GLP-1 Medications and Resistance Training: A Powerful Pairing

It is no secret that GLP-1 medications are quickly becoming established as a primary tool for fat loss and weight management. While these medications have demonstrated impressive results, there are still nuanced conditions to consider to ensure safe and responsible use. First, we will discuss what GLP-1 medications actually are, what they aim to do, and the costs and benefits associated with using them. Finally, we will explore why exercise (namely resistance training) can be such an effective tool to use with them.

What are GLP-1 medications?

GLP-1 stands for glucagon-like peptide-1 agonists. This is a naturally occurring hormone created by the small intestine that has many tasks including:

• Triggering insulin to be released from the pancreas, resulting in lower blood sugar levels. Insulin is an essential hormone that acts as a key to open cells, allowing sugar in the blood to occupy these cells and leave the bloodstream.
• Slowing gastric emptying (slow digestion), resulting in a smaller, steadier release of sugar into the bloodstream. This impact on digestion also increases satiety, or your feeling of fullness throughout the day, resulting in a decreased secretion of the hunger hormone, ghrelin.
• Blocking glucagon secretion, the hormone responsible for raising blood sugar levels by deconstructing stored glycogen within the liver.

In short, these medications typically work by injecting drugs such as Liraglutide or Semaglutide, which act by attaching to the GLP-1 receptors, upregulating the effects of the naturally occurring GLP-1 hormone. Common brands of GLP-1 medications include Wegovy or Ozempic, with newer iterations like Mounjaro or Zepbound emerging, which take advantage of joint GLP-1 and GIP (Glucose-dependent insulinotropic polypeptide) hormone pathways to target specific outcomes (diabetes, weight loss, etc).

While new iterations and brands are constantly hitting the market and use becomes even more accessible, there are substantial considerations regarding the safety of the brand, proper dose, and duration of use. The decision to take advantage of these medications should be a joint effort between doctor and patient.

GLP-1 Costs and Benefits

It is worth mentioning that time after time, clinical trials since the early 2000’s show that these medications work, and they work quite well. It is widely known that intervening with behavioral therapy, a caloric deficit, and/or increased exercise (both resistance training and cardiovascular) will yield weight loss. However, many struggle with making reasonable changes and long-term adherence, with patients typically regaining a third of weight lost (Moiz et. al., 2025). GLP-1 medications consistently show a 15-20% weight reduction across clinical trials, and are far less invasive/risky than the only other intervention more effective, bariatric surgery (Courcoulas et. al., 2024). GLP-1 medications have shown to significantly decrease risk of Major Adverse Cardiovascular Events (MACE) amongst patients with cardiovascular disease and diabetes, and reduce roughly 20% of kidney-related complications in patients with diabetes or chronic kidney disease (Moiz et. al., 2025). Reductions in insulin resistance and systemic inflammation contribute to decreased liver inflammation and fibrosis, while lower overall adiposity and weight reduce symptoms associated with sleep apnea and osteoarthritis. There is even preliminary research indicating that some of these medications impact neurodegenerative diseases. Lixisenatide and exenatide were shown to improve motor activity in patients with Parkinson’s compared to the placebo, and liraglutide indicated an 18% reduced cognitive decline amongst Alzheimer’s patients (Athauda et. al., 2017; Alzheimer’s Association, 2024).

That said, there are still risks to acknowledge when considering whether or not these medications are the right choice for you. As stated by Locatelli et al. (2024), these rapid decreases in weight will come at the cost of a roughly 10% decrease specifically in lean muscle mass, with others estimating 20-45% of weight loss coming from lean muscle mass (Moiz et. al., 2025). With the populations who typically would use these medications already being at higher risk of cancers, cardiovascular diseases, etc, it is hard to draw causality from a GLP-1 medication. While there is no concrete evidence in large-scale randomized controlled trials, there were initial observations of greater risk of pancreatic and thyroid cancers in GLP-1 users, with more long term research warranted (Moiz et. al., 2025). There have also been slightly higher observed rates of gallbladder and biliary diseases across multiple trials amongst patients receiving higher doses for longer durations (He et. al., 2022). Weight regain after medication removal is a concern as well, with the STEP-1 trial reporting 68% of lost weight was regained after one year off of the drug (Wilding et. al., 2022). This highlights that these medications are tools, not magic pills. Without combining with healthy, sustainable lifestyle behaviors, long-term weight loss relies heavily on continuing medication use.

GLP-1 and Resistance Training

As stated above, rapid weight loss (particularly in older populations) greatly increases risk of lean muscle mass loss (sarcopenia), resulting in lower rates of strength and power, and greater fall and/or fracture risk (Ruiz et. al., 2008). In fact, elderly individuals classified with low strength relative to their age have a 50% higher risk of all-cause mortality (Ruiz et. al., 2008). Additionally, having low muscle mass yields an 81% higher risk of cardiovascular events compared to those in the upper categories of muscle mass (Tyrovolas et. al., 2020).

In a randomized, controlled trial conducted by Lundgren et al. (2021), it was demonstrated that not only did a combined exercise and medication group see nearly double the fat loss compared to the medication only group (3.5% vs 1.5%), but there was also an increase of 0.5 kg of lean mass in one year. It is worth mentioning that this intervention was built on the WHO guidelines, which predominantly incorporated cardiovascular exercise (150 min low-moderate intensity/week, 75 min vigorous intensity/week). It can be speculated that an emphasis of resistance training would have improved muscle mass by a larger margin.

Zakaria et al. (2024) demonstrated a combined intervention of guided resistance training and nutrition counseling with GLP-1 medications caused significant decreases in total weight (>10% for 47% of participants, >15% for 31% of participants), cholesterol, and reversal of prediabetes in 80% of participants in just 3 months. Not only does exercise clearly improve outcomes when paired with medication, but Jensen et al. (2024) demonstrated in a 6 month trial of 115 participants that those who received a combined intervention of structured exercise with GLP-1 medications maintained 10% decreased weight compared to the placebo 1 year post study participation, indicating that structured exercise played a role in fostering continued positive lifestyle changes independent of pharmacological intervention.

Final Thoughts

GLP-1 agonist medications should not be feared, and those who use them should not be shamed. These medications can be incredible tools to help someone struggling with lifestyle changes to reduce body weight and mortality risk factors quickly. That said, use of a GLP-1 agonist should include proper dosing from a professional, thoughtful attention paid towards a healthy, diverse diet, and implementation of a workout routine consisting of strength training and cardio. Without establishing sustainable lifestyle changes, such tools can be used as crutches, and potentially even increase risk of muscle or bone loss, falls, or fractures. When in doubt, talk to a primary care physician, seek help from a registered dietician, or hit up your local trainer (maybe from Body Basics).