Translational Journal of the American College of Sports Medicine: 2025 Paper of the Year

The following article was chosen as the 2025 Translational Journal of the American College of Sports Medicine Paper of the Year: Chase PJ, Owen CM, Bantham A, et al. A review of the cost-effectiveness of supervised exercise therapy for adults with chronic conditions in the United States. Transl J Am Coll Sports Med. 2025;10(3). doi:10.1249/TJX.0000000000000313. Physical activity is among the most effective interventions for the prevention and management of chronic disease, yet it remains underutilized within the U.S. healthcare systems. The review by Chase and colleagues represents an important translational advance by evaluating whether supervised exercise therapy (SET) constitutes a cost-effective healthcare intervention for those with chronic conditions in the United States (1). This paper was selected as the 2025 TJACSM Paper of the Year because it addresses a central barrier to the integration of exercise into routine care. By synthesizing economic evaluations across cancer, diabetes, hypertension, obesity, depression and anxiety, and fall prevention, the authors demonstrate that SET programs deliver favorable economic outcomes alongside clinically meaningful benefits. Across the included studies, SET programs were associated with positive returns on investment, ranging from 1.15:1 to 1.7:1, with savings driven largely by reductions in healthcare costs or treatment charges (1). These findings align with, and extend, prior literature supporting the economic value of established exercise-based clinical programs, such as cardiac rehabilitation and pulmonary rehabilitation, that are reimbursed and have well-documented cost-effectiveness and cost savings (2–4). Chase et al. demonstrate that comparable economic value exists across a broader range of chronic conditions that account for a substantial proportion of U.S. healthcare expenditure. SET is often discounted as impractical or too resource-intensive for widespread adoption within healthcare systems. The evidence summarized in this review challenges that assumption, demonstrating that professionally supervised, scalable exercise programs delivered in clinical and community settings can meet accepted standards for value-based care. Notably, the review also highlights a persistent policy asymmetry: pharmacologic and procedural therapies are routinely reimbursed once deemed safe and effective, even when associated with substantial long-term costs, whereas lifestyle-based interventions are frequently required to demonstrate cost savings rather than cost-effectiveness alone. The policy implications are timely. American College of Sports Medicine initiatives such as Exercise is Medicine, the inclusion of physical activity assessment within the U.S. Core Data for Interoperability standards, and recent U.S. Preventive Services Task Force recommendations supporting exercise-based interventions for chronic disease have established a foundation for broader clinical integration (5). However, reimbursement remains the primary obstacle. The evidence synthesized in this review provides a strong empirical rationale for expanding coverage of SET beyond currently reimbursed indications, particularly for high-risk populations with chronic disease. For clinicians, this work reinforces supervised exercise as an effective therapy. For health systems and payers, it strengthens the case for investment in exercise professionals and programs as part of chronic disease management. For researchers, it reinforces the importance of embedding economic evaluations within exercise trials to accelerate translation from efficacy to policy. The authors declare no conflicts of interest. The results of the present study do not constitute endorsement by the American College of Sports Medicine.