? They're hiding it from you. Okay, well, pretend it's really bright yellow. It's beige. So we looked at three sort of columns here of claims, medical claims, pharmacy claims, and workers' comp claims. So we had access to all those claims. And this was for the period of 2011 to 2019. And what we found was on the medical claims, on the blue side is the cost of the claim. So for workers' comp people, this is the cost of the claim, or the severity, if you wanna call it that. And on the right side that you can't see is the frequency of the claim, the number of claims. And over here is the workers' comp, which most people talk about frequency and the depth of the claim or the cost of the claim. So on the medical side is what I didn't know, what I didn't expect was that there was a decrease in the average cost of the claim by 28% compared to the two groups, which is like, really, why? This is one year of claims. And as you can see, the frequency of the claim, half frequency, so half the people who took the test, the stronger people who we hired, were basically 50% less likely to be injured, or to have a claim, to have a medical claim. On the pharmacy, pretty much the same thing, it was more dramatic on the number of claims. So people who are healthier are less sick, they have less claims in a health plan. And their pharmacy costs are less, they have less claims, which makes sense if you're not gonna be utilizing, if you're not gonna be utilizing the health plan. And then on the work comp side, you can see that the frequency of the claim is down 43%, and the severity's down 80%. So those that were injured were less sick, if you wanna say, injured, they were less out of work for a longer, less period of time, it cost less. So it was a, not a severe injury. So I mean, this is amazing results for a program, it was really a screening program. That's all it was, was a screening program. And we just kept those people out. And so it became obvious to me at the time, that this is an important measurement, because at the clinic we had a comprehensive wellness program, a well-being program, and this was part of it, because you're trying to build a healthier workforce, and you're promoting well-being within the institution. Part of the reason we didn't hire people who failed the test was because we told them, we want you to be stronger when you come to the clinic. And it became sort of a myth or a legend around Cleveland, that if you wanna be a nurse at the Cleveland Clinic, you gotta be strong, because you have to take this test. Which is, you know, a nice thing to have. Now, obviously, since COVID, there's no nurses to hire. There's competition around the country for nurses, there's a shortage, both in the schools, the clinic actually doesn't do this test anymore on the pre-employment basis, because of that. We had about a 5% failure rate for the nurses, so we lost 5% of the nurses who applied for the job. And I guess today that's like bad, to have even that, because you're trying to get everybody, because of the few people. So overall, when you take those numbers, and you make them into dollars, the true cost of what, the cost avoidance associated with this program, is pretty significant. I think it's like 60, whatever that adds up to be, 65 million dollars over 10, eight years. And the ROI on the program itself, $32 for the cost of the program. Now the program cost included the machinery, we had at the clinic four machines to do the testing. And obviously the cost of having to test it, interpret it. But it was really, we fit it nicely into the pre-employment onboarding process. It was part of the occ health onboarding, they would go right from the drug testing, and the whole thing we did, it was very routine, and worked very well. So, what we're doing now, what we're trying to do, and what I want you to understand we're doing here, is the pre-employment is one of those, it's a legal test, really, because you're not hiring anybody, and you gotta have a lot of, make sure that it's done right. I'm a believer that the test itself is a measurement of strength, as Tom went through, for all the reasons. Most of the savings we saw were in people who were already hired in the health plan, who weren't having any claims. It seems it would be the right thing to do to figure out how to maintain that level of strength amongst your workforce. And most wellness programs, or wellbeing programs in the country, that's what they're trying to do, right? They just tell you to go to the gym, we'll pay you money to go to the gym, we'll pay you money to have 10,000 steps a day, we'll pay you money to do whatever, that's a well, but no one measures it. There's no way to measure it, because they, how do you measure it? And that's the reason why wellness programs fail in our country, is because there's no ROI on what it means to go to the gym every day. It just must be okay, right? I mean, that's the whole purpose. What this test does is it measures that, and it allows you to, it's like blood pressure, it's like having a blood pressure cuff when you're taking your medication. You now know if it's high or low, and you need to adjust it. So the idea was to figure out how to put it within the framework of a wellbeing program, and make it voluntary, not mandatory, but as part of maybe a weight loss program, or however you want to do it. So that's really what I encouraged Tom to take our data and try