US President Joe Biden is healthy and fit for duty. He continues to work out five days a week and does not use tobacco products, drink alcohol, or use any medication that could impair his ability to serve. He also suffers from gastroesophageal reflux, which causes him to cough often, and a stiff walking motion due to "wear and tear" in his spine. Two issues noted in the previous annual exam, in November 2021, remain mostly unchanged.