Note: This transcript has been auto-generated and lightly edited for clarity. It may contain minor errors.

Hello and welcome to the Sustainable Healthcare Podcast where we talk about everything sustainability and the healthcare system and for pharma and. And today I’m really excited ’cause we are going to talk about preventative healthcare in the context of exercise. And I have with me Anders who is quite an expert in the field. Anders who has a PhD in muscle biology and a host of other things.

What do you say you work with when people ask,

I usually say that I’m a seafarer. So I’ve been self-employed for eight years now doing lectures and consultancies and health coaching and I had a couple of health sector startups. None of those panned out unfortunately, but that’s the way it is.

Yeah, so these days it’s mostly lectures and health coaching.

And what sparked your interest, perhaps in exercise and training first, and then secondly as a way of working with health as well.

So my interest was, originally I’m like an OG nerd. I did role playing and war hammer and played magic, the gathering and.

Japanese comic books, all the way back in the eighties, way before it became mainstream geeky, but at some point I started going to the gym because I was very long and skinny and I got really infatuated with that whole thing. And somehow, somewhere during that, my autistic like interest focus was changed over to the whole like.

Physiology and it started with resistance training physiology, and just like expanded from there into like physiology in general and pathophysiology, public health, health psychology, that kind of stuff. And I read a lot of primary literature.

Yeah. That’s why we’re happy to have you here.

Yeah. I also play Magic the Gathering and still do. But we are going to avoid that and dive into the other giggy rabbit hole. And you mentioned the things about public health as well, that I think we all intuitively know this and we hear it in the media. But why is it exercise?

Why is it running and lifting weights is good for you as a human being?

Yeah, I think I might try to be really annoying and to answer that by posing a counter question. So doing my PhD work, I was in university of Missouri Columbia with professor Frank Booth, and he had this so he had this.

Kind of gimmick or whatever, pet peeve is probably the correct word for it. That with all these training studies where you have an intervention group that is doing some kind of training and then you have a control group that is not doing any kind of training, you would consistently argue that the control group that was not doing any kind of training was actually the intervention group ’cause the artificial condition was being inactive.

So from a general standpoint being active is the normal condition and physical activity in general normalizes and stabilizes all kinds of physiological homeostasis. Blood sugar regulation, regulation of lipids in the blood, blood pressure and inflammation, mood, intestinal function, all that stuff that is super important, both for objectives, biomarkers of health, as well as subjective biomarkers of wellbeing.

All of those are stimulated by it in a myriad of different ways. And I could talk about any one in particular, but obviously there’s a lot of different pathways and mechanisms contributing to those effects. And it is just that’s matrix biology at its best. It’s multifactorial.

And it’s not only physiological like community building and companionships and social integration from participating in communities where physical activity is performed is obviously also part of that.

So in reality it’s actually super complex exactly how the biology works on why it’s healthy for us.

And I also heard you say was that the movement or exercise is the norm would it. It should be at least. Yeah. So the problem happens when we remove the movement or the exercise. Yeah. So modern life, it’s unhealthy not to move. Is that a better way of framing it?

Well,

inactivity is bad and inactivity combined with a caloric surplus is very bad. So we, because the like modern life is associated, we are most people have heard the term the epigenic environment, the environment that promotes obesity which happens primarily through delivering a caloric surplus from being in food environments with very caloric dense foods and eating behaviors that.

Facilitates eating excessive amounts of calories, and it’s been shown in intervention studies, that physical activity. So when you’re overfed for a sustainable amount of time, you’ll see increased biomarkers of autoimmunity and inflammation and all that stuff will increase pretty fast, even in pretty slim healthy people.

If you overfeed consistently, it won’t be long before you start seeing some of the biomarkers of inflammation starting to go the wrong way.

Overfeeding, just overfeeding is when you deliberately in a study forces someone or they agree to eat more calories than they feel like? Yeah. So they’re provided for caloric dense

foods and the caloric intake is monitored.

So it’s a general term is just overfeeding studies. Just like we have a lot of underfeeding studies normally called weight loss studies. We have overfeeding studies as well. And interestingly so obviously you see that people gain weight during overfeeding studies. They, but after the overfeeding studies, they lose weight just as fast, actually, even faster than people regain weight after weight loss studies.

