GLP-1 drugs and exercise for muscle and weight maintenance

What the exercise trial found after treatment ended

A particularly useful study compared exercise, medication, their combination and placebo, then assessed participants after the interventions ended.[2] It was a post-treatment extension of a randomized trial in adults with obesity aged 18–65 years, whose initial BMI was 32–43. The BMI body-size measure was used here to set the trial’s eligibility range. The study asks a maintenance question in a specific population, rather than testing every way someone might begin a weight loss journey.

Participants first lost 13.1 kg during an 8-week low-calorie diet. They were then randomly allocated to a 1-year maintenance intervention involving supervised exercise, liraglutide, both together or placebo.[2] The exercise and medication comparisons therefore began after a substantial diet-induced loss. This sequence matters: the trial was not simply a comparison of people starting exercise and medication from their original weight.

The maintenance phase was completed by 166 participants. One year after treatment ended, 109 attended the post-treatment assessment.[2] All randomized participants were invited back, and the primary analysis used the intention-to-treat population, organized around the original allocation.[2] Randomization is a strength of the design. The fact that not everyone attended the later measurement is also a limitation to keep alongside that strength.

From randomization to 1 year after treatment termination, the combination group had a body-weight change 5.1 kg lower than the medication-only group. The 95% confidence interval was −10.0 to −0.2 kg. The difference in body-fat percentage change favored combination treatment by 2.3 percentage points, with an interval of −4.3 to −0.3.[2] Percentage points describe the difference between percentage values, rather than a percentage change in the percentage itself.

This comparison spans the maintenance intervention and the year after it. It captures the overall difference left by the treatment paths, rather than isolating the amount regained only after treatment stopped. That is a useful result, but it answers a specific question. The distinction becomes clear when the paper changes the starting date of its comparison.

During the year after termination alone, weight regain was 6.0 kg greater in the previous liraglutide-only group than in the previous exercise-only group. The confidence interval was 2.1 to 10.0 kg.[2] This comparison uses different groups and a different starting point from the 5.1 kg result. The first begins at randomization into maintenance; the second begins when maintenance treatment ends.

For medication alone versus combination treatment, the difference in regain during the post-treatment year alone was 2.5 kg, with a confidence interval of −1.5 to 6.5 kg.[2] That interval includes no difference. The overall study supports the potential value of exercise alongside medication, but this particular comparison does not establish with certainty that combination treatment reduced regain during the period after stopping.

The trial also assessed maintenance of a loss of at least 10% of initial body weight, using the weight before the low-calorie diet as the starting reference. One year after treatment ended, the odds of meeting this threshold were 7.2 times higher after combination treatment than after placebo, and 4.2 times higher than after medication alone. The reported intervals were 2.4 to 21.3 and 1.6 to 10.8, respectively.[2]

Previous exercise alone also favored maintenance of this threshold compared with placebo: the odds ratio was 3.7, with an interval of 1.2 to 11.1.[2] Odds compare the number meeting a condition with the number not meeting it. An odds ratio is therefore a different kind of result from a mean difference in kilograms. It should not be read as the number of times more weight someone will lose.

Together, the average changes and threshold comparisons favored groups that included exercise on several outcomes.[2] The authors interpret supervised exercise added to medication as potentially improving healthy weight maintenance after treatment termination compared with medication alone.[2] For someone still in treatment, this makes exercise worth discussing as preparation for maintenance. It does not turn every activity into the supervised program tested, or remove the uncertainty from the post-treatment-only comparison.

Regain after stopping involves more than weight

A 2025 systematic review and meta-analysis pooled 8 randomized trials involving 2,372 participants with BMI of at least 27. Average regain after liraglutide was 2.20 kg, with a 95% confidence interval of 1.69 to 2.70 kg. For semaglutide and tirzepatide pooled together, regain was 9.69 kg, with an interval of 5.78 to 13.60 kg.[1] The authors reported that greater original weight loss was associated with greater regain.

They concluded that weight regain occurs after discontinuation regardless of lifestyle interventions.[1] Alongside the favorable exercise-trial results, this supports a measured expectation: exercise is an option for supporting maintenance, while post-treatment management still has to account for regain.[1][2] The drug-specific averages also reflect the size of the preceding loss. They do not provide a simple ranking of what will happen to an individual after stopping.

A separate meta-analysis included 18 randomized trials and 3,771 participants. Among participants with obesity, average post-discontinuation weight gain was 5.63 kg, with a 95% confidence interval of 3.52 to 7.73 kg.[12] This differs from the drug-specific averages above, but the direction is consistent: body weight increased after treatment ended.[1][12] Different pooled questions can yield different averages without making either number a personal forecast.

The second analysis reported a high level of variation between study results: the weight heterogeneity statistic was 99.57%.[12] The average needs to be read alongside that variation and the follow-up period. Longer follow-up was associated with greater regain. Studies following participants for more than 26 weeks showed 7.31 kg, compared with 2.51 kg in the shorter-follow-up subgroup.[12] The date of the measurement changes what can be seen.

The same analysis found changes beyond body weight in participants with obesity. HbA1c, a blood glucose measure, increased by an average of 0.25%, with a 95% confidence interval of 0.18 to 0.32%. Waist circumference, systolic blood pressure and fasting blood glucose also deteriorated.[12] These findings give a reason to discuss clinical monitoring after discontinuation, even when the scale is the most visible measure at home.

In participants with type 2 diabetes, average weight regain was 2.03 kg, with an interval of 1.63 to 2.42 kg. HbA1c increased by 0.65%, with an interval of 0.22 to 1.08%.[12] The obesity and type 2 diabetes results should remain separate. A smaller average weight increase does not automatically mean that every other health measure changed less, as these differing HbA1c results make clear.

