Episode 094 | December 4, 2025 | 21:31
Guest: Anders Nedergaard
Published: December 4, 2025
Duration: 21:31
Note: Part 2 of 2 with Anders Nedergaard
Description
Part 2 of 2 with Anders Nedergaard (muscle biologist and health coach). Continuing the conversation from Episode 093 on exercise as medicine within healthcare systems, and how physical activity can reduce chronic disease burden and healthcare costs.
Full transcript
About this transcript
This transcript was automatically generated and may contain inaccuracies, typos, or mistranslations. Episodes recorded before 2024 were transcribed by an on-site model and may have a higher error rate. The content reflects the original conversation to the best of our ability. For the authoritative version, please listen to the audio episode.
Anders Nedergaard: Everyone with conditions that we know are influenced or affected positively by lifestyle. It doesn’t really matter if you’ve got osteoporosis, it actually doesn’t matter if you’re 80 or if you’re 65, resistance training is going to make your bones better. And if you are pre-diabetic and have elevated blood pressure, cardio is going to help you, no matter if you’re 70 or if you’re 40. Obviously, the incidence of these problems are higher the older you get.
Joachim Almdal: Hello, and welcome to the Sustainable Healthcare podcast, the podcast where we talk about everything sustainability in the healthcare system, how can we deliver better health outcomes using less resources. Today we’re going to continue our talk on exercise as preventive healthcare, focusing on how and if we should integrate exercise into the healthcare system. Anders, introduce yourself quickly.
Anders: Sure. I’m a biochemist and a human biologist by trade. I’m a PhD in muscle biology, and I did my doctoral work in molecular muscle physiology. I’m super interested in all things physiology and public health.
Joachim: Where we left off in the last episode was that we saw that exercise is really good for you in a complex way, and that it doesn’t take a lot to work. A lot of people, both in the healthcare system and outside, has this thing — well, this is what we should do, but why isn’t it then happening? Anders, what has actually been tried? What do we know about prescribing exercise or treating with exercise where people were told that they had to move their body for health reasons by a clinician, by a system?
Anders: First of all, we have cross-sectional observational evidence that shows that when people change health behaviors successfully, it also changed their health trajectory — higher healthspan and less encounters with the health systems. If you look at intervention studies, most are hampered by the fact that you lose people to follow-up. You have an intervention period of one or two or three years and as you follow up afterwards you’ll see people jump off the intervention. Here in Denmark, we had a big study like this. It had a measurable health economic effect. But the Danish project was designed horribly relative to what we now know about maintaining health behaviors and mastery and autonomy.
People that have had poor health behaviors and haven’t trained, you have to have some really serious talks and coaching with them about how we can establish these behaviors and reinforce them. That wasn’t done in that project at all. So I think the time is really ripe for another one of those projects.
For a lot of sociocultural reasons, when we spend money on health, both American and European, we spend like 98-99% of our money on treatment rather than prevention. That also means the billions of dollars and euros that go into drug research are larger than the amount of money spent on health behavior or implementation research by thousands of fold. So it’s a venue that has not been tried thoroughly relative to the amount of resource being spent on pharmaceutical drug research.
What we know about health behaviors is that structural interventions seem to make a bigger difference than individualized interventions. What’s a structural intervention? Something that provides accessibility to physical activity to everyone — for example, having a better availability of bike lanes. In Denmark there was a big project where they expanded bike lanes, allowed right turns on red lights for bikes, etc. That showed huge public health economic efficiency because it made people ride bikes a lot more. Also economic incentives — making exercise cheaper and making shitty foods more expensive and healthy foods cheaper. It’s very unfortunate that VAT has been put back on exercise from New Year, and the sugar tax we had was also removed. Those are probably going to have adverse effects on public health.
There’s a lot of sociocultural context that makes health professionals not consider working with exercise counseling enough. Working with exercise counseling is not represented in the same way that nursing or being a doctor is. And neither nurses nor doctors are especially trained in counseling about these things. The core issues associated with primary prevention of health issues are not represented by any trade group. They’re not appreciated as a separate kind of craft knowledge, and I think that is part of the problem.