So the weight homeostasis is definitely active and a powerful factor. But the point was that when you’re doing overfeeding studies, if you put physical activity on top of that. The we don’t, you don’t see the increase in autoimmunity and inflammation on that stuff. So it seems like that physical activity protects against the effects of caloric surplus.

And it has also been shown in large like population studies that. If you normalize for oxygen uptake for cardiometabolic health or cardiometabolic performance, if you normalize for that, then the excess mortality associated with being overweight, obese almost drops to zero.

Okay, so increased.

Increased cardiometabolic fitness seems to counter the excess mortality and morbidity associated with being overweight, obese to a very large extent. So this is something that’s seen both in intervention studies and in population studies and it’s probably a real thing.

Wow. So just if I have to retell this at the dinner table, even if you are quite overweight, if you exercise and you move.

That will offset a lot of the bad stuff from being overweight if qualified, of course. Yeah.

If you maintain a high oxygen uptake. It seems to be able to almost completely counter the excess mortality and morbidity associated with being overweight, obese, yes.

And a higher oxygen uptake. Is that that you can still breathe in a lot of oxygen during the day or is that that you do some exercise?

Yeah.

I mean, it’s, well, the oxygen uptake is well a cardiometabolic performance parameter that is measured. So it is usually associated with actual cardio training. So actual cardio training is the one where that will give the biggest return on investment on oxygen uptake.

And it’s also, I hate because I’m mostly interested in my greatest love is the whole resistance training stuff, and it aches my heart to say so, but the overall health benefits from doing cardio training is probably bigger than the ones from doing resistance or strength type training.

That’s not good for me either. It’s much harder to force myself down on the rower than it is to lift weight. Yeah. And yeah, that’s also how we met each other back in the day in a weightlifting club. And I should probably say as well, why why were we even talking about exercise here in our sustainability podcast?

And that’s of course the. Sustainability healthcare literature increasingly shows that prevention is very important to reduce the CO2 emissions from healthcare. Put simply, the more intensive care you need, the more you go to the hospital, the more CO2 is emitted. And as you’re alluding to here in this exercise, can do a lot of things in making people go less to the hospital.

And you mentioned something about societal changes as well, and this thing about that the normal thing is actually to move and inactivity was bad as well. How has this changed? Just in general terms over the last decades and we see that is in the literature.

That people are moving less or or having worse cardio or

Well, we can see that cardio performance is decreasing. That is evident from conscript data in most of Europe. Interestingly, like Northern Europeans have way better cardio than American conscripts do, but perform way worse at doing pushups.

So there are some social cultural differences in which aspects of performance is weighted or prioritized but that’s a good question. I can’t remember any of those studies actually, but I would certainly also, it’s kind of a tricky question because like occupational physical activity is. At least after a certain point, inversely related to health outcomes, while recreational physical activity is positively associated with health outcomes.

So it’s a little bit tricky.

Okay so just trying to grab some things here that we do know. Cardio is decreasing when some of the studies are on the soldiers being tested when they’re 18, going into the Army. And then that’s probably interesting to double click on.

So what you said, as I understood it, that if you are moving a lot in your work. You are at a factory or a carpenter or whatever, that can actually be a bad thing in terms of health outcomes, but that is in your spare time then it’s usually a good thing. And

it seems paradoxical, but it’s a very known fact in occupational medicine.

And the reason, so there’s probably some kind of socioeconomic component to it as well. We know the socioeconomic conditions influence like health outcomes strongly as well. But there’s probably also something related to monotony. So occupational physical activity tends to have a higher degree of monotony, which leads to like.

Wearing

your body out than recreational activity does. And that is probably part of it, but it’s a very well established paradox. That’s this there’s opposite effects of recreational and occupational physical activity. But I think I can, without knowing the specific studies, I would be fairly sure to say that over the last like 50 years at least, like that recreational activity outside of sports and has dropped.

Well, we see that the over at least the last 20 or so years, it seems that around the same amount of people are going to like football clubs, playing badminton, track and field, going to the commercial gyms. It seems over this period that people, some people have moved from like union club-based sports into the commercial training environment.

