President Joe Biden underwent his annual physical Friday morning at Walter Reed Medical Center, his first such appointment since he was inaugurated as the oldest first-term president in US history. Afterward, his physician Dr. Kevin O’Connor wrote in a memo Biden “remains fit for duty, and fully executes all of his responsibilities without any exemptions or accommodations.” The doctor, who has been with the President since he served as vice president, singled out two areas of “observation” he set aside for detailed investigation: an “increasing frequency and severity of ‘throat clearing’ and coughing during speaking engagements” and the President’s ambulatory gait, or walking abnormality, which O’Connor said was “perceptibly stiffer and less fluid than it was a year or so ago.” Both have been noticeable elements of Biden’s public appearances since taking office. In a detailed, six-page summary of Biden’s health, O’Connor said X-rays showed Biden has arthritis of his spine and normal wear and tear damage for someone of his age. The doctor characterized that damage as moderate to severe, but said it was not severe enough to warrant any specific treatment. He wrote it would help account for some of Biden’s recent stiffness and clumsy gait. An “extremely detailed neurologic exam” was “reassuring,” O’Connor wrote, and showed no evidence of a stroke, multiple sclerosis or Parkinson’s. Biden also has a condition known as hiatal hernia, which causes him to have reflux – something O’Connor said could account for his more frequent throat clearing. The document contained a detailed accounting of the physical exam, including his height of 5 feet 11.65 inches; his weight of 184 pounds; and his blood pressure of 120/70. Biden does not drink or use tobacco and works out five times a week, according to the report. “President Biden remains a healthy, vigorous, 78-year-old male, who is fit to successfully execute the duties of the president, to include those as Chief Executive, Head of State and Commander in Chief,” O’Connor wrote in his summary. Biden received a routine colonoscopy Friday while at Walter Reed. The process, which required anesthesia, meant that he temporarily transferred power to Vice President Kamala Harris, who became the first woman to assume presidential power for 85 minutes Friday morning. As he left Walter Reed, Biden said he “had a great physical and a great House of Representatives vote,” alluding to the House passing his Build Back Better bill on Friday morning. The last extensive update on Biden’s medical state came in December 2019, when the doctor he eventually recruited to serve as White House physician described him as “a healthy, vigorous, 77-year-old male, who is fit to successfully execute the duties of the Presidency.” Biden, who turns 79 on Saturday, hasn’t released a full report on his health since. Biden is not behind in releasing medical information compared to his recent predecessors, who waited a full year before undergoing a physical and authorizing details to be released publicly. The latest update on Biden’s health came after he, then-president-elect, fractured his foot in November while playing with his dog. In February, Biden’s physician said the foot fractures “are completely healed.” Presidents are not required to publicly disclose results of their annual check-ups but have done so to be transparent and assure the American people in the face of questions about their state of health. Presidents, however, have also hidden their illnesses, the severity of their illness, or medical treatments. Dr. Kevin O’Connor, Biden’s primary care doctor since 2009 and the White House physician, wrote the three-page medical summary Biden’s presidential campaign released nearly two years ago. The 2019 summary showed Biden was being treated for non-valvular atrial fibrillation, or AFib – an irregular heartbeat that O’Connor said Biden experiences no symptoms of. He was taking Crestor to lower cholesterol and triglyceride levels, as well as Eliquis to prevent blood clots, Nexium for acid reflux, and Allegra and a nasal spray for seasonal allergies. The most significant medical event in Biden’s history, O’Connor wrote, was when Biden suffered a brain aneurysm in 1988. He was serving in the Senate at the time. During surgery, doctors found a second aneurysm that had not bled, which they also treated. While in the hospital after that surgery, Biden suffered deep vein thrombosis and a pulmonary embolism. Doctors at the time inserted an “inferior vena cava filter,” which would prevent future blood clots from reaching the heart and lungs and treated him with an oral anti-coagulant for several months. Biden also had his gallbladder removed in 2003, and according to O’Connor he has had multiple surgeries and physical treatments for orthopedic injuries and sports medicine. Biden also has had several non-melanoma skin cancer lesions surgically removed. This story has been updated with additional information.