Joachim: If you could design your dream study and your dream implementation, what would that look like?
Anders: So there’s a premise first that I would like to contest. It is fully accepted that if you start on cholesterol-reducing medicine, statins, or on incretins for regulating your blood glucose, or if you’re starting on blood pressure medication, that is just something you do for the rest of your life. That is fully accepted. I think we should talk about health behavior counseling in the same way. Why would you expect it to stop being necessary when you see these drop-off problems?
The real question is: how can you scale health behavior counseling? In the beginning, people will probably require individualized one-on-one to get them going, and then gradually you can put people on more scalable counseling services. Maybe it becomes a group-based thing or something online, or maybe it goes from once a week to once a month to once every three months. If this has to become public health policy, it has to go by politicians who say that’s a good idea. So you have to find ways to scale them in order for it to be health economically viable.
You can scale the amount of confrontations that you have, and you can scale from one-to-one versus one-to-many, and you can scale from physical to online. I live in Copenhagen and everything is close by, but I’m from Western Jutland where everything is far away. You would have to establish some kind of localized systems or online systems to do that. Along these three axes I think it would be possible to create something meaningful, but it should be subject to scientific inquiry.
Joachim: How would you see that collaborating with the existing system of general practitioners, doctors, and the hospitals?
Anders: If this was to exist in a meaningful scale, it would mean probably hundreds of thousands of people that should be engaging in counseling services. I think the most realistic way would be in some kind of collaboration with commercial training providers. In Denmark there are about half a million members in fitness gyms. What we’re talking about would involve several hundred thousand — most elderly people would probably have some kind of benefit from this. The most realistic way that this could come to fruition would be in collaboration with commercial training providers.
Joachim: Who would be the most likely patient groups, and how would you qualify?
Anders: Everyone with conditions that we know are influenced or affected positively by lifestyle. It doesn’t matter if you’ve got osteoporosis, it doesn’t matter if you’re 80 or 65 — resistance training is going to make your bones better. If you are pre-diabetic and have elevated blood pressure, cardio is going to help you, no matter if you’re 70 or 40. Obviously the incidence of these problems is higher the older you get. It would be 20% of everyone above 50 that has what would be considered a lifestyle disease, and 40% above 60. So many hundreds of thousands of people.
Joachim: If you could change three things in the Danish healthcare system to facilitate more exercise, what would those be?
Anders: First, I would make all exercise tax-exempt. We know that works. In Denmark, when cities are built — what’s called lokalplaner — the city has rules for what kind of buildings can be approved. I think having buildings that are usable for physical activity, either outside or inside, or for actual gyms, is something that should be prioritized. There should be more exercise in schools, and better collaborations between sports clubs and physical activity in schools. That is common in a lot of other European countries but not in Denmark. And I would do some tax stuff to foods as well.
I would also very much like to have a new formal education of bachelor length for professional trainers — with specializations into personal training (extra mercantile/business), clinical training (extra clinical), and one for club sports. If you did that, you would get so many applications, and you would have people that would be really qualified to get into the business, both the public side and the commercial side.
Joachim: Any parting thoughts?
Anders: One of the reasons that a lot of people don’t like doing exercise — most people do like exercise to some extent, but a lot of those who don’t like it, they don’t like it because exercise itself has been operationalized to do something, that they should lose weight or for indirect purposes rather than enjoying the exercise itself. Movement should be fun, and if it’s funny and enjoyable in itself, then it will much more easily become part of a lasting behavior. It’s important to keep playing around with your body for life. Don’t stop climbing trees even though you’re 50, man. You may fall down and break considerably more bones, but just imagine the amazing time you’ll have on the way down.
Joachim: Where can people find you?
Anders: I have a webpage, andersnørgaard.dk, that’s also my Instagram handle. I’m active on Facebook with the same name, on LinkedIn, and I’m starting out on Twitter/X. I have a podcast called Fitness MK, but that’s mostly in Danish.