But it seems like the numbers are overall about the same. Something happened of course during COVID where there was less participation in organized sports and increased participation in self-organized sports. But that was kind of. It’s kind of an outlier, but it seems at least from what people are reporting in the studies where they try to measure like sports participation, says that the overall sports participation over the last 20 years is about the same.

That but some is a migration from club-based sports to the commercial fitness niche or commercial fitness products.

Interesting. But cardio is still decreasing even though. Sports membership at least. I think that’s related to how,

yeah, I think that’s related to how what people do when they’re kids.

Interesting. Especially.

Yeah. Could you elaborate? Do we know anything about that? You don’t have to come with citations, but just maybe.

there’s I can’t remember if there’s data available for Denmark, but I know that year by year comparisons of youth generation youth. Like they take all 10 year olds or 12 year olds whatever, year after year after year to see how the change.

But there’s data for some other countries at least. I don’t know if there is for Denmark, that shows that there are like oxygen uptake for kid age groups are dropping in these years as we speak. And that’s probably computer and telephone phenomenon.

Yeah.

Do we know anything about if your physical exercise in the youth influences how your health is as an adult, or can you make it up if you just do exercise as an adult?

I think both are true. So actually even the in-utero exposure from your mom’s physical activity will influence your body’s like musculoskeletal and cardiometabolic phenotype into your adulthood. So that starts already while you’re a fetus. Blame your mom if you’re in shitty condition.

But that’s it. It always starts there. But of course you can do a lot of, of course you can catch up but it becomes harder. But it becomes harder with the older you get. But it’s never too late

and it’s probably a very good point to cut out there. And What does how much exercise do you actually need to have on improvement in health?

Just like very generally speaking.

So yeah, so that is also a question that’s difficult to give a concise answer to. There’s a lot of studies that have measured those response relationships between various doses of exercise and various health outcomes, both in terms of mortality and morbidity and in terms of health biomarkers like blood pressure or blood glucose regulation and all that jazz.

And of course the real big difference is when you go from zero to something. But then when you go from one arbitrary unit to two arbitrary units, the difference is not nearly as big as the one when you’re going from zero to one and then the like, it tapers off pretty fast. And in general, it seems to taper off.

A lot faster than most people probably think so, if you’re working with this guy that is doing his triathlon training and running, cycling and cycling 15 hours a week, despite the fact that he doesn’t like cycling, running, or swimming. But yeah, the type most people would be prone to think that this is a super healthy behavior.

And this guy or girl, a woman is way above the point of saturation, in terms of health effects of exercise, way, way, way above, probably by threefold or something. So he would be just

a healthy, exercising five hours a week? Yes. Yes. Yeah. Yeah. That’s I think that’s a lot of people probably have different thoughts about that.

I guess the way that a lot of exercise and fitness is communicated tends to lean towards the extremes as well, or that we are dragging athletes or higher performance athletes are working into the everyday lives of normal people. Yeah. But would you, what you say is that the most important thing is just to do something going from zero to something and then we know that more is better to a point, but exactly when and how it’s a bit difficult.

Is that so?

Yeah. So the graph tapers off really fast. So I think. Depending on how you measure physical activity. Some of it is done with like accelerometers. Some of the stuff is done with GPS based like movement tracking, and some of that is self-reported and they give the same kind of answer.

And so we, most people have heard the discussion about how many steps per day. For what is considered like desirable outcomes in health. And I think if you want to give, so basically the question is do we want to know the highest point on that graph or do we want to know the steepest, like return on investment that like the best return on investment point, because those are different answers.

So the most efficient point of that curve for younger adults is usually seen at like seven, 8,000 steps. So obviously the highest point on that curve is seen at a slightly higher, but it’s only like 10% higher than what you get at 7,000, even though you have a 50% increase in number of steps.

So yeah. I hope that makes sense. I’m sitting here and drawing stuff with my hands.

No, I think it makes sense. I think the zeros to something being the most important part and that the triathlete training 15 hours a week is. No more healthy than somebody training five hours a week and not that much more healthy than someone training three hours a week is.

Yeah. And if I have to be

and if I can be the devil’s advocate, some of those exercise dose response studies looking comparing like exercise dosages with health outcomes, some of those actually report an increase in mortality and morbidity with very high exercise dosages.

