You know them as Ozempic, Wegovy and Mounjaro. They’re a class of drugs called GLP-1 (Glucagon-like peptide-1) agonists originally developed to treat type 2 diabetes. When these drugs were discovered to suppress appetite and promote weight loss, they exploded in popularity. What we have learned over time is that lifestyle change – including establishing a well-rounded personal fitness program - is at the heart of maximizing use of these medications.

Let’s look at the intersection of fitness and GLP-1 agonist therapy to understand how physical activity and incorporating it into your lifestyle while taking these medications can support your best health. As always, reach out to your Concierge Medicine physician or PCP for guidance on whether these medications are right for you.

How do GLP-1s Work?

GLP-1s work by triggering your pancreas to release insulin, lowering the amount of glucose (sugar) in your blood. If you do not produce enough insulin, your blood sugar level increases, which can lead to diabetes.

GLP-1s also slow stomach emptying. You digest food more slowly and release less glucose from the food you eat into your bloodstream.

Finally, GLP-1s promote satiety by affecting areas of your brain that process sensations of hunger and fullness. Not surprisingly, these combined effects often result in weight loss.

Understanding the GLP-1 Agonist and Muscle Loss

Research tells us that exercise improves insulin sensitivity, enhances cardiovascular health, and supports weight management. Plus, it feels good to move.

Initially, research around GLP-1s suggested that using these medications put you at significant risk for loss of muscle mass. A 2022 study suggested that the degree of muscle mass loss was not as significant as believed (Jastreboff, Ania, M. et.al. Tirzepatide Once Weekly for the Treatment of Obesity. New England Journal of Medicine (Waltham) 2022;387:205-216). The same study reported that the ratio of fat-mass loss to lean muscle mass loss was like that reported for lifestyle-based and surgical interventions for obesity.

However, anytime you lose weight, you also lose muscle mass. Muscle loss is a concern for some important reasons. Muscle strength supports physical independence. It mitigates the risk of falling. And it is a key factor in maintaining bone density which is achieved through movement. Strength training has the greatest effect building muscle mass.

Take Six Steps

When designing a fitness plan while taking GLP-1 agonists, consider the following six steps to make fitness effective, something you can maintain over time and, most importantly, fun!

  1. Consult with Your Physician
    Before you begin a new fitness program, talk with your physician for personalized recommendations based on your medical history, current health status, and the specific GLP-1 agonist you are taking. This step is important if you have underlying health conditions or have been inactive for an extended period.
  2. Start Slowly
    Starting slowly and gradually increasing the intensity and duration of exercise prevents injury and helps to ensure you stick with your program. You might begin with walking, gentle stretching, and low-impact aerobic exercises. As your fitness level improves, add more challenging activities. And find forms of fitness you enjoy. You’re more likely to continue with a program if it includes an element of fun.
  3. Vary Your Fitness Program
    A well-rounded fitness program includes a mix of these elements:
    • Aerobic Exercise: Walking, cycling, swimming, or dancing. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity activity per week.
    • Strength Training: Two days a week to help build muscle mass, increase metabolism, and improve bone density. Use free weights, resistance bands, or even body-weight exercises like push-ups and squats.
    • Flexibility and Balance: Stretching exercises and activities like yoga or tai chi can enhance flexibility, reduce the risk of injury, and improve your balance.
  4. Monitor Blood Glucose Levels
    If you have diabetes, monitoring blood glucose levels before, during, and after exercise is crucial. You may need to adjust your medication or carbohydrate intake based on these readings and the intensity of your workout. Again, check in with your physician and registered dietitian for specific guidance that reflects your unique needs.
  5. Stay Hydrated and Nourished
    Proper hydration and nutrition are vital for optimal exercise performance and recovery. Learn more about best practices and options that support your specific needs by again, consulting with your physician and registered dietitian. Striking the right balance between hydration and what you consume is vital to supporting muscle mass development and your best health.
  6. Listen to Your Body
    Pay attention to how your body responds to exercise, especially when starting a new fitness routine. Fatigue, dizziness, or unusual discomfort may indicate that you need to modify your activity level or seek medical advice.

Overcoming Challenges – Solutions to Four Obstacles

Incorporating fitness into your routine while taking GLP-1 agonists may come with challenges. Here are four of the common obstacles you might encounter and strategies you can use to overcome them:

  1. Side Effects of Medication
    GLP-1 agonists have known side effects like nausea and gastrointestinal discomfort. These impacts can make it difficult to engage in physical activity. If you experience these symptoms, try exercising at a time when these side effects tend to be less impactful. And consider low-impact activities that might be easier on your body yet still productive.
  2. Motivation
    Staying motivated to exercise regularly can be challenging. Setting realistic goals, tracking progress, and finding a workout buddy or fitness group can help to keep you motivated by building in accountability. Additionally, choosing activities you enjoy will make exercise feel less like a chore and more like a rewarding part of your day.
  3. Time Management
    Your busy schedule can make it difficult to find time for exercise. Prioritize physical activity by adding it to your calendar as you would any other appointment. Break fitness into shorter sessions. For example, three 10-minute walks throughout the day can be as effective as a single 30-minute walk.
  4. Get Creative
    If you have physical challenges or chronic conditions find activities that are safe and that reflect your unique needs. Water aerobics, exercises done seated versus standing, and modified yoga poses can provide a good workout without putting undue stress on your body.

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