American Council on Exercise by American Council on Exercise
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In the evolving landscape of weight management, the emergence of drugs like Ozempic, Wegovy and Mounjaro marks a significant shift. These drugs, and others like them, are classified as either GLP-1 analogs or GLP-1/GIP receptor agonists. For the sake of simplicity, in this blog they are referred to collectively as “GLP-1 drugs” or “GLP-1 medications.” 

Though these medications are meant for individuals with type 2 diabetes, they are increasingly being prescribed “off-label” for those with obesity (note that Wagovy has been approved for weight loss, while the others have not). And, while these drugs have been applauded for their effectiveness in appetite suppression and weight loss, they also bring new considerations for exercise professionals and health coaches. This blog aims to equip you with insights and practical strategies to effectively support your clients who, in collaboration with their physicians, choose these medications for their weight-loss journey. 

How Do These Drugs Work?  

GLP-1 drugs work by mimicking gut hormones, reducing blood sugar levels post-eating and slowing stomach emptying. Their efficacy in weight loss has garnered a lot of attention, but it's crucial to understand that weight loss alone doesn't encompass all health benefits.  

Emerging Research on the Intersection of GLP-1 Medications and Physical Activity     

In one of the first peer-reviewed articles of its kind, researchers report on how physical activity fits into the treatment of obesity when using GLP-1 drugs. This research underscores the need to refocus on lifestyle factors, including physical activity, for those using these medications. 

With these medications, traditional goals of exceeding the minimum 150 minutes of moderate-intensity physical activity per week and achieving 200 to –300+ minutes of exercise weekly for substantial weight loss and weight-loss maintenance might be less relevant. That is, meeting the lowest level public health recommendation of 150 minutes of moderate-intensity activity and two days of resistance training per week might be enough to support and maintain weight loss when a person is on a GLP-1 medication. This shift in focus acknowledges the drug’s role in weight loss while also emphasizing the importance of physical activity for overall health. However, because research in this area is still emerging, no specific guidance in this area is available. 

Key Takeaways for Exercise Professionals and Health Coaches 

Educate About Lean Mass Loss: A growing concern with GLP-1 drugs is the rate of lean-mass loss associated with rapid reductions in body weight.  Therefore, a comprehensive exercise regimen, with a strong focus on resistance training, is essential to mitigate muscle mass reduction and improve overall body composition. 

Emphasize Muscle Quality Over Quantity: The findings of the research cited above highlight the importance of improving muscle functionality rather than solely increasing muscle mass. Resistance training, which is crucial in this aspect, enhances muscle strength and function without necessarily increasing its size, promoting better insulin and glucose control. 

Promote Healthy Eating Habits: While GLP-1 drugs aid in appetite suppression, integrating healthy eating habits is crucial. Encourage your clients to focus on nutrient-dense foods that support overall health and complement their weight-loss goals. Balanced diets rich in fruits, vegetables, whole grains, lean proteins and healthy fats can enhance the effectiveness of the medication, improve energy levels for physical activity and support metabolic health. As exercise professionals and health coaches, guide your clients in making informed food choices and developing sustainable eating habits that align with their health objectives. 

Explain Potential Side Effects 

As an exercise professional or health coach, it is important to be aware of potential side effects caused by GLP-1 drugs. While it is not within your scope of practice to determine if your client is experiencing a drug-related side effect, you may be the first person to recognize symptoms shared with you or to observe signs during your sessions. In this case, it would be prudent to make the client aware of the possible connection between what they are experiencing and the drug they are taking and refer them to their prescribing physician. Here is a list of possible side effects of which you should be aware: 

  • Kidney, pancreas, and stomach problems: Nausea, vomiting, diarrhea, stomach/back pain, constipation, bloating, belching, gas, heartburn and dehydration 
  • Changes in vision 
  • Low blood sugar: Dizziness, lightheadedness, anxiety, slurred speech, sweating, irritability or mood changes, confusion, drowsiness, shakiness, weakness, headache, feeling jittery and fast heart rate 
  • Serious allergic reaction: Swelling of face, lips, tongue or throat; severe rash or itching; and problems breathing or swallowing 
  • Depression or thoughts of suicide 
  • Runny nose or sore throat 
  • Stomach flu 
  • Decreased appetite 
  • Gallbladder problems: Fever, yellowing of skin or eyes, and clay-colored stools 
  • Thyroid problems: Lump or swelling in neck, hoarseness, trouble swallowing and shortness of breath 

Stay Within the Scope of Practice: As exercise professionals and health coaches, it's crucial to operate within your scope of practice. This means: 

  • Providing evidence-based exercise and lifestyle recommendations 
  • Sharing evidence-based dietary guidelines and resources, such as those endorsed or developed by the federal government, especially the Dietary Guidelines for Americans and MyPlate recommendations 
  • Avoiding medical advice or adjustments to medication regimens 
  • Collaborating with healthcare providers for a holistic approach to your client’s health 
  • Collaborating with clients to identify and set goals not related to weight loss 

The Future of Exercise in the Era of GLP-1 Drugs 

Research in this area is still emerging, and updated perspectives may evolve as new studies emerge. It is important to keep up on the latest research and be flexible in adapting your coaching and training strategies accordingly. Rest assured that these medications do not negate the need for lifestyle change or lessen the importance of the work you do with your clients. Your role in guiding clients through their weight-loss journey, especially those using GLP-1 drugs, is as invaluable as ever. And, remind clients that weight loss alone is not a replacement for movement and that there are countless reasons and benefits associated with physical activity and exercise beyond weight loss, including heart health, mobility, strength and emotional well-being.  

Conclusion 

The ubiquity of GLP-1 drugs has reshaped the weight-loss landscape, requiring a nuanced approach from exercise professionals and health coaches. By focusing on improving muscle quality, adapting exercise recommendations and understanding the implications of lean mass loss, you can play a pivotal role in your clients' health and well-being. Stay informed, collaborate with healthcare professionals, and continue to inspire your clients toward healthier, more active lives. 

 

For a deeper dive into the science behind weight loss, exercise and these medications, watch this video from Dr. Steve Stites from the University of Kansas Healthcare System.

And, be sure to continue to follow ACE for more on this important topic. 

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