Usually in the scientific literature, this is considered an artifact because the number of observations become very small, and it usually reflects people with extreme lifestyles and the confidence intervals and that end of the graph becomes very wide.

But. I’m just throwing it out there. I’m not saying it’s a real thing, but it’s certainly not an evidence based point of view to say that it’s necessarily more healthy to train that much.

And yeah that’s we at least know that in a lot of other places with the human body that just because a little is good a lot can is not necessarily better.

But I think

but I think there’s a psychosocial point to that as well, because in this time and age, exercise behaviors, health behaviors has become identity markers. So it’s part of the narrative that we present around who we are to our surroundings. And I think that is. That is part of what drives extreme exercise behaviors.

I am a triathlete. I am a weight lifter. I am a CrossFitter, whatever. And if you are a CrossFitter, it means you have to train a lot of CrossFit because that is how CrossFit is defined or triathlon. But and if I can add on you, just let me know if I’m running out of time, but so I kind of have a pet peeve about this whole stuff around.

Around people that have so it seems like health behaviors have become more polarized across the population over the last years. So there’s definitely an emerging pattern of an A or a B team, that one that have very solidly established health behaviors and some that are very.

Poor health behaviors. We know that health behaviors tend to cluster if you smoke, then there’s added risk of drinking, added risk, like statistical chance in population studies of having I mean, so they cluster. Health behaviors cluster and unhealthy behaviors seem to cluster with each other.

And the whole thing is that a lot of the people that are not very physical or that are physically inactive. I think that most of them would actually like to be more physical active. But why so in the same way that people that are overweight want to lose weight, but find it hard to do so.

So why is it hard for people to go from being inactive to being at least more active? And if you ask people, if you talk to people that don’t train and ask them this question that they just have to like pick themselves up and do something about it. And maybe they’ve told themselves that for decades and they still haven’t picked themselves up.

And a lot of those people actually have some

complicated thoughts and feelings around that. The health behaviors concerning training and it’s become part of a pet peeve for me that while if we’re talking about disordered eating, where people have complex thoughts and feelings around their eating behavior and they have some kind of weird eating behavior, usually with binge eating episodes, that is the most common thing these days.

You have a very well conceptualized and defined framework for talking about disordered eating behavior. So you have a lot of diagnosis in terms of bulimia, binge eating disorder, anorexia, and you have some pseudo diagnosis in orthorexia and then you have disordered eating as another pseudo diagnosis.

That is considered risk factor for developing real eating disorders afterwards. But if you’re talking about exercise behaviors. The only concept that really exists around having a disordered exercise behavior is overtraining or training addiction. It’s not considered as a diagnosis in Denmark, but in the DSM five, the American Manual for Psychiatric diagnosis, it is considered one.

But I think a lot of those people that are have are physically inactive, could actually be termed like having involuntary physical activity abstinence or involuntary training abstinence. And a lot of those that they would

actually like to train, but for some complex psychosocial.

Yeah.

They’re not able to. And I think and it’s super weird because if you apply the framework of disordered eating to like disordered training or whatever you want to call it, you can see that and this is empirical because there’s virtually no literature on this whatsoever. It’s simply not a concept that exists.

Anywhere in the literature you can see that many of the same concepts can be projected from disordered eating onto disorder training or involuntary training abstinence. And I think that’s I think that could be a really important thing in public health. Because we know that physical activity can counter the effects of being overweight and those tend to migrate.

And we know also that people that are overweight have an either harder time participating in physical activity than slim people do because they feel alienated in fitness contexts.

Yeah, no, that’s at least anecdotally I have a lot of stories about that. That’s super interesting and a fantastic segue onto our second episode where we’ll talk about how exercise can be integrated into the healthcare system and if we should integrate it and why it might be difficult.

And I think this framework that we spoke of here could be a key element. Thank you so much for coming in. This was really exciting and just always nice to have a wealth of knowledge in here. I’m very privileged to speak to a lot of smart people on this show.

And yeah there’s a second episode coming up with Anders as well, which we’ll publish in a week or so. And this was the Sustainable Healthcare Podcast. You’re checking out here. Yeah.