to associate it with what it would look like if we took these people and managed them over the course of their life cycle at the clinic. It's called the Physical Strength Risk Assessment. It's really the same thing as the PCE, sort of the algorithm, the ratio of body mass to strength. So as we went through, it's the same as what Tom said. It's really important, and really was sort of a change for me to think about, because we're docs, and we grew up with, you have a broken arm, you set it in a cast. That muscle really is, it's 40% of your body mass, and it's responsible for 75% of all of your metabolic functions in your body. So it's really a unique organ, and we generally take it for granted, and you get old and die, and you get weak. I mean, that's the whole point. No one really thinks about it. But what we have shown, that it does actually reduce morbidity, and it makes your life better. And as we know what all those things are that Tom went through, it makes you more productive at the workplace, and as people get older, obviously we have to deal with this. Because sarcopenia, which is generally you're losing your muscle mass, is gonna be happening pretty rapidly at the workplace, because of obesity, and also because of the aging workforce. So the idea that this is not an occupational health issue is wrong. It is an occupational health issue, especially now. So to start thinking about ways to incorporate muscle health within the framework of population health, is really the way to look at it, using whatever tools you have to measure it, and right now there are none, except for a program like this, that you can then incentivize people to take care of themselves in a better way, and prove it vis-a-vis testing. So this is how the, we took the PSR and graded it for ease of understanding. It's quadrants, four quadrants. As you can see, the first quadrant up here is bad, right? You're poor strength, and you're overweight, right? That's sort of the red quadrant. And the good quadrant is you're good strength, and you have, or I'm sorry, the best quadrant is down here at four. It's good strength and normal body weight, right? And up here, you're good strength, but you're a little bit overweight, and down here, you're poor strength, but you're normal body weight. So this is the normal body weight, and this is the excess. So when we took the data and divided, the clinic divided the groups into that, the nurses into that, and then took out where people fit, and then we applied it to Tom's database of almost 120,000 people tested in the database. This is what it spans out to be, essentially, is that, believe it or not, the greatest risk pool is the people who are in the red zone, which are 36,000 people, 31%. They basically are overweight and poor strength. And obviously, the least is the people who are in the green zone, which is almost 20%, but they have good strength and the normal body weight. And then in between, you see 22 and 26%. These are the people that are gonna move into the red zone. So these people, there's a way to look at a population, very, very simply, if you test them and put them in this category. And it's clear that we're on the, most populations, and at least the populations that were re-looked at, are in this group. I mean, they're in one of these four groups, but obviously, the red group is the worst group. So we know that this thing, more than what, it's obvious to you when you see what's going on in our country with people trying to get in shape or trying to lose weight or the obesity epidemic, that this makes sense. I mean, it just sort of codifies it for you. And at the clinic, when we took the 2,300 nurses and put them into the quartiles, essentially, and we tried to look and see what it would cost us, essentially, what we found is that they have about a 42% higher medical cost, high risk compared to low risk, right? 42%. So, which makes sense, right? Obviously, the people who are your utilizers are gonna be the people who are in the worst category, which is no strength and overweight. So it's pretty straightforward to take a population and to do this with. And the national trend, when we look across the, what's happening, and obviously, Tom just alluded to this, if you start looking at what's going on in our workplace, in our population, is that the red zones are separating from the green zones. They're getting wider over time. So from our data point between 18 and 22, it's clear that delta is growing. So something's gonna happen. I mean, the risk, the people who manage risk on both health plans and works comp, they're gonna realize this. Because if it keeps growing this way, someone's gonna say, do something, right? And wellbeing programs are trying to do something, but they don't know how to. Because they're usually over in some part of the HR department. It's not connected to the CFO, and certainly not connected to people who understand muscle health. So it's gonna happen, and this is a possibility of how you can address the issue. Okay, next steps, Tom. We're gonna talk about next steps? Okay. Thank you, Paul. All right, we'll conclude with, oh, wrong slide. With this slide. So what can be done? I mean, obviously we have data to say we got a problem. You know that we have a problem. So how do we fix it? It's doable, but it's not gonna be easy. So we wanna be able to incent the worker to maintain a healthy and strong muscle mass. And