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How to Combat Muscle Loss While Taking GLP-1s

By Julie Mulcahy, PT, DPT, CAPP OB

This edition covers:

  • How rapid weight loss impacts muscle mass and metabolism
  • The way muscles respond to GLP-1 discontinuation
  • The best form of exercise to mitigate muscle loss

GLP-1s are deemed a “once in a generation” weight loss drug due to their impressive outcomes — however their side effects can’t be ignored, especially the loss of muscle mass, ¹ ² and reduced metabolic rate, which may impact patients’ ability to maintain results.

It’s important to note that this loss of muscle mass and metabolism is a result of rapid weight loss, and not caused by the drug itself. That’s why regular exercise, especially resistance training, which builds muscle mass, should be considered an essential component of weight management with GLP-1s.

What happens to our muscles when we discontinue GLP-1s after weight loss?

Only one-third of patients³ who are prescribed GLP-1s continue taking them after one year.

After discontinuing GLP-1s, the body’s biological predisposition is to try to regain the weight by way of a slower metabolism and increased muscle efficiency⁴, resulting in fewer calories burned during exercise and rest.

People who have lost significant (~>5%) weight will need to eat less and exercise more than their never-obese peers of the same weight and body composition, which can persist for months, years, or even a lifetime.

While obesity has been recognized as a chronic disease requiring ongoing management ⁵, when GLP-1 medications are discontinued, healthy behaviors are also essential for long-term weight maintenance.⁶ Research indicates that after one year, two-thirds of people end up regaining weight. ⁶ ⁷

What can we do to maintain weight loss, build muscle mass and increase metabolism?

GLP-1 labels state that the drugs should be taken with a healthy diet and exercise, however they don’t state the best type of exercise to mitigate muscle loss.

Resistance training is essential for individuals both during and after use of GLP-1s to facilitate weight loss, as it can increase muscle mass, which in turn increases metabolic rate.

When an individual has increased muscle mass they will burn more calories at rest. Resistance training causes tissue microtrauma that requires large amounts of energy for muscle remodeling that may persist for 72 hours after the training session. This process is referred to as the after-burn because calories continue to burn as the body repairs and rebuilds muscle in response to resistance training.⁸

But that's not the only benefit of resistance training. Research indicates that it also:

  • Assists the management of type 2 diabetes and can improve glycemic control and insulin sensitivity
  • Enhances cardiovascular health by reducing resting blood pressure
  • Promotes bone development
  • Reduces the incidence of musculoskeletal pain, anxiety and depressive symptoms⁹

Reaping the benefits of resistance training does not require long hours at the gym.

Many types of resistance exercises can be performed at home using weights, resistance bands or even bodyweight exercises, such as squats and wall push ups that do not require equipment. Evidence suggests one set of 10 to 15 repetitions for eight to 10 exercises twice a week, with a goal of progressing to three sets of eight to 10 repetitions three times a week, will build muscle mass with time and consistency. ¹⁰



Consider Exercise Snacks

It is possible to improve strength and functional ability by performing resistance training at lower intensities performed at higher frequencies utilizing minimal-to-no equipment. This approach is known as exercise snacks. These snacks are short exercise bouts performed with minimal to no equipment and repeated throughout the day and/or week, for a brief period of time at high repetitions. An example of an exercise snack would be climbing three flights of stairs repeatedly three times per day⁹. Leveraging these evidence-based exercise practices can assist individuals using GLP-1s to create healthy habits that keep them moving along the path to wellness.

Physical activity, especially resistance training, is essential for weight maintenance⁸ following the use of GLP-1s, and may enhance the effectiveness of GLP-1s when done concurrently.  It can be challenging for patients to go it alone when choosing an optimal exercise plan. That is one reason why the CDC recommends that people with chronic conditions consult a healthcare professional or physical activity specialist about the types and amounts of activity appropriate for their abilities.

Omada Health offers support and guidance between visits for individuals using GLP-1s,  including evidence-based exercise programs focused on maintaining and building muscle mass before, during, and after GLP-1 use to support metabolic function, mitigate weight regain, and help individuals achieve and maintain better health.



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This Proof Points edition was originally published on LinkedIn on 2/22/24.