Fasting blood glucose in the type 2 diabetes group was reported as stable. The mean change was 0.90 mmol/L, with a 95% confidence interval of −0.36 to 2.17 mmol/L.[12] This sits alongside the HbA1c increase in the same analysis. Treating all blood glucose measures as interchangeable would obscure that distinction. The relevant discussion with a doctor is about the individual measurements and their course, not just a single label such as “blood sugar.”

When considering stopping, the appointment can therefore cover the weight target, follow-up measurements and maintenance strategies that include exercise.[1][2][12] A treatment decision involves more than whether a class fits into the coming month’s calendar. The research gives concrete subjects to raise while that decision is being made with a doctor, rather than instructions to stop medication once exercise has begun.

Common misconceptions

“If the medication makes me lose weight, exercise has finished its job.” This combines weight loss and maintenance into one outcome. The supervised-exercise trial found favorable differences in weight and body-fat percentage for combination treatment compared with medication alone across the period from randomization to 1 year after treatment ended.[2] Exercise during treatment remained relevant to the outcome measured afterward.

“All the lean mass lost is muscle that has disappeared.” Lean mass includes components other than muscle, and a change in muscle quantity needs to be distinguished from a change in function.[14] The reverse assumption is also unhelpful: because lean mass is not identical to muscle, there is nothing to check. The randomized evidence still found an average lean mass reduction.[17] Accurate terminology makes the clinical question clearer; it does not make the question vanish.

“Exercise guarantees that weight will not return after I stop.” The discontinuation analyses found regain, while the exercise trial’s post-treatment-only comparison between medication alone and combination treatment retained uncertainty.[1][2] Evidence supporting exercise is not a guarantee against regain. Expectations about strength training should not become a reason to discontinue a prescription on your own.

What you can do today

• If your doctor has cleared you to exercise, carry out the resistance-training plan agreed for your treatment, with a supervisor adjusting the load. The review describes supervised interventions lasting more than 10 weeks; it does not specify a weekly session frequency or session length, so agree those details with your doctor and supervisor.[6]
• If aerobic exercise is part of your agreed plan, attend a supervised exercise program that follows the activities agreed with your doctor. The combination trial used a 1-year maintenance intervention, with continued exercise during treatment.[2][6]
• At your next appointment, discuss how weight and blood glucose will be checked if you are considering stopping treatment. Bring weight records that distinguish treatment from the period after stopping: the combination trial compared changes from the beginning and end of maintenance separately. Regain even with lifestyle interventions makes follow-up part of the preparation.[1][2][12]
• If everyday movement feels different, tell your doctor about changes noticed on stairs or when carrying bags. Review body-composition measurements together with strength and mobility.[14]

Planning movement during GLP-1 treatment at On the Shore Tachikawa

During GLP-1 treatment, discuss suitable exercise with your doctor and check the lesson options at On the Shore Tachikawa. The studio can be a place to keep attending as part of that exercise habit.

The studio is a 1-minute walk from the North Exit of JR Tachikawa Station, at 3F Etoile Bldg, 2-14-10 Akebonocho, Tachikawa, Tokyo. It is open every day 8:00–23:30. Compare those hours with the times you could keep attending.

Guests told by a doctor not to exercise cannot join. For pregnant guests, lava-stone hot yoga is unavailable; the studio offers room-temperature maternity yoga.

On the Shore is a lava-stone hot yoga studio and also offers room-temperature yoga, Pilates, women-only kickboxercise, boxercise, HIIT and personal training. There are more than 25 kinds of yoga lessons. Many of our yoga instructors speak English, and the studio’s owner often helps guests from the US bases in English herself.

The yoga trial costs ¥1,980 including tax for a 60-minute lesson, with 2 bath towels, 1 face towel and mat rental. Consult the studio website, prices and trial booking to check the lesson options alongside the exercise plan discussed with your doctor.

References

1. Discontinuing glucagon‐like peptide‐1 receptor agonists and body habitus: A systematic review and meta‐analysis — Sara Berg et al., 2025, Obesity Reviews. DOI: 10.1111/obr.13929
2. Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial — S. Jensen et al., 2024, eClinicalMedicine. DOI: 10.1016/j.eclinm.2024.102475
3. Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition? — J. C. Locatelli et al., 2024, Diabetes care. DOI: 10.2337/dci23-0100
4. Metabolic rebound after GLP-1 receptor agonist discontinuation: a systematic review and meta-analysis — Chih-Chen Tzang et al., 2025, eClinicalMedicine. DOI: 10.1016/j.eclinm.2025.103680
5. Changes in lean body mass with glucagon‐like peptide‐1‐based therapies and mitigation strategies — I. Neeland et al., 2024, Diabetes. DOI: 10.1111/dom.15728
6. Effect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: Systematic review and network meta-analysis. — P. Karakasis et al., 2024, Metabolism: clinical and experimental. DOI: 10.1016/j.metabol.2024.156113
7. GLP-1 agonists and changes in body mass and composition in adults with overweight or obesity with or without type 2 diabetes mellitus: a systematic review and meta-analysis — N. Sawicka-Gutaj et al., 2026, International Journal of Obesity (2005). DOI: 10.1038/s41366-026-02088-1

Cover photo: Dumbbells used for weight training and strength exercises in a gym. (Photo: Sterling / CC BY 3.0 / Wikimedia Commons)

Information as of October 2026. For your own health, consult a doctor.

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