you can give them all kinds of things, and nothing works except for that health plan. We have some groups that now will give you, if you have a $5,000 deductible with your health plan, if you participate in some sort of resistance exercise or physical activity exercise, we're gonna reduce that $5,000 deductible to a $2,000 deductible. Well, $3,000 is a lot of money in your pocket. You give them a gym bag for 60 bucks, they don't care about that. They don't wanna go to a dinner to eat. They don't wanna do it. Give them thousands of dollars, and they're gonna maybe do something. But how do you know they're gonna do something? And there's a lot going on right now. And one is what we call these virtual programs. There's a lot of virtual programs out there today. Some are good, and some are not so good. Most of them obviously use your cell phone. Some have actually athletic trainers interacting with you. Some do not. But you can actually get a program for about $2 a month per employee, and have it on your phone, and it tracks everything, and it gives you what the history is, and so forth and so forth. And the only way it's gonna work if you incentivize them. You just can't say, yeah, we're gonna give you this nice little virtual program. But no, if I do something, if I enhance my strength, then you have to be able to measure whether there's been any improvement in that strength. And there's a lot of ways to do that. You can certainly use what we do, which is costly and also sophisticated, and involves specialized equipment. But recently, I've been reading a lot on phase angle. I don't know if some of you know much about phase angle, but it's bioelectric impediment analysis. And basically, they're doing this with body composition today. You hold onto something, and it measures your bioimpedance, and tells you which percent body fat is. Well, you can have these sophisticated machines, which cost about $10,000, $12,000, $14,000. It will actually give you a phase angle measure. And some of the recent research has said, if you have a low phase angle, which is, depending on what you read, it might be right around four, four and a half for males, and about three, three and a half for females. If you're below those cutoff numbers, you have low muscle mass, which means you're gonna be at risk for chronic disease. You're gonna be at risk for falls. And you use this information to incentivize people to improve that number. And you can improve that number if you increase your strength. And so, that's another way of trying to assess what's going on with people over a period of time, because you have to be able to track them. Yes, you can do isoclinic testing like we do. That's correct. You can do hand grip strength. And what they're seeing also with sarcopenia, by the way, is a better measure than hand grip strength is the circumference of your calf muscle. And as you see that calf muscle decrease in circumference with age, they now have cutoffs for that in terms of that person's at risk for sarcopenia. And they do use the thigh muscle every now and then, but it seems like the calf muscle is a better measure for predicting whether or not you're at risk for sarcopenia. So, we know that if you can maintain that strength level, maintain that muscle mass, and muscle mass is not as important as strength. They're two different things, okay? Strength, you wanna keep, you need strength, but you're gonna lose some muscle mass as you get older, no matter what, but if you keep your strength, you're gonna be okay, and you can do that through resistance training exercises. Okay, so anyways, we're gonna have a healthier, more productive workforce as a result of what can be done, but I read a study just the other day is people are looking for something quick. They want an injection. I'm gonna inject something into my muscle, and I'm gonna be strong as hell. No, it doesn't work that way, you know? Training a muscle is no different than it was back in when DeLorme did it back in 1948, okay? It's called resistance. You have to stimulate the muscle. You have to do enough, put enough resistance on that machine so that the muscle gets stimulated, because we're constantly building muscle up, or excuse me, tearing muscle down and building muscle up. That's what we do every single day, and when we get older, we lose, that whole homeostasis of that balance between building muscle up and tearing it down goes wrong, and what happens is that your body can no longer build enough muscle up compared to the muscle loss, and that's when that muscle loss occurs, again, leading to sarcopenia, so I like to conclude with a quote from Dr. Chin that appeared in the Skeletal Muscle Health, an article he wrote called Skeletal Muscle Health, a Key Determinant of Healthy Aging, appeared in Archives, Gerontology, and Geriatrics in mid-year last year. He says, skeletal muscle emerges as a critical component of healthy aging, yield significant influence over the physical function, metabolic health, cognitive performance, and overall well-being. In my opinion, he says it all. That's exactly why we want to keep our muscle healthy and strong, because of that. It impacts everything within our body. So I thank you for attending our presentation today, and you have any questions for us? Thank you.

muscle health

workforce performance

safety

aging workers

sarcopenia

chronic diseases

resistance exercises

nutrition