GLP-1 and exercise: preserving strength beyond weight loss

What happened after treatment ended?

Does the value of exercise end when active treatment does? A 2024 follow-up study extended a randomized controlled trial in adults with obesity. Participants had first lost weight on a low-energy diet, then completed a maintenance phase involving supervised exercise, liraglutide, the combination or placebo. The researchers subsequently examined outcomes after those treatments ended. This is a post-treatment analysis of a trial extension, rather than a comparison of independently chosen exercise habits in the general population. [13]

The initial diet phase lasted 8 weeks and produced a weight loss of 13.1 kg. Maintenance treatment then continued for 1 year, with a further assessment 1 year after treatment ended. Of the participants, 166 completed the maintenance phase and 109 attended the post-treatment assessment. Keeping those stages visible is essential: the study followed an initial diet, active maintenance treatment and then a period without that treatment. The final findings should be read together with how many people reached the assessment. [13]

From the beginning of maintenance to the post-treatment assessment, the difference in body-weight change favored the former combination group over the medication-only group by −5.1 kg. The 95% confidence interval was −10.0 to −0.2 kg. The corresponding between-group difference in body-fat percentage change was −2.3 percentage points, with an interval of −4.3 to −0.3 points. These comparisons suggest a more favorable outcome after the combined approach over that full period. [13]

The −5.1 kg figure does not mean that everyone lost that additional amount after treatment stopped. It is a difference between groups in changes measured from the start of maintenance. A timeline gives the number its meaning. If the headline retains the weight but removes the starting point, it creates a different claim. The same paper can answer separate questions about the full follow-up period and the period after treatment, and those answers need to remain distinct. [13]

Looking only at the year after treatment ended, weight regain was 6.0 kg greater after medication alone than after exercise alone, with a confidence interval of 2.1–10.0 kg. The difference between medication alone and the combination was 2.5 kg, but its interval was −1.5 to 6.5 kg. Because that interval crosses zero, this latter comparison does not establish a clear difference. [13]

The authors interpreted adding supervised exercise to medication as appearing to improve healthy weight maintenance after treatment ended. The drug and the structured exercise program used here cannot stand for every related medication or every possible activity. Nor does the study provide instructions for a reader to stop treatment. Starting, changing or ending a prescription remains a matter for the prescribing doctor. [13]

For daily life, the study makes planning ahead a reasonable subject to raise while treatment is going well. An exercise routine can be discussed during the period when weight is falling, rather than waiting until attention shifts to maintenance. It does not tell us that exercise guarantees protection against regain, but it does show why treatment outcomes and later activity deserve consideration within the same care plan. [13]

Resistance training has a rationale, with questions still open

The case for resistance training also draws on exercise research beyond direct medication-and-exercise trials. The 2024 narrative review describes supervised strength-training studies lasting more than 10 weeks that produced increases of approximately 3 kg in lean mass and approximately 25% in strength. It uses these findings to support a proposal for tailored resistance exercise alongside incretin therapy. Those are the reported exercise-study outcomes, rather than a prediction of what a particular person taking medication will achieve. [1]

The distinction between evidence stages is important here. Studies showing what supervised resistance training can achieve give a rationale for the proposal. They do not establish that a reader can recover a specified weight of muscle lost during drug treatment. The combined treatment would need to be assessed in its own setting. [1][2]

A network meta-analysis of 9 trials involving 1,009 adults with overweight or obesity provides broader comparative evidence. This method combines direct comparisons with indirect comparisons across interventions. Medication plus structured exercise showed large effects on body weight and fat mass compared with placebo. However, the main outcomes concerned weight and fat, so they should be kept separate from a direct estimate of muscle preservation. [18]

For fat mass, the combination had a standardized mean difference of −1.01, with a 95% confidence interval of −1.27 to −0.75. A standardized mean difference puts results onto a comparable scale; its unit is not kilograms. Reading it as “about 1 kg of fat” changes the measure. [18]

A more everyday form of support was examined in a 12-week quasi-experimental study of 245 adults with obesity who had started medication. The intervention used personalized, strength-focused physical-activity support delivered online. There were 151 people in the support group and 94 receiving usual care. Adjusted weight loss was 6.0% of starting body weight in the support group and 3.3% in the usual-care group. [6]

Muscle-mass percentage rose by 0.6 percentage points with support and 0.2 points in the control group. That does not necessarily mean absolute muscle mass increased. Body composition was estimated using home bioelectrical impedance scales, which use the body’s response to an electrical current, and allocation was not randomized. The findings are therefore best treated as encouraging evidence about this support approach, rather than definitive proof that it built muscle or that coaching caused every observed difference. [6]

Together, these studies give reasons to include exercise without resolving exactly which activity, at what dose, will preserve how many kilograms of muscle for each person. Reviews also emphasize adequate nutrition and protein alongside resistance training. They do not provide a single intake that this article can prescribe to every reader. The useful starting point is to bring eating and movement into the same discussion, especially when illness or other circumstances make an individualized plan necessary. [2][3][10]

Common misconceptions

“If lean mass falls, medication-assisted weight loss has failed.” Lean-mass reduction is a real finding that should be reported, but it cannot alone determine the value of the entire treatment. Reviews also discuss preserved function and potentially improved muscle quality. Quantity, force and movement need to be considered together. [4][10]

“Once medication lowers weight, exercise and food no longer matter.” The exercise trial found fitness benefits that medication alone did not deliver. Several reviews propose resistance training together with nutrition as part of the effort to preserve muscle. These components address overlapping but different questions. [2][3][17]

“My muscle percentage rose, so I gained muscle.” A smaller total weight or less fat can change the proportions. The online-support study reported changes in muscle-mass percentage, which must not be relabeled as gains in absolute muscle mass. Before drawing a conclusion, identify whether the outcome was an amount, a proportion or a measure of function. [4][6]

“The results look reassuring, so the same exercise suits everyone.” A review focused on people at high risk for sarcopenia found insufficient evidence about body-composition effects in older adults and people with chronic kidney disease, liver disease or inflammatory bowel disease. It calls for individualized nutrition and physical activity. That uncertainty should not be converted into a blanket instruction to eat more protein or raise exercise intensity without considering the person’s condition and medical advice. [3]

Someone whose weight is falling but who finds standing up harder has different information to discuss from someone whose clothing size is changing and whose journeys feel easier. Weight records alone do not describe either situation completely. Specific changes in movement, eating and the exercise actually being done help keep quantity and function separate in a medical conversation. Concern about a change in everyday ability is a reason to consult a doctor, rather than to diagnose the cause from the scale. [3][4]

What you can do today

• Make room in your week for the exercise program agreed with your doctor, confirming activity and intensity before starting. Trial participants combined indoor cycling, circuit training and individual moderate-to-vigorous activity, completing a median 2.65 sessions and 116 minutes weekly. Use those figures to discuss your schedule, rather than as a target for everyone. [17]
• Once cleared to exercise, do the agreed movements at the selected load and reserve a regular time you can sustain. The review’s supervised strength-training studies lasted more than 10 weeks; choose a continuing routine rather than one hard session intended to recover lost muscle. [1]
• Prepare the meals agreed with your doctor, including protein-containing foods, instead of skipping meals. Keep nutrition and strength-focused activity in the same routine. This applies the reviews’ proposals to daily life, not a tested meal prescription; they supply no universal intake, and existing illnesses affect the amount appropriate for you. [2][3][10]
• Before your next appointment, note 1 everyday task that has changed, such as stairs or getting out of a chair, and describe it alongside your weight change. This is a clue for discussion, not a recreation of the trial’s functional assessment at home. [4][15]
• When measuring body composition, check whether “muscle” is expressed in kg or as a percentage. A rising share of a lighter body does not establish an increase in absolute muscle mass. [4][6]

A weekly movement slot during GLP-1 care at On the Shore Tachikawa

If station stairs have kept everyday fitness on your mind during GLP-1-assisted weight loss, consider how a visit to On the Shore Tachikawa could fit the activity plan agreed with your doctor.

Pregnant guests cannot join lava-stone hot yoga; room-temperature maternity yoga is available. Guests who have been told by a doctor not to exercise cannot join.

On the Shore Tachikawa (オンザショア立川店) is a lava-stone hot yoga studio at 3F Etoile Bldg, 2-14-10 Akebonocho, Tachikawa, Tokyo, a 1-minute walk from the North Exit of JR Tachikawa Station. It is open every day, 8:00–23:30. Many of our yoga instructors speak English, and the studio’s owner often helps guests from the US bases in English herself.

Alongside lava-stone hot yoga, the options include personal training, HIIT, boxercise, women-only kickboxercise, Pilates and room-temperature yoga. There are 25+ kinds of yoga lessons. Compare the options with the activity agreed with your doctor; the exercise trials do not establish muscle-preservation effects for these lessons.

Read the studio website and prices when planning your weekly slot. A trial yoga lesson costs ¥1,980 including tax for 60 minutes, with mat rental, 1 face towel and 2 bath towels included. Use trial booking to choose a time.

References

1. 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
2. Lean Mass Changes With Incretin Therapy Versus Lifestyle Intervention: A Systematic Review and Meta‐Analysis of Randomised Controlled Trials — Naseem Eisa et al., 2026, Diabetes. DOI: 10.1111/dom.70666
3. Impact of GLP- 1 Receptor Agonist Therapy in Patients High Risk for Sarcopenia — Zoe N. Memel et al., 2025, Current Nutrition Reports. DOI: 10.1007/s13668-025-00649-w
4. 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
5. Quality Plus Quantity: Evaluation of a Virtual GLP-1 Programme With Physical Activity Support to Promote Healthy Body Composition Change During GLP-1 Weight Loss. — Lisa A. Stanton et al., 2026, Diabetes, obesity & metabolism. DOI: 10.1111/dom.71152
6. Muscle health in the modern era of incretin‐based therapies — G. De Girolamo et al., 2025, European Journal of Clinical Investigation. DOI: 10.1111/eci.70155
7. 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
8. 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
9. Effects of GLP‐1 Receptor Agonists on Muscle Mass, Strength, and Quality in MASLD: A Systematic Review — F. Iorra et al., 2026, Liver International. DOI: 10.1111/liv.70643
10. Physical Fitness with Exercise and GLP-1 Receptor Agonist Treatment Alone or Combined After Diet-Induced Weight Loss: A Secondary Analysis of a Randomized Controlled Trial in Adults with Obesity — S. Jensen et al., 2026, Sports Medicine (Auckland, N.z.). DOI: 10.1007/s40279-025-02386-0
11. Comparative Efficacy of GLP‐1 Receptor Agonists, Exercise, and Their Combination on Body Composition and Glucolipid Metabolism in Adults With Overweight or Obesity: A Network Meta‐Analysis of Randomized Controlled Trials — M. Vandoni et al., 2026, Obesity Reviews. DOI: 10.1111/obr.70189

Cover photo: Gym interior with benches, strength-training machines and an illuminated sign on the wall. (Photo: GymNation / CC BY-SA 4.0 / Wikimedia